Key practice challenges - 2020 and beyond

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I’d like to ask about clinicians’ responsibilities when doing a telehealth consult. What should you do if a patient connects to the consultation via an inappropriate site like their work desk in a crowded office or in a park surrounded by people etc.

Your duty to protect the privacy of your patients as outlined in the Medical Board of Australia Guidelines for technology-based patient consultations outline standards of care expected in providing care via telehealth should always be adhered to. In this situation however, it is the patient that is jeopardising their own privacy. This is their choice in the same way if they choose to bring additional people to their face-to-face consult. They are thereby giving implied consent. As you would in such a face-to-face scenario however you would still confirm with the patient that they are happy to proceed in what you consider to be an ‘inappropriate site’. This should be documented in your notes.

I have a patient in chronic pain who is under a pain management team specialist and psychiatrist. The patient needs on going scripts for opioids as spinal manipulators. The patient has experienced failure of a nerve block as well as multiple failed surgeries for clinical pain management. What is my role as their GP?

The pain management team specialist will guide you as to appropriate treatment including prescribing and you should ensure regular follow up consults for a current assessment. As a GP your role is to consider that advice and assess the best interests of your patient. When prescribing, adhere to the current prescribing regime in your jurisdiction and record appropriately in the patient health records.

How do you define informed consent over telehealth?

Informed consent requires a practitioner to communicate in a way that the patient understands and can respond to. It should therefore include the risks, benefits, alternatives and cost of any proposed medical intervention. Telehealth does not alter this requirement. The practitioner should document the details of this discussion in their notes. If the patient’s signature can subsequently be obtained attesting to the details of this discussion, then this should be obtained.

For telehealth assessment as long as clinician feels patient is appropriate to have telehealth assessment is that ok or is there guidelines that should be followed instead?

It is possible that your view may change during a consultation and you should therefore be prepared to arrange a face-to-face visit. Always ask yourself whether the consultation would be significantly improved, and therefore safer, if it were face-to-face.