Background: Recent advances in telecommunications technology allow physicians to consult on patients at a distance via an interactive video format. Few data exist as to the reliability of this form of consultation.

Objective: Our purpose was to measure the degree of concordance between a dermatologist seeing a patient in a clinic and another dermatologist seeing the same patient over a commercially available videoconferencing system.

Methods: Patients referred to a general dermatology clinic were seen by both a “live” dermatologist and a “teledermatologist” via a T1 connection. Diagnosis and recommendations were recorded by both physicians and compared. The physicians were also asked to rate the degree of confidence they had in their diagnosis.

Results: Seventy-nine diagnoses were made on 60 patients. The two physicians were in absolute agreement on 61 of the diagnoses (77.2%). Race or sex of the patient, nature of the skin problems, or which of the two physicians was the teledermatologist did not statistically correlate with the concordance of the two physicians.

Conclusion: There was a reasonable degree of agreement between the two examining physicians. Despite the relatively high degree of concordance the teledermatologist had a significantly lower degree of confidence in his diagnoses. (J Am Acad Dermatol 1997;37:398-402.)