Curbside (Corridor to the E-corridor) Consultations and the Dermatologists

The prevalence, reasons and attitudes for the practice of informal medicine

BACKGROUND

Informal medicine, entailing undocumented medical advice, has been described in diverse medical disciplines and geographical regions. We assessed the current prevalence and characteristics of informal medical consulting, the reasons physicians provide it, and their attitudes toward it.

METHODS

We conducted a survey among family physicians in Israel, a country with a national health insurance system. A questionnaire was emailed to all primary care physicians in the two largest HMOs in southern Israel. Fifteen questions addressed the prevalence, practice and attitudes to informal medical consulting. Ten questions assessed demographics and professional experience.

RESULTS

Of 143 respondents (mean age 41 years), 55% were women. Ninety-five percent of the respondents reported requesting informal medical consulting from other physicians. Fifty-four percent reported often providing informal consulting to family and friends; and an additional 27% reported doing so under exceptional circumstances. The main reasons given for informal consulting requests were availability and accessibility (81% of respondents), and not financial savings. Only 17.5% stated being in favor of informal consulting for family and friends. Only 11% expressed feeling satisfaction after providing such consultation; 49% expressed discomfort. Sixty-six percent thought a position paper on informal consulting to family and friends is needed.

CONCLUSIONS

Our survey of primary care physicians shows very frequent informal medical consulting, despite high dissatisfaction with such, and an interest in receiving guidelines on this practice.

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

BACKGROUND/OBJECTIVES

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.

METHODS

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

RESULTS

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.

CONCLUSIONS

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.

Social media in dermatology: clinical relevance, academic value, and trends across platforms

Social media encompasses multiple sites for online communication that reach a large proportion of the global population. While the increase in number of publications investigating dermatology content on social media has paralleled the growth of social media in the past decade, there has not yet been an extensive review of past literature on this topic. Our objective is to summarize and analyze publications on the role of social media within the field of dermatology. Social media is frequently used by patients to solicit advice related to cutaneous concerns and even when seeking out a dermatologist, but it is underutilized among both clinicians marketing their practices and academicians collaborating with colleagues in the field. Social media has the potential to advance instruction for trainees in dermatology and facilitate new research methods. Patient-centered perspectives and advocacy groups have a larger presence overall on social media platforms than stakeholders in academic dermatology. Furthermore, specific platforms like Facebook, YouTube, and Twitter vary in originators of material, messaging strategies, and reliability of information with regards to certain dermatologic conditions and behaviors.