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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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2x Speed
55. Telemedicine
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A person will not address a medical practitioner as a nobody, nor a magistrate as an everyday individual. The medical practitioner has the power of skill, the magistrate the power of position.
~ Saint Basil
Digital Deception
The Complexities of Telemedicine
Detective Sarah was on the case of a puzzling murder that had occurred during a telemedicine appointment. The victim, Dr. James, was a renowned telemedicine practitioner who had been at the forefront of advancing telemedicine technology to improve patient care and access. His patient, Mrs. Green, had been scheduled for an synchronous telemedicine appointment with him to discuss her recent blood pressure readings.
During the appointment, Mrs. Green reported hearing a commotion and Dr. James abruptly ending the call. Concerned, she tried to reach him multiple times but was unsuccessful. She finally contacted the authorities who found Dr. James’s lifeless body in his home office, where he conducted telemedicine appointments.
As Detective Sarah began her investigation, she quickly realized that the use of telemedicine technology had added a new layer of complexity to the case. She reviewed the recorded call between Dr. James and Mrs. Green, which revealed no clues as to who might have committed the murder. The call was also encrypted and secured using the latest technology, making it difficult to hack and extract information.
However, as Detective Sarah dug deeper, she discovered that Dr. James had recently been involved in a legal dispute with a rival telemedicine company over patent rights for a new telemedicine technology he had developed. The rival company had been threatening legal action, and tensions between the two had been high.
Furthermore, she found evidence that suggested that Dr. James had been involved in illegal prescribing practices, prescribing controlled substances through telemedicine appointments without proper evaluation or justification. It was possible that he had angered a patient or family member who had discovered his illicit practices.
As Detective Sarah pieced together the evidence, she realized that the case was not a simple murder but a complex web of legal and ethical issues surrounding telemedicine technology. The case highlighted the need for strict regulation and oversight of telemedicine practices to ensure patient safety and prevent illegal practices.
In the end, the killer was revealed to be a former patient of Dr. James, who had discovered his illegal practices and sought revenge. The case was a cautionary tale of the potential dangers of telemedicine technology and the importance of upholding the principles of beneficence and nonmaleficence in healthcare practices, whether in-person or online.
Abstract
Telemedicine is a technology that has revolutionized healthcare delivery and distribution, providing increased convenience and expanded access to underserved populations. There are three main types of telemedicine: synchronous, asynchronous, and monitoring. Synchronous involves real-time interactions between patients and practitioners, while asynchronous involves non-real-time interactions and is used for educational purposes and non-emergency communications. Monitoring involves tracking a patient’s vital signs and other data remotely. Advances in technology have opened the doors to expanded opportunities for telemedicine in care and monitoring. To ensure patient autonomy, practitioners must obtain informed consent and ensure privacy and security protocols. Practitioners must also follow the principle of beneficence and nonmaleficence and establish clear professional boundaries. Telemedicine is primarily regulated by state legislation, with some states having telemedicine parity laws mandating reimbursement for telemedicine visits at the same rate as in-person visits. As telemedicine becomes more widespread, there is a growing need to consider whether medical licensure should also be national rather than state-based. Issues arise with state-based medical licensure exams and the dispersing of state Medicaid funds to practitioners in other states. In 2020, the “Coronavirus Preparedness and Response Supplemental Appropriations Act” loosened existing telehealth restrictions to enhance patient access to care services during the COVID-19 outbreak.
**
Think
[55:1] Telemedicine is a technology that has resulted in changes in both the delivery and distribution of healthcare, providing increased patient convenience and expanded patient access for underserved populations.
[55:2] Telemedicine is synchronous, asynchronous, and monitorial:
- 1. Synchronous: patient-practitioner interactions occur live in realtime. Synchronous communications are appropriate for personal and sensitive information disclosures.
- 2. Asynchronous: patient-practitioner interactions occur not at the same time. Asynchronous communications are appropriate for patient educational materials and many types of non-emergency communications.
- 3. Monitoring: Patient’s vital signs and other data are tracked from a distance. Information can be automatically graphed and periodically checked by the practitioner for red flags, at which point the practitioner will contact the patient. Other types of indicators can immediately alert the practitioner of an emergency.
