Telemedicine doctors abroad don’t have to register with the GMC
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e873 (Published 07 February 2012) Cite this as: BMJ 2012;344:e873
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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.
Dr Fitzgerald details a number of points that he feels precludes doctors who work overseas from General Medical Council regulation. This is not entirely accurate. Doctors who practice overseas but remain registered with the GMC are still subject to the same standards and requirements as their UK-based, GMC registered peers, regardless of where they work.
The GMC has powers to take disciplinary action against all doctors on the medical register when their fitness to practise has been called into question.
Anyone unsure about the GMC status of an overseas based doctor can check the online medical register located on the homepage of our website and should report any concerns to our fitness to practise team.
Competing interests: No competing interests
In his interesting letter, Richard FitzGerald cannot I think mean exactly what he writes. He advocates legislation requiring the GMC to regulate "all doctors who care for British patients wherever the doctor is located..." He surely doesn't mean British patients must be treated by GMC-regulated doctors when they (the patients) are abroad. Nor, presumably, can he mean the GMC to regulate overseas-based doctors who continue to treat their existing non-British patients by phone or email when they (the patients)are staying in Britain. So perhaps he means that the GMC should regulate doctors who treat British patients when they are in Britain. What this illustrates is how much more complicated it is to regulate remote practice than it may appear at first glance.
Competing interests: No competing interests
Re: Telemedicine doctors abroad don’t have to register with the GMC
Please, not MORE regulation! Hasn't Dr Fitzgerald heard of 'caveat emptor'? Its utterly futile to expect that doctors giving opinions from overseas via telemedicine must be GMC registered, just as it would to expect any clinician giving an opinion to a British citizen overseas so to be. And what's wrong with a telemedicine doctor being registered and recognised solely by his/her own country's regulators? This is just arrogance based upon the assumption that British medicine must surely hold to higher standards than that which all those damned natives out there practice.
Sadly the opposite is true and much overseas medicine is better than ours these days. That's why foreign patients don't come in droves to Harley Street any more, and why Premiership footballers mostly go to Switzerland, Germany or the USA to have their knee injuries dealt with. Once we grasp this, and the terrible damage done to our own system by the over-regulation and interference of government and bodies such as the GMC then we might start to rescue the situation.
Competing interests: No competing interests