There are many potential medico-legal pitfalls to be aware of when practicing telemedicine. As telemedicine is generally regarded as a form of delivering healthcare rather than a separate specialty, all the usual rules apply in terms of good medical practice. This includes clear communication skills, strict adherence to confidentiality rules, and the use of safety netting advice.
Always bear in mind that the appropriateness of a remote consultation is key: if doubts arise regarding the suitability of the medium at any point before, during or after the consultation, these must be urgently addressed. Any new information from the patient can change the nature of the consultation, so don’t be afraid to book them in for a face-to-face appointment if it seems correct to do so. Patient safety within telemedicine has been highlighted as a major concern by healthcare regulators, and organisations need to demonstrate they have robust processes in place to anticipate and manage any potential issues. Information from remote consultations needs to be made available to other healthcare individuals and organisations in a timely fashion, adhering to usual consent processes. Doctors have a responsibility to check a patient’s identity and any known patterns of behaviour prior to the consultation, including their potential to misunderstand or abuse the system when requesting medications. Doctors also need to assess whether confidentiality could be breached at either end of the remote consultation as soon as it begins, and act accordingly. Generally patients under 16 should be seen in person, to protect both parties and to ensure proper safeguarding measures can be taken.
Many clinical negligence claims arise from a perceived or actual lack of communication with patients. The potential for this to occur in remote consultations could be higher than face-to-face appointments, partly due to difficulties picking up on non-verbal cues and the slightly delayed response time (latency) which is present on many platforms. Doctors are expected to ensure that patients understand the nature of their remote consultation, that they know what to expect practically, and that they are prepared to be seen in-person if it’s deemed necessary. It’s considered good practice to arrange an in-person appointment before commencing or significantly changing a particular treatment, and to provide accurate documentation explaining and justifying any decision-making.
Another medico-legal issue with telemedicine is that patients or doctors might begin to make audio/visual recordings of telemedicine consultations as standard. The current guidance is that any still photos or recordings require both parties’ consent in advance, and can only be used, disclosed or transferred in line with data protection laws and organisational requirements. The European Union General Data Protection Regulations (GDPR), passed in May 2018, include stringent processing rules which apply to all personal data (including pseudonymised information). Therefore, it’s relatively uncommon for recorded consultations with 2-party consent to be undertaken in face-to-face consultations. If a patient is concerned about forgetting the information they have been given, it’s usually better to suggest they have a relative present with them during the remote appointment and provide them with written information to digest, before arranging a follow-up appointment if necessary. As with face-to-face medical practice, if a covert recording by a patient is discovered which the doctor didn’t consent to then a clear request should be made that it’s deleted in line with the organisation’s policies. There should also be timed and dated documentation of these events.
• You must provide the same level of care as if the patient was seen face-to-face
• Do your homework — access their medical records in advance, check their identity, and regularly make sure that they can hear and understand you clearly
• If you have doubts at any point regarding whether the use of telemedicine is appropriate, be safe and book them an in-person appointment instead
Don’t take photos or press ‘record’ unless you have their consent and a good reason to do so