Reflections on remote consultation

Capelo, Marta; Lopes, Nuno; Rosa, Bárbara Santa; Silvestre, Margarida

doi:10.1590/1983-803420233274EN

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Brasil

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Sumário

Update • Rev. Bioét. 31 • 2023 • https://doi.org/10.1590/1983-803420233274EN copy

Reflections on remote consultation

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Information and communication Technologies are increasingly present in health care, as exemplified by the recourse to remote consultation. Such care delivery modality brings unquestionable benefits, such as helping to face the contemporary challenges plaguing health systems worldwide. But its ever-increasing use underlines the importance of safeguarding ethical issues related to autonomy, equity, privacy, and the quality of the user-professional relations. This paper reflects on the ethical challenges presented before, during, and after remote consultation as to optimize and shape its use.

Remote consultation; Ethics; medical; Ethical theory; Information and communication technologies

Potentialities	Risks/barriers
Expands access to specialist care where it is not available ¹⁴14. Nittari G, Khuman R, Baldoni S, Pallotta G, Battineni G, Sirignano A et al. Telemedicine practice: review of the current ethical and legal challenges. Telemed J E Health [Internet]. 2020 [acesso 13 fev 2023];26(12):1427-37. DOI: 10.1089/tmj.2019.0158 15. Atac A, Kurt E, Yurdakul S. An overview to ethical problems in telemedicine technology. Procedia Soc Behav Sci [Internet]. 2013 [acesso 13 fev 2023];103:116-22. DOI: 10.1016/j.sbspro.2013.10.315 - ¹⁶16. Gioia G, Salducci M. Medical and legal aspects of telemedicine in ophthalmology. Rom J Ophthalmol [Internet]. 2019 [acesso 13 fev 2023];63(3):197-207. Disponível: https://bit.ly/42LoJeI https://bit.ly/42LoJeI...	Problems with ensuring data privacy and security ⁵5. Ortúzar M. Igualdad de acceso a la telesanidad en zonas rurales y aisladas: propuesta de un marco ético normativo integral de acceso y distribución. Rev Latinoam Bioet [Internet]. 2009 [acesso 13 fev 2023];9(1):76-93. Disponível: https://bit.ly/3X7S0PP https://bit.ly/3X7S0PP... , ⁶6. Kuziemsky C, Hunter I, Gogia S, Lyenger S, Kulatunga G, Rajput V et al. Ethics in telehealth: comparison between guidelines and practice-based experience: the case for learning health systems. Yearb Med Inform [Internet]. 2020 [acesso 13 fev 2023];29(1):44-50. DOI: 10.1055/s-0040-1701976 , ¹⁶16. Gioia G, Salducci M. Medical and legal aspects of telemedicine in ophthalmology. Rom J Ophthalmol [Internet]. 2019 [acesso 13 fev 2023];63(3):197-207. Disponível: https://bit.ly/42LoJeI https://bit.ly/42LoJeI... , ¹⁷17. Osman M, Schick-Makaroff K, Thompson S, Bialy L, Featherstone R, Kurzawa J et al. Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review. BMJ Glob Health [Internet]. 2019 [acesso 13 fev 2023];4(5):e001629. DOI: 10.1136/bmjgh-2019-001629
	Risk of technical failures that jeopardize the quality of the service provided ¹⁴14. Nittari G, Khuman R, Baldoni S, Pallotta G, Battineni G, Sirignano A et al. Telemedicine practice: review of the current ethical and legal challenges. Telemed J E Health [Internet]. 2020 [acesso 13 fev 2023];26(12):1427-37. DOI: 10.1089/tmj.2019.0158 , ³¹31. Vitolo F. Telemedicina: nuevas tecnologías: nuevos riesgos. Biblioteca Virtual Noble [Internet]. 2011 [acesso 13 fev. 2023]. Disponível: https://bit.ly/3p6vqu8 https://bit.ly/3p6vqu8...
