Dr Fitzgerald sensibly raises the concept of regulation of doctors offering a telemedicine service and others (1) have acknowledged the difficulty of such regulation for doctors involved in remote practice. We write as a team of doctors who are active in offering telemedicine advice in the international field of mountain medicine. We frequently rely on Satellite phone images when offering field advice to frostbitten climbers in difficult circumstances (2,3). This advice can be digit, limb or even life, saving prior to arranging a patient’s evacuation to their home country.

We must be aware that any UK based legislation can be a double edged sword. It would be arrogant of us to assume that UK based and registered practitioners would not be subject to the same reciprocal legislation when offering advice to patients in other remote areas of the world. When medicine transcends international boundaries care in drafting any legislation has to be very carefully worded.

If legislation had been in place, to offer our emergency service (accessed via the British Mountaineering Council website (4)) over the last eight years, we would have had to arrange prior registration in Nepal, India, Pakistan, Argentina, Chile, Namibia, Spain, Peru, Alaska, the Arctic and the Antarctic.

Dr David Hillebrandt
Prof Christopher Imray
Dr Paul Richards
Dr Andy Clark

16.2.21

Refs:
1. Joanne Shaw BMJ Rapid Response 14.2.12
2. Chris Imray and David Hillebrandt. International Internet care of Frostbite by digital photography. BMJ Minerva. Vol 328. p1210. May 15 2004.
3. Hallam MJ, Cubison T, Dheansa B, Imray C. Managing Frostbite. BMJ 2010 Nov 19;341:c5864.doi; 10.1136/bmj.c5864.
4. www.thebmc.co.uk

Competing interests: All authors help run the UK Frostbite Advice Service which is entirely voluntary and run as a service to fellow mountaineers.