Telehealth, images, prescribing and doctors' health

Telehealth is a clinical encounter

Confirm identity, the patient's location, contact details and whether privacy is adequate. Establish a plan for disconnection and emergency help, particularly in a remote or mental-health consultation. Decide whether the modality permits an adequate assessment: severe respiratory symptoms, an uncertain abdominal emergency or a needed examination may require in-person care. Explain limitations and arrange a workable alternative rather than using telehealth to delay essential examination. A video view does not substitute for every physical sign or observation.

The Medical Board's telehealth guidelines emphasise real-time consultation. Questionnaire-only asynchronous prescribing without an appropriate real-time assessment is not good practice under the guideline, with specific limited exceptions requiring the actual framework. Prescribing, certificates and referrals need adequate clinical information and judgement, not merely completion of a web form. Assess medical history, medicines, allergy, pregnancy possibility and relevant investigations. Document the modality, findings, limitations and plan with the same care as an in-person encounter.

Medicines and continuity

Medication review includes what is actually taken, dose, indication, benefit, adverse effects and adherence barriers, including non-prescription and complementary products. Reconcile changes across hospital and community care. Check renal/liver function, interactions, duplicate therapy and monitoring requirements. Polypharmacy is a prompt for review, not automatic cessation of all medicines. Agree deprescribing priorities and follow-up, particularly for drugs with withdrawal or rebound risks. Explain the plan in a format the patient can use.

Repeated requests for controlled medicines across clinicians can raise unsafe use or doctor shopping, but should prompt a factual, respectful assessment. Review real-time prescription monitoring where applicable, records, pain/withdrawal, substance-use risks and legitimate access problems. Coordinate a single safe prescribing plan with consent and local rules. Do not automatically accuse or abandon a dependent patient. Conversely, pressure or threats do not justify unsafe prescribing. Treat acute illness and withdrawal risks while seeking addiction/pain and regulatory advice as needed.

Patient images and records

Obtain specific consent for clinical photographs, explain purpose, storage, who may see them and any separate teaching/publication use. Consent to treatment is not automatic consent to public posting. Use approved clinical devices and secure records; personal phones, informal messaging and social media create privacy risks. De-identification can fail when tattoos, context or rare conditions identify someone. A teaching image may require separate permission even if a clinician thinks the face is absent. Respect refusal and use alternative documentation where practical.

Records should be contemporaneous, accurate and relevant, documenting assessment, options, consent, treatment, follow-up and communication. Corrections require a transparent dated process rather than silently deleting the original entry. Avoid copying an old normal examination as if newly performed. A patient may have access rights subject to lawful exceptions; unflattering content is not by itself a reason to deny access. Electronic access should be role-appropriate, audited and limited to a legitimate clinical or authorised purpose. Curiosity about a colleague or celebrity is not a care reason.

Doctors as patients and boundaries

Doctors should have independent healthcare and avoid relying on self-treatment or informal corridor consultation for substantial illness. Professional knowledge does not eliminate emotional involvement or the need for a proper assessment. The code advises avoiding care of close relations and specifically prohibits certain prescribing and elective surgery in that context. Emergency help can be necessary, followed by independent care. Document unavoidable treatment appropriately rather than assuming familiar people need no record or consent process.

Fatigue, burnout, illness and substance use can affect safe practice. Seek support early, arrange leave or restrictions when needed and obtain independent care. A diagnosis alone is not automatically a mandatory notification; the treating-practitioner and colleague thresholds differ and require the applicable Ahpra guidance. Do not invent an additional “imminence” requirement for the substantial-public-risk test. Address immediate patient safety while preserving lawful confidentiality and supporting treatment. A doctor receiving care deserves the same respect and privacy as another patient.

Boundaries in digital and ordinary care

Professional boundaries apply to texts, emails and social media as well as consultations. Avoid exploiting dependency, sharing unnecessary personal information or entering inappropriate personal/sexual relationships. Gifts, paid endorsements and conflicts require transparent judgement; a patient's vulnerability may persist beyond an appointment. Clarify communication times and emergency alternatives so an unread message does not become the patient's only crisis plan. If ending care, provide reasonable continuity and transfer arrangements rather than abrupt exclusion without access to essential treatment.

For example, a patient sends a photograph of a painful swollen eye. The image may help triage but cannot rule out orbital disease; concerning symptoms require urgent examination. A clinician requested to prescribe a controlled medicine solely from a questionnaire needs an adequate assessment and legal prescribing pathway. A doctor with deteriorating mental health benefits from independent care and a safe work plan, not automatic concealment or automatic reporting based on diagnosis alone. These decisions combine clinical limits, privacy and professional responsibilities.

Medical Board telehealth update, code of conduct and Ahpra mandatory reporting.

Review checkpoints

• Questionnaire-only prescribing without an appropriate consultation is not good telehealth practice.
• Obtain specific consent and use approved systems for clinical photographs.
• Medication review should reconcile prescription, non-prescription and complementary medicines.