	Difficulties of actors to use ICT ¹⁷17. Osman M, Schick-Makaroff K, Thompson S, Bialy L, Featherstone R, Kurzawa J et al. Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review. BMJ Glob Health [Internet]. 2019 [acesso 13 fev 2023];4(5):e001629. DOI: 10.1136/bmjgh-2019-001629 , ²⁹29. Denecke K, Bamidis P, Bond C, Gabarron E, Househ M, Lau AY et al. Ethical issues of social media usage in healthcare. Yearb Med Inform [Internet]. 2015 [acesso 13 fev 2023];10(1):137-47. DOI: 10.15265/IY-2015-001
Enables better follow-up ¹²12. Catapan S, Calvo M. Teleconsulta: uma revisão integrativa da interação médico-paciente mediada pela tecnologia. Rev Bras Educ Med. [Internet]. 2020 [acesso 13 fev 2023];44(1):e003. DOI: 10.1590/1981-5271v44.1-20190224.ING , ¹⁴14. Nittari G, Khuman R, Baldoni S, Pallotta G, Battineni G, Sirignano A et al. Telemedicine practice: review of the current ethical and legal challenges. Telemed J E Health [Internet]. 2020 [acesso 13 fev 2023];26(12):1427-37. DOI: 10.1089/tmj.2019.0158 , ¹⁷17. Osman M, Schick-Makaroff K, Thompson S, Bialy L, Featherstone R, Kurzawa J et al. Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review. BMJ Glob Health [Internet]. 2019 [acesso 13 fev 2023];4(5):e001629. DOI: 10.1136/bmjgh-2019-001629	Possible weakening of the relationship between patient and healthcare provider ¹³13. Langarizadeh M, Moghbeli F, Aliabadi A. Application of ethics for providing telemedicine services and information technology. Med Arch [Internet]. 2017 [acesso 13 fev 2023];71(5):351-5. DOI: 10.5455/medarh.2017.71.351-355 14. Nittari G, Khuman R, Baldoni S, Pallotta G, Battineni G, Sirignano A et al. Telemedicine practice: review of the current ethical and legal challenges. Telemed J E Health [Internet]. 2020 [acesso 13 fev 2023];26(12):1427-37. DOI: 10.1089/tmj.2019.0158 15. Atac A, Kurt E, Yurdakul S. An overview to ethical problems in telemedicine technology. Procedia Soc Behav Sci [Internet]. 2013 [acesso 13 fev 2023];103:116-22. DOI: 10.1016/j.sbspro.2013.10.315 - ¹⁶16. Gioia G, Salducci M. Medical and legal aspects of telemedicine in ophthalmology. Rom J Ophthalmol [Internet]. 2019 [acesso 13 fev 2023];63(3):197-207. Disponível: https://bit.ly/42LoJeI https://bit.ly/42LoJeI...
Improves the quality of services provided ³3. Chang V, Cao Y, Li T, Shi Y, Baudier P. Smart healthcare and ethical issues. In: International Conference on Finance, Economics, Management and IT Business [Internet]. Setúbal: SciTePress; 2019 [acesso 13 fev 2023]. p. 53-9. DOI: 10.5220/0007737200530059 https://doi.org/10.5220/0007737200530059... , ⁵5. Ortúzar M. Igualdad de acceso a la telesanidad en zonas rurales y aisladas: propuesta de un marco ético normativo integral de acceso y distribución. Rev Latinoam Bioet [Internet]. 2009 [acesso 13 fev 2023];9(1):76-93. Disponível: https://bit.ly/3X7S0PP https://bit.ly/3X7S0PP...	Aversion to change/complacency/lack of interest and/or knowledge on the part of healthcare providers ²2. van der Kleij R, Kasteleyn M, Meijer E, Bonten T, Houwink E, Teichert M et al. Series: eHealth in primary care. Part 1: concepts, conditions and challenges. Eur J Gen Pract [Internet]. 