Lee Danny W H, Tong Kar-Wai, Lai Paul B S
Private Practice Hong Kong China.
City University of Hong Kong Hong Kong China.
Surg Pract. 2021 Feb;25(1):42-46. doi: 10.1111/1744-1633.12479. Epub 2021 Feb 10.
There was rapid growth of telehealth practice during the COVID-19 outbreak in 2020. In surgery, there were beneficial effects in terms of saving time and avoiding physical contact between healthcare professionals and patients when using telehealth in the delivery of perioperative care. As telehealth is gaining momentum, the evolving ethical and medico-legal challenges arising from this alternative mode of doctor-patient interaction cannot be underestimated. With reference to the "Ethical Guidelines on Practice of Telemedicine" issued by the Medical Council of Hong Kong and some published court and disciplinary cases from other common law jurisdictions, this article discusses relevant ethical and medico-legal issues in telehealth practice with emphasis on the following areas: duty of care; communication and contingency; patient-centred care and informed consent; limitations and standard of care; keeping medical records, privacy, and confidentiality; and cross-territory practice. Whilst existing ethical and legal obligations of practicing medicine are not changed when telehealth is used as opposed to in-person care, telehealth practitioners are advised to familiarize themselves with the ethical guidelines, to keep abreast of the medico-legal developments in this area, and to observe the licensure requirements and regulatory regimes of both the jurisdiction where they practice and where their patients are located.
2020年新冠疫情爆发期间，远程医疗实践迅速发展。在外科手术中，在围手术期护理中使用远程医疗时，在节省时间和避免医护人员与患者之间的身体接触方面具有有益效果。随着远程医疗的发展势头越来越强劲，这种医患互动的替代模式所引发的不断演变的伦理和医学法律挑战不容小觑。参照香港医务委员会发布的《远程医疗执业伦理指引》以及其他普通法司法管辖区一些已公布的法庭和纪律处分案例，本文讨论远程医疗实践中的相关伦理和医学法律问题，重点关注以下领域：注意义务；沟通与应急；以患者为中心的护理和知情同意；限制与护理标准；保存医疗记录、隐私和保密；以及跨境执业。虽然与面对面护理相比，使用远程医疗时现有的行医伦理和法律义务并未改变，但建议远程医疗从业者熟悉伦理指引，了解该领域的医学法律发展动态，并遵守其执业所在司法管辖区以及患者所在司法管辖区的许可要求和监管制度。
