There was a time, not too long ago, when going to your doctor meant you were going to see someone who had known you over the years and had seen you healthy and ailing. Your doctor knew you as a person and brought a level of observation and intuition into the treatment room that was far more important than what was learned in medical school. Because your doctor-patient relationship was truly a personal relationship, you trusted your doctor.
Then, something changed. The relationship became impersonal. The doctor no longer seemed to be treating you but instead hustled you through the office in a seven-minute race to the next patient. You no longer trusted his judgement and resented the high bills. The doctor-patient relationship became the doctor-patient transaction.
Now a new level of impersonal medical care has been enacted into law. As part of a growing national trend to make medical care more accessible, Florida Statute 456.47 now allows doctors (“telehealth providers”) to see patients over the internet by “telehealth”. In other words, you can see a doctor and get a diagnosis and treatment over the internet. By paying a small fee and filing a little paperwork, an out of state doctor can now see Florida patients over the internet. No longer is there any need for physical examinations or face to face contact. Just log in, speak to a doctor, get a diagnosis and a prescription (there are limitations on controlled substances) and you’re good to go. If the telehealth provider conducts a patient evaluation sufficient to diagnose and treat the you, the telehealth provider is not required to research your medical history or conduct a physical examination.
To be fair, the law does require that telehealth providers provide the same level of care via telemedicine as they do in person. And there are certain easily diagnosable ailments such as colds, flus, allergies, etc. that lend themselves to a tele-visit. Psychiatric or psychological maladies or well-controlled chronic problems that require no invasive procedures may also be good uses of telemedicine. Furthermore, people who live far from medical providers or in underserved areas need quicker and better access to health care providers.
Before Florida congratulates itself too quickly about providing needed access to care, we should look at some of the downsides. For example, this is a cash cow to insurance companies. Because telemedicine is far cheaper for insurance companies, insurers can now (1) significantly reduce their rosters of local participating providers, thereby reducing the number of local doctors available to see patients live; (2) make it more difficult to see a doctor in person, and, yes, (3) charge you more for a visit with a live doctor.
From a treatment standpoint, many ailments are likely to fall through the cracks and people will suffer as a result. Some illnesses at a quick glance look like one ailment but are really another. Andrew Rader, an attorney at Cutler Rader who represents people and families injured by medical malpractice, poses the following scenario:
You have an ache in your belly. Through telemedicine, you see a doctor who is licensed in South Dakota. He tells you not to worry about it, he’s pretty sure it’s just gas. Then, you ask yourself this: “How far do you think your South Dakota doctor will go to confirm a diagnosis that he is “pretty sure” is correct. He may not even tell you of other possible causes of you belly pain, but unlike a live doctor he cannot rule out those other possible causes because he cannot feel your belly. Ask yourself if you think he is likely to tell you to go in to see a live doctor who can feel your belly at the expense of the insurance company that is paying his salary. After all, this South Dakota doctor is “pretty sure” you have gas but has no personal relationship to you. He may have a doctor-patient relationship under the law, but that’s it. And even though he’s “pretty sure” of his diagnosis, he’s not as sure as he would be if he could palpate (feel) you. So, out of convenience and because most of the time these complaints wind up being gas, he tells you not to worry about it. Unfortunately for you, you have a burst appendix which is deadly. Too bad for you.
Rader’s illustration demonstrates the gray zone where telemedicine increases the potential for medical malpractice with potentially fatal consequences because it condones the practice of bad medicine. “The doctor is not making a diagnosis based on all available information. He’s making it based on the information that is available to him thousands of miles away. If he were local, he’d palpate the abdomen, have all the necessary information and send you immediately to the hospital.”
Rader warns, “nor should you be consoled that the new law allows malpractice suits to be filed in your county or that the tele-provider has to follow Florida medical liability insurance requirements. Florida’s laws ensuring that doctors carry sufficient malpractice insurance to cover their errors are laughable. Many doctors carry no insurance and even though they are required to be able to satisfy a judgement, the State of Florida rarely enforces that requirement and the doctors’ personal assets are usually well protected from you, the victim. So, your South Dakota doctor is not only miles away in another jurisdiction, but he also has no insurance and is judgement proof. You’re out of luck because your legislature did not see fit to protect you.
The lesson, according to Rader, is that you need to be very careful when you see a tele-provider. It can be very convenient, but it can also be deadly. For more information about Cutler Rader or Andrew Rader, go to www.CutlerRader.com or call 954-913-2273.