2019 [acesso 13 fev 2023];25(4):179-89. DOI: 10.1080/13814788.2019.1658190 , ¹⁰10. Comité Consultatif National d’Éthique pour les Sciences de la Vie et de la Santé. Enjeux d’éthique liés aux outils numériques en télémédecine et télésoin dans le contexte de la COVID-19. Bulletin de Veille [Internet]. 2020 [acesso 13 fev 2023];3. Disponível em: https://bit.ly/3qRJN6k https://bit.ly/3qRJN6k... , ¹²12. Catapan S, Calvo M. Teleconsulta: uma revisão integrativa da interação médico-paciente mediada pela tecnologia. Rev Bras Educ Med. [Internet]. 2020 [acesso 13 fev 2023];44(1):e003. DOI: 10.1590/1981-5271v44.1-20190224.ING , ¹⁷17. Osman M, Schick-Makaroff K, Thompson S, Bialy L, Featherstone R, Kurzawa J et al. Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review. BMJ Glob Health [Internet]. 2019 [acesso 13 fev 2023];4(5):e001629. DOI: 10.1136/bmjgh-2019-001629 , ²⁰20. Segrelles G, López-Padilla D, Granda-Orive JI. Ventajas e inconvenientes de la telemedicina en el manejo de pacientes con enfermedades crónicas respiratorias. Arch Bronconeumol [Internet]. 2016 [acesso 13 fev 2023];52(12):575-6. DOI: 52. 10.1016/j.arbres.2016.05.016 https://doi.org/10.1016/j.arbres.2016.05... , ²⁶26. Caldwell B, Bischoff R, Derring-Palumbo K, Liebert J. Best practices in the online practice of couple and family therapy. AAMFT [Internet]. 2017 [acesso 13 fev 2023]. Disponível: https://bit.ly/3XabWBA https://bit.ly/3XabWBA... and patients ⁶6. Kuziemsky C, Hunter I, Gogia S, Lyenger S, Kulatunga G, Rajput V et al. Ethics in telehealth: comparison between guidelines and practice-based experience: the case for learning health systems. Yearb Med Inform [Internet]. 2020 [acesso 13 fev 2023];29(1):44-50. DOI: 10.1055/s-0040-1701976 , ²⁷27. Welch BM, Marshall E, Qanungo S, Aziz A, Laken M, Lenert L, Obeid J. Teleconsent: a novel approach to obtain informed consent for research. Contemp Clin Trials Commun [Internet]. 2016 [acesso 13 fev 2023];3:74-9. DOI: 10.1016/j.conctc.2016.03.002
Encourages autonomy and self-care of patients ²2. van der Kleij R, Kasteleyn M, Meijer E, Bonten T, Houwink E, Teichert M et al. Series: eHealth in primary care. Part 1: concepts, conditions and challenges. Eur J Gen Pract [Internet]. 2019 [acesso 13 fev 2023];25(4):179-89. DOI: 10.1080/13814788.2019.1658190 , ⁵5. Ortúzar M. Igualdad de acceso a la telesanidad en zonas rurales y aisladas: propuesta de un marco ético normativo integral de acceso y distribución. Rev Latinoam Bioet [Internet]. 2009 [acesso 13 fev 2023];9(1):76-93. Disponível: https://bit.ly/3X7S0PP https://bit.ly/3X7S0PP... , ¹⁸18. Montforta R, Brunsomsb D. Avances en la informatización de los sistemas de salud. Aten Primaria [Internet]. 2005 [acesso 13 fev 2023];36(8):448-52. DOI: 10.1157/13081059	Excessive reduction of in-person and home consultations ³²32. Gilmartin C, Arbe-Barnes EH, Diamond M, Fretwell S, McGivern E, Vlazaki M, Zhu L. Varsity medical ethics debate 2018: constant health monitoring: the advance of technology into healthcare. Philos Ethics Humanit Med [Internet]. 2018 [acesso 13 fev 2023];13(1):12. DOI: 10.1186/s13010-018-0065-0 https://doi.org/10.1186/s13010-018-0065-... , ³³33. Leão CF, Coelho MES, Siqueira AO, Rosa BAA, Neder PRB. O uso do WhatsApp na relação médico-paciente. Rev. Bioét. (Impr.) [Internet]. 2018 [acesso 13 fev 2023];26(3):412-9. DOI: 10.1590/1983-80422018263261
