“Your patient may return to the physician and say that the people on CrowdMed think I have this bizarre disease, and you should order all these [high-dollar] tests,” says Dr. Collins. “However, it is the physician taking care of the patient who still has to make these decisions. It isn’t at all a bad thing to have these kinds of conversations with your patients, and there is some inherent benefit in patients being more involved in their own healthcare. Most of the people on these websites have had no clear diagnosis for many years in some cases. It’s hard to fault anyone for seeking additional help.”
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Explore This IssueOctober 2015
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There are some legal concerns that physicians will want to think about when replying to patient requests—not the least of which is avoiding even the hint of a patient–physician relationship.
“Out-of-the-office consults are always dangerous, whether over the Internet or at a party, because the [doctors] give advice without performing a full history and physical examination,” says David Walsh, JD, a healthcare attorney in the Dallas office of Chamblee, Ryan, Kershaw and Anderson PC. “I would be worried about patient-centered websites for similar reasons and would probably advise my clients to be very careful about what they say.”
CrowdMed has the physicians post anonymously, which might alleviate some of these concerns. However, a subpoena would quickly breach this protection.
Mr. Walsh also suggests that physicians preface every interaction with a statement that you are not practicing medicine, rather suggesting things the patient can take back to their doctor for further evaluation.
The fact that you may be in one state and the patient in another, at least theoretically, opens up a physician to licensing issues. For example, the state where the patient resides could decide you are practicing in their state without a license. Mr. Walsh knows of no examples in which this has yet happened, but if a state were to take that position, litigating it could be very expensive because this is new law.
Similarly, a physician could run afoul of the various telemedicine laws across the country (Note: Also see “Legalities of Telemedicine”). He points to the very strict laws about telemedicine in his home state of Texas, where the current rules prohibit treating a patient remotely until you have done a history and physical examination in person.
Another problem is that the concept of patient-centered crowdsourcing of a diagnosis is so new. There really isn’t any case law to guide either the practitioner or their attorney when looking at liability.