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Case A: Patient-Provider Email

Case A: Patient-Provider Email

In the present cyber age information technology is being extensively to overcome constraints of time and place. Use of such technology like email in highly specialized and sensitive fields like medicine raises peculiar situations, the pros and cons of which have to be weighed in the right perspective. “The legal rules, ethical guidelines, and professional etiquette that govern and guide traditional communications between the physician and patient are equally applicable to e-mail, Web sites, list serves, and other electronic communications. However, the technology of online communications introduces special concerns and risks:

Security. Online communications between physician and patient should be conducted over a secure network, with provisions for authentication and encryption in accordance with eRisk, HIPAA, and other appropriate guidelines. Standard e-mail services do not meet these guidelines. Physicians need to be aware of potential security risks, including unauthorized physical access and security of computer hardware, and guard against them with technologies such as automatic logout and password protection.

Authentication. The physician has a responsibility to take reasonable steps to authenticate the identity of correspondent(s) in an electronic communication and to ensure that recipients of information are authorized to receive it.

Confidentiality. The physician is responsible for taking reasonable steps

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to protect patient privacy and to guard against unauthorized use of patient information.

Unauthorized access. The use of online communications may increase the risk of unauthorized distribution of patient information and establish a clear record of this distribution. Physicians should establish and follow procedures that help to mitigate this risk.
Informed consent. Prior to the initiation of online communication between physician and patient, informed consent should be obtained from the patient regarding the appropriate use, limitations, and risk of this form of communication.

Doctor-patient relationship. The use of online communication between the physician and patient is appropriate only after the establishment of the traditional patient-physician relationship.
Medical records. A record of online communications pertinent to the ongoing medical care of the patient must be maintained as part of, and integrated into, the patient’s medical record, whether that record is paper or electronic.
Licensing jurisdiction. Online interactions between a physician and a patient may be subject to the licensing requirements.
Highly sensitive and emergency subject matter. Physicians should advise patients of potential privacy risks associated with online communication related to highly sensitive medical subjects, such as issues of mental health, substance abuse, etc. and emergency situations such as chest pain, shortness of breath, bleeding during pregnancy, etc.” (TMA 2002)
Ethically, email communication may seem like a sad alternative to actual doctor patient interaction. But considering the factors of time and place constraints it’s essentially a right bargain keeping the benefit of patients at large in mind.        Socially, with a large number of people using the internet these days for solving daily problems, the use of internet or email as a means to address issues pertaining to health is inevitable and can be considered as a part of normal process of development of our society. Although problems may arise when patients start asking irrelevant queries becoming hypochondriacs, due to the relative ease of communicating with the doctor. This will disrupt the whole communication cycle therefore, strict measures must be taken to maintain the value of such communication. Governments must incorporate this communication as the norm in its public policy structuring and plan accordingly the actual time given to doctor patient communication and the issues addressed during that and marking out the issues that can be discussed via email, making room for more patients to be treated in a shorter time with maximum efficiency.

Case B

Population genomics

With advancement in genetic studies and its ability to bring out patterns of specific genetic variations for specific population groups, there has been an impending need and opportunity to modify the present public health programs which were based just on the environmental factors, without taking consideration of the ‘type’ of people included under that fold. Specific disease pre-dispositions can be brought out within population groups after studying their genetics and then the health care can proceed accordingly. There are various complications arising out of such studies at the population level for study of chronic diseases which are more common, rather than rare single gene disorders which are effectively treated by genetic interventions.                                                 “Some have argued that the focus of public health efforts should be on “phenotypic prevention” (the prevention of disease manifestation) rather than “genotypic prevention” (avoiding the birth of individuals with a given genotype).( Khoury, 1997)

 Certain people believe that ‘killing’ of fetus with genetic abnormalities sends out the wrong signals to all the handicapped people in the world and that threatens to doubt their usefulness in the society and therefore, genetic screening before birth should be banned completely. Whereas the usefulness of pre natal screening to rule out certain life threatening conditions in light of available technology can’t be ignored, for its role in alleviating human suffering is immense.

 Legally, there may be complications regarding decision of the cost of certain new treatment and prevention genetic regimes related to diseases. New technology which at one place is used to make public health care cost effective may be misused by private enterprises by high end marketing making it out of reach of public at large. Issues such as informed consent, protection and confidentiality of genetic information may arise quite frequently.

“Two related areas of social concern are fears of a rebirth of eugenics and the potential of genetics to widen health disparities between different demographic groups. Historians have pointed out the intersections between public health and eugenics during the early 20th century and the danger that new genetic technologies might be misused to serve goals other than that of preventing disease.” (Citrin & Modell, 2003) Lack of adequate knowledge among the general population may give birth of incorrect notions of superiority of certain races over others just based on recent findings of susceptibility of few diseases over others in certain population groups. Public health authorities may tend to overlook easily amendable environmental factors of cleanliness and personal hygiene in order to prevent diseases by giving undue importance to genetic factors; this would be especially harmful in case of developing countries where infectious diseases affect one and all.

References:

Khoury MJ (1997). Relationship between medical genetics and public health: changing the paradigm of disease prevention and the definition of a genetic disease. Am J Med Genet;71:289-91.

Citrin, Toby & Modell, Stephen (2003). Genomics and Population health- United States. Genomics and public health: ethical, legal and social issues. Ch 8; 22,121.

Texas Medical Association (2002). Annual journal of medicine. Guidelines for physicians for online communication with patients. 22:11-12.

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