From The Annals of A Telemedicine Expert Witness: Managing Cutaneous Drug Eruptions Via Telemedicine




This is a common chief complaint.



Usually a pretty benign problem, but in rare cases, it can evolve into Transient Epidermal Necrolysis (TEN).



TEN is catastrophic.



When it occurs, the pain and concomitant morbidity make for a perfect malpractice action.



From a pathophysiologic standpoint, once the cascade of events from drug exposure to TEN begins, there is nothing that can be done to interrupt it. Even stopping the offending medication won’t affect the severity and duration of the episode (though you should still do it).  All you can do is supportive care and skin grafting as needed as the patient recovers.



Those facts, however, won’t keep you from getting involved in a lawsuit.



Even if you’re eventually dropped, the experience won’t be worth the $25 you probably got paid for the encounter.



Think long and hard before treating these via a telemedicine cross coverage service.



Don’t mess their meds or recommend an anti-histamine. Refer them for an immediate in-person evaluation and document their understanding of the risks of not complying.



Doing otherwise is simply not worth the risk.