Knowledge Library

Audio and video recordings: What is permissible?

In an age in which most people have a recording device handy at all times, physicians may wonder what their rights and obligations are with respect to audio and video recordings in their private practices. It is clear that video recording, either by staff or by patients, should generally not be permitted in areas in which patient information may be exposed, but what about within the privacy of the exam room?   California is a “two-party consent” state with respect to audio recordings. This means that in the context of a private conversation, both parties taking part in the conversation must consent to having the conversation recorded.    Alaska, Idaho,...

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Capacity v. Competency and Why it Matters

Evaluating medical decision-making capacity can be challenging when treating patients who exhibit cognitive deficits. Understanding the physician’s role in assessing capacity versus the judicial determination of incompetence can make a significant difference in how these situations should be approached.  In healthcare, medical decision-making capacity refers to “an individual’s ability to understand the significant benefits, risks, and alternatives to proposed health care and make and communicate a healthcare decision” (Uniform Health Care Decisions Act of 1993). Medical decision-making capacity is specific to the proposed medical intervention, and it can change over time. Incompetence is a legal term that refers to an enduring general inability to make valid decisions. This is established by a judge or magistrate, and it is reserved for...

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Telehealth Update

Since shortly after the technology was first invented, physicians have been using telecommunications to facilitate the practice of medicine.  Physicians in the Netherlands were able to transmit heart rhythms by telephone in the early 1900’s; by the 1940’s telephone lines were used to transmit radiographic images.  There were even early predictions of videoconferencing in medicine; the cover art on the April 1924 issue of Radio News depicted a future “Radio Doctor” interacting with his patient from the comfort of the family living room, through a radio equipped with a live screen.  In the 1960’s, NASA developed several methods of remote monitoring of biometric information as part...

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Unanticipated Medical Outcomes – Disclosure and Apology

It has been twenty years since the Institute of Medicine report To Err is Human: Building a Safer Health System was released. Pioneers such as the University of Michigan, University of Illinois, the Veteran Affairs Medical Center in Lexington, KY, and the Agency for Healthcare Research and Quality (AHRQ) undertook the challenge to research and develop methods to communicate medical errors and other adverse outcomes to patients and families. Disclosure, apology, and potential resolution present particularly challenging topics in the setting of medical professional liability, where state and federal laws and regulations can impact the scope of communication and the...

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Ketamine – The Next Breakthrough for Depression?

A Modern Epidemic Major Depressive Disorder (MDD) affects an estimated 320 million individuals worldwide (16 million in the U.S. alone), and the incidence of this condition has increased substantially in the last decade. Further challenging psychiatrists, current pharmacologic therapies (MAO inhibitors, tricyclic antidepressants, and SSRIs) are limited by therapeutic lag times of up to weeks or months, and high refractory rates of approximately 30%. Patients with treatment-resistant depression face limited options, such as transcranial magnetic stimulation (r-TMS) or electroconvulsive therapy (ECT), and patients with suicidal ideation may remain at risk while they wait for a newly-prescribed antidepressant to take effect....

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