Physician assistant Jason Sanchez measures the growth on patient Adrienne Gray's nose and takes digital photos for the dermatologist to review via e-mail. Photo by Shellie Branco

Dr. Marc Goldyne, a UC San Francisco dermatology professor who also has a private practice, has partnered with Alta Family Health Clinic in Dinuba to offer dermatology through telemedicine.

By Shellie Branco, Valley Public Radio Correspondent

Adrienne Gray has a large mole on her nose that’s been growing for a while. She’s worried, but she’s kept her sense of humor.

“A Wicked Witch,” she says, laughing. “That’s what I call it … it’s ugly, it’s horrible.”

Her fear that the spot might be skin cancer is no joke. The 29-year-old has traveled from Fresno to Alta Family Health Clinic in Dinuba to get treatment. Physician assistant Jason Sanchez meets with her and takes digital photos of the mole. A medical assistant types notes on a computer.

Gray isn’t going to meet her dermatologist in person. That’s because the doctor works in San Francisco. Partnering with the clinic’s telemedicine program, Dr. Marc Goldyne will get an e-mail with her medical records and the digital photos of the mole.

Patients like Gray often wait months to see a dermatologist because of a shortage of specialists in the San Joaquin Valley and problems with insurance reimbursements. Telemedicine allows patients to get treatment right away. Alta Family Health Clinic started its teledermatology program five years ago with a grant from Blue Cross. It primarily serves uninsured and low-income patients in surrounding rural areas, but patients have come from as far as Sacramento with diseases ranging from psoriasis to skin cancer.

Dr. Goldyne, who teaches at UC San Francisco, says a diagnosis through telemedicine is as accurate as a face-to-face consultation. He’s seen many patients who didn’t receive proper treatment from primary care doctors.

“I’ve done now almost 3,000 consults and I’ve seen enough patients where I’ve changed their lives after five to eight years of dealing with something, and we were able to turn things around,” he says.

Telemedicine is used throughout the state, but it’s struggled to take hold in the Valley. The clinic’s CEO, Dr. Kuldip Thusu, says bureaucracy can get in the way.

“We are not a clinic, we are not a business, we are a mission, and our goal is to take care of everybody who walks through our doors,” he says.

That approach hasn’t been easy. Dr. Thusu is willing to lose money to serve uninsured patients. The clinic breaks even with grants, donations and reimbursements from Medi-Cal and other insurances.

Another ambitious telemedicine program was started by UC Merced in 2007. The university leads six Valley clinics, including sites in Reedley and Kerman. The head of the program, Maria Pallavicini, says the clinics have had varying degrees of success. Patient turnout is unexpectedly low. And their doctors have used the equipment more often for training than treating patients.

“There are issues about patients, there are issues about the number of specialists,” she says. “How does the specialist get reimbursed? How does the originating site where the patient is sitting … how does that site get reimbursed?”

Pallavicini says the approach taken by clinics like Alta Family Health might not be financially sustainable in the long run, if they want to take care of large numbers of patients.

As for Gray, the dermatology patient, her mole might be removed at the clinic. As a 20-something, she’s comfortable with technology and an e-mailed diagnosis.

“I’m always on the computer – yeah, I trust it,” she says.

The clinic plans to add neurology and ophthalmology to its program. There’s even a plan to start telepsychiatry, with patients and therapists meeting through webcams. In the near future, their patients might use their own gadgets to seek treatment. With a few snaps from an iPhone camera, a patient like Gray could one day make her own house call.

Shellie Branco is a correspondent for Valley Public Radio. This report will air at 9 a.m. Tuesday, July 20, to kick off a discussion about addictions on the public radio station’s call-in show, Quality of Life. Tune in on the radio at KVPR 89.3 in Fresno and KPRX 89.1 in Bakersfield. Or listen online at www.kvpr.org. To call in to the show, dial 800-224-8989 or e-mail comments to talk@kvpr.org. The show re-airs at 7 p.m. the same day and an archived Podcast of the show will also be available online after it airs.