Assists in the monitoring/follow-up of care without the need for in-person interaction ¹⁰10. Comité Consultatif National d’Éthique pour les Sciences de la Vie et de la Santé. Enjeux d’éthique liés aux outils numériques en télémédecine et télésoin dans le contexte de la COVID-19. Bulletin de Veille [Internet]. 2020 [acesso 13 fev 2023];3. Disponível em: https://bit.ly/3qRJN6k https://bit.ly/3qRJN6k... , ¹⁹19. Capitão A, Leite P, Rocha Á. Telemedicina: uma análise da situação portuguesa [Internet]. In: Anais da 3ª Conferência Ibérica de Sistemas e Tecnologias de Informação; 2008; Ourense. Ourense: Cist; 2008 [acesso 13 fev 2023]. Disponível: https://bit.ly/3PzkiB5 https://bit.ly/3PzkiB5... 20. Segrelles G, López-Padilla D, Granda-Orive JI. Ventajas e inconvenientes de la telemedicina en el manejo de pacientes con enfermedades crónicas respiratorias. Arch Bronconeumol [Internet]. 2016 [acesso 13 fev 2023];52(12):575-6. DOI: 52. 10.1016/j.arbres.2016.05.016 https://doi.org/10.1016/j.arbres.2016.05... - ²¹21. Domínguez-Ocadio G, Allende-Pérez S, Verástegui-Avilés E, Monreal-Carrillo EA. Medicina del futuro: atención virtual como modelo de atención en Medicina Paliativa. Gac Mex Oncol [Internet]. 2013 [acesso 13 fev 2023];12(4):240-3. Disponível: https://bit.ly/3NyyoB5 https://bit.ly/3NyyoB5...	Lack of defined rules and regulations ⁶6. Kuziemsky C, Hunter I, Gogia S, Lyenger S, Kulatunga G, Rajput V et al. Ethics in telehealth: comparison between guidelines and practice-based experience: the case for learning health systems. Yearb Med Inform [Internet]. 2020 [acesso 13 fev 2023];29(1):44-50. DOI: 10.1055/s-0040-1701976 , ¹⁴14. Nittari G, Khuman R, Baldoni S, Pallotta G, Battineni G, Sirignano A et al. Telemedicine practice: review of the current ethical and legal challenges. Telemed J E Health [Internet]. 2020 [acesso 13 fev 2023];26(12):1427-37. DOI: 10.1089/tmj.2019.0158 , ²⁵25. Wang Z, Deng Z, Wu X. Status quo of professional-patient relations in the internet era: bibliometric and co-word analyses. Int J Environ Res Public Health [Internet]. 2019 [acesso 13 fev 2023];16(7):1183. DOI: 10.3390/ijerph16071183 , ²⁷27. Welch BM, Marshall E, Qanungo S, Aziz A, Laken M, Lenert L, Obeid J. Teleconsent: a novel approach to obtain informed consent for research. Contemp Clin Trials Commun [Internet]. 2016 [acesso 13 fev 2023];3:74-9. DOI: 10.1016/j.conctc.2016.03.002 , ³⁴34. Brall C, Schröder-Bäck P, Maeckelberghe E. Ethical aspects of digital health from a justice point of view. Eur J Public Health [Internet]. 2019 [acesso 13 fev 2023];29(supl 3):18-22. DOI: 10.1093/eurpub/ckz167 , ³⁵35. Martinez-Martin N, Kreitmair K. Ethical issues for direct-to-consumer digital psychotherapy apps: addressing accountability, data protection, and consent. JMIR Ment Health [Internet]. 2018 [acesso 13 fev 2023];5(2):e32. DOI: 10.2196/mental.9423
