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CME / ABIM MOC

“Doctor, Can’t You Just Phone a Prescription In?” and Other Ethical Challenges of Telemedicine Encounters

  • Authors: Case History by Thomas A. Bledsoe, MD, FACP; Lois Snyder Sulmasy, JD; Commentary by Daniel T. Kim, MA, MPH; Thomas A. Bledsoe, MD, FACP; Lois Snyder Sulmasy, JD
  • 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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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

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.

Upon completion of this activity, participants will:

  • Describe ethical issues related to video-based encounters for physicians practicing telemedicine, according to an ACP case history and commentary
  • Determine ethical issues related to professional judgment for physicians practicing telemedicine, according to an ACP case history and commentary
  • Identify ethical issues related to continuity of care for physicians practicing telemedicine, according to an ACP case history and commentary


Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Authors, Case History

  • Thomas A Bledsoe, MD, FACP

    Clinical Associate Professor of Medicine
    Alpert Medical School of Brown University
    Brown Medicine
    Brown Physicians, Inc.
    East Providence, Rhode Island

    Disclosures

    Disclosure: Thomas A. Bledsoe, MD, FACP, has disclosed no relevant financial relationships.

  • Lois-Snyder Sulmasy, JD

    Director
    Center for Ethics and Professionalism
    American College of Physicians
    Philadelphia, Pennsylvania

    Disclosures

    Disclosure: Lois Snyder Sulmasy, JD, has disclosed no relevant financial relationships.

Authors, Commentary

  • Daniel T Kim, MA, MPH

    Senior Associate
    Center for Ethics and Professionalism
    American College of Physicians
    Philadelphia, Pennsylvania

    Disclosures

    Disclosure: Daniel T. Kim, MA, MPH, has disclosed no relevant financial relationships.

  • Thomas A Bledsoe, MD, FACP

    Clinical Associate Professor of Medicine
    Alpert Medical School of Brown University
    Brown Medicine
    Brown Physicians, Inc.
    East Providence, Rhode Island

    Disclosures

    Disclosure: Thomas A. Bledsoe, MD, FACP, has disclosed no relevant financial relationships.

  • Lois-Snyder Sulmasy, JD

    Director
    Center for Ethics and Professionalism
    American College of Physicians
    Philadelphia, Pennsylvania

    Disclosures

    Disclosure: Lois Snyder Sulmasy, JD, has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Editor

  • Lois Snyder Sulmasy, JD

    Director
    Center for Ethics and Professionalism
    American College of Physicians
    Philadelphia, Pennsylvania

    Disclosures

    Disclosure: Lois Snyder Sulmasy, JD, has disclosed no relevant financial relationships.

CME Reviewer

  • Amy Bernard, MS, BSN, RN-BC, CHCP

    Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Disclosure: Amy Bernard, MS, BSN, RN-BC, CHCP, has disclosed no relevant financial relationships.


    Medscape staff have disclosed that they have no relevant financial relationships.


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    For Physicians

  • The case and commentary were developed by the American College of Physicians.

    Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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CME / ABIM MOC

“Doctor, Can’t You Just Phone a Prescription In?” and Other Ethical Challenges of Telemedicine Encounters

Authors: Case History by Thomas A. Bledsoe, MD, FACP; Lois Snyder Sulmasy, JD; Commentary by Daniel T. Kim, MA, MPH; Thomas A. Bledsoe, MD, FACP; Lois Snyder Sulmasy, JDFaculty and Disclosures

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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Case History

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.

Table of Contents

  1. Case History
  2. Commentary
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