Telehealth practice in surgery: Ethical and medico‐legal considerations

Abstract

There was rapid growth of telehealth practice during the COVID‐19 outbreak in 2020. In surgery, there were beneficial effects in terms of saving time and avoiding physical contact between healthcare professionals and patients when using telehealth in the delivery of perioperative care. As telehealth is gaining momentum, the evolving ethical and medico‐legal challenges arising from this alternative mode of doctor–patient interaction cannot be underestimated. With reference to the “Ethical Guidelines on Practice of Telemedicine” issued by the Medical Council of Hong Kong and some published court and disciplinary cases from other common law jurisdictions, this article discusses relevant ethical and medico‐legal issues in telehealth practice with emphasis on the following areas: duty of care; communication and contingency; patient‐centred care and informed consent; limitations and standard of care; keeping medical records, privacy, and confidentiality; and cross‐territory practice. Whilst existing ethical and legal obligations of practicing medicine are not changed when telehealth is used as opposed to in‐person care, telehealth practitioners are advised to familiarize themselves with the ethical guidelines, to keep abreast of the medico‐legal developments in this area, and to observe the licensure requirements and regulatory regimes of both the jurisdiction where they practice and where their patients are located.

Applications and Current Medico-Legal Challenges of Telemedicine in Ophthalmology

“…In a systematic review of 24 studies using telecommunications technologies in the field of surgical care, Asiri and collaborators concluded that the use of telemedicine had beneficial effects in preand post-operative examinations, including follow-up visits [2]. It was also particularly appropriate to use teleconsultation to provide patients with post-operative care for low-risk elective procedures [3,10].…”

“…Recent studies have shown that telemedicine, if used by the community, can lead to a significant improvement in patient management, long-term cost savings and greater sustainability for public health, even in developed countries. The current modalities for performing teleconsultation are: (i) real time, in which doctor and patient can interact with each other at the time of consultation and (ii) synchronous, where the patient answers question and the doctor responds later, according to his convenience via short message service (SMS) or e-mail [3][4][5][6][7]. The current COVID-19 outbreak has further reinforced the need for the use of remote consultation in order to reduce contact between patients and healthcare professionals to the bare minimum [3].…”

“…The current modalities for performing teleconsultation are: (i) real time, in which doctor and patient can interact with each other at the time of consultation and (ii) synchronous, where the patient answers question and the doctor responds later, according to his convenience via short message service (SMS) or e-mail [3][4][5][6][7]. The current COVID-19 outbreak has further reinforced the need for the use of remote consultation in order to reduce contact between patients and healthcare professionals to the bare minimum [3]. In fact, the fear of being infected by COVID-19 has drastically reduced access to hospitals in favour of telematic consultations between patient and doctor.…”

A look to the future: Pandemic-induced digital technologies in vascular surgery

“…In some institutions, clinical governance of these matters are rudimentary or scarce despite being HIPAA (Health Insurance Portability and Accountability Act)-compliant and stressed further by the rapidly moving, pandemic-related landscape. It is critical that surgeons worldwide proactively engage in developing guidelines and practices that remain consistent with existing medicolegal and ethical obligations [44] .…”

Commentary: The Legal and Socioeconomic Considerations in Spine Telemedicine

“…International standards have been defined to govern how confidentiality can be maintained through the use of telehealth services. 9 The surgeon must be aware of what can be constituted as medical records when legal issues arise.…”