Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
This article is intended for physicians practicing or considering the practice of telemedicine.
The goal of this activity is to describe ethical issues faced by physicians practicing telemedicine and solutions for these issues, according to an American College of Physicians (ACP) case history and commentary.
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AMA PRA Category 1 Credit(s)™
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CME / ABIM MOC Released: 10/17/2019; Reviewed and Renewed: 9/5/2023
Valid for credit through: 9/5/2024, 11:59 PM EST
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Dr Benson is a full-time telemedicine doctor working from home. She provides as-needed consultations to employees whose employers subscribe to Telehealthy through a secure video link embedded in an electronic health record maintained by Telehealthy. No enhancements other than the video link and the facilitation of patient and physician exchange of material (records, test results, etc) electronically through secure email are offered. Of note, Dr Benson is compensated additionally if she is able to provide services that save costs by decreasing inappropriate use of health care resources by employees. Employers who subscribe actively promote the availability of telemedicine and provide financial incentives to employees who use the service.
Dr Benson is talking to Ms Jones, 29, who works at Company A; she is using the service for the first time. Her medical records are not available. The patient has had a few days of dysuria, vaginal discharge, and some burning and itching. She is also experiencing bouts of fatigue. She is sexually active but is reluctant to talk about sexual history from the office conference room she is sitting in or to give more details about the discharge. Dr Benson suggests this is likely a simple urinary tract infection but could also be vaginitis secondary to candidiasis, pregnancy, or a sexually transmitted infection.
Ms Jones would like to try antibiotics for a bladder infection. Dr Benson is weighing how to tell Ms Jones she needs a physical exam and lab work when Ms Jones says she feels really uncomfortable and is in pain now, has multiple project deadlines to meet this week, and is not able to leave work.
"I had a UTI last year, can’t you just phone in a prescription for something?" Ms Jones asks.
Dr Benson tells the patient she needs to be seen for an in-person exam and lab work (and when Ms Jones eventually sees her primary care physician 2 weeks later, it turns out she still has symptoms, is pregnant, and her physician tells her, "Yes, you needed to be seen").
Nevertheless, the patient hangs up frustrated that this service did not yield a prescription. Dr Benson is frustrated at the outcome of this interaction as well. She also reflects on the fact that her compensation could be adversely affected by doing what she thinks is clinically indicated and the right thing in recommending this patient have an in-person evaluation.