Risk Management
Tip

There is no doubt that the Internet is changing the traditional physician-patient relationship.   A recent article entitled "Doctors' House Calls are Back, Virtually" states that a survey of 10,000 physicians found 85% use the Internet.  This represents an 875% increase from 1997.  Of those physicians surveyed, one-third has exchanged e-mail with their patients.  The majority of physicians who are using the Internet use it to stay in touch with patients between visits or as a triage and advice tool.  If you have not already started to use cyberspace as an augment to your traditional medical practice, chances are you soon will.  Here are some of the risks associated with your jump into cyberspace along with helpful tips on how to manage them.

Last month the American Telemedicine Association (ATA) issued guidelines to consumers and physicians on use of medical Web sites.  The guidelines pertain only to patient e-mail, not to telemedicine consultations.  They closely follow those of the AMA in their policy on Telecommunication Advisory Services.  First, the AMA states that physicians should not make clinical diagnosis or prescribe medications on-line.   From the risk management perspective, it is important that a physician-patient relationship not be established with visitors to a Web site who are unknown to you.  Once a physician-patient relationship is established, the physician is legally obligated to treat the patient as dictated by the applicable standard of care.  Such treatment is almost impossible without a face-to-face, clinical exam.  Set forth general health care information rather than making a clinical diagnosis.  This can help to circumvent medical malpractice liability.  Also, ensure both the physician and visitors remain anonymous.   Absence of a physician-patient relationship also averts the problem of practicing medicine in a state in which you are not licensed.  The Illinois state credentialing agency recently sanctioned a physician licensed in that state for prescribing medications on-line to a patient in Florida where he was not licensed to practice medicine.

If you do choose to give clinical advice to known patients, be certain you protect the patient by thoroughly disclosing the limitations of the e-mail encounter.  The ATA expands this guideline by suggesting any clinical consultation should include protective measures such as:

1. informed consent,

2. security and privacy protection for medical information, and

3. documentation of the clinical encounter.

Finally, remember that Internet information is unregulated.  Carefully selected links will help visitors to your Web site obtain information about health and medicine from reliable and credible sources.  For more information go to www.atmeda.org or www.ama-assn.org.

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