[55:3] Recent advances in computers, mobile phones, watches, wearables, audio-video, and security have opened the doors to expanding opportunities for telemedicine for care and monitoring that have historically only been available in the hospital or office based setting.
Assess
Patient: 1) Autonomy
[55:4] Although not required by all states, the practitioner should always attain a written informed consent from the patient authorizing the use of telemedicine. The informed consent should include a simple explanation of how telemedicine works, services available, scheduling, confidentiality, privacy, prescribing policies (such as no schedule II drugs only schedule III to V drugs), coordinating with other care providers, contingency plans for emergencies, security protocols, risk of patient information breach, professional boundaries, and billing: fees, costs, federal Medicare, state Medicaid, and private insurance reimbursements.
[55:5] The medical practitioner may also assure the patient of their education, licensure, and skills by directing the patient to go to the Federation of State Medical Boards (FSMB) website where the patient can: select DocInfo.org, put in the name of their practitioner, and the link will provide the practitioner’s: school of education, board certifications, states with active licenses, and any legal actions that have been taken against the practitioner. Such knowledge about the practitioner will enhance the patient-practitioner relationship.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[55:6] Telemedicine does not change the medical practitioner’s prime directive of maximizing the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities, using the biomedical principles of beneficence (do good) and nonmaleficence (do no harm). The benefits of telemedicine patient-practitioner interactions must always outweigh the increased risk of harm caused by online patient-practitioner interactions.
[55:7] Since telemedicine allows for frequent patient-practitioner exchanges, it becomes imperative for the practitioner to establish clear and definable professional boundaries early on to avoid any perceived, implied, or actual patient-practitioner impropriety. Any practitioner conflict of interest must be disclosed to the patient.
Public Policy: 4) Justice
[55:8] Telemedicine is regulated primarily by state legislation. Most states have passed telemedicine parity laws that mandate private payers to reimburse telemedicine visits at the same rate as comparable in-person visits. Telemedicine being an electronic online service, is not geographically bounded by physical borders, unlike medical licensure, which is geographically bounded. Practitioners must be licensed to practice medicine in each state that they practice. Crossing state borders through the use of telemedicine technology that results in the practicing of medicine where the practitioner is not licensed is illegal, unprofessional, and unethical.
[55:9] As of 2022, 34 states, the District of Columbia and the Territory of Guam and are part of the Interstate Medical Licensure Compact (IMLC), making getting licensure more straightforward if one has a primary license in one of the participating states. The Interstate Medical Licensure Compact (IMLC) uses a uniform standard for licensure, allowing practitioners to treat patients who reside in participating states.
[55:10]
[55:11]
[55:12] As telemedicine becomes more nationalized, there will be a greater need to consider whether or not medical licensure should also be national rather than state licensure. The Federation of State Medical Boards of the United States (FSMB) and the Nation Board of Medical Examiners (NBME) have already collaborated and established the Step exams as the national standard that every state uses as the minimum standard for medical licensure eligibility.
[55:13] Problems with trying to nationalize medical licensure for telemedicine are the vast differences in state laws, of which the practitioner must be held accountable. State medical licensure exams assure that practitioners who practice in the state are knowledgeable about the state’s medical laws. Other issues arise with the dispersing of state Medicaid funds to practitioners who reside in other states. Medicaid is managed by states and is based on income. Medicare is managed by the federal government and is based on age.
[55:14] On March 6, 2020, the “Coronavirus Preparedness and Response Supplemental Appropriations Act” became law. In addition to providing healthcare agencies with more money to address the COVID-19 outbreak, it also loosens existing telehealth restrictions in order to enhance patient access to care services. On March 17, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that they have expanded the waiver for telehealth in several areas, including the care of new patients for the diagnosis and treatment of COVID-19 as well as other conditions unrelated to the public health emergency. However, it does not open up telehealth billing to new practitioners.
