Could a low-cost audio-visual link be useful in rheumatology?

We have investigated prospectively the diagnostic accuracy, specialist sati sfaction and patient-specialist rapport of a low-cost audio-visual link bet ween a junior doctor with a patient and a consultant rheumatologist. Using a telephone link and subsequently a video-phone link, 20 patients, with var ious rheumatological problems, were presented by a junior doctor to the con sultant rheumatologist for provisional diagnosis. All patients were then se en face to face by the consultant, when a final diagnosis was made. An inde pendent consultant rheumatologist made a 'gold standard' diagnosis. Thirty- five per cent of diagnoses were made correctly over the telephone and 40% o ver the video-phone - there was no significant difference in the diagnostic accuracy between these two methods of communication. Rapport over the vide o-phone was universally poor. Where it was important, clinical signs could not be visualized over the video-phone and in more than 85% of cases small joint swellings could not be seen clearly.