Excerpt From Medical Ethics: Real-World Application By Afshin Nasser

Telemedicine and Telecommunicating with Patient

Telemedicine is defined as medical diagnosis and patient care through electronic media where the patient and the provider are in different locations. The technology’s potential to enhance value-based care has contributed to the widespread adoption of telemedicine. A licensed physician in one state cannot treat a patient across state lines, unless said physician also holds a license for the state where the patient resides. Otherwise, practicing in a state without a medical license has serious legal implications.

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Telemedicine is defined as medical diagnosis and patient care through electronic media where the patient and the provider are in different locations. The technology’s potential to enhance value-based care has contributed to the widespread adoption of telemedicine. A licensed physician in one state cannot treat a patient across state lines, unless said physician also holds a license for the state where the patient resides. Otherwise, practicing in a state without a medical license has serious legal implications.

Important considerations for telemedicine include:
-Do not start practicing telemedicine without a written informed consent specifically for platform used,

  • Know the location of the patient before treatment – are you licensed in the state where the patient is located?
  • Determine what your role is with this patient. Diagnosing? Therapy? Treatment? Evaluation? Consulting?
    -Are you licensed in the state the patient is located?
    -The standard of care does not change with telemedicine, and is equivalent to an in-person clinical visit
    -A business associates’ agreement is necessary if information is stored in any way for any amount of time by your technology vendor.
    -You must require audit trails from your business associate, and they must be contractually required to notify you of any privacy breaches
    -check with state law and licensing board requirements for compatibility and encryption requirements for your system
    -Ensure compatibility with payer requirements, including Medicaid and Medicare, and other approved vendors.
    -Be aware of state laws on telemedicine where the patient is living, and if treating a patient in another state you must know clinical legal standards that apply to the patient’s location.
    -You must have a reliable and HIPAA compliance system in place

Q35 A 27-year-old female is using the telemedicine services for the first time. She is connected to the telemedicine doctor from her cubicle at the office. Her medical records are not available. The patient has had a few days of a productive cough, headache and inability to have a good night sleep due her spastic cough and associated fatigue. Dr. Eager suggests an infection of her lungs.The patient reports feeling uncomfortable, has many deadlines to meet for work and is not able to leave work. “I had a similar infection last year, and I would appreciate calling in an antibiotic.”


The physician requests an in person visit, for a full exam and chest x-ray.The patient hangs up frustrated. The physician is frustrated with the interaction and fears that his compensation could be negatively affected by exercising proper clinical judgement.


What would have improved the outcome?
A-Restructure the reimbursement not to affect standard of care.
B-Educate the patient further regarding standard of care to improve her health
C-Provide the patient with a sick note, to manage her work deadlines till she is seen in person.
D- Speak to patient’s primary care giver to obtain history. E-All the above

Email:
You must have a written informed consent specifically for email usage with a patient, and your first email (unless in response to the patient) should be without a message, with the word “test” as the subject line. Educate patients about the need for security and password protection for their devices, and if uncomfortable with e-communications with a client, seek alternative means of communication. Patients must be made understand the pitfalls of email.

It is important to ensure a HIPAA compliant encrypted email system is in place, and avoid using a patient’s name, nicknames, protected information, or record identifiers within emails, including, but not limited to:
●  Address, ZIP Code, birth date, admission dates and age.
●  Phone or fax number, photographic image, Social Security number.
●  Information about mental illness, developmental disabilities, communicable diseases, substance abuse, sexual assault, child abuse, and medical illnesses.

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State Medical Boards

The medical board’s duty is to protect the public, not the physician. State medical boards today focus on licensed physicians who violate professional ethics, and their mandate has significantly evolved to focus on disciplining physicians.

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Boundary Violation

Boundaries create a therapeutic distance between physician and patient and clarify their respective roles and expectations. Boundaries define limits of the therapeutic relationship.

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Medical Ethics: Real-World Application By Afshin Nasser

You may have acquired this book as a result of conflicts with peers, administrators, patients, or State Medical Boards, where the outcomes of those interactions have left you wondering, “…what if I had done things differently?”

In that case, I hope that this book answers some of your questions and guides you with regards to any future quandaries you may encounter.


If you are a healthcare worker seeking to understand the subject of medical ethics, then I hope this book helps you acquire the clarity you seek.
If you are an individual simply curious about medical ethics, then I raise my hat to you for your pursuit of knowledge.