Conclude
[55:15] For telemedicine, the patient-practitioner relationship is still foundational for the practice of medicine, and the federal mandate for full compliance with HIPAA regulations for confidentiality and privacy is enforced. Telemedicine practitioners need to know the state medical laws of each state in which they practice medicine.
[55:15] In summary, telemedicine, is a technology that has revolutionized healthcare delivery and provides increased convenience and expanded access to underserved populations. There are three main types of telemedicine: synchronous, asynchronous, and monitoring. Telemedicine is primarily regulated by state legislation, with some states having telemedicine parity laws mandating reimbursement for telemedicine visits at the same rate as in-person visits. As telemedicine becomes more widespread, there is a growing need to consider whether medical licensure should also be national rather than state-based. This new technology augments the importance of patient autonomy, practitioner beneficence and nonmaleficence, and the need for establishing clear professional boundaries.
**
Interstate Medical Licensure Compact (IMLC)
Average Number of Licenses Obtained
3
90%
Approval Rate
Average Wait Time for License
19 days
Licenses Available Within a Week
51%
55. Review Questions
1. Telemedicine can be synchronous, asynchronous, and monitorial.
2. Recent advances in computers, mobile phones, watches, wearables, audio-video, and security have opened the doors to expanding opportunities for telemedicine for care and monitoring that have historically only been available in the hospital setting.
3. Telemedicine does not change the practitioner’s prime directive of maximizing the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities, using the biomedical principles of beneficence (do good) and nonmaleficence (do no harm).
4. Since telemedicine allows for frequent patient-practitioner exchanges, it becomes imperative for the practitioner to establish clear and definable professional boundaries early on to avoid any perceived, implied, or actual patient-practitioner impropriety.
5. Telemedicine allows practitioners to have patients and practice medicine in states where the practitioner is not licensed.
6. The Interstate Medical Licensure Compact (IMLC) uses a uniform standard for licensure, allowing practitioners to treat patients who reside in participating states.
**
Wrong 😕
[55:2] Telemedicine is synchronous, asynchronous, and monitorial:
1. Synchronous: patient-practitioner interactions occur live in real-time. Synchronous communications are appropriate for personal and sensitive information disclosures.
2. Asynchronous: patient-practitioner interactions occur not at the same time. Asynchronous communications are appropriate for patient educational materials and many types of non-emergency communications.
3. Monitoring: Patient’s vital signs and other data are tracked from a distance. Information can be automatically graphed and periodically checked by the practitioner for red flags, at which point the practitioner will contact the patient. Other types of indicators can immediately alert the practitioner of an emergency.
CORRECT! 🙂
[55:2] Telemedicine is synchronous, asynchronous, and monitorial:
1. Synchronous: patient-practitioner interactions occur live in real-time. Synchronous communications are appropriate for personal and sensitive information disclosures.
2. Asynchronous: patient-practitioner interactions occur not at the same time. Asynchronous communications are appropriate for patient educational materials and many types of non-emergency communications.
3. Monitoring: Patient’s vital signs and other data are tracked from a distance. Information can be automatically graphed and periodically checked by the practitioner for red flags, at which point the practitioner will contact the patient. Other types of indicators can immediately alert the practitioner of an emergency.
CORRECT! 🙂
[55:3] Recent advances in computers, mobile phones, watches, wearables, audio-video, and security have opened the doors to expanding opportunities for telemedicine for care and monitoring that have historically only been available in the hospital setting.
Wrong 😕
[55:3] Recent advances in computers, mobile phones, watches, wearables, audio-video, and security have opened the doors to expanding opportunities for telemedicine for care and monitoring that have historically only been available in the hospital setting.
CORRECT! 🙂
[55:6] Telemedicine does not change the practitioner’s prime directive of maximizing the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities, using the biomedical principles of beneficence (do good) and nonmaleficence (do no harm). The benefits of telemedicine patient-practitioner interactions must always outweigh the increased risk of harm caused by online patient-practitioner interactions.
Wrong 😕
[55:6] Telemedicine does not change the practitioner’s prime directive of maximizing the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities, using the biomedical principles of beneficence (do good) and nonmaleficence (do no harm). The benefits of telemedicine patient-practitioner interactions must always outweigh the increased risk of harm caused by online patient-practitioner interactions.
