The New York Times ran an article on January 20, 2010 entitled: Skin Deep – Should Surgeons Meet Patients Online?  

 http://www.nytimes.com/2010/01/21/fashion/21Skin.html?scp=1&sq=plastic%20surgery%20consultation%20online&st=cse   

The article discusses the many sites that are available where patients can do online consultations.  The article presents interviews pro and con such an approach to establishing a doctor-patient relationship and the value of the consultation received.  The advantages for the patient seemed to be that it was convenient, “empowers them with knowledge”, and may be more cost effective than seeking multiple consultations.  The advantage for the physicians who participate in such a site is obvious – it is a form of marketing that brings them patients from a distance they probably would not have otherwise seen.

Reading about these services gives me a feeling similar to chalk screeching on a blackboard. It is my experience that there is enough information on the internet that patients can come to an initial, face-to-face consultation already “empowered with knowledge”.   Secondly, I have found patient photographs to be notoriously unreliable as they are often off as far as color and focus and are lacking all the appropriate views.  Even professional photographs do not tell the whole story.  There is no substitute to seeing and examining the patient in person.  That is part of the art of surgery.

Furthermore, a patient who has scheduled and paid for a procedure based on a virtual consultation may be reluctant to change plans the day of the surgery, undergo an more extensive procedure (and recovery), or be subject to additional financial responsibilities even if the surgeon now states that the ideal procedure for the patient is not the one they agreed upon online.  One would hope that the physician has the ethics and fortitude to stand by the recommendations of his or her in-person consultation. Nevertheless, the physician is in the unenviable position of having to cancel surgery and deal with a very unhappy patient.

The article points out other problems with such online consultations including security, privacy, legality and professional liability.

There are times in a surgeon’s career where he will have to initially consult with a patient from a distance.  In my experience, these are former patients who are seeking consultation for a new problem or patients referred by a colleague. Even in these cases, where some sort of relationship exists, the path from initial consultation to possible surgery has to be followed slowly and carefully.  In my opinion, these sites increase the chances of violating that important medical maxim of “physician do no harm.”