Tele-Doctors under attack

New Jersey prohibits out-of-state teledoctors from talking to patients.

https://www.wsj.com/articles/the-doctor-is-in-but-the-patient-is-out-of-state-new-jersey-lawsuit-telehealth-specialty-2a197f2d?mod=hp_opin_pos_3#cxrecs_s

{{ Hospital lawyers may even instruct physicians to avoid giving medical advice by phone to their in-state patients who are temporarily out of state for vacation or work, a scenario that could affect any of us. This is callous and in conflict with a physician’s ethical obligations. }}

This is almost like the madness over abortion in Texas.

intercst

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Apples to oranges? How so?

Quality doctors need patients in front of them for diagnosis. Over the course of several diagnoses, things are not going to be as good over the phone. The diagnosis determines the quality of care.

If you don’t have a license to practice in the state, doesn’t matter if you’re a tele doc or in office visit, just can’t do it. On the opposing side, I’ve always wondered why there isn’t a national license because we all take the same national board exams.

As far as telemedicine, is ok for established relationships, but there is absolutely no substitute for placing your hands and stethoscope on the patient. Plus, picking up all the non-verbal cues that you won’t get over the phone or FaceTime.

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Loss of an income stream for State Licensing boards springs to mind.

I always think telemedicine is a nifty little niche…for doctors who realise they don’t like patients or actual doctoring, and patients who don’t have much serious going on and don’t need a doctor.

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Possibly the USA should foster & facilitate rural doctors also doing telemedicine? They could become extremely busy and make enough money and feel enough love and thanks from patients to reverse the abandonment of rural facilities.

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(muttering under breath about the total stupidity of USA health policy by a stoopidifying combination of inertia, shifted only by greed and faddish religious insanities)

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The author is a specialist and sees patients from nearby states. She can’t legally consult with them by telephone, especially if they live in New Jersey because she could be facing criminal charges. She’s gotten licensed in six states to try to work around this. Which is bonkers.

She points are there are already exceptions for sports team doctors who travel with their team, so it isn’t like there is something sacred about this rule.

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While I can’t access the WSJ article, there are a fewmore accessible accounts on this case (the author’s lawsuit against New Jersey) that sheds a slightly different light on the topic…at least, I think that’s the case.

It seems that, whilst Dr Macdonald may well have gotten licensed in a number of states, New Jersey isn’t one of them. If she wishes to provide telehealth services to New Jersey residents, she just needs to apply for a New Jersey license. The same as she’d have needed to before Covid-19 provided for a relaxation of the licensing laws.

There are issues. I heard of a theory six months ago that a cancer drug would keep you alive longer. I looked into it. There are doctors online who will prescribe the drug. Just call them. Looking further into it the theory is absolutely crazy and a good doctor in the office would never have a non-cancer patient on the drug.

That is extreme but bit by bit the standard of care will drop with more teledoctoring. Patients will shop by iPhone elsewhere.

Just because you can does not mean you should.

If it was all allowed. I mean all of it. Patients would quickly say they allow it for the money. Let’s cut stupid out and not just allow everything.

This looks like the firm that’s doing the legal stuff…purely out of the goodness of their hearts. I’m sure.

According to online descriptions of this Pacific Legal Foundation, it’s apparently a conservative organization that supports libertarian causes.

I am sure the companies that insure doctors for malpractice are lining up to support the states. Not because a national board does not make good sense. The doctors going down this route are bad. I mean horrid. Good screw your well-being if you do not believe that folks. It can be screwed royally.

She isn’t trying to crack into the lucrative New Jersey telehealth market. She’s an oncologist who works in Boston. Her patients come to her from various states for treatment, one of those patients was from New Jersey.

When the patients are back home, she still needs to be able to talk to them and they still need to be able to ask her questions. But if the patient is in New Jersey, that action is the considered to be the practice of medicine. That is illegal in New Jersey unless the doctor is licensed in that state. And it is a criminal violation.

She saying she should have the right to talk to her patients in any state. I don’t see any downside to that.

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You are talking about a patient with possibly very serious health problems. There can be huge downsides.

We do not know. But clinically it is not all that good. Depends if it is just calling in a script or a lot more.

Neither do I really…at least as far as the specific details of this test case appear to present. I just find myself wondering why, if she’s already licensed in multiple states (including Massachusetts which isn’t recognized as being particularly lenient with licensure requirements…for physicians, dentists or veterinarians) New Jersey isn’t one of them given the geographic proximity and relative ease of doing this. Especially if her expertise is such that she can provide a standard of care that’s unavailable elsewhere.

I’m a CPA. We’re also regulated by the individual states. But we also have a reciprocity system. With that, we don’t have to take any further tests, just register with the Board of Accountancy (or equivalent) and pay a typically reasonable fee. Then we’re free to practice in that state.

I would hazard a guess that Drs have some kind of similar arrangement. But it wouldn’t shock me if the fees to the other states are stupidly high.

—Peter

I suspect that whatever it is, it’s going to be a lot less than hiring a legal firm to challenge the law…and a lot quicker to implement with a far greater likelihood of success.

Doctors seeing patients need to diagnose the patient. Diseases progress.

Do not kid yourself this should be done over the phone. Does not matter if the top doctor in Boston is doing it. For a very long time, Dr. Oz was a top doctor. That is not at all true today.

This is not about one patient. This is about proper clinical standards. Patients demand things and the industry complies. That easily can mean the patients get the short end of the stick.

My CPA sits at his desk, sits out on his deck, or can be out on his boat. He can diagnose if you will my financial needs easily.

Leap, are you saying there should be no telehealth?

From the Pacific Legal Foundation’s website…it ain’t just Jersey. Seems Massachusetts (the doctor’s home state) also requires state licensure to treat MA residents

Scrolling through the site, I notice a lack of cases challenging legal “cronyism” (a frequent word on that site) The foundation’s largesse seems to be confined to the low hanging fruit in medical licensure …purely out of the goodness of its heart, I’m sure.

On further reading, a foundation dedicated to preserving our freedom, apparently. Not just from medical “cronyism” but cases that follow a winnable formula of “sympathetic client, evil villain and outrageous facts” (or facts that can easily be presented as outrageous enough to bamboozle the unwary?)

https://www.reuters.com/legal/government/pacific-legal-foundation-snags-supreme-court-trifecta-2023-03-10/

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And this would be a terrible outcome.

Personally, I’ve had knee surgery twice over the last twelve months. Mobility and being able to drive to a doctor was incredibly difficult, and often a complete waste of time. Things like a doctor’s certificate for missing a day of work (not sure if Americans have the same system) is a perfect example of the benefits of telehealth.

A lot of visits to a GP are not for serious diseases or a diagnosis.

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