CORRECT! 🙂
[55:7] Since telemedicine allows for frequent patient-practitioner exchanges, it becomes imperative for the practitioner to establish clear and definable professional boundaries early on to avoid any perceived, implied, or actual patient-practitioner impropriety. Any practitioner conflict of interest must be disclosed to the patient.
Wrong 😕
[55:7] Since telemedicine allows for frequent patient-practitioner exchanges, it becomes imperative for the practitioner to establish clear and definable professional boundaries early on to avoid any perceived, implied, or actual patient-practitioner impropriety. Any practitioner conflict of interest must be disclosed to the patient.
Wrong 😕
[55:8] Telemedicine is regulated primarily by state legislation. Most states have passed telemedicine parity laws that mandate private payers to reimburse telemedicine visits at the same rate as comparable in-person visits. Telemedicine being an electronic online service, is not geographically bounded by physical borders, unlike medical licensure, which is geographically bounded. Practitioners must be licensed to practice medicine in each state that they practice. Crossing state borders through the use of telemedicine technology that results in the practicing of medicine where the practitioner is not licensed is illegal, unprofessional, and unethical.
CORRECT! 🙂
[55:8] Telemedicine is regulated primarily by state legislation. Most states have passed telemedicine parity laws that mandate private payers to reimburse telemedicine visits at the same rate as comparable in-person visits. Telemedicine being an electronic online service, is not geographically bounded by physical borders, unlike medical licensure, which is geographically bounded. Practitioners must be licensed to practice medicine in each state that they practice. Crossing state borders through the use of telemedicine technology that results in the practicing of medicine where the practitioner is not licensed is illegal, unprofessional, and unethical.
Wrong 😕
[55:9] As of 2022, 34 states, the District of Columbia and the Territory of Guam and are part of the Interstate Medical Licensure Compact (IMLC), making getting licensure more straightforward if you have a primary license in one of the participating states. The Interstate Medical Licensure Compact (IMLC) uses a uniform standard for licensure, allowing practitioners to treat patients who reside in participating states.
[55:10]
CORRECT! 🙂
[55:9] As of 2022, 34 states, the District of Columbia and the Territory of Guam and are part of the Interstate Medical Licensure Compact (IMLC), making getting licensure more straightforward if you have a primary license in one of the participating states. The Interstate Medical Licensure Compact (IMLC) uses a uniform standard for licensure, allowing practitioners to treat patients who reside in participating states.
[55:10]
55. Clinical Vignettes
1. Ms. Amanda Jackson is a 45-year-old working mother who lives in a rural area. She has been experiencing symptoms of anxiety and depression for several months and has been struggling to find a local mental health provider who is able to see her in-person due to her work schedule and the limited availability of mental health professionals in her area. She has heard about telemedicine and is interested in receiving mental health services through this method. Which of the following is a potential benefit of telemedicine for Ms. Jackson's situation?
2. Ms. Rachel Cooper is a 45-year-old woman who has a history of hypertension and diabetes. She lives in a rural area and has difficulty accessing healthcare due to her busy work schedule and limited transportation options. Her primary care Practitioner recommends a telemedicine consultation to monitor her blood pressure and blood glucose levels. Ms. Cooper is provided with a wearable device that measures her vital signs and is connected to her smartphone. During the consultation, the Practitioner notes that Ms. Cooper's blood pressure is elevated and her blood glucose levels are high. The differential diagnosis includes poorly controlled hypertension and diabetes. The Practitioner orders medication adjustments and advises Ms. Cooper to follow a healthy diet and exercise regimen. What ethical issue arises in this scenario?
