Limits...
Towards ethical guidelines for dealing with unsolicited patient emails and giving teleadvice in the absence of a pre-existing patient-physician relationship systematic review and expert survey.

Eysenbach G - J. Med. Internet Res. (2000 Jan-Mar)

Bottom Line: Different media are appropriate at each point on the continuum between dispensing general health information and handling patient problems that would require the practice of medicine to solve.For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology.More research is needed to establish more evidence regarding situations in which teleadvice is beneficial and efficient.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Heidelberg, Dept. Of Clinical Social Medicine, Unit for Cybermedicine, Heidelberg, 69115, Germany. ey@yi.com

ABSTRACT

Background: Many health information providers on the Internet and doctors with email accounts are confronted with the phenomenon of receiving unsolicited emails from patients asking for medical advice. Also, a growing number of websites offer "ask-the-doctor" services, where patients can ask questions to health professionals via email or other means of telecommunication. It is unclear whether these types of interactions constitute medical practice, and whether physicians have the ethical obligation to respond to unsolicited patient emails.

Objective: To improve the quality of online communication between patients and health professionals (physicians, experts) in the absence of a pre-existing patient-physician relationship or face-to-face communication, by preparing a set of guiding ethical principles applicable to this kind of interaction.

Methods: Systematic review of the literature, professional, and ethical codes; and consultation with experts.

Results: Two different types of patient-physician encounters have to be distinguished. "Traditional" clinical encounters or telemedicine applications are called "Type B" interactions here (Bona fide relationship). In comparison, online interactions lack many of the characteristics of bona fide interactions; most notably there is no pre-existing relationship and the information available to the physician is limited if, for example, a physician responds to the email of a patient who he has never seen before. I call these "Type A" consultations (Absence of pre-existing patient-physician relationship). While guidelines for Type B interactions on the Internet exist (Kane, 1998), this is not the case for Type A interactions. The following principles are suggested: Physicians responding to patients' requests on the Internet should act within the limitations of telecommunication services and keep the global nature of the Internet in mind; not every aspect of medicine requires face-to-face communication; requests for help, including unsolicited patient questions, should not be ignored, but dealt with in some appropriate manner; informed consent requires fair and honest labeling; health professionals and information providers must maintain confidentiality; health professionals should define internal procedures and perform quality control measures.

Conclusions: Different media are appropriate at each point on the continuum between dispensing general health information and handling patient problems that would require the practice of medicine to solve. For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology. Patients have to be educated that it is unethical to diagnose and treat over the Internet in the absence of a pre-existing patient-physician relationship, and if the interaction is limited to a single email. More research is needed to establish more evidence regarding situations in which teleadvice is beneficial and efficient.

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Related in: MedlinePlus

Different media are appropriate at each point on the continuum between dispensing general health information and handling patients' problems which would require the practice of medicine to solve. For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology. Likewise, when dispensing general health information, a Type A relationship between the patient and the physician is sufficient; for practicing medicine, a Type B relationship is desirable. The difficulty is that there is no clear-cut line between the two extremes - and it is in this grey area that the majority of patient-physician interactions on the Internet take place
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getmorefigures.php?uid=PMC1761847&req=5

figure3: Different media are appropriate at each point on the continuum between dispensing general health information and handling patients' problems which would require the practice of medicine to solve. For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology. Likewise, when dispensing general health information, a Type A relationship between the patient and the physician is sufficient; for practicing medicine, a Type B relationship is desirable. The difficulty is that there is no clear-cut line between the two extremes - and it is in this grey area that the majority of patient-physician interactions on the Internet take place

Mentions: That lawyers focus on the concepts of diagnosis and treatment has its justification, as many other people also give health information, and provide emotional support or health advice, without being physicians and having a medical license; for example, journalists, webmasters of health websites, librarians, priests, or hair stylists. While there seems to be consensus that giving general health information is not "practicing medicine," and that the process of diagnosing and treating clearly constitutes practicing medicine, there is a large grey area between these two extremes (see Figure 3).


