Researchers posing as patients with skin problems sought help from 16 online telemedicine companies—with unsettling results.

Some of the online doctors misdiagnosed syphilis, herpes and skin cancer, and some prescribed medications without asking key questions about patients’ medical histories or warning of adverse effects, the researchers found. Two sites linked users with doctors located overseas who aren’t licensed to practice where the patients were located, as required by state law.

“The services failed to ask simple, relevant questions of patients about their symptoms, leading them to repeatedly miss important diagnoses,” said Jack Resneck, a dermatologist with the University of California, San Francisco, and lead author of the study, published online in JAMA Dermatology on Sunday.

Ateev Mehrotra, an associate professor of health-care policy at Harvard Medical School who wasn’t involved with the current study, said it “identifies a number of egregious quality issues that raise significant concern.” 

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He added that studies have identified quality issues with in-person visits as well, and that because many dermatologists don’t accept Medicaid, the online visits, which generally cost $35 to $95, may be all that some patients can afford.

Direct-to-consumer telemedicine services have exploded in recent years, with more than one million virtual medical visits expected this year, according to the American Telemedicine Association, a trade group. Many insurers cover the services and promote them as a convenient and low-cost way for plan members to get care.

But some physician groups are concerned that the services are eroding doctor-patient relationships, lowering the quality of care and further fragmenting the health-care system.

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