3. Mr. John Smith is a 68-year-old retired carpenter who lives in rural Mississippi. He has been experiencing worsening shortness of breath and chest pain for the past week. He has a past medical history of hypertension, hyperlipidemia, and coronary artery disease. Mr. Smith is unable to travel to a healthcare facility due to the COVID-19 pandemic and the distance from his home to the nearest hospital. He contacts his primary care Practitioner, Dr. Keven Kim, who practices in Tennessee. Dr. Kim is licensed in both Tennessee and Mississippi and is part of the Interstate Medical Licensure Compact. Dr. Kim decides to conduct a synchronous telemedicine visit with Mr. Smith to assess his condition and determine the best course of action. What ethical considerations must Dr. Kim take into account when conducting a telemedicine visit with Mr. Smith?
4. Ms. Olivia Grant is a 65-year-old retired school teacher living in a rural area of North Dakota. She has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus. Recently, she has been experiencing shortness of breath, chest pain, and palpitations. She contacts her primary care Practitioner, who is licensed in North Dakota, but due to the COVID-19 pandemic, the Practitioner is unable to see her in person. Instead, the Practitioner recommends a telemedicine consultation with a specialist who is licensed in Minnesota, which is a participating state in the Interstate Medical Licensure Compact (IMLC). Which ethical principle is best upheld by the Practitioner recommending a telemedicine consultation with a specialist licensed in Minnesota?
5. Ms. Rachel Jones is a 62-year-old retired teacher who lives in a rural area with limited access to healthcare services. She reports to her primary care practitioner, through a telemedicine visit, that she has been experiencing shortness of breath and chest pain. Her practitioner suggests a differential diagnosis of either congestive heart failure (CHF) exacerbation or pulmonary embolism (PE). The practitioner orders a chest X-ray and a D-dimer test for Ms. Jones. The results indicate that the chest X-ray is negative, while the D-dimer test is positive, raising the possibility of a PE. The practitioner recommends that Ms. Jones be referred to the nearest hospital for further testing, including a CT scan of her chest, to confirm or exclude the diagnosis of PE. Ms. Jones refuses to go to the hospital, stating that she is afraid of contracting COVID-19. The ethical question is whether the practitioner should override Ms. Jones's refusal and insist that she go to the hospital for further testing.
Wrong 😕
Explanation: Telemedicine can provide greater convenience for patients who may have difficulty accessing in-person care due to location, work schedule, or other factors. By using telemedicine, Ms. Jackson would be able to receive mental health services from the comfort of her own home, which can save time and reduce travel costs [55:1]. While telemedicine can also provide access to specialized care, the option of avoiding sharing personal information with a practitioner is not a benefit as it may hinder the ability to diagnose and treat her conditions [55:4]. Lastly, the likelihood of receiving a prescription for medication is not necessarily higher in telemedicine compared to in-person visits, as that would depend on the practitioner's assessment and clinical judgment [55:1].
CORRECT! 🙂
Explanation: Telemedicine can provide greater convenience for patients who may have difficulty accessing in-person care due to location, work schedule, or other factors. By using telemedicine, Ms. Jackson would be able to receive mental health services from the comfort of her own home, which can save time and reduce travel costs [55:1]. While telemedicine can also provide access to specialized care, the option of avoiding sharing personal information with a practitioner is not a benefit as it may hinder the ability to diagnose and treat her conditions [55:4]. Lastly, the likelihood of receiving a prescription for medication is not necessarily higher in telemedicine compared to in-person visits, as that would depend on the practitioner's assessment and clinical judgment [55:1].
Wrong 😕
Explanation: The ethical issue in this scenario is the Practitioner's obligation to follow the principle of beneficence and nonmaleficence during the telemedicine consultation [55:6]. As stated in paragraph 55:6, telemedicine does not change the practitioner's prime directive of maximizing the patient's best interests as determined by the patient's reasonable goals, values, and priorities, using the biomedical principles of professional beneficence (do good) and professional nonmaleficence (do no harm) [55:6]. The Practitioner must ensure that the benefits of telemedicine patient-practitioner interactions always outweigh the increased risk of harm caused by online patient-practitioner interactions [55:6]. In this scenario, the Practitioner has a duty to make medication adjustments and provide advice on diet and exercise to improve Ms. Cooper's health [55:6]. The other options are incorrect because informed consent, patient privacy and security protocols, and the practitioner's responsibility to establish clear and definable professional boundaries, are not the central focus of this scenario.
