Public Health Law Map - Beta 5 - Medical and Public Health Law Site

possible, the letter should be sent by certified mail, with a return receipt requested. The
certified mail number should be noted in the letter, and a copy of the letter and the
return receipt should be put in the patient’s medical record. If the letter is returned and
efforts to find a correct address fail, the unopened letter in the patient’s record will
document that a diligent effort was made to contact the patient.
Patient-initiated terminations must be carefully documented. Although the patient
always has the right to terminate the physician–patient relationship, this is usually done
not by confronting the physician but passively by not returning for care. It is the
physician’s responsibility to follow up on patients who disappear if they have
conditions that require continuing medical care. (It is also good business to keep track
of patients and their reasons for seeking care elsewhere.) These conditions may be
acute, such as an orthopaedic patient who does not return to have a cast removed, or
chronic, such as a diabetic.
Following up on missing patients requires that medical records be kept in such a
manner that the physician is aware that a patient has been lost to follow-up. Tickler
files serve as reminders that a patient is due to return for care. These may be
computerized, or kept in a manual tickler file. When a patient misses an appointment,
the physician should call to find out what has happened to the patient. If the patient
cannot be located, refuses to come back, or has found care elsewhere, the physician
should document this information in the chart. The physician should send the patient a
certified letter explaining why the patient should return or find alternate care.
I. Telemedicine and Internet Medicine
Since the 1950s, health planners and medical informatics sages have wanted to link
local practitioners in remote areas with specialists in academic medical centers.
Despite several pilot projects and substantial federal monetary support, practical
remote medical consultations remained beyond reach until recently. The revolution in
personal computers and Internet communications makes it possible to piggyback
telemedicine on multiuse computers and communications channels. This solves the key
technological problem that stalled the routinization of telemedicine—access to
sufficient audio and video processing power and communications bandwidth at an
affordable cost. With the technological barriers lowered, the implementation of
effective telemedicine now depends on solving legal and reimbursement policy
questions. Until these questions are resolved, telemedicine poses substantial legal risks,
making it essential that medical care practitioners who are involved with telemedicine
understand the basic legal constraints on such practice.
1. Traditional Electronic Physician–Patient Relationships
Physicians and patients have used electronic consultations since Alexander Graham
Bell invented the telephone. Patients call their physician for medical advice and
physicians call other physicians for consultations. Records have also moved
electronically between physicians, first as photocopies, then as faxes. For decades,
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