Second opinions in remote surgical practice using email and digital photography.

BACKGROUND: Email offers the opportunity to improve communication between surgeons across the world. This experimental study aimed to assess the feasibility of obtaining clinical opinions by email and digital photography in remote surgical practice. METHODS: Over a 3-week period, all adult general surgical cases with a visual component to their condition admitted to a remote developing-world hospital were invited to participate. Clinical details and digital images were emailed to a UK general surgeon who consulted specialist colleagues if required and emailed back a suggested diagnosis and management plan, rating the confidence with which these were made on a five-point scale. The concordance between diagnoses and management plans from each centre were rated by three independent general surgeons. RESULTS: In this prospective study of 32 patients, 56% of diagnoses and 78% of management plans were made by the UK surgeons with 'high' or 'total' confidence. Causes of low diagnostic confidence included vague swellings and low-resolution X-ray images. Diagnostic and management concordance between centres was adjudged 'high' or 'total' in 88 and 43% of cases, respectively. CONCLUSION: Obtaining second opinions using email and digital photography is feasible in adult general surgery, but its efficacy is limited in cases where image resolution or non-visual clues are important.

Surgical service centralisation in Australia versus choice and quality of life for rural patients.

High patient volume for both hospitals and surgeons is an important determinant of operative mortality and outcome for complex and infrequently performed operations. The 13% of Australia's population who live in rural and remote areas often choose to have surgery close to home and support networks despite the potentially higher operative mortality and morbidity. Rural patients should be able to make an informed choice about having their surgery locally. Rural and metropolitan surgeons should discuss and reach mutual agreement on where each patient is best treated. A balance must be struck between quality of services that can be provided locally and geographic convenience.