Ethics and Telemedicine

Telemedicine has revolutionized healthcare in recent years, and with it has come a variety of ethical considerations.  These ethical concerns can range from patient privacy and data security to physician-patient relationships and medical decision-making.   Just last week the F.T.C. accused GoodRx of leaking health data to Google and Facebook.  An ethical lapse?

https://www.nytimes.com/2023/02/01/business/goodrx-user-data-facebook-google.html

Patient privacy and data security are of paramount importance in telemedicine. Due to the nature of the technology, patient data must be encrypted and transmitted securely. Furthermore, any healthcare provider must have the proper authorization to access and view a patient’s data.

The physician-patient relationship is also of great importance in telemedicine. Telemedicine can provide patients with timely access to medical advice and care, but it also raises concerns about the quality of the doctor-patient relationship. It is important that physicians can develop rapport with their patients and build trusting relationships.

Medical decision-making is a key ethical concern in telemedicine. Because telemedicine is often conducted remotely, physicians must ensure that they are making the best decisions possible for their patients. This includes considering all relevant medical information, considering the patient’s individual situation, and discussing any decisions with the patient before making a final determination.

I asked some renowned experts in the field to help with this question.

Jay H. Sanders, M.D., and CEO, The Global Telemedicine Group shared:

“while telemedicine assures access to care, it does not necessarily improve the quality of care if the physician is not up-to-date, or if the time allotted for the information exchange is inadequate and/or in the absence of having all the critical information, offers a misguided diagnostic and/or therapeutic opinion. I should point out, however, that in the absence of EHR inoperability today, lack of availability of all the important information leads to the same mistakes as well as if the patient is standing in front of the physician”.

Joseph P. McMenamin, attorney with Christian and Barton wrote:

“To me, one of the most important ethical questions is the one I would recommend a provider ask himself at the beginning of the visit, or at least soon after he understands the chief complaint: is the nature of this patient’s problems such that virtual care will probably be beneficial, or is it too likely that proper evaluation will require techniques or procedures that can be carried out only in person?”

Christian Milaster, telemedicine veteran and CEO of Ingenium Digital Health Advisors wrote about three aspects of privacy in a virtual care environment:

1. Seeing the patient’s environment: does seeing some paraphernalia behind them, or seeing someone else in the background change the level of care?
2. Not knowing who else is in the room with the patient: who could overhear the conversation, or could just through their presence influence what the patient is willing to share?
3. And on the other side — How private is the clinician’s environment? Who can overhear? What if at home – can the conversation be overheard by their teenage kid outside the office door?

And when would it be unethical NOT to offer telehealth? According to Christian:

“From my perspective, it would be unethical not to offer care via telehealth when it is clinically appropriate, but the provider does not want to do it and as a result the patient does not receive care. Some patients may have limited access to transportation or do not want to leave the house and telehealth may be most conducive option for them to receive care.”

Maria Kunstadter, founder and CEO of The TeleDentist shared:

“The AMA Journal of Ethics in January 2022 addressed the ethical responsibility of physicians and dentists to patients. These apply to patients served with hands-on care or virtually.

The AMA code has two directives a physician must follow. 1. To care for the patient in the moment. 2. To provide appropriate follow-up referral or care.

The ADA Code of therapeutic alliance, and virtue ethics states a dentist has a duty to advocate on a patient’s behalf and to encourage him to seek and pursue treatment for his health care generally.

Both organizations emphasize the need for Dental/Medical Integration. Providing the right specialist for the right condition at the right time is now available through virtual care platforms that have physicians and dentists on their site or refer to a telemedicine and/or teledental site to provide the continuum of care with a referral which is required. Ethical duty made simple, thanks to virtual care access.”

Some other ethical issues come to mind:

• In an emergency, might a telemedicine service provider deploy an un-licensed (in that state) provider to deliver care?
• Might a telemedicine doctor choose which patient to see (first?) based on age, race, gender, medical condition, or ability to pay?

Telemedicine will likely increasingly use artificial intelligence going forward.  The issue of ethics in Artificial Intelligence (AI) with regards to healthcare is a complex and important one. AI has the potential to make healthcare more efficient, accurate, and cost-effective, however, ethical considerations must be considered to ensure that its use does not lead to unintended negative consequences. The potential for AI to collect, store, and use sensitive personal data can lead to ethical considerations.  This data could be used to inform decisions about treatments or to identify new treatments, but it must be done in accordance with laws and regulations that protect patient privacy. Additionally, AI algorithms must be designed and implemented in a way that respects patient autonomy; AI should not be used to override a patient’s wishes or to make decisions without their knowledge or consent. Another important ethical issue in AI for healthcare is fairness. AI algorithms can have built-in biases that lead to biased outcomes, such as incorrect diagnoses or treatments that are not appropriate for certain patient populations. It is essential that AI algorithms are designed and tested to ensure that they are free from bias and are fair to all patients, regardless of their race, gender, or other characteristics.

One would hope that all physicians are ethical, but this is not always the case.  It is the responsibility of all involved (physicians, service providers, and patients alike) to call out unethical practices and ensure that the benefits of new technologies continue to flourish.

This blog post was reviewed using an A.I. Bot (Wordtune).  Ethical?