7th August, 2018, New Delhi :
Following high court verdict to proceed with criminal prosecution in an incident which involved TELEPHONIC CONSULTATION, the issue came to attention of the public and was widely discussed. Although the particular stand by the high court was not finding negligence in TELEPHONIC consultation, but was due to other reasons also. Subsequently arrest of the doctors in the case was stayed by Supreme Court.
In this situation it will be worthwhile to discuss legal & ethical aspects of TELEPHONIC CONSULTATION.
MCI code of Ethics has not spelt on this at all.
In this situation Judicial Law comes into force and thereby the Bombay high court verdict gains importance.
Ethically only on seeing a patient only can a Doctor can prescribe Medicines or advice on the treatment to be followed.
A history of the ailment, clinical examination is needed to prescribe any medication.
Hence a telephonic consultation without seeing the patient is not Ethically or Legally valid.
A regular patient seeking advice on phone is also not valid as the call will be on any change in symptoms or signs which has to be examined before we alter the medication or advise further.
An instruction given by the consultant to his patient to inform the investigation results by phone and thereby advising may be held valid as the consultant is responsible for the Patients action.
On the issue of Telemedicine it is between a Doctor and a Paramedical or between a Doctor and super specialist hence each other are VICARIOUSLY responsible for any Negligence.
Deficiency of service occurs when there is deviation from common practice and lack of reasonable care causing damage to the patient. The common practice involved in treating a patient is eliciting history, physical examination (inspection, percussion, palpation& auscultation), going through investigations and arriving at a diagnosis. Treatment is instituted after diagnosis. In TELEPHONIC CONSULTATION all or part of the above may not be undertaken. Hence there is always a possibility of alleging and finding negligence on the part of the doctor in cases of TELEPHONIC consultations, by the legal fora.
But in situations where physical examination is not required ( eg: adjusting insulin according to blood sugar levels in a regular patient, analgesics for acute exacerbation of chronic pain under regular treatment etc.) telephonic consultation will not amount to negligence. Also in situations of managing emergencies, till the doctor arrives TELEPHONIC CONSULTATION can be undertaken in a judicious manner.
Another aspect of TELEPHONIC CONSULTATION is that, there is an element of contributory negligence from the part of patient or relatives if they by themselves opt for a TELEPHONIC CONSULTATION for their convenience.
Topic of TELEPHONIC CONSULTATION is an ethical dilemma. In a patient in distress, the treatment suggested by the practitioner in whom he has confidence is appropriate and ethically correct. But at the same time the method is used by the practitioner to avoid the botheration of seeing the patient directly, it is ethically incorrect.
But at the same time, information explosion and advancing technology can be harnessed for augmenting health care in remote areas, especially Telemedicine and Mobile Health.
Online consultations, online prescriptions and telemedicine are all topics which have posed ethical dilemmas.
As the code of ethics is silent on this emerging areas, judicial over activism can be detrimental to the profession.
IMA requests the MCI to come out with clear cut guidelines on this important issues.
Many developed countries have clear cut guidelines on it.
Take home message: TELEPHONIC Consultations are legally & ethically incorrect in the strict sense. Their judicious use in certain circumstances can be justified.
Dr Ravi Wankhedkar Dr R N Tandon
National President Hony. Secretary General