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T-Space at The University of Toronto Libraries >
Journal of Medical Internet Research >
Volume 2 (2000) >

Please use this identifier to cite or link to this item: http://hdl.handle.net/1807/4563


Title: Towards ethical guidelines for dealing with unsolicited patient emails and giving teleadvice in the absence of a pre-existing patient-physician relationship — systematic review and expert survey
Authors: Eysenbach, Gunther
Keywords: Green Paper
Internet
Ethics
Quality of Health Care
Referral and Consultation
Remote Consultation
Physician-Patient Relations
Professional-Patient Relations
Medical History Taking
Teleadvice
Electronic Mail
Chat
Newsgroup
Issue Date: 24-Feb-2000
Publisher: Gunther Eysenbach; Centre for Global eHealth Innovation, Toronto, Canada
Citation: Gunther Eysenbach. Towards ethical guidelines for dealing with unsolicited patient emails and giving teleadvice in the absence of a pre-existing patient-physician relationship — systematic review and expert survey. J Med Internet Res 2000;2(1):e1 <URL: http://www.jmir.org/2000/1/e1/>
Abstract: [This item is a preserved copy and is not necessarily the most recent version. To view the current item, visit http://www.jmir.org/2000/1/e1/ ] Background: Many health information providers on the Internet and doctors with email accounts are confronted with the phenomenon of receiving unsolicited emails from patients asking for medical advice. Also, a growing number of websites offer "ask-the-doctor" services, where patients can ask questions to health professionals via email or other means of telecommunication. It is unclear whether these types of interactions constitute medical practice, and whether physicians have the ethical obligation to respond to unsolicited patient emails. Objective: To improve the quality of online communication between patients and health professionals (physicians, experts) in the absence of a pre-existing patient-physician relationship or face-to-face communication, by preparing a set of guiding ethical principles applicable to this kind of interaction. Methods: Systematic review of the literature, professional, and ethical codes; and consultation with experts. Results: Two different types of patient-physician encounters have to be distinguished. "Traditional" clinical encounters or telemedicine applications are called "Type B" interactions here (Bona fide relationship). In comparison, online interactions lack many of the characteristics of bona fide interactions; most notably there is no pre-existing relationship and the information available to the physician is limited if, for example, a physician responds to the email of a patient who he has never seen before. I call these "Type A" consultations (Absence of pre-existing patient-physician relationship). While guidelines for Type B interactions on the Internet exist (Kane, 1998), this is not the case for Type A interactions. The following principles are suggested: Physicians responding to patients' requests on the Internet should act within the limitations of telecommunication services and keep the global nature of the Internet in mind; not every aspect of medicine requires face-to-face communication; requests for help, including unsolicited patient questions, should not be ignored, but dealt with in some appropriate manner; informed consent requires fair and honest labeling; health professionals and information providers must maintain confidentiality; health professionals should define internal procedures and perform quality control measures. Conclusions: Different media are appropriate at each point on the continuum between dispensing general health information and handling patient problems that would require the practice of medicine to solve. For example, email is a sufficiently capable medium for giving out general health information, while diagnosis and treatment usually requires at least advanced telemedical technology. Patients have to be educated that it is unethical to diagnose and treat over the Internet in the absence of a pre-existing patient-physician relationship, and if the interaction is limited to a single email. More research is needed to establish more evidence regarding situations in which teleadvice is beneficial and efficient.
URI: http://hdl.handle.net/1807/4563
ISSN: 1438-8871
Other Identifiers: doi:10.2196/jmir.2.1.e1
Rights: Copyright (cc) Retained by author(s) under a Creative Commons License: http://creativecommons.org/licenses/by/2.0/
Appears in Collections:Volume 2 (2000)

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