There was rapid growth of telehealth practice during the COVID‐19 outbreak in 2020. In surgery, there were beneficial effects in terms of saving time and avoiding physical contact between healthcare professionals and patients when using telehealth in the delivery of perioperative care. As telehealth is gaining momentum, the evolving ethical and medico‐legal challenges arising from this alternative mode of doctor–patient interaction cannot be underestimated. With reference to the “Ethical Guidelines on Practice of Telemedicine” issued by the Medical Council of Hong Kong and some published court and disciplinary cases from other common law jurisdictions, this article discusses relevