Privacy cannot be guaranteed and this brings into question the ethics of diagnosis and treatment via Skype. There is a potential for inadvertent HIPAA violations. Not to mention that it is impossible to perform a physical exam through a Web exchange.
Can providers really uphold the standards of care that their profession demands via a technological exchange? Even psychiatrists, psychologists, and therapists could miss key findings. There are subtle nuances in every mental status exam, every patient encounter, that could be easily evade the narrow range of the camera’s eye.
Notwithstanding, Skype interviews are sometimes necessary and better than nothing. It could even be optimal when weather is dangerous, when an elderly or impaired patient can’t get to the office, or when somebody lives in a rural location.
It’s definitely a topic worth exploring. I worked with a colleague years ago to offer a more comprehensive medico-legal review of the merge between medicine and Skype, which can be found at http://www.currentpsychiatry.com/pdf/1012/1012CP_Malpractice.pdf
Currently, there is no official recommendation about the benefit to risk ratio of doctoring via Skype. The American Telemedicine Association has issued some practice standards and guidelines that could be very helpful for practitioners. (3)
Technology is exponentially taking over our world. Let’s continue this discussion! Has anyone here had any experiences either giving or receiving care via Skype? What were your experiences?
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References
(1) Hilty DM, Yellowlees PM, Cobb HC, et al. Models of telepsychiatric consultation—liaison service to rural primary care. Psychosomatics. 2006;47(2):152-157.
(2) Freudenheim M. The doctor will see you now. Please logon. New York Times. May 29, 2010:BU1.
(3) American Telemedicine Association. Telemental standards and guidelines. http://www.americantelemed.org/i4a/ pages/index.cfm?pageID=3311.
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