With just two months until the implementation of telemedicine (December 24), private clinics, including dermatology, otolaryngology, and neurology practices, have launched a collective protest. Although telemedicine focuses on managing chronic diseases, with private practitioners serving as the primary providers, signs of a "telemedicine boycott" are emerging among these doctors.
According to the Ministry of Health and Welfare on the 26th, an amendment to the Enforcement Decree of the Medical Service Act, which outlines the scope of telemedicine and prescribing criteria, has been open for public comment since the 19th. The core of this amendment is to limit the number of days for initial prescriptions via telemedicine to within seven days, while allowing up to 30 days in a single instance under certain conditions.
However, the Korean Dermatological Association, an organization of private dermatologists, issued a statement on the 23rd stating that "skin diseases cannot be diagnosed with 'one photo'" and that "the expansion of telemedicine, which does not guarantee patient safety, must be comprehensively reconsidered."
In a phone interview with MoneyToday on the same day, Lee Sang-ju, president of the Korean Dermatological Association, stated, "Diagnosing skin diseases requires directly palpating lesions to check texture and depth, as well as performing dermoscopy (magnifier) examinations, full-body skin inspections, and fungal or tissue biopsies when necessary." He pointed out that "in telemedicine, smartphone photos can make the same lesion appear differently depending on lighting, angle, and resolution." For example, if a melanoma, a type of skin cancer, is examined via a smartphone, there is a risk of misdiagnosing it as a simple mole.
Private thoracic surgeons who primarily treat varicose veins also sharpened their criticism, arguing that photo and video consultations would increase the rate of misdiagnosis. According to the Korean Society of Cardiovascular and Thoracic Surgeons (hereinafter referred to as the Association), varicose veins cannot be diagnosed or have a treatment plan determined solely by observing whether blood vessels are bulging in the legs. It is necessary to check all symptoms such as pain, swelling, and a feeling of pressure, and to evaluate the structure and blood flow of superficial and deep veins to confirm the presence, location, and extent of venous valve dysfunction and reflux.
Kim Seung-jin, president of the Association, told MoneyToday on the same day, "Video resolution and lighting, communication delays or interruptions, voice transmission errors, and signs not visible on the screen can be missed." He pointed out that "the risk of misdiagnosis due to these factors is inevitably greater in 'initial visits,' where existing information about the patient is lacking, compared to 'follow-up visits.'"
Concerns are also rising that telemedicine will encourage the misuse and abuse of medications. Ahn Young-jin, president of the Korean Otolaryngological Association, lamented, "In telemedicine, it is difficult to distinguish between 'acute otitis media,' which requires antibiotic treatment, and 'otitis media with effusion,' which does not, based solely on ear pain reported by the patient. Similarly, it is difficult to differentiate between 'simple pharyngitis' and 'acute epiglottitis' based on sore throat symptoms." He further argued that "if prescriptions are issued without in-person consultation, defensive prescribing to avoid misdiagnosis will increase, potentially encouraging the abuse of antibiotics and steroids."
Private anesthesiologists have even threatened to refuse participation in telemedicine. The Korean Society of Anesthesiology and Pain Medicine issued a statement on the 21st, declaring that "if the government forces through a hasty amendment that ignores even minimal safety measures, we will launch an all-out struggle, including a 'complete refusal to participate in telemedicine,' through solidarity across the medical community."
Meanwhile, the Ministry of Health and Welfare plans to gather opinions until the 9th of next month to establish detailed operational guidelines in line with the implementation of the amended Medical Service Act on December 24. The Ministry stated that it will "finalize the amendment after broadly gathering opinions from the public and relevant agencies during the legislative comment period."
in THEBIO
