What are your thoughts on using the National interpreter service when seeing a patient?
This is a good service and likely highly trustworthy in keeping details confidential. You can even use this service in your practice with the patient rather than just over the telephone if you think it is more appropriate to have a in person consultation.
Where do we stand when I order imaging and the scans are delivered to the patient via link before they are sent to me and interpretation misunderstood?
The patient already has a right to access this information so this shouldn’t present a legal problem. However, you should endeavour to follow up as you do have a duty of care to follow up patients.
There are innumerable examples on social media of grossly slanderous and abusive posts opinions etc what can be done to eradicate or mitigate it?
This is a difficult topic. MIPS’ advice is generally not to fan the flames and provide a response. If you are a user of the service, eg Facebook, YouTube, Instagram, you can flag the content as inappropriate and see if the automated filters will remove it. There are also options to mark content as libellous but you have to very far more specific in your response if you choose to do this. The mechanisms for responding vary for providers but the major providers such as Facebook as much better at this nowadays. MIPS has provided assistance to members in the past to remove content. If the content is libellous then it is easier to deal with, if is simply an expression of an opinion then there is little that can be done. In some cases business that have had poor reviews on their Facebook page or similar have posted more content to push the poorer content deeper into the history – most things on social media are forgotten quickly so often our own angst and repeated views of a post do not necessarily reflect what other internet users are feeling or viewing. For further information see Dealing with bad online reviews.
Sharing content is a problem, but what worries me more is when Facebook changes settings with upgrades
Agreed. We recommend you check your privacy settings for any social media and keep these very tight. In the vast majority of scenarios, you should not be sharing patient information over mediums such as social media. While there are messaging apps that will destroy messages, eg Snapchat deletes chats within 30 days by default, this is problematic as you are then destroying a medical record.
What is your advice when we see patients giving advice to other patients about how to break the law? an example would be telling other patients to fill a script for methotrexate, throw it away (ie non adherence) then lie to get biological therapy for rheumatoid arthritis?
In this instances it should be made clear to the patient that their actions are deliberately misleading. It may be reasonable to refuse treatment for the patient moving forward if you felt the conduct was morally reprehensible. It would be important to ensure that you have a reasonable basis before confronting patients with these types of allegations as it may damage the therapeutic relationship.
Do I require a different provider number for each patient location when providing telehealth?
No, a provider number is linked to the provider’s location, not the patient’s location.
Who is responsible for care in a telehealth consult?
If you are the practitioner speaking with the patient on the phone, you are responsible for the treatment. If there is also a doctor with the patient on the other end of the line, then you are likely both responsible for the treatment.
I heard a GP went to a party and because the other guests learned she was a GP they asked her medical questions. she answered them but after the party she asked for the Medicare number of the people who asked for medical advice. Would that be considered a 'consultation'?
This seems inadvisable on a number of levels and no doubt a poor way to make friends. MIPS recommends doctors politely decline to provide an opinion during social occasions. It is highly likely that Medicare would think it was unreasonable if any practitioner made claims on consultations they made at a party and potentially give reason for AHPRA to investigate the practitioner. This would be made worse if they were under the influence of alcohol at the party while knowingly providing consultations.
Is it OK to send test results via SMS if patient have given permission to do this?
Yes, however, you may be failing to meet a sufficient level of care if the matter is serious and requires a discussion or further follow-up. In most cases a phone call or further appointment are probably better.
What if you need to provide medical assistance in flight OR What if you are travelling overseas for a holiday and an emergency came up and you are the only doctor available to help?
MIPS would provide Good Samaritan cover in these cases. The only time this does not apply is when the healthcare is provided in the USA.
I have a patient that called me from Thailand while on holiday, she contacted me today via telephone and asked me for my advice. It was a simple question and I did answer it and gave advice. I was not aware that I need to contact MIPS. Should have I?
It is not necessary to contact MIPS in these circumstances unless you have a concern of a complaint or other issue. MIPS considers the risk to Australian doctors providing inadvertent or urgent telehealth/telemedicine to Australian residents temporarily outside of Australia to be low but increasing. This article provides further explanation about the Potential exposure to complaints when providing telehealth.
Is it in order to give MIPS the details of the patient via email when a practitioner seeks advice regarding a possibility of a future claim by that patient?
Yes, this is acceptable, however, for greater security we recommend you lodge claims via the secure online form on our website
Can we communicate with medical staff in another country when the patient attends a health service whilst travelling overseas?
Yes, depending on the advice you provide this may not be considered healthcare and you would be considered to be providing a transfer of care or simply information at the patient’s request.
Where do we stand when using iPhones/mobile devices to send images/ECGS/results to other specialists? I work in ED and often after hours the on call specialist requests these details so they can make a clinical decision regarding that patient. I always get consent from the patient and document this - is this enough?
It is good you are acquiring consent in the first instance. The bigger problem is that any image you send becomes part of the patient’s medical record so must be stored appropriately and kept for the necessary length of time. While it is permissible to send a message using a mobile device, you need to ensure it is then properly filed in the medical record, likely on a separate device or with cloud storage, and later deleted from the device. MIPS recommends the on-demand Health Records Unit for further detailed information (1 hour CPD).