Telemedicine and the Patient-Physician Relationship
The patient-physician relationship remains a keystone of healthcare
Many professional organizations recommend that a valid patient-physician relationship must be established before the provision of telemedicine services
The Federation of State Medical Boards has guidelines for the establishment of a valid relationship via telemedicine
The patient-physician relationship is based on trust and the ethical duty to place the patients’ welfare above the physician’s own self-interest
May 15, 2020 — The patient-physician relationship has been and remains a keystone of healthcare (1). A study published by the Council of Accountable Physician Practices (2017) revealed that patients consider the patient-physician relationship "the single most important hallmark of quality care." For some, many questions remain about whether it is possible to maintain a valid patient-physician relationship via telemedicine.
All states allow a physician to establish a relationship with a new patient via telemedicine, though state laws differ (2). The American Medical Association (AMA) and the American Telemedicine Association (ATA) recommend that a valid patient-physician relationship must be established before the provision of telemedicine services (2, 3), and most states require the relationship before medications can be prescribe.
Additional Resource for State-Specific Regulation: CCHP’s State Telehealth Laws & Reimbursement Policies 2020
The patient-physician relationship is fundamental to the provision of acceptable medical care, and physicians are discouraged from rendering medical care via telemedicine without establishing a valid relationship first (4). Per the Federation of State Medical Boards (FSMB), the following are guidelines for the establishment of a valid relationship via telemedicine:
Verifying the patient’s identity and location at the time of the visit
Disclosing the provider's identity and credentials
Obtaining an appropriate informed telehealth consent
Verification of the Patient’s Identity and Location at the Time of the Visit
Asking the patient to verify their full name and date of birth is important to assure the physician is addressing the correct patient, and to avoid HIPAA violations. Verification of the patient location should include the place where he/she is connecting from (coffee shop, home, office, etc…). This information provides context of the patient's surroundings as it pertains to safety and privacy. Also, the patient should verify the state where he/she is connecting from at the time of the visit. This is important to confirm that the patient is located within the practice jurisdiction of the licensed physician.
Disclosing the Physician’s Identity and Credentials
An appropriate physician-patient relationship has not been established when the identity and credentials of the physician may be unknown to the patient (4). This information provides the patient with a point of reference and helps build trust and rapport in the relationship. Since there are different types of providers (MD, DO, NP, PA) it is helpful to disclose this information in order to address patient uncertainties.
“Hello. My name is William Gonzalez. I’m a medical doctor and I’m board certified by the American Board of Family Medicine.”
Obtaining an Appropriate Informed Telehealth Consent
The AMA, FSMB, ATA and most states require an informed telehealth consent from the patient before the beginning of the telemedicine visit. The goal is to educate the patient on what telemedicine is and what benefits it offers. The consent should also address the possible consequences and risks involved in a telemedicine visit, including HIPAA considerations.
Whether the patient-physician relationship is established in-person or via telemedicine, the physician has the ethical duty to place the patients’ welfare above the physician’s own self-interest or obligations to others, to use sound medical judgment on patients’ behalf, and to advocate for their patients’ welfare (5).
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References
Dorr Goold S, Lipkin M, Jr. The doctor-patient relationship: challenges, opportunities, and strategies. J Gen Intern Med. 1999;14 Suppl 1:S26-33.
American Medical Association. 50-State Survey: Establishment of a Patient-Physician Relationship via Telemedicine. Advocacy Resource Center https://bit.ly/3fRrm7t. 2018
American Telemedicine Association. Core Operational Guidelines for Telehealth Services Involving Provider-Patient Interaction. 2014.
Federation of State Medical Boards. Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine. https://bit.ly/2T7dVGR. 2014.
American Medical Association. Patient-Physician Relationships - Code of Medical Ethics Opinion 1.1.1. AMA Ethics. https://bit.ly/3bEqi3T
