Most people would agree that a strong doctor-patient relationship is crucial to helping the patient maintain optimal health. Traditionally, this relationship has been cultivated during in-person office visits. With the advent of telemedicine, however, debate has centered on whether telemedicine visits contain enough doctor-patient interaction to build a trusting relationship and provide enough data for the doctor to make an accurate diagnosis. Most recently, the American College of Physicians (ACP) clarified their position on the issue: First-time visits that are conducted via telemedicine must include a live audio-visual component.
The ACP’s Ethics Manual, released earlier this month, explains the stance. As described by the manual, the potential benefits of increased access to health care through telemedicine have to be weighed against the potential risks of any elements that normally accompany an in-person visit, such as body language, the therapeutic value of touch, or continuity of care. The manual instructs physicians to take the appropriate steps to establish a relationship with a new patient according to the standard of care for an in-person visit; this may include consulting with another physician who already has a relationship with that patient.
Compared to a phone conversation or e-mail, a live audio-visual conversation has less risk of miscommunication. Thus, these alternative avenues should only be used within the context of existing patient-physician relationships and with the patient’s consent. This standard is similar to that of prescribing medicines or other treatment; issuing new treatment based on a phone call or online questionnaire falls short of the acceptable standard of care.
The ACP’s position follows that of the American Medical Association, who emphasized in 2016—after three years of debate—that physicians’ ethical responsibilities and standard of care must remain the same regardless of whether the patient visit is conducted in-person or via telemedicine.
The debate over telemedicine ethics is far from over. Some healthcare providers believe that a telemedicine visit cannot replace an in-person visit, while others believe that technology has rendered telemedicine an acceptable substitute for in-person visits in certain situations. Yet other providers feel comfortable relying on telemedicine visits for established patients, but not for new patients. It will be interesting to watch this discussion and its effects on access to care in the coming years.
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