Tim Knettler writes an interesting article over at CheckMd.com entitled “The Perils of Internet Prescribing.” The article mainly focuses on weeding out the safe, legit pharmacies from the bad and specifically mentions the “Ryan Haight Act.” This proposed legislation, currently introduced in Congress, would require a physical examination (or, as Mr. Knettler puts it, a doctor-patient relationship) before a prescription is issued. In other words, it would effectively outlaw online consultation services.
What is interesting is that Mr. Knettler is the “former Senior Vice President of the Federation of State Medical Boards (FSMB), the national association of state medical boards that licenses physicians and regulates medicine.” Contrary to the position of the DEA and the underlying basis of the Ryan Haight Act, the FSMB is clearly of the position that online consultations performed by doctors via internet websites do form a physician-patient relationship. FSMB’s “Model Guidelines for the Appropriate Use of the Internet in Medicine Practice” specifically state on page 4 that:
[a]lthough the Board recognizes that it may be difficult in some circumstances, particularly in an online setting, to define precisely the beginning of the physician-patient relationship, it tends to begin when an individual seeks assistance from a physician with a health-related matter for which the physician may provide assistance. However, the relationship is clearly established when the physician agrees to undertake diagnosis and treatment of the patient and the patient agrees, whether or not there has been a personal encounter between the physician (or other supervised health care practitioner) and patient.
It is hard to argue with the FSMB’s conclusion, especially given the fact that many online consultations are probably more thorough and longer lasting that your everyday five minute physical examination with your local general practitioner. I would be interested in hearing what Mr. Knettler’s position is regarding the Federation of State Medical Board’s conclusion.
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