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Use of the internet and electronic communication.pdfMEDICAL COUNCILM
OF NEW ZEALAND
Statement on use of the internet and electronic communication 01 The internet, email and other methods of 06 Patients who obtain information from the electronic communication are useful tools which internet may wish to discuss this with their can help health professionals communicate with patients and one another, find information and opportunity to discuss the quality of the participate in specialised, worldwide medical information obtained by the patient may be of empower patients and allow them to inform poor quality and/or creates certain expectations.
themselves about their illness and treatment.
In such cases doctors must take care to provide sound reasons why the patient should reject 02 However, doctors need to be aware of the limits the information and, where possible, provide of any method of communication they or their documentation to support the alternative advice patients use and to ensure that they do not the Ministry of Health’s Privacy, or treatment that they are recommending.
attempt to provide a service which puts patient 07 The Council’s publication Cole’s medical practice in New Zealand includes a list of 03 The Medical Council of New Zealand (the reputable websites that doctors might find Council) wishes to emphasise the inherent risks useful. This list is also available on the Council’s in providing medical advice when a physical examination of the patient is not possible.
Use of email and other forms of electronic
04 Doctors are also reminded that patients have communication
rights under New Zealand’s privacy laws and the Code of Health and Disability Services 08 Whatever method doctors use to communicate, Consumers’ Rights with respect to electronic they must consider issues of privacy, security communication, as they do with all other forms and the sensitivity of health information.
applies rules to the health sector to ensure the Use of the internet for information by patients
protection of individual privacy. All doctors must 05 Patients sometimes come to doctors with ensure that they act within the rules it outlines2.
detailed information about their conditions obtained from the internet. Patients should communicate with a patient, they should advise not be discouraged from using the internet the patient of any limits they would like to place to research their condition or treatment, but on its use. For example the patient should they may need to be reminded that internet be advised not to use email if urgent advice research cannot take the place of a face to face consultation. Doctors may also refer patients to the Council’s resource, You and your doctor1, 10 Patient information should only be emailed which offers advice for patients on using the internet to look for information about a condition transmission is secure and preserves the quality of the information (including images).
Level 13, Mid City Tower, 139-143 Willis St, PO Box 11-649, Wellington, Tel 04 384 7635, 0800 286 801, Fax 04 385 8902, Email email@example.com
11 There are security issues specific to the use of in the location where their patient is located.
email. It is difficult to verify a person’s identity Doctors may also be liable if they assist patients from an email; some families and groups share to contravene another country’s laws or regulations, for example, a country’s importation (particularly family computers) may be accessed and possession requirements. Doctors should by a number of different people. For these seek legal advice in that country if necessary.
reasons, in the absence of consent and an Providing advice to a patient located within email address nominated by the patient, doctors should use other forms of communication to transmit sensitive information. Receiving an email from a patient should not be taken as Assurance Act 2003 requires doctors providing tacit consent that the patient is happy to receive treatment to patients located in New Zealand at the time of treatment to be registered by the Council and to hold a current practising 12 Doctors must maintain a clear, accurate and certificate issued by the Council. Adherence contemporaneous record of all communication to this strict legal position is often problematic concerning their medical practice, especially when the doctor is located in another country, particularly in regards to registration and 13 Prescriptions issued only by email do not recertification requirements and enforcement.
19 A doctor located overseas who is asked to provide an opinion in relation to a patient 14 When publishing information on the internet, under the care and clinical responsibility of a doctors must comply with the Health on the Net New Zealand registered doctor does not have to be registered to practise in New Zealand.
Distance medicine (incorporating prescribing)
20 A doctor located in another country who reports Providing advice to a patient located outside performed in New Zealand should, wherever practicable, be registered to practise in 15 Doctors residing in New Zealand who practise New Zealand. Council recognises that this medicine5, but only provide services to patients may not always be possible. When a doctor located in another country at the time of located in another country is not registered to treatment are not required to be registered with practise in New Zealand, it is incumbent on the the Council. However, they are expected to be New Zealand practice performing the procedure registered in the country where the patient is to ensure that the remote reporting doctor is located and meet all the requirements expected suitably qualified to provide the advice being sought and is appropriately registered in their registered doctors provide to patients located 21 A doctor who is uncertain whether a remote in another country falls within the Council’s reporting colleague’s qualifications are jurisdiction insofar as it reflects on the doctor’s 22 When a New Zealand registered doctor assists a patient located in New Zealand to seek advice New Zealand at the time of treatment remain or treatment from an overseas based doctor, the subject to New Zealand law (notably in respect patient should be advised that the doctor may of prescribing) and may be subject to other not be registered to practise in New Zealand, legal obligations, requirements or liabilities authorities may not be able to hold them to 29 The issuing of prescriptions is legally restricted8.
23 Doctors who use telemedicine must assume responsibility for ensuring the introduction of and adherence to appropriate quality standards at Regulations 1984 no doctor is permitted to both the transmitting and receiving sites. Where prescribe medication to an individual unless both the transmitting site and the receiving it is for the treatment of a patient under his site are located in New Zealand and doctors are involved at each location, responsibility is shared. Quality standards and procedures Prescriptions must be legibly and indelibly should encompass technical personnel and all equipment used in the telemedicine process.
prescriber with his or her usual signature (not a facsimile or other stamp). Therefore 24 With each communication and before advising or treating patients in another location doctors must first confirm to their satisfaction the identity legislative standards under sections 40-41 25 Doctors who advise or treat patients are 30 The Council’s view is that for a patient to be responsible for the evaluation of information “under his or her care”, a doctor must have used to form a diagnosis, irrespective of had a face to face consultation with the patient its source. A doctor who receives a referral or have discussed the patient’s treatment with another medical practitioner who can verify required to make a fair assessment, should request the relevant information or return the referral to the referrer with a request for more 31 Doctors may therefore only prescribe medication when they have had a face to face consultation with a patient or have discussed the patient’s 26 Advice or treatment provided to a patient in treatment with another doctor who can verify another location must meet the same standards as care provided in a face to face consultation6.
This includes standards relating to patient Related statements
selection, assessment, diagnosis, consent and Responsibilities in any relationships between doctors and health related commercial organisations (December 2003).
27 Doctors need to be confident that a physical examination would not add critical information The maintenance and retention of patient before providing treatment or advice to a patient and must be prepared to defend that position, Information and consent (April 2002).
with evidence, in the event of a subsequent 28 Specific distance medicine applications have This statement is scheduled for review by been demonstrated to provide safe and effective May 2011. Legislative changes may make this care and are the subject of College approved statement obsolete before this review date. clinical guidelines. Such guidelines may place additional requirements on doctors7.
Sexual Function/Infertility Minimizing Pain During Vasectomy: The Mini-Needle Anesthetic Technique Grace Shih, Merlin Njoya, Marylène Lessard and Michel Labrecque* From the Department of Family and Community Medicine, University of California-San Francisco (GS), San Francisco, California, andResearch Centre of the Centre Hospitalier Universitaire de Québec (MN, ML) and Department of Famil