Reduces individual (travel, absenteeism at work) ⁵5. Ortúzar M. Igualdad de acceso a la telesanidad en zonas rurales y aisladas: propuesta de un marco ético normativo integral de acceso y distribución. Rev Latinoam Bioet [Internet]. 2009 [acesso 13 fev 2023];9(1):76-93. Disponível: https://bit.ly/3X7S0PP https://bit.ly/3X7S0PP... , ¹²12. Catapan S, Calvo M. Teleconsulta: uma revisão integrativa da interação médico-paciente mediada pela tecnologia. Rev Bras Educ Med. [Internet]. 2020 [acesso 13 fev 2023];44(1):e003. DOI: 10.1590/1981-5271v44.1-20190224.ING , ¹⁴14. Nittari G, Khuman R, Baldoni S, Pallotta G, Battineni G, Sirignano A et al. Telemedicine practice: review of the current ethical and legal challenges. Telemed J E Health [Internet]. 2020 [acesso 13 fev 2023];26(12):1427-37. DOI: 10.1089/tmj.2019.0158 , ¹⁶16. Gioia G, Salducci M. Medical and legal aspects of telemedicine in ophthalmology. Rom J Ophthalmol [Internet]. 2019 [acesso 13 fev 2023];63(3):197-207. Disponível: https://bit.ly/42LoJeI https://bit.ly/42LoJeI... , ²²22. Wootton R, Bahaadinbeigy K, Hailey D. Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: proposal for quantitative synthesis in a systematic review. BMC Health Services Res [Internet]. 2011 [acesso 13 fev 2023];11:185. DOI: 10.1186/1472-6963-11-185 and public ³3. Chang V, Cao Y, Li T, Shi Y, Baudier P. Smart healthcare and ethical issues. In: International Conference on Finance, Economics, Management and IT Business [Internet]. Setúbal: SciTePress; 2019 [acesso 13 fev 2023]. p. 53-9. DOI: 10.5220/0007737200530059 https://doi.org/10.5220/0007737200530059... , ⁵5. Ortúzar M. Igualdad de acceso a la telesanidad en zonas rurales y aisladas: propuesta de un marco ético normativo integral de acceso y distribución. Rev Latinoam Bioet [Internet]. 2009 [acesso 13 fev 2023];9(1):76-93. Disponível: https://bit.ly/3X7S0PP https://bit.ly/3X7S0PP... , ¹⁸18. Montforta R, Brunsomsb D. Avances en la informatización de los sistemas de salud. Aten Primaria [Internet]. 2005 [acesso 13 fev 2023];36(8):448-52. DOI: 10.1157/13081059 costs	Difficulties in digital access/exclusion ⁵5. Ortúzar M. Igualdad de acceso a la telesanidad en zonas rurales y aisladas: propuesta de un marco ético normativo integral de acceso y distribución. Rev Latinoam Bioet [Internet]. 2009 [acesso 13 fev 2023];9(1):76-93. Disponível: https://bit.ly/3X7S0PP https://bit.ly/3X7S0PP... , ⁶6. Kuziemsky C, Hunter I, Gogia S, Lyenger S, Kulatunga G, Rajput V et al. Ethics in telehealth: comparison between guidelines and practice-based experience: the case for learning health systems. Yearb Med Inform [Internet]. 2020 [acesso 13 fev 2023];29(1):44-50. DOI: 10.1055/s-0040-1701976 , ⁹9. Rezende E, Melo M, Tavares E, Santos A, Souza C. Ética e telessaúde: reflexões para uma prática segura. Rev Panam Salud Pública [Internet]. 2010 [acesso 13 fev 2023];28(1):58-65: DOI: 10.1590/S1020-49892010000700009
Reduces the risk of transmitting infectious diseases ¹⁰10. Comité Consultatif National d’Éthique pour les Sciences de la Vie et de la Santé. Enjeux d’éthique liés aux outils numériques en télémédecine et télésoin dans le contexte de la COVID-19. Bulletin de Veille [Internet]. 2020 [acesso 13 fev 2023];3. Disponível em: https://bit.ly/3qRJN6k https://bit.ly/3qRJN6k...	High pace of change ¹²12. Catapan S, Calvo M. Teleconsulta: uma revisão integrativa da interação médico-paciente mediada pela tecnologia. Rev Bras Educ Med. [Internet]. 2020 [acesso 13 fev 2023];44(1):e003. DOI: 10.1590/1981-5271v44.1-20190224.ING , ¹⁷17. Osman M, Schick-Makaroff K, Thompson S, Bialy L, Featherstone R, Kurzawa J et al. Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review. BMJ Glob Health [Internet]. 2019 [acesso 13 fev 2023];4(5):e001629. DOI: 10.1136/bmjgh-2019-001629
