Question: I have a skin problem and did a Google search to see if I could figure out what it is. I found a website called DermaGo.ca where Canadian dermatologists will provide a diagnosis and even a prescription—for a fee. I didn’t think our doctors could charge for providing basic medical care. Is this legit?
Answer: It is indeed a “legit” website. But you are also correct in assuming that Canadian doctors can’t charge for services that would usually be covered under our publicly funded health care system.
However, the dermatologists get around this restriction by giving their advice online. Normally, doctors have to treat a patient in person to receive a payment under the various provincial and territorial health insurance plans. And the fact that an online dermatology consultation isn’t on the list of insured “medically necessary” services means they can do it.
What you also need to know is that DermaGo isn’t the only Canadian-based website that’s now offering health services directly to paying patients. For instance, getmaple.ca will connect patients to doctors through their phones, tablets or computers 24/7. “Skip the waiting room!” the website beckons.
This emerging trend is worrying some experts who are concerned it’s a step toward two-tiered medicine, in which those who can afford to pay get quicker access to care.
“It has the potential to undermine the universal health care system,” warns Dr. Danielle Martin, vice-president of medical affairs and health-system solutions at Women’s College Hospital in Toronto.
Meanwhile, DermaGo, which was launched in Quebec in December 2017, is moving forward with plans to expand nationally. A total of six dermatologists are now offering their expert advice online—three in Quebec, two in Ontario and one in Alberta. Efforts are underway to recruit more dermatologists across Canada.
“Obviously there is a demand for our service,” says Dr. Marc-André Doré, a dermatologist in Quebec City and co-founder of DermaGo. Part of that demand, he says, is being fuelled by long wait times, which can vary from a few weeks to several months to see a dermatologist.
Doré says he was inspired to set up DermaGo because of the success of similar websites in the United States.
It’s fairly easy for patients to use DermaGo. They create a file through the website and use a smartphone to take and upload photos of their troubling skin conditions.
A dermatologist replies with a written message and—if it’s needed —sends the patient a prescription for medication.
It costs $179.99 to get an answer within 72 hours, and $249.99 for a 24-hour response.
(These prices are higher than what doctors are usually paid in the public health care system. An Ontario dermatologist, for instance, gets $72.15 for a patient consultation.)
Doré say the online service is best suited for skin conditions involving acne, psoriasis, eczema and hair loss. “These are problems that can be diagnosed easily on the web platform,” he explains.
Even so, a few patients have sent images of lesions that looked suspiciously like melanoma—a potentially deadly form of skin cancer. The only way to accurately diagnose melanoma is through a biopsy in which a small skin sample is removed and examined under a microscope.
In these cases, the patients happened to be in Quebec and lived relatively close to the offices of the doctors involved with the website. So each patient was directed to the nearest office of a DermaGo dermatologist where a biopsy was performed and melanoma confirmed.
“Some of them actually had already been waiting to see a dermatologist for a couple of months,” says Doré. “I am not saying we saved their lives, but we certainly helped them.”
Buying medical services in this way does raise questions about who is ultimately responsible for the patient’s ongoing care, says Dr. Joel DeKoven, a dermatologist at Sunnybrook Health Sciences Centre in Toronto. “Once a physician-patient contact has been made, one might expect that there is a duty of care for the online physician to provide subsequent in-office care if requested by the patient.”
Furthermore, Dr. Danielle Martin believes problems of fragmented care might arise when the patient’s family doctor has been sidestepped. “If something is identified as being an important part of a person’s medical history, how will that person’s primary-care provider ever learn about it?” Under the traditional approach, she explains, the family doctor makes the referral to the specialist who then sends back a report about the patient.
But Dr. Marc-André Doré defends his direct-to-consumer website, saying that patients have some responsibility to keep their family physicians in the loop. He notes that patients can print their files from the DermaGo platform. “So, if they want, they can just drop them off at their doctor’s office.”
Despite the controversy created by the sale of medical services, there’s general agreement that providing virtual health care online can be extremely convenient for patients.
In fact, the value of “virtual” care has been well established by Ontario Telemedicine Network (OTN), a not-for-profit organization that operates within the health care system but is funded separately from the Ontario Health Insurance Plan (OHIP).
OTN has created a video-conferencing network that enables Ontario patients who live in remote locations to have virtual doctor appointments in their own communities.
In some respects the arrival of websites dispensing medical diagnoses and prescriptions is a natural evolution of virtual medicine.
“This could be part of the solution to how we make the health care system more efficient and sustainable,” says Martin.
“I would like to see lots of virtual visits happening with specialists as well as with family physicians,” she adds.
“But it should be offered to people on the basis of need, not the ability to pay.”
Sunnybrook’s Patient Navigation Advisor provides advice and answers questions from patients and their families. This article was originally published on Sunnybrook’s Your Health Matters, and it is reprinted on Healthy Debate with permission. Follow Paul on Twitter @epaultaylor.
If you have a question about your doctor, hospital or how to navigate the health care system, email AskPaul@Sunnybrook.ca
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Hi, Can someone please help me with getting rid of this red acne scars. i keep having acne and this red bumps, my confidence are getting low. sometimes i just wanna cry because of my acne scars, i have them around my jawline and chin and starting to form in my forehead, i think i started having pimples when i started using this cerave products which i saw on tik-tok then i decided to try it, and ya im pretty sure it was because of cerave. and now i’m struggling with this acne scars, if you know something about acne scars( like how to resolve it) please help me. and by the way my skin type is dry skin. Thank you, I’ll really appreciate it.
