Table 3.

Problems encountered during Teleconsultation and possible solutions

Problem	Solution
Image quality is poor	Instruction leaflet can be provided at the time of booking for online appointment for capturing good quality images.
	Image should be clicked parallel to the skin lesion; background should be clear to avoid any distractions.
	Image should be clicked at a distance first so that anatomical area can be recognized followed by close up photo without blurring the image.
Patient don't pick up the call	Reminder through message can be given one day before specifying the timing of scheduled appointment
Difficulty in clicking the image as patient is outdoors while teleconsultation	At the time of online booking of appointment instruction leaflet can be provided to click the images one day before the scheduled date of appointment.
Privacy and security issue	Using reliable platforms with end.to.end encryption.
	Confirming identity of both patient and doctor.
Hesitancy in sending images of genital lesions	Patient can be called for face.to.face consultation.
Some care cannot be provided remotely such as full body examinations, procedures/Sometimes images may be inadequate for teledermatology evaluations	Instruction leaflet should contain a disclaimer that patient may be needed to be seen physically in case necessary.
Illiterate patients and patients not having multimedia cell phones	During the time of telemedicine booking patient must be advised that images will be required and patient may be required to make arrangements for the same.
Patients having hesitancy to reveal sexual history and contacts due to privacy in telemedicine	Such patients should be counselled and a rapport must be established among the patients and if necessary, should be called for history taking and physical evaluation.
Few patients are not satisfied and urge on physical appointment.	Proper counselling is required for the patient and patient must be given each and every information required and must be asked for any questions from their side. If the patient isn't satisfied then the patient can be called for a physical appointment.
Hesitancy of females in sending images due to improper information about who has access to the photos.	Patients should be properly informed that who will have access, and how the information will be stored.
Overdiagnosis/Underdiagnosis	Image quality should be improved, in case of any doubt in diagnosis proper detailed history should be taken and patient can be called physically
Internet connectivity	Connectivity should be improved on both sides i.e., patient as well as provider for faster and smoother communication
Patients not understanding treatment advices	Each and every drug should be explained in detail and the duration up to which the drug has to be applied should be informed. Special care should be taken for immunosuppressives.