Towards ethical guidelines for dealing with unsolicited patient emails and giving teleadvice in the absence of a pre-existing patient-physician relationship systematic review and expert survey.

Eysenbach G - J. Med. Internet Res. (2000 Jan-Mar)

Different media are appropriate at each point on the continuum between dispensing general health information and handling patients' problems which would require the practice of medicine to solve. For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology. Likewise, when dispensing general health information, a Type A relationship between the patient and the physician is sufficient; for practicing medicine, a Type B relationship is desirable. The difficulty is that there is no clear-cut line between the two extremes - and it is in this grey area that the majority of patient-physician interactions on the Internet take place
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC1761847&req=5

figure3: Different media are appropriate at each point on the continuum between dispensing general health information and handling patients' problems which would require the practice of medicine to solve. For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology. Likewise, when dispensing general health information, a Type A relationship between the patient and the physician is sufficient; for practicing medicine, a Type B relationship is desirable. The difficulty is that there is no clear-cut line between the two extremes - and it is in this grey area that the majority of patient-physician interactions on the Internet take place
Mentions: That lawyers focus on the concepts of diagnosis and treatment has its justification, as many other people also give health information, and provide emotional support or health advice, without being physicians and having a medical license; for example, journalists, webmasters of health websites, librarians, priests, or hair stylists. While there seems to be consensus that giving general health information is not "practicing medicine," and that the process of diagnosing and treating clearly constitutes practicing medicine, there is a large grey area between these two extremes (see Figure 3).

Bottom Line: Different media are appropriate at each point on the continuum between dispensing general health information and handling patient problems that would require the practice of medicine to solve.For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology.More research is needed to establish more evidence regarding situations in which teleadvice is beneficial and efficient.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Heidelberg, Dept. Of Clinical Social Medicine, Unit for Cybermedicine, Heidelberg, 69115, Germany. ey@yi.com

ABSTRACT

Background: Many health information providers on the Internet and doctors with email accounts are confronted with the phenomenon of receiving unsolicited emails from patients asking for medical advice. Also, a growing number of websites offer "ask-the-doctor" services, where patients can ask questions to health professionals via email or other means of telecommunication. It is unclear whether these types of interactions constitute medical practice, and whether physicians have the ethical obligation to respond to unsolicited patient emails.

Objective: To improve the quality of online communication between patients and health professionals (physicians, experts) in the absence of a pre-existing patient-physician relationship or face-to-face communication, by preparing a set of guiding ethical principles applicable to this kind of interaction.

Methods: Systematic review of the literature, professional, and ethical codes; and consultation with experts.

Results: Two different types of patient-physician encounters have to be distinguished. "Traditional" clinical encounters or telemedicine applications are called "Type B" interactions here (Bona fide relationship). In comparison, online interactions lack many of the characteristics of bona fide interactions; most notably there is no pre-existing relationship and the information available to the physician is limited if, for example, a physician responds to the email of a patient who he has never seen before. I call these "Type A" consultations (Absence of pre-existing patient-physician relationship). While guidelines for Type B interactions on the Internet exist (Kane, 1998), this is not the case for Type A interactions. The following principles are suggested: Physicians responding to patients' requests on the Internet should act within the limitations of telecommunication services and keep the global nature of the Internet in mind; not every aspect of medicine requires face-to-face communication; requests for help, including unsolicited patient questions, should not be ignored, but dealt with in some appropriate manner; informed consent requires fair and honest labeling; health professionals and information providers must maintain confidentiality; health professionals should define internal procedures and perform quality control measures.

Conclusions: Different media are appropriate at each point on the continuum between dispensing general health information and handling patient problems that would require the practice of medicine to solve. For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology. Patients have to be educated that it is unethical to diagnose and treat over the Internet in the absence of a pre-existing patient-physician relationship, and if the interaction is limited to a single email. More research is needed to establish more evidence regarding situations in which teleadvice is beneficial and efficient.

Show MeSH
Related in: MedlinePlus