CORRECT! 🙂
Explanation: The ethical issue in this scenario is the Practitioner's obligation to follow the principle of beneficence and nonmaleficence during the telemedicine consultation [55:6]. As stated in paragraph 55:6, telemedicine does not change the practitioner's prime directive of maximizing the patient's best interests as determined by the patient's reasonable goals, values, and priorities, using the biomedical principles of professional beneficence (do good) and professional nonmaleficence (do no harm) [55:6]. The Practitioner must ensure that the benefits of telemedicine patient-practitioner interactions always outweigh the increased risk of harm caused by online patient-practitioner interactions [55:6]. In this scenario, the Practitioner has a duty to make medication adjustments and provide advice on diet and exercise to improve Ms. Cooper's health [55:6]. The other options are incorrect because informed consent, patient privacy and security protocols, and the practitioner's responsibility to establish clear and definable professional boundaries, are not the central focus of this scenario.
CORRECT! 🙂
Explanation: Dr. Kim must ensure that Mr. Smith's privacy and security are protected during the telemedicine visit [55:4]. This includes obtaining informed consent from Mr. Smith, explaining how telemedicine works, and establishing clear professional boundaries [55:6]. Dr. Kim must also ensure that he is licensed to practice medicine in the state where the patient is located [55:8]. Being licensed in both Tennessee and Mississippi, as part of the Interstate Medical Licensure Compact, allows Dr. Kim to conduct telemedicine visits with patients residing in either state [55:9]. The best option presented is that privacy and security protocols are crucial in telemedicine, and ensuring patient privacy and security is an ethical obligation for practitioners. The other options are incorrect because obtaining informed consent is a necessary ethical obligation for practitioners, because establishing professional boundaries is essential for all patient-practitioner relationships, regardless of pre-existing relationships, and because being licensed in both Tennessee and Mississippi is allowed as part of the Interstate Medical Licensure Compact [55:9].
Wrong 😕
Explanation: Dr. Kim must ensure that Mr. Smith's privacy and security are protected during the telemedicine visit [55:4]. This includes obtaining informed consent from Mr. Smith, explaining how telemedicine works, and establishing clear professional boundaries [55:6]. Dr. Kim must also ensure that he is licensed to practice medicine in the state where the patient is located [55:8]. Being licensed in both Tennessee and Mississippi, as part of the Interstate Medical Licensure Compact, allows Dr. Kim to conduct telemedicine visits with patients residing in either state [55:9]. The best option presented is that privacy and security protocols are crucial in telemedicine, and ensuring patient privacy and security is an ethical obligation for practitioners. The other options are incorrect because obtaining informed consent is a necessary ethical obligation for practitioners, because establishing professional boundaries is essential for all patient-practitioner relationships, regardless of pre-existing relationships, and because being licensed in both Tennessee and Mississippi is allowed as part of the Interstate Medical Licensure Compact [55:9].
Wrong 😕
Explanation: The ethical principle of beneficence, which requires practitioners to act in the best interests of their patients and to maximize the benefits and minimize the harms, is best upheld by the Practitioner recommending a telemedicine consultation with a specialist licensed in Minnesota [55:3]. By doing so, the Practitioner is ensuring that the patient receives the appropriate care and treatment for her symptoms, despite not being able to see her in person. This also promotes access to healthcare for patients living in rural areas [55:1]. The other options are incorrect because, autonomy, nonmaleficence and justice although important in for telemedicine consultations they are not the central focus of this scenario of the Practitioner's decision to recommend a telemedicine consultation with a specialist in another state [55:4].
CORRECT! 🙂
Explanation: The ethical principle of beneficence, which requires practitioners to act in the best interests of their patients and to maximize the benefits and minimize the harms, is best upheld by the Practitioner recommending a telemedicine consultation with a specialist licensed in Minnesota [55:3]. By doing so, the Practitioner is ensuring that the patient receives the appropriate care and treatment for her symptoms, despite not being able to see her in person. This also promotes access to healthcare for patients living in rural areas [55:1]. The other options are incorrect because, autonomy, nonmaleficence and justice although important in for telemedicine consultations they are not the central focus of this scenario of the Practitioner's decision to recommend a telemedicine consultation with a specialist in another state [55:4].
