The ethical problems of remote care

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What are the potential ethical and legal areas of conflict for physicians who practice telemedicine? This was pondered at the recent American Medical Association’s (AMA) annual meeting in Chicago during the Council on Ethical and Judicial Affairs (CEJA) open forum. The main issues won’t be a surprise to our readers: the lack of confidentiality in non-secure online consults (e.g. Skype), misdiagnosis (earache symptoms turning out to be a blocked eustachian tube, not an ear infection) and doctor-shopping for controlled substances. What is a little surprising is that physicians are feeling consumer pressure to diagnose online, for instance from patient-taken pictures, even though only 10 states have limited telemedicine licensure. CEJA addressing this issue is significant as the council proposes policy to AMA delegates. The article (published in AMEDnews, which is an AMA publication) reflects a generally negative view. And this doesn’t even get into integration of vital signs–telehealth. Telemedicine can pose ethical problems, delegates warn (


  1. Sande Olson

    Privacy will continue to be an issue but should not be limited to Skype (Skype creates a session with a 256-bit session key); all forms of patient data are at risk to some extent.

    In Texas the Texas Medical Board allows the use of Skype in telemedicine. The real issue is the patient physician relationship and initial diagnoses.

    Texas legislation requires mental health patients being seen via telemedicine for pre-admission evals be seen on-site by a physician within 24 hours and that a full H&P is conducted. Telemedicine is invaluable in helping ER patients get admitted 24/7.

    For clarification, the TMB also places restrictions around telemedicine use (see

    There is value in telemedicine particularly when there is an existing patient physician relationship. States can help legislate the use of telemedicine.