A specialist registrar member emailed the MDU for advice on prescribing remotely over the internet. A colleague had asked him to help in responding to queries logged through a forum on a website offering dietary and lifestyle advice to patients with type II diabetes.
The doctor explained that most of the patients using the forum were resident in a rural community in the UK. The interactive service was intended to assist patients who lived far from the diabetic clinic and could not easily travel there. However, he was alert to the possibility that the website could be visited by patients from anywhere in the UK, or abroad.
The member proposed to add a disclaimer on the forum to the effect that his advice could only be general and should not be used as a substitute for individual advice from the patient’s own doctor.
Offering medical advice through the internet is a rapidly developing area of medical practice. Although advising patients via a website has many benefits, equally it can be problematic when the doctor does not have access to the information they might normally have about the patient such as the clinical records or a full medical history.
The MDU adviser explained that advising individual patients about specific medical problems is likely to establish a duty of care and could allow a patient to pursue a clinical negligence claim if they were dissatisfied with their remote consultation.
In Good Medical Practice (2006) the GMC states that good clinical care must include an adequate assessment of the patient’s condition, taking a history and, where necessary, examining the patient. The doctor should also provide or arrange advice, investigations or treatment, and refer patients where necessary.
In an online consultation of the type the doctor described, there is a risk that advice given may be inappropriate for the individual patient, particularly when it is not based on a complete assessment of the patient’s condition. The internet has the potential to reach people all over the world.
Doctors should ensure that they practise within the laws and regulations applicable to the country where the patient is resident and check that their indemnity covers such situations. It is unlikely that MDU indemnity would extend to circumstances where assessments and advice are being provided in this way to patients who are not based in the UK.
The medico-legal adviser suggested that rather than responding with specific advice based on the information received from individual patients, the doctor limits his activity to publishing generic advice. In these circumstances, the ‘disclaimer’ he had drafted would be satisfactory.
However, it should not be described as a ‘disclaimer’, as it is generally not possible in law to rely on a disclaimer where personal injury is caused through negligence. The medico-legal adviser recommended it would probably be better to display the note prominently on the forum and refer to it as an “important notice”.
Members who are intending to provide advice over the internet are advised to contact the MDU membership team to confirm whether the MDU will indemnify this work.
These are fictional cases compiled from actual cases in the MDU’s files.
This page was correct at publication on 01/08/2012. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.