The Next Time You See Your Doctor Could Be Online

By Christine Vestal, Stateline

The next time you see your doctor could be onlineDemand for doctors – whether in person or via a computer screen – is expected to surge as millions more Americans become insured under the Affordable Care Act. About 10 million people already rely on telemedicine, often from doctors who live in another state.

As a result, more physicians are applying for medical licenses in multiple states – a costly and time-consuming proposition for some. Without a license to practice medicine in the patient’s state of residence, both doctors and patients may be at legal risk.

Many states are embracing telemedicine by encouraging it in their Medicaid programs and requiring private insurers to pay for it. But they have made little progress in removing medical licensing barriers that proponents of the technology say have kept doctors and hospitals from expanding even more.

Telemedicine was once the purview of small town doctors who needed to consult with specialists available only in larger urban areas. Today, telemedicine technology is even being used to conduct surgeries using robotics, typically only in emergency situations such as during war.

Most telemedicine consists of video teleconferencing between a doctor and a patient. Doctors also routinely use telemedicine technology to transmit and discuss diagnostic images and to remotely monitor patients with chronic diseases so they don’t have to leave their homes or nursing facilities.

For some consumers, it is the primary way they receive medical care. Using Skype on a computer or FaceTime on an iPhone, patients discuss their symptoms and show their doctors any visible evidence of their conditions, such as a swollen eye or skin rash. Patients most often conduct these consultations from home or their workplace. In some cases, patients go to a medical facility and use high-end, secure equipment to teleconference with a doctor in another location.

Much of the growth in telemedicine is expected to be in remote monitoring of patients with heart and lung diseases and diabetes, who have recently been discharged from a hospital. The aim is to detect health problems early enough to prevent them from being sent back to the hospital.

States have argued that easing licensing requirements could jeopardize patient safety. If doctors practice in a state without obtaining a license there, regulators maintain that they have no power to conduct an investigation or explore a consumer complaint. Also, these doctors would not benefit from any legal protections the state may have against malpractice lawsuits.

Proponents of telemedicine argue that since doctors take standardized national exams and most requirements are set by federal agencies such as the U.S. Department of Health and Human Services, states should recognize other state licenses. They say state medical boards are simply trying to shield doctors from out-of-state competition and preserve state revenues from licensing fees.

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Multiple Relationships Revealed

Multiple Relationships RevealedA female psychologist works with a male patient for about one year in a suburban area. They agreed to meet weekly for the first four months of psychotherapy, and then they agreed to meet twice per month. They developed a good therapeutic alliance. During the course of their work, he discussed significant facts about his troubled past, numerous details about failed past relationships, and sexual fantasies. The main therapeutic issues are depression and loneliness.

During the current session, the patient related having made a new female friend. As social isolation, loneliness and depression are regular themes in treatment; the psychologist frames this as positive progress.

As the conversation continues, the psychologist is surprised to learn that the patient’s new friend is the ex-wife of the psychologist’s husband. The patient reveals that he became aware of that information after several dates and recently felt comfortable revealing this to the psychologist. He also indicated that the relationship is taking on a more serious tone.

The ex-wife moved back to the area about six months ago. The psychologist knows that the ex-wife had been struggling with isolation and loneliness as well. The psychologist, her husband, and his ex-wife are on good terms. They see her regularly for informal family events and do holidays together with their adult children and grandchildren.

After the session is over, the psychologist has time to reflect on her concerns. The psychologist feels stuck and overwhelmed by her present situation. She calls you for an ethics consult.

  • What are the ethical issues involved?
  • What would you suggest that she does?
  • With whom does the psychologist discuss the multiple roles?
  • With only the patient?
  • With the patient and the ex-wife?
  • With her husband, the patient and the ex-wife?
  • Can the psychologist continue the treatment relationship with the patient?
  • Even if they terminate therapy, how does the psychologist cope with family gatherings since she knows significant details about her patient’s life?


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Preventing Medical Errors in Speech-Language Pathology

Preventing Medical Errors in Speech-Language Pathology

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2-hour course required for license renewal of Florida SLPs and Audiologists on December 31, 2011.

This course addresses the impact of medical errors on today’s healthcare with a focus on root cause analysis, error reduction and prevention, and patient safety. Multiple scenarios of real and potential errors in the practice of speech-language pathology are included, along with recommended strategies for preventing them. Evidence shows that the most effective error prevention occurs when a partnership exists among care facilities, health care professionals, and the patients they treat. Suggested strategies for preventing errors address all three elements: (1) models for changing the culture in care facilities, (2) lifelong learning for SLPs that is focused on ethical, evidence-based, culturally competent practice, and (3) tools for educating and empowering patients. 2010 | 33 pages | 16 posttest questions | Course #20-10S

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