CORRECT! 🙂
Explanation: In telemedicine, practitioners must ensure patient autonomy and obtain informed consent, while adhering to the principles of beneficence and non-maleficence and establishing professional boundaries [55:4-7]. In this scenario, Ms. Jones's refusal to go to the hospital must be respected, and alternative options must be offered. The practitioner may suggest arranging for home oxygen therapy and monitoring, with periodic telemedicine follow-ups, to assess Ms. Jones's condition and provide the necessary care. The practitioner may also discuss the potential risks and benefits of alternative options and provide Ms. Jones with the necessary information to make an informed decision. In addition, the practitioner must ensure that Ms. Jones's decision is voluntary, without coercion, and that her refusal does not result in harm or neglect [55:4-7]. The practitioner may consider seeking a second opinion from a specialist or consulting with an ethics committee if necessary [55:3]. However, consulting with Ms. Jones's family members and obtaining their opinion may violate her confidentiality and privacy rights and compromise her autonomy [55:4]. The practitioner must respect Ms. Jones's decision and provide the necessary care through telemedicine, while ensuring her safety and well-being.
Wrong 😕
Explanation: In telemedicine, practitioners must ensure patient autonomy and obtain informed consent, while adhering to the principles of beneficence and non-maleficence and establishing professional boundaries [55:4-7]. In this scenario, Ms. Jones's refusal to go to the hospital must be respected, and alternative options must be offered. The practitioner may suggest arranging for home oxygen therapy and monitoring, with periodic telemedicine follow-ups, to assess Ms. Jones's condition and provide the necessary care. The practitioner may also discuss the potential risks and benefits of alternative options and provide Ms. Jones with the necessary information to make an informed decision. In addition, the practitioner must ensure that Ms. Jones's decision is voluntary, without coercion, and that her refusal does not result in harm or neglect [55:4-7]. The practitioner may consider seeking a second opinion from a specialist or consulting with an ethics committee if necessary [55:3]. However, consulting with Ms. Jones's family members and obtaining their opinion may violate her confidentiality and privacy rights and compromise her autonomy [55:4]. The practitioner must respect Ms. Jones's decision and provide the necessary care through telemedicine, while ensuring her safety and well-being.
**
55. Reflection Vignettes
1. Dr. Sarah Kim, a 38-year-old telemedicine practitioner, receives a call from a patient, John Smith, who resides in an IMLC state where Dr. Kim is not currently licensed to practice medicine. John Smith is seeking medical care for his chronic back pain and is interested in receiving telemedicine services from Dr. Kim. Dr. Kim holds licenses to practice medicine in multiple IMLC states, but not in John Smith's state.
The practitioner should verify their eligibility for practicing in the patient's state of residence under the IMLC. If the practitioner is eligible, then they can proceed with the telemedicine consultation and provide medical care to the patient after the practitioner is licensed. If the practitioner is not eligible, they should inform the patient and provide them with a referral to a licensed practitioner in their state of residence. It is important to ensure that all telemedicine consultations are conducted in compliance with state and federal regulations to protect the patient and maintain the integrity of the medical profession.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
Dr. Julia Miller, a 35-year-old board-certified family medicine practitioner, has been hired to lead the new telemedicine clinic that is being proposed to meet the medical needs of the rural community after the local hospital closed due to financial challenges. Dr. Miller is aware that telemedicine offers benefits such as improved access to care and lower costs for patients, but also acknowledges some of the challenges that telemedicine may bring, such as limited physical examination capabilities and potential issues with patient privacy and data security. The clinic aims to provide a range of services including consultations, diagnostic tests, and prescriptions for common illnesses. Dr. Miller plans to establish a strong network with local healthcare providers to ensure continuity of care and to collaborate with other clinics in the area to ensure that patients receive the best possible care. The differential diagnosis for patients will include common illnesses that can be treated using telemedicine, such as respiratory infections, skin rashes, and gastrointestinal issues.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
