Traditional consultations are premised on a relationship of trust between the primary physician and the consultant. If either does not know the other, or does not trust the other, these consultation become problematic. Putting aside telemedicine, many MCOs are already raising this issue by forcing primary care physicians to consult with specialists they know nothing about, and putting consultants in the position of not knowing the capabilities of the primary physician. This will be exacerbated by telemedicine. Local practitioners could be in the same position as the consumer as regards determining the competence and license status of the remote practitioner, with the caveat that the courts are likely to find that there is a duty to ensure the competence of the remote consultant.

Practitioners who work with remote consultants, especially those across state lines, should document the training and licensure of the consultant as part of their office records. This does not need to be duplicated in each patient’s record, but it must be available to show proper diligence in screening the consultant. There should also be a record of the consultation and any recommendations of the consultant. This could be in the form of ordinary chart notes and a letter from the consultant. If the consultation is conducted through a computer, then the session could be recorded by the computer and stored as an electronic file. These files can be compressed and transferred to a CD-ROM that is kept with the patient’s other medical records.