Introduction

As with every professional aspect of medicine there is both science and art involved in the practice of teledermatology. While the evidence shows that, compared to in-person care, we generally make the same diagnosis and recommend the same treatment using teledermatology, technology's impact on the “art” of practicing dermatology has been less well described. The art of teledermatology, in many respects, is equally important as the scientific considerations. Referring clinicians, patients, and teledermatologists that are uncomfortable or dissatisfied with the teledermatology consult process can prevent a teledermatology program from being successful regardless of the scientific evidence that supports its use.

This chapter will address the art of teledermatology as it applies to both live-interactive and store-and-forward teledermatology. These two modalities are discussed separately since various factors (e.g., differences in dermatologist-patient interactivity) influence how the teledermatology consult is managed by the teledermatologist.

Store-and-forward teledermatology

The finite dataset and store-and-forward teledermatology

There are notable differences in how we manage skin conditions and practice clinic-based dermatology compared to how we practice store-and-forward teledermatology. A major departure from live-interactive teledermatology revolves around the fact that the dermatologist and the patient (with rare exceptions) do not interact with one another. We should also acknowledge that most of what we do in traditional dermatology consists of managing referrals and not consultations. Store-and-forward teledermatology, for the most part, is truly a consultation service. A consultative service implies that the teledermatologist is only making recommendations and that the referring provider remains responsible for managing the patient.