Increases security in providing care to potentially dangerous patients ²³23. Yellowlees P, Chan SR, Parish MB. The hybrid doctor-patient relationship in the age of technology: telepsychiatry consultations and the use of virtual space. Int Rev Psychiatry [Internet]. 2015 [acesso 13 fev 2023];27(6):476-89. DOI: 10.3109/09540261.2015.1082987	Work overload/difficulty for healthcare providers to integrate this methodology into their workflow ¹²12. Catapan S, Calvo M. Teleconsulta: uma revisão integrativa da interação médico-paciente mediada pela tecnologia. Rev Bras Educ Med. [Internet]. 2020 [acesso 13 fev 2023];44(1):e003. DOI: 10.1590/1981-5271v44.1-20190224.ING , ²⁰20. Segrelles G, López-Padilla D, Granda-Orive JI. Ventajas e inconvenientes de la telemedicina en el manejo de pacientes con enfermedades crónicas respiratorias. Arch Bronconeumol [Internet]. 2016 [acesso 13 fev 2023];52(12):575-6. DOI: 52. 10.1016/j.arbres.2016.05.016 https://doi.org/10.1016/j.arbres.2016.05...
Decreases social stigma, especially in small environments ²³23. Yellowlees P, Chan SR, Parish MB. The hybrid doctor-patient relationship in the age of technology: telepsychiatry consultations and the use of virtual space. Int Rev Psychiatry [Internet]. 2015 [acesso 13 fev 2023];27(6):476-89. DOI: 10.3109/09540261.2015.1082987 , ²⁴24. Giota K, Kleftaras G. Mental health apps: innovations, risks and ethical considerations. Ehealth Telecommun Syst Netw [Internet]. 2014 [acesso 13 fev 2023];3:19-23. DOI: 10.4236/etsn.2014.33003 https://doi.org/10.4236/etsn.2014.33003...	Absence of physical examination and other indicators that can only be collected in person ¹²12. Catapan S, Calvo M. Teleconsulta: uma revisão integrativa da interação médico-paciente mediada pela tecnologia. Rev Bras Educ Med. [Internet]. 2020 [acesso 13 fev 2023];44(1):e003. DOI: 10.1590/1981-5271v44.1-20190224.ING , ¹⁶16. Gioia G, Salducci M. Medical and legal aspects of telemedicine in ophthalmology. Rom J Ophthalmol [Internet]. 2019 [acesso 13 fev 2023];63(3):197-207. Disponível: https://bit.ly/42LoJeI https://bit.ly/42LoJeI...
Increases patient satisfaction ⁴4. Ferreira D. Teleconsultas: ir ao hospital sem sair de casa: implicações na relação médico-doente. Medicina Interna [Internet]. 2018 [acesso 13 fev 2023]. DOI: 10.24950/rspmi/Opiniao/1/2018 , ²³23. Yellowlees P, Chan SR, Parish MB. The hybrid doctor-patient relationship in the age of technology: telepsychiatry consultations and the use of virtual space. Int Rev Psychiatry [Internet]. 2015 [acesso 13 fev 2023];27(6):476-89. DOI: 10.3109/09540261.2015.1082987 , ²⁵25. Wang Z, Deng Z, Wu X. Status quo of professional-patient relations in the internet era: bibliometric and co-word analyses. Int J Environ Res Public Health [Internet]. 2019 [acesso 13 fev 2023];16(7):1183. DOI: 10.3390/ijerph16071183 26. Caldwell B, Bischoff R, Derring-Palumbo K, Liebert J. Best practices in the online practice of couple and family therapy. AAMFT [Internet]. 2017 [acesso 13 fev 2023]. Disponível: https://bit.ly/3XabWBA https://bit.ly/3XabWBA... - ²⁷27. Welch BM, Marshall E, Qanungo S, Aziz A, Laken M, Lenert L, Obeid J. Teleconsent: a novel approach to obtain informed consent for research. Contemp Clin Trials Commun [Internet]. 