Once there is contact between the patient and the telemedicine practitioner, the question shifts from whether there is a physician–patient relationship to the nature of the physician–patient relationship. As is demonstrated by occupational medicine, the law recognizes that there are physician–patient relationships with limited duties to the patient. Just as an occupational medicine physician may examine a patient or treat a workplace injury without triggering a duty to evaluate the patient’s general medical status, the courts are likely to hold that the telemedicine practitioner’s duty is limited to the extent of the matter that is the subject of the consultation. This will probably depend on the status of the local practitioner.

If the patient is cared for locally by a physician, then that physician will have primary responsibility for the patient’s care and the court is more likely to find that the telemedicine practitioner’s duty is limited. Conversely, if the patient’s local contact is not a physician, then the court is more likely to find that the local practitioner has become the borrowed servant of the telemedicine practitioner and that the telemedicine practitioner is responsible for all aspects of the patient’s care. This would be moderated if the local contact was under the supervision of another physician, who would then have primary legal responsibility for implementing the telemedicine practitioner’s recommendations.

Physicians who conduct remotely controlled surgical and medical procedures will have the same legal duties as they would if they were in the operating room with the local physician. At least for the next several years, until these procedures become commonplace, remote physicians can also assume that they will be held liable for problems with the equipment and the other aspects of the procedure that deviate from ordinary practice. This expanded liability mirrors the situation in experimental medicine, where the supervising physician must ensure the integrity of the entire process. They may be able to counterclaim against the manufacturers of the equipment, but these counterclaims may be limited if it was not specifically manufactured for telemedicine. For example, if a standard desktop computer were used as a monitoring terminal for a remote surgical procedure, the manufacturer could reasonably claim that this was not an intended use and that it should not be responsible for personal injuries flowing from the monitor’s failure.