[Teledermatology--experiences from Northern Norway]

Distant diagnosing by two-way interactive motion video (videoconference) appeared in the 1980s, the last four years with weekly teleconsultations to Hammerfest and Kirkenes.

Patients are mostly referred from general practitioners. A physician with a 20% position is responsible for organising the videoconferences and participates in the consultation. A close-up camera is used for detailed examination of skin lesions. Photographs of skin areas may be transmitted directly to the specialist screen (still images). The studio physician writes prescriptions and sick leave notes. The specialist writes a reply to the referring physician. Referrals using still images are as yet at a pilot stage.

Patients view early diagnosis, time saved, reduced costs, and less need for leave from work as important advantages with videoconferences. Patient satisfaction is high, although 10% are dissatisfied. Having a physician in the studio makes patients feel safer, and they understand the specialist better. This is a new role for the specialist; the doctor/patient relationship is often taken care of by the studio physician. Comparisons between videoconference and face-to-face consultations have shown up to 90% diagnostic agreement. A pilot study using still image referrals showed similar results.

Videoconferences are well suited in everyday dermatology, when follow-up by specialist is necessary, and for patients in regular treatment at local clinics for skin disease. Still image referral seems promising. The studio physician's diagnostic abilities are enhanced. Many patients are not suited for teleconsultation, but telemedical solutions will have a role in the years to come.