Q&A -Dealing with the Modern Patient

Many questions were asked in relation to patient recording consultations.

It may be of concern if a patient requests to record a consultation. You can decline the recording. Should you be suspicious of a patient's intentions or if you believe the professional relationship has been compromised, another option might be to terminate the patient-doctor relationship. Naturally you should facilitate continuity of care. Termination may not be appropriate where urgent treatment is required and/or the patient is at risk of any harm. Alternatively, a recording may be viewed as an excellent resource and evidence of your appropriate professional conduct, accepted level of clinical care, behaviour, consent etc. It may also be used by the patient to better understand the health issues at hand or the management plan you propose. Perhaps you may agree to the recording on the basis you are provided with a copy of the recording and include this in the patient record. It should be noted that all electronic communications such as texts, emails and recordings would form part of the patient's record. Any detailed record keeping is a valuable asset in the defense of any complaint, claim or investigation against you. There is specific State/Territory legislation relating to audio recordings of private conversations and whether consent of all parties is required. In all jurisdictions except Victoria, Queensland and Northern Territory, it is illegal for patients to record your consultation without your permission and members with concerns could advise their patients of this scenario.

Do you have to physically examine a patient to complete the medical certificate or simply be involved in their care?

It would certainly be advisable given the wording in the Code of Conduct - 8.8 Medical reports, certificates and giving evidence. In summary, you should only sign certificates that you know or reasonably believe are true. The details on any certificate should reflect your findings. If the patient has an unverified condition, then the certificate should be worded cautiously such as 'The patient attended today and tells me they are unfit to work'. You should be honest and accurate and be prepared to verify the details stated in the certificate in court under oath if requested.

If a picture has been taken with consent from the patient -- sent to a specialist, say plastics; does the photo need to be deleted after the transfer of the photo to the specialist?

It should be retained as part of the patient's medical record but deleted from the device from which it was sent.

When doing a home visit during work hours on weekdays, do i need to be accompanied by a nurse or is it safe to do it on my own?

Your own safety is a priority and this can only be determined on a case by case basis. The only requirement for another practitioner to be with you is one where chaperones conditions are applied.

I am an after-hours doctor. On a weekend, it's difficult to get them (patient) to a GP as their GP is not practicing and another GP will not take them as they are fully booked and the patient is new. So, the problem is getting a follow up during the weekend. How doe we manage such a situation?

All reasonable efforts should be made to effect follow up and continuity of care with appropriat referrals and infromation. Your efforts will depend on the urgency or potential seriousness of the medical condition. In situations where the patient needs urgent review and the regular GP is still not available it may be appropriate to suggest review again by the after-hours service, or suggest referral to the Emergency Department. Any urgent investigations ordered after-hours are the responsibility of the doctor ordering the tests and appropriate follow up should be arranged.

I have found it quite alarming reading consumer to consumer posts on Facebook, giving health advice, recommendations of practitioners, use of alternative therapies. I have refrained from being involved in these group discussions completely, despite being alarmed of public misinformation. What is your advice on this?

The Medical and Dental Board - Social Media Policy should be followed. Ultimately you conduct will be gauged against what is stated in the code. Practitioners should be wary of providing advice online lest it is considered the provision of telehealth and refraining is certainly the safest option. Additionally, the RACGP guidelines now prohibit the practice of homeothapy by GPs.

As a rural dermatologist, I receive GP calls/text/photos asking for advice. Usually I cannot make firm diagnosis so prefer to see the patient. I want to be helpful whilst protecting the patient, referrer and myself. I'm not keen to give specific advice to a patient I have not (and may never) see. Advice please?

That is indeed a reasonable approach. A physical examination in the first instance is preferred. In respect of dermatological matters there may be conditions such as atopic dermatitis etc where teledermoscopy/teledermy it is very appropriat as part of the interim progress assessment for ongoing clinical matters but MIPS view is that it is significantly inferior to in-person clinical examination of skin lesions. The concern is that they might be carcinoma and with teledermoscopy/teledermy there is no opportunity to xamine/feel thickness/texture of the lesion; check for lymph nodes and look/feel for other clinical features. Most telehealth guidelines allow for consultation by telehealth, in conjunction with the GP if distance prevents review by yourself in person. For telehealth consults you should follow the guidelines of AHPRA, your College and Medicare.