For more than a century the telephone has been an integral part of medical practice. Used appropriately, it has the potential to make physicians more efficient and patients safer. But, even after 100 years, making good decisions on the telephone requires superior clinical judgment.
Telemedicine has the potential to reduce the risk of error by providing physicians with considerably more information. However, a decision to rely on a virtual visit to conclude a medical assessment for an acute concern will always be a high stakes one, which requires thoughtful consideration and superior clinical judgment.
Telemedicine is here to stay. Like the telephone, physicians must learn to use these new technologies safely. The College urges registrants to review two articles:
- The College’s professional standard Telemedicine at https://www.cpsbc.ca/files/pdf/PSG-Telemedicine.pdf
- An editorial in the BCMJ by Deputy Registrar Dr. W.R. Vroom, titled Does telemedicine need stricter rules for engagement? at http://www.bcmj.org/editorials/does-telemedicine-need-stricter-rules-engagement
The College regulates medical practice, not communications technology. Standards for patient assessment and documentation are the same, whether the interaction is face-to-face or virtual. Failure to perform an adequate physical examination is one of the most common deficiencies identified when patients suffer adverse outcomes and bring complaints to the College.
Physicians are accountable every time they decide that a physical examination is not required.
In his BCMJ editorial, Dr. Vroom comments that “Telemedicine has tremendous potential value in enhancing comprehensive longitudinal care and should not result in greater fragmentation.” The College’s depth and breadth of experience reviewing physician practices and investigating complaints indicates that telemedicine will add value for patients and providers if it forms part of an integrated whole, such as a full-service primary care clinic, a provincial or regional specialty service, or a robust outreach program for people living in remote locations. Significant risk is anticipated if physicians attempt to use telemedicine to provide episodic services in isolation to patients they are not familiar with. Telemedicine holds great promise as an adjunct to well-organized systems of care. Without the support of such systems, it is expected that telemedicine will be neither efficient nor safe.