The shadow clinic: Emails, "curbsides," and "quick peeks" in pediatric dermatology

Curbside consultations are common in pediatric dermatology. There are both associated risks and benefits. Email, text messaging, and cell phone cameras have greatly facilitated this practice. We sought to characterize the nature of this practice among pediatric dermatologists and highlight concerns.

A 21-question anonymous survey was sent to the 486 active members of the Society for Pediatric Dermatology.

There were 156 responses (32%). Over 45% of respondents received at least six consults per week. About half (49%) spent 6 minutes or more per case. Almost none of these consultations (3%) were compensated or captured in work relative value units. Most (87%) did not document or have a practice or institutional policy in place to address these consultations. A similar majority (80%) were uncertain if their existing liability insurance covered these activities. Over three-quarters (76%) of respondents did not think or were unsure that Health Insurance Portability and Accountability Act concerns were appropriately addressed.

Curbside consultations in pediatric dermatology are common. They increase access, promote collegiality, and can be used for educational gain. They are also generally not compensated, consume considerable time, risk liability exposure for providers, and potentially compromise patient confidentiality. Effort should be made to standardize this practice so that the benefits are not outweighed by risks.