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Opinion 5.025 - Physician Advisory or Referral Services by Telecommunication

Telecommunication advisory services, by way of phone, fax, or computer, distinct from an existing patient-physician relationship can be a helpful source of medical information for the public. Often, people are not sure where to turn for information of a general medical nature or do not have easy access to other sources of information. Individuals also may be embarrassed about directly bringing up certain questions with their physicians. Although telecommunication advisory services can provide only limited medical services, they can be a useful complement to more comprehensive services, if used properly.

Any telecommunication advisory service should employ certain safeguards to prevent misuse. For example, the physician responding to the call should not make a clinical diagnosis. Diagnosis by telecommunication is done without the benefit of a physician examination or even a face-to-face meeting with the caller. Critical medical data may be unavailable to the physician. Physicians who respond to callers should therefore act within the limitations of telecommunication services and ensure that callers understand the limitations of the services. Under no circumstances should medications be prescribed.

Physicians who respond to the calls should elicit all necessary information from the callers. When callers are charged by the minute, they may try to hurry their calls to limit their costs. As a result, important information may not be disclosed to the physician. Physicians should also ensure that callers do not incur large bills inadvertently or without understanding the billing system.

Physician referral services can also offer important information to the public. Referral services are often provided by medical societies, hospitals, and for-profit entities. To ensure that the service bases its recommendation on medically legitimate considerations rather than the likelihood of being paid by the physician, when the service charges physicians a fee to participate, physicians should not pay the service per referral. Also, callers should be told how the list is created. For example, callers should be informed whether the list includes physicians who pay a flat fee to be listed, members of a particular hospital staff or medical society, or physicians who meet some general quality-based criteria.

While these safeguards are described as applying primarily to telephone services, they should be considered equally applicable to any other communication media, such as radio or television, in which the physician and patient do not meet face-to-face. (I, IV, VI)

Issued June 1994; Updated June 1996