Table: Remote Consultation Expectations & Obligations

May 9, 2008

Additional material for "Remote Consultation Offers a Valuable Alternative to Face-to-Face Medical Treatment"—read the article

Patient

Expectations	Obligations
Receives an expert second opinion Pays less for physician's opinion than cost of travel for face-to-face visit Obtains summary of the course of the illness from referring physician Receives a copy of report outlining the opinion, with citation of relevant literature Feels more comfortable engaging the physician offering the remote service in a subsequent, traditional office consultation	Makes clear to the physician arranging the consultation the reason for the request, generating an appropriate list of questions and expectations from the consultation Understands that services offered are a physician-to-physician consultation, without any expectation of a patient-physician relationship Acknowledges that service requires payment, which is most often not covered by the insurance company; in addition, patient realizes that it will be up to him or her to contact and work with the insurance company for reimbursement

Expectations

Obligations

Receives an expert second opinion

Pays less for physician's opinion than cost of travel for face-to-face visit

Obtains summary of the course of the illness from referring physician

Receives a copy of report outlining the opinion, with citation of relevant literature

Feels more comfortable engaging the physician offering the remote service in a subsequent, traditional office consultation

Makes clear to the physician arranging the consultation the reason for the request, generating an appropriate list of questions and expectations from the consultation

Understands that services offered are a physician-to-physician consultation, without any expectation of a patient-physician relationship

Acknowledges that service requires payment, which is most often not covered by the insurance company; in addition, patient realizes that it will be up to him or her to contact and work with the insurance company for reimbursement

Neurologist Requesting Consultation

Expectations	Obligations
Allows patient to get an opinion from an expert in the disease process (for complex cases, with or without a firm diagnosis), which may assist in diagnosis or treatment Offers the opportunity to revisit elements of the case that may have been neglected or forgotten (even though the process of writing a summary of the case might be time-consuming)	Cancel planned remote consultation after discussion with the patient, if patient's expectations are too broad for the intended purpose Spend time writing a summary letter, gathering appropriate information, etc. Understand that remote consultant is not a treating physician Acknowledge that remote consultant will not take over the care of patient or answer questions posed in the future by patient

Expectations

Obligations

Allows patient to get an opinion from an expert in the disease process (for complex cases, with or without a firm diagnosis), which may assist in diagnosis or treatment

Offers the opportunity to revisit elements of the case that may have been neglected or forgotten (even though the process of writing a summary of the case might be time-consuming)

Cancel planned remote consultation after discussion with the patient, if patient's expectations are too broad for the intended purpose

Spend time writing a summary letter, gathering appropriate information, etc.

Understand that remote consultant is not a treating physician

Acknowledge that remote consultant will not take over the care of patient or answer questions posed in the future by patient

Consulting Primary Care Doctor

Expectations	Obligations
Assists the doctor in role as an effective advocate for the patient or patient's family, especially when local consultants are not in agreement or when there are limited regional resources Strengthens the concept of the primary care doctor being the true "medical home" for patients	Same as Neurologist Requesting Consultation.

Remote Consultant

Expectations	Obligations
Offers expert services and expands the benefit to those unable to travel (important for consultant with a very sub-specialized focus) Allows payment for services that were simply given away in the past Promotes gratification in assisting colleagues and patients, through the use of a much simpler paradigm than traditional office consultation	Generate a meaningful written consultation in a pre-defined time period Be willing to discuss additional questions with the referring doctor, which may have been left out of the initial evaluation Provide appropriate resources, which may not be known to the referring doctors or patient Offer suggestions that are free of conflict of interest, or declare any known or potential conflicts of interest

Expectations

Obligations

Offers expert services and expands the benefit to those unable to travel (important for consultant with a very sub-specialized focus)

Allows payment for services that were simply given away in the past

Promotes gratification in assisting colleagues and patients, through the use of a much simpler paradigm than traditional office consultation

Generate a meaningful written consultation in a pre-defined time period

Be willing to discuss additional questions with the referring doctor, which may have been left out of the initial evaluation

Provide appropriate resources, which may not be known to the referring doctors or patient

Offer suggestions that are free of conflict of interest, or declare any known or potential conflicts of interest