Store-and-forward telemedicine for doctors working in remote areas.

For doctors working in remote areas, access to medical specialists is crucial in order to provide patients with the best possible health care. Telemedicine is now widely used to obtain second opinions from consultants and is a mainstay of the organization of health care in Antarctica. Taking advantage of our extreme geographical isolation on a polar station, we tested the possibilities for obtaining specialist advice by telemedicine based on email. Two virtual case reports with one question each were sent to six correspondents: two non-governmental organizations (NGOs), two personal acquaintances and two institutions. Initial email replies were received between 13 hours and 7 days later. There were three kinds of reply: well argued and well adapted to our situation (one NGO); argued but not well adapted to our situation (one NGO, one acquaintance and one institution); and a short reply without argument (one acquaintance). Contacting personal acquaintances was not as reliable as we had expected. The best support was provided by one of the NGOs whose efficiency was based on the use of an automatic message-handling system and a team of specialists well trained in giving advice to isolated doctors. This NGO demonstrated how a store-and-forward telemedicine system can be efficient and reliable; the study also highlighted some limitations in other methods of obtaining specialist advice.