Lee DWH, Tong KW, Lai PBS. Telehealth practice in surgery: Ethical and medico-legal considerations. Surgical Practice. 2021 Feb;25(1):42-46. DOI: 10.1111/1744-1633.12479.
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.
Undoubtedly, the COVID‐19 outbreak expedited the development of telehealth practice. It is anticipated that telehealth perioperative care of surgical patients will gain further popularity beyond the pandemic. As telehealth is growing in speed, practitioners need to acquire new skills in communication and technology in order to deliver remote care effectively. Although telehealth offers benefits for patients in terms of saving time and costs and avoiding physical contact, significant limitations such as the absence of physical examination, possibility of transmission failure, and potential privacy and confidentiality breaches should be made known to patients. To this end, it is good practice to get informed consent from patients before the commencement of telehealth. Whilst existing ethical and legal obligations of practicing medicine are not changed when telehealth is used as opposed to in‐person care, the evolving ethical and medico‐legal issues in telehealth, such as whether to consult and prescribe treatments for first‐time patients, can be challenging. As a starting point, practitioners should familiarize themselves with the MCHK Guidelines, which outlined the broad ethical principles and set out the necessary standards of care in telehealth practice. It cannot be overemphasized again that the standard of care shall be at all times comparable to conventional in‐person consultations and treatments. Practitioners should also keep abreast of the medico‐legal developments in this area. Last but not least, practitioners who practice cross‐territory telehealth should observe the licensure requirements and regulatory regimes of both the jurisdiction where they practice and where their patients are located.