E-mail breeds client rapport, liabilities


As veterinarians warm up to cyber communicating, are you exposing yourself to malpractice and other legal claims?

New York-No one screens Dr. Rebecca Campbell's e-mail.

In between appointments, on the telephone, at the day's end, the smallanimal veterinarian picks through her inbox, weeding through the 50-or-soclient messages she receives each day.

If this daily dose of Internet doctoring adds time to her workweek, Campbell,owner of the Symphony Veterinary Center in Manhattan, doesn't seem to mind.E-mail, she says, is vital to bonding with clients.

"They love it," Campbell says. "It can get a bit out ofcontrol, but I find time to answer every one. It's something I can reallyfit in between the cracks of the day. E-mail means no phone tag, no endlessloops to try and report back simple blood results."

But while e-mail seems simple, it's not risk-free, warns Dr. Jim Wilson,attorney and legal consultant in veterinary management. By design, e-mailtracks DVM-client correspondence, which not only leaves practitioners vulnerableto various legal injuries, it ups the ante on liability claims.

"There are many ways a practitioner can get in trouble with e-mail,"says Wilson, who heads a consulting firm in Pennsylvania. "I haven'tseen any cases involving it just yet, but it's just a matter of time."

A fine line

Major risks concern e-mail consultations. Without face-to-face contact,there's virtually no way practitioners can be positive a client understandsor even receives their messages. Also, most state laws require physicalexaminations for diagnosis, Wilson says.

"It's no different than oral communication, which can be faulty,erroneous or negligent," he says. "But with e-mail, you don'teven have physical contact to go on, and that normally violates the requiredveterinary-client-patient relationship. You can't prescribe a drug for apatient you haven't seen."

But Dr. Robert Wilbanks, owner of the Castle Hills Companion Animal Hospitalin San Antonio, Texas, says he and his­e-mail savvy colleagues recognizethe fine line between diagnosing and advising.

"It's no different than talking on the phone," he says. "Youdon't diagnose, prescribe or do surgery over the phone and you don't doit over e-mail.

"E-mail has its deficiencies; you can't discern a person's emotionsand I prefer a frontal conversation in an examining room, but on a simpleinquiry on a medial case, it makes a client feel good to know they can easilyaccess you."

Jumping jurisdiction

Recognizing e-mail pitfalls aren't always so easy. One way a practitionercan unwittingly encounter legal problems is by sending advice over statelines.

"We're seeing a lot of problems concerning interstate e-mail diagnosticsand consultations," Wilson says. "With a new client or clientswho've moved - when you start crossing state lines with your advice, youmight be practicing medicine in jurisdictions where you're not licensed.E-mail doesn't include a residential address."

Delete-happy clients

It's also nearly impossible to confirm that clients actually receiveand understand DVM correspondence, a flaw that potentially could lead tomalpractice claims. This is where oral communication gains the advantage.

"People probably change their e-mail addresses more rapidly thanthey change their residential addresses," Wilson says. "You knowwhen you're looking at someone whether or not they understand you, and that'snot something you can see through e-mail."

Clients also expect reminders on everything from refills to check-ups,says Wilson, who receives "plenty of complaints from owners who claimthey weren't adequately reminded of their obligations to their pets."

Relying on e-mail to send reminders leaves the veterinarian no way toguarantee clients received them.

"Ten years ago, this was considered excessive marketing," Wilsonclaims. "Today, the failure to send reminders is viewed as negligence.That's a pretty major change in the attitude of clients toward their veterinarians."


Top 5 ways to steer clear of e-mail hazards

An American Veterinary Medical Association poll reveals 93 percent ofU.S. veterinarians have access to the Internet.

With that kind of data, it's easy to extrapolate that this online communitycomes with e-mail addresses - easily accessible mailboxes available to friends,relatives and clients.

With so much riding on the professionalism and respectability of veterinariansto boost their practices and the profession, it's no surprise that thisnewest form of communication brings with it a throng of potential legalcomplications as well as advantages. With this in mind, Dr. Jim Wilson,attorney and owner of Priority Veterinary Management Consultants in Yardley,Pa., shares his advice on how to avoid the pitfalls of client e-mail:

* Do not prescribe or diagnose via e-mail. You might be electronicallyaccessible 24 hours a day, but your office hours have stayed the same. Remindowners that they still need to make an appointment.

* Know where your e-mail clients reside, and make sure it's astate where you're licensed. Be especially wary of new clients, and if yourespond, choose your words carefully.

* Make sure your e-mail methods allow you to keep records of allclient correspondence. Most states require practitioners to retain recordsfor three to five years. Even if a message seems trivial, print and fileit. You never know when you'll need it.

* Stress to clients that convenient e-mail advice cannot replacea physical exam. Realize that many owners expect you to remind them of bloodor urine analyses, to pick up prescriptions or come in for their pet's annualcheckup.

* Avoid sending technical information to clients, especially ifit involves care instructions. What you view as self-explanatory is likelyto confuse a client. You have no immediate feedback to determine if youradvice is understood, and missteps can trigger malpractice claims.

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