Dear Robert:
Thank you for your insight.
As in the UK, MDs in Canada are also paid by governmental bodies. However,
this is on a "fee for service" basis. Furthermore, telephone cosultations
is NOT a covered service (except when dealing with warfarin dosing and
anticoagulation care). Also, I don't believe we are allowed to "medically
assess" the patient over the telephone per se (ie. come to a diagnosis or
conclusion and recommend further investigation/treatment) because of the
inability to see and examine the patient. Yet this is becomng an increasing
demand on physician time and resources at the same time we are not being
reimbursed and could in fact get into medico-legal difficulties if there was
ever an adverse outcome arising out of such a cosultation. So it is a
dis-incentive for us to provide such services except in dire emergencies.
I would argue that internet consultations may in fact be more appropriate
given the new and expanding technologies of video/teleconferencing and real
time access with minimal delays. This is an evolving field obviously and we
need to find the optimal delivery of health care using such technologies.
It is curious that telephone consults in the UK has not only become
allowable but also subsidized by your governmental heath plans. Whether the
UK system is right or the Canadian system is right,..., who knows. I
suspect the answer lies somewhere in the middle
Regards,
JS
Robert Treharne Jones wrote:
> Hi Jason
>
> In the UK, where medical care is free at the point of delivery for NHS
> patients, the question of billing does not arise.
>
> As far as the medicolegal aspects are concerned the position gets more
> interesting. The key point in legislation is that the clinician must
> place themselves in a position so as to make an appropriate assessment
> of the patient, and can then take further action if required. Telephone
> consultations allow the clinician to speak directly to the patient, gain
> appropriate information, and gain further impressions of the state of
> health of the patient, based on factors other than the words they speak.
> This form of consultation is therefore seen as 'allowable' and there has
> been a dramatic rise in telephone consultations in the UK in the last
> five years.
>
> The same is not true for Internet consultations, where there is no easy
> means for the clinician to determine exactly who they are speaking to,
> much less engage in a two-way dialogue about the clinical situation. As
> a result this form of consultation is frowned upon, but that hasn't
> stopped a couple of very innovative practices trying to push the
> boundaries further forward!
>
> Robert
>
> > -----Original Message-----
> > From: To support research in sports medicine [mailto:SPORT
> > [log in to unmask]] On Behalf Of jason su
> > I am a sport med MD in Canada and would like to inquire re. the
> following.
> > I am curious how one "bills" for such services and the medico-legal
> > ramifications of telephone and/or internet consultations.
> > Does others have experience in this evolving field ??
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