title: Second opinions in remote surgical practice using email and digital photography.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Royal Infirmary Edinburgh, Upper GI Surgery, Edinburgh, East Lothian, United Kingdom.
authors.forename: Ben M
authors.initials: BM
authors.lastname: Stutchfield
authors.forename: Rooney
authors.initials: R
authors.lastname: Jagilly
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Tulloh
mesh_terms: D016009:Chi-Square Distribution; D003657:Decision Making; D034742:Electronic Mail; D005240:Feasibility Studies; D006801:Humans; D008542:Melanesia; D010781:Photography; D011446:Prospective Studies; D019114:Remote Consultation; D013514:Surgical Procedures, Operative; D006113:United Kingdom