There’s a mass in your lower back and its edges are rough to the touch. You’re anxious, naturally. Perhaps you’re struggling with depression after a divorce. However, you live in a rural area, and finding a specialist would require an hour-long drive, which interferes with the daily operations of your own general practice.
Would you seek medical advice first online? You’re a physician and know that web chatting or Skyping isn’t the proper way to initially go about checking out your symptoms but does every patient know that?
You also know you don’t want to take first-time patients via Skype or email – the ethical repercussions are enormous. With that said, we dig deeper into a few examples and discuss how you can avoid telemed’s ethical pitfalls.
General Rules of Thumb
There are several questionable issues with telemedicine. In fact, it may be the most contentious of all recent medical innovations, ethically speaking.
Before anything else, avoid legal and ethical issues by practicing telemedicine within your state, or you could be facing some rather menacing federal charges.
Also, CMS requires you to have a process in place for credentialing, meaning the verification of a provider’s credentials, so you can prove you have the license, education, and provider’s insurance to practice. Lastly, don’t forget to follow AMA’s guidelines for telemedical practices.
Skype and Other Forms of Video Conferencing
Physicians and other industry delegates gathered at the Council on Ethical and Judicial Affairs open forum at the AMA Annual Meeting earlier this year to discuss many of these contentions, and Skyping took center stage.
While we don’t worry about Skyping with a family member studying abroad, it’s still a very insecure technology in the medical world, where sensitive information can be compromised due to the lack of guaranteed confidentiality.
However, Skype meets HIPAA encryption requirements, making it technically safer than a telephone conversation, which can easily be tapped and is easier to usurp information from.
You also can’t readily tell, from looking at one’s Skype log, what calls were placed to friends, family, patients, and/or lovers, so it’s safer than both phone calls and email exchanges in that sense. In a sense, the Skype debate is reminiscent of the ’90s cell phone scare. Do, however, ensure your computer is password protected and be cautious about who can access your Skype account.
If you want to play it a little safer, consider more sophisticated platforms by companies like Cisco, who provide stronger encryption and aren’t unspecialized, proprietary third parties that won’t let you know if a breach has occurred.
Conflicts with Online Chat
What about web-based chat services, where a patient can ask physicians questions regarding their symptoms in an effort to receive quick, short answers that serve as mini-diagnoses?
A virus can easily be mistaken for a bacterial infection, or the online doctor may suggest treatment for muscle spasms instead of a herniated disk. Imagine the risks associated with incorrect prescriptions.
The patient chat scare is a little different in nature from Skyping, but ultimately produces similar conclusions. A doctor shouldn’t diagnose patients online in the first place.
Telemedicine is more useful after the first patient-doctor encounter, when the intention is to provide support for an existing condition and/or ailment. Just don’t try diagnosing, but you wouldn’t anyway. You’re a professional, right?
ePrescription Abuse
What about patients who actively seek a certain prescription? This is fairly popular with mental health patients, who want an escape from depression or anxiety.
In 2005, a Stanford teenager committed suicide after being prescribed fluoxetine (generic Prozac) for depression online two months earlier. This put into question the idea of who ‘owns’ a prescription, how ‘follow-ups’ are performed online, and whether you can use telemedical technologies to create effective therapeutic relationships.
The case of prescribing for mental health is always tricky, whether it’s a remote or in-person relationship. States like Virginia have even passed legislation on this matter. In the end, no matter what kind of medicine you practice, a general rule of thumb still stands – forge a physical, genuine relationship with your patient before prescribing online.
With the telemedicine market set to more than double by 2015, these issues are about to start feeling much closer to home, and your practice is going to have to adjust.
Are you ready to do so?