My wife has white patches on scalp and ichy and become red
I have lots of sun damaged skin on my face and upper body. There are several spots that dont seem to heal. I had previous excisions for squamous cell carcinoma and melanomas. I need a hands-on dermatologist to treat my sores with liquid nitrogen.
Completely comprehensive Information regarding this subject. I am suffering with a skin condition presently and I’m waiting for a dermatologist appointment which is months away. The office managed to see me on Monday however due to Covid, she didn’t examine the skin, look at my photos, get close to me (within 6 feet )and just handed me a prescription for rosacea. I know a lot of skin conditions share similar similarities and a biopsy would have to be done if she thought it was something else. I know I have KP But that doesn’t usually hurt and my condition right now is accompanied by a flare up of hives on joints maybe due to stress? I feel like my body is attacking itself. KP is also on the face anywhere you have facial hair follicles. The hair is trapped under thick skin in a coil it itches severely. It also looks like ingrown hair and it you could manage to penetrate top layer of the skin off, the tiny hair would just fall out. The skin has a bumpy appearance in some places like “ck” the skin around eyebrows has a waxy glossy shiny appearance like psoriasis it looks as though there’s an overproduction of Keratin around nose, The mucous membranes all seems irritated and affected. Plus my nails Started to crumble In the last few years, but not all of them. My mother suffers severely with psoriasis, She also has rheumatoid arthritis and osteoporosis at very young age along with dry mouth so mucous membranes again including vaginal area . She also suffered macular degeneration in her eye which could be due to mucous membranes , I’m not sure. she’s never tested for celiac disease however her family is rampant in celiac disease along with sister Diseases such as IBS ,Crohn’s ,colitis, Cataracts at a young age, pilar cyst, bowel problems etc. bowel cancer,anemia and neurology Issues like restless leg syndrome, a lot of bipolar severe bipolar and anxiety,depression. I myself was diagnosed with bipolar 20 years ago when hospitalized with psychosis. The psychosis was postpartum after the birth of first child,I do not take any meds for bipolar, never been hospitalized since, never experienced this episode again with the birth of three other children within fairly close proximity to the first. Back to my chin and KP in crease of chin, around the eyes eyebrows, hairline, leaves red blood pinpoint mark on legs, arms, torso, back, lip, hairline, etc.I’ve lost all the hair on my arms, legs, thighs,calves. Hairline is receding slightly on forehead (waxy, shiny). Skin on legs looks blotchy when you press on it, I bruise easily and now there’s also streaks across my back where the pain I is, could this infected? blisters were present at Monday’s appoint. Dermatologist Referred to them as a few pimples on neck but didn’t look at them, didn’t consider past history information, didn’t ask symptoms etc. she also didn’t ask about family history, she asked nothing actually. She simply handed me info on what to avoid etc. I realize she doesn’t know how informed I am or ill-informed. I would have become a dermatologist if blood didn’t make me so faint and touching other people Squeamish. I thought I could be an aesthetician as an alternative but no , I don’t want to touch other ppl skin conditions either. I’ve treated my skin like a fine piece of gold foil my whole life I’ve only been to the dermatologist once at 14 yrs old, diagnosis contact dermatitis however have suffered skin conditions over the years rashes hives etc. I know it’s a complicated matter so I’ve never bothered to ask to go again. What prompted me to request a derm. this time was the blistering rash that came on like cold sores on my cheeks , blisters on the neck clear blisters around the eyes which have been present for months , polyps in the nose, swollen membranes in the nose tightness in the throat, blurry vision has continued even after cataract removal approx 2 years ago. I’m only 52 yrs old now. My concern is not only the keratosis Polaris which isn’t generally itchy but I am suffering extreme itchiness,burning,tingling, I’ve lost my appetite and am suffering insomnia due to this. I need ice packs to sleep and now lorazepam to calm down and not think about it. It feels like the worst sunburn of your life , poison ivy, being bitten by ants , or black flies and wrapped in a woolblanket . I wish this was an exaggeration. My doctor does not think stress is a factor, allergies ,or diet. even though I am experiencing tightness in the throat , feeling short of breathe like throat closing, awaken b/c feeling like I’m choking or lack of air, slightly swollen lymph nodes plus the insomnia due to the heat of the skin.The blisters around the eyes which seemed to develop after Cateract Surgery approx 2 yrs ago(perhaps triggers this condition)and my blurriness still there and worsening. First I thought just KP, then maybe DH now perhaps pemphigus. I take no meds, allergic to penicillin (rash), take no supplements/vit. I hardly take pain relief even for headaches which now has suddenly appeared. Feeling like a migraine that last two weeks. I never complain. Never seek treatment. Went to the ER with body rash thinking it was shingles, one glance diagnosed contact dermatitis.
Hi there, I am using cerave facial moisturizer lotion (AM) spf 30 and wanna know that can i use vichy spf 45 sheer lotion after applying cerave?
There is also another site I’ve found recently called Acne.ca that seems to be an online dermatology service. Looks cheaper than the other services in this article.
Hello, so I’m 17 years old and I’ve been getting a lot of stretch marks over my button and now is going up my back, I don’t know what to do. I’m fairly skinny and it’s getting worst over time.
I am fed up with griping about physician remuneration. We have a bigger problem of regulated health professionals that are highly trained to provide quality patient care that are neglected under the Canada Health Act. Dieticians, physiotherapists, occupational therapists, pharmacists and social workers for example are skilled and competent- but their advice is not publically funded. We have remuneration models that are siloed and incentivize individual professions and not team-based care. And when there are models for team-based care, they tend to prioritize physician-dominated governance structures that at times hinders true collaborative practice.