Magazine article Clinical Psychiatry News

Electronic Communications and Liability Exposure

Magazine article Clinical Psychiatry News

Electronic Communications and Liability Exposure

Article excerpt

On a recent rerun of the 1960s TV series, "The Addams Family," Thing, the disembodied hand that lived without a body, came down with a cold. So Morticia Addams contacted a doctor who agreed to see Thing during a house call. The need for convenient access to a physician has not changed in 50 years, but technology is offering new solutions to fill the need for patient-physician interaction that range from e-mail to text messaging to video chat, offering both promises and pitfalls. In this article we will explore some of the emerging liability issues that these new forms of patient evaluation present.

Today, there are essentially three types of interactions between patients and physicians: office/hospital visits, telephone conferences, and electronic communications. The first two interactions have long been practiced, and physicians have a good sense of the parameters of their use. Electronic communication is new. Clinicians often do not have a well-honed sense of the boundaries of interaction with these new mediums, and unfortunately, electronic communications have created another avenue for physician liability.

When a physician sees a patient in person, the physician assesses the patient's subjective complaints and objectively evaluates the patient. While it has been said that 90% of the diagnosis is arrived at through the taking of a careful history, I think we would all agree that a physical exam is an important part of a complete evaluation, and, depending upon the presenting problem and the differential diagnosis, it may be an essential part of the evaluation. When a physician interacts with a patient over the phone, that physician's ability to evaluate the patient's complaints through physical contact is removed, but the physician still has the ability to hear the patient's voice and engage with the patient. Voice inflections--a slight tremor in the voice of a tearful patient, the sense of heightened concern from the mother of a sick 5-year-old--can give insight into the severity of illness beyond what was conveyed by the words themselves. The conversation, in person or on the phone, allows for an iterative exchange of information, with one piece of information allowing the physician to ask the next important question, and so on. When a physician interacts with a patient through electronic communication via e-mail or text message, the tools that the physician uses to evaluate the patient objectively are removed.

Though patients are pushing for fewer in-person interactions with health care providers and have become used to electronic communications, clinicians need to be careful not to relinquish the opportunity for robust two-way conversations that allow them to obtain the information necessary to formulate a thoughtful diagnosis and plan. Recently, we have seen an important increase in lawsuits stemming from electronic interactions. In most cases, liability stems from the lack of an objective evaluation of the patient or from a perception of a lack of caring by the health care provider.

In a lawsuit we (G.W.C.) recently defended, a husband and wife had been seeing their primary care physician for 15 years. During one of the husband's visits with the physician, the husband complained of weight loss and fatigue. The husband's initial complaints were not concerning. However, at the next visit, the husband complained of new symptoms, including chills, cramping, fatigue, and a poor appetite. …

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