ABSTRACT
We present a comparison of a mature teledermatology service using hospital-based photography and a new face-to-face SPOT diagnosis clinic. Our model, clinician experience, patient outcomes and feedback are discussed to help you choose the right service for your area. There has been a substantial increase in the use of teledermatology over recent years and, in particular, during the COVID-19 pandemic. The increase in the use of teledermatology during the pandemic has been instrumental in meeting the needs of patients, but it does have some challenges. The main drawbacks to teledermatology are the technological requirements for both patient and clinician, difficulty in reviewing multiple lesions, and lack of background information or detailed history. There is also limited opportunity for patients to get instant feedback about their management. Our department has an established teledermatology service, using hospital medical photography, for the rapid management of patients with skin lesions. Our model involves one supervising consultant and 2-4 assistants [junior doctors, general practitioner (GP) trainees or physician associates]. We typically see 50-80 patients per clinic. As part of a local National Health Service transformation plan, a new face-toface clinic was set up to provide rapid access to patients for a lesion review: the dermatology SPOT diagnosis clinic. This is aimed to be a prehospital service, largely as an alternative to our teledermatology model, to determine whether patients need to be seen in secondary care. The clinic provides a rapid triage assessment of the lesion of concern with a shorter, focused clinic appointment. The same consultant, supported by the same assistants have been used during the pilot, with 60-80 patients seen in one session. Follow-up arrangements, if any, were planned on the day of clinic attendance. Sameday treatment was limited to cryotherapy and, where appropriate, GPs are given instructions for management of conditions in primary care. A follow-up anonymous online survey was conducted of patients who used both services. The purpose of the survey was to ascertain the views of patients and the level of patient satisfaction after their interaction with either the teledermatology clinic or the SPOT clinic. The new SPOT clinic offers some advantages over the existing teledermatology model. This includes having the opportunity to review the rest of the patient and make sure we are not missing something more serious. There was greater diagnostic certainty by the clinicians. Patients requiring surgery could be assessed, counselled and booked on the day. Patients with lesions suitable for cryotherapy could be treated on the day. We were able to give clearer instructions for further management in primary care. Levels of satisfaction were higher among patients and staff.