'Cyber-Psychiatry' May Redefine the Physician-Patient Relationship. (Medicolegal Limbo)

Article excerpt

BOSTON -- Although the legal and ethical implications of technologic innovations in psychiatry have yet to be defined in any detail, they are expected to evolve largely within the confines of the classic physician-patient relationship, Dr. Peter Ash said at the annual meeting of the American Academy of Psychiatry and the Law.

But the most intimate interface of technology and clinical practice--online therapy, or "cyber-psychiatry"--may necessitate redefining the relationship that carries with it different duties, responsibilities, and liabilities, said Dr. Ash of Emory University, Atlanta.

Although electronic technology has made inroads into medicine in general and psychiatry in particular, the profession as a whole has made little accommodation. "The field takes a conservative position, but it can't stand.... We're hanging on by our fingernails," he said. "Once the technology is there, people will use it."

While laws and guidelines characteristically lag behind technology, and legal rulings have been sparse, it seems likely that the physician-patient relationship will be a central concern.

For example, although the issue has yet to be decided by the courts, a physician might well be at legal risk for material on his Web site despite an unambiguous disclaimer, if it were determined that a physician-patient relationship had been established. Supporting cases suggest that contract liability may be extended to a physician who performs a medical service and receives a fee, even though the parties have never met, Dr. Ash said.

Generally, the law tries to expand the standard physician-patient relationship to embrace practice innovations, an approach that seems apt for most electronic applications. …