How to establish a patient-physician relationship via telemedicine, according to the American College of Physicians

It's important for patients and physicians to establish a relationship before a telemedicine visit, according to the most-recent edition of the American College of Physicians' ethics manual. However, there are ways to adequately establish this relationship via remote care technology.

The American College of Physicians published the seventh edition of its ethics manual in the Annals of Internal Medicine Jan. 15. The document covers various issues in medical ethics, including confidentiality, informed consent, gifts from patients, social media use and physician-assisted suicide.

"Reexamining the ethical tenets of medicine and their application in new circumstances is a necessary exercise," the manual reads. "The manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession."

Three notes on how to establish a patient-physician relationship using telemedicine, as outlined in the American College of Physicians' recently updated ethics manual:

1. There must be a "valid patient-physician relationship for a professionally responsible telemedicine service to take place." However, the manual notes a telemedicine encounter can be used to establish this relationship, if it takes place in real-time and with appropriate audiovisual technology.

2. In cases where there has not been previous contact between a patient and a physician before a telemedicine visit, the physician must take steps to establish a relationship based on the standards of care used during in-person visits. They may also consult with a physician who has had a relationship with the patient.

3. The benefits of telemedicine — chiefly increasing access to healthcare services — must be balanced against the risks — such as the potential for misdiagnosis, loss of personal interaction, lack of physical communication and issues with continuity of care — for each patient encounter.

To access the newest American College of Physicians' ethics manual, click here.

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