Does managing a patient with suspected strep throat and an abscess via telemedicine increase the risk of litigious actions for the provider?

Managing Strep Throat with Abscess via Telemedicine: Legal Liability Considerations

Providing care for a patient with suspected strep throat and an abscess via telemedicine significantly increases the risk of litigious actions for the provider, as proper diagnosis of peritonsillar abscess requires in-person examination.

Limitations of Telemedicine for Diagnosing Peritonsillar Abscess

• Peritonsillar abscess is the most common deep infection of the head and neck, requiring physical examination for proper diagnosis 1
• Diagnosis of peritonsillar abscess typically requires direct visualization and examination for key clinical findings including trismus (limited mouth opening), deviation of the uvula, and fluctuance of the peritonsillar area 1
• Telemedicine platforms do not allow for adequate physical examination needed to properly diagnose a peritonsillar abscess, which is a suppurative complication of strep throat 2
• The Infectious Diseases Society of America specifically notes that "additional diagnostic and therapeutic measures may be necessary for patients with suppurative complications (e.g., peritonsillar abscess or cervical lymphadenitis)" beyond standard pharyngitis management 2

Legal Vulnerability Despite Patient Choice of Care Modality

• The 2024 NICE guidelines explicitly state: "Do not routinely prescribe antimicrobials based on a remote assessment" and recommend arranging face-to-face assessment when considering antimicrobial treatment 2
• Patient choice of telemedicine does not absolve the provider of the standard of care, which includes proper examination for complications of pharyngitis 2
• The American College of Physicians notes that telemedicine "may not be appropriate for all patients or conditions" and specifically mentions that "the lack of physical interaction can affect the type of care a patient may receive and the degree to which a physician can examine the patient" 2
• Missing a peritonsillar abscess can lead to serious complications including airway obstruction, aspiration, or extension of infection into deep neck tissues, which could form the basis for malpractice claims 1

Risk Mitigation Strategies

• Providers should clearly document the limitations of telemedicine assessment and recommend in-person evaluation when complications like abscess are suspected 2
• Safety netting advice should be provided, ensuring patients know when and how to seek medical help if symptoms worsen rapidly or significantly 2
• Consider the threshold for treatment or referral for further assessment to be lower for patients with concerning symptoms that might indicate complications 2
• Clearly document that the patient was advised of the need for in-person evaluation to rule out complications such as peritonsillar abscess 2

Proper Management Approach

• Suspected peritonsillar abscess requires drainage of the abscess, appropriate antibiotic therapy, and supportive care - procedures that cannot be performed via telemedicine 1
• The standard of care for peritonsillar abscess includes direct visualization, possible incision and drainage, and close monitoring - all requiring in-person evaluation 1
• Streptococcal pharyngitis with complications like abscess formation requires more aggressive management than uncomplicated cases 2
• Failure to identify and properly manage a peritonsillar abscess could lead to serious complications including toxic shock syndrome in rare cases 3

Conclusion

The provider is not protected from liability simply because the patient chose telemedicine. When complications like peritonsillar abscess are suspected, the standard of care requires recommending in-person evaluation, regardless of the patient's preference for telemedicine. Failure to do so significantly increases liability risk for the provider.