2016 [acesso 13 fev 2023];3:74-9. DOI: 10.1016/j.conctc.2016.03.002	Consumerism/increased demand for trivial matters and ease of access ⁵5. Ortúzar M. Igualdad de acceso a la telesanidad en zonas rurales y aisladas: propuesta de un marco ético normativo integral de acceso y distribución. Rev Latinoam Bioet [Internet]. 2009 [acesso 13 fev 2023];9(1):76-93. Disponível: https://bit.ly/3X7S0PP https://bit.ly/3X7S0PP... , ¹⁰10. Comité Consultatif National d’Éthique pour les Sciences de la Vie et de la Santé. Enjeux d’éthique liés aux outils numériques en télémédecine et télésoin dans le contexte de la COVID-19. Bulletin de Veille [Internet]. 2020 [acesso 13 fev 2023];3. Disponível em: https://bit.ly/3qRJN6k https://bit.ly/3qRJN6k... , ³⁰30. Vidal-Alaball J, López Seguí F. Ha llegado para quedarse: beneficios e inconvenientes de la eConsulta. Atención Primaria Práctica [Internet]. 2020 [acesso 13 fev 2023];2(1-2):100043. DOI: 10.1016/j.appr.2020.100043 , ³³33. Leão CF, Coelho MES, Siqueira AO, Rosa BAA, Neder PRB. O uso do WhatsApp na relação médico-paciente. Rev. Bioét. (Impr.) [Internet]. 2018 [acesso 13 fev 2023];26(3):412-9. DOI: 10.1590/1983-80422018263261 , ³⁵35. Martinez-Martin N, Kreitmair K. Ethical issues for direct-to-consumer digital psychotherapy apps: addressing accountability, data protection, and consent. JMIR Ment Health [Internet]. 2018 [acesso 13 fev 2023];5(2):e32. DOI: 10.2196/mental.9423 , ³⁶36. Ho A, Quick O. Leaving patients to their own devices? Smart technology, safety and therapeutic relationships. BMC Med Ethics [Internet]. 2018 [acesso 13 fev 2023];19(1):18. DOI: 10.1186/s12910-018-0255-8
Improved communication between patient and healthcare provider ²⁰20. Segrelles G, López-Padilla D, Granda-Orive JI. Ventajas e inconvenientes de la telemedicina en el manejo de pacientes con enfermedades crónicas respiratorias. Arch Bronconeumol [Internet]. 2016 [acesso 13 fev 2023];52(12):575-6. DOI: 52. 10.1016/j.arbres.2016.05.016 https://doi.org/10.1016/j.arbres.2016.05... , ²⁵25. Wang Z, Deng Z, Wu X. Status quo of professional-patient relations in the internet era: bibliometric and co-word analyses. Int J Environ Res Public Health [Internet]. 2019 [acesso 13 fev 2023];16(7):1183. DOI: 10.3390/ijerph16071183 , ²⁸28. Sabesan S, Allen D, Caldwell P, Loh PK, Mozer R, Komesaroff PA et al. Practical aspects of telehealth: doctor-patient relationship and communication. Intern Med J [Internet]. 2014 [acesso 13 fev 2023];44(1):101-3. DOI: 10.1111/imj.12323 https://doi.org/10.1111/imj.12323... , ²⁹29. Denecke K, Bamidis P, Bond C, Gabarron E, Househ M, Lau AY et al. Ethical issues of social media usage in healthcare. Yearb Med Inform [Internet]. 2015 [acesso 13 fev 2023];10(1):137-47. DOI: 10.15265/IY-2015-001	Patients may consider that the remote consultation should not be charged ³⁷37. Frade S, Rodrigues H. Benefits, challenges and impact of teleconsultation: a literature review. Stud Health Technol Inform [Internet]. 2013 [acesso 13 fev 2023];192:1157. DOI: 10.3233/978-1-61499-289-9-1157
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[1] Correspondence: Marta Sofia Batista Capelo – Estrada Nacional, 16, Outeiro de S. Miguel CEP 6300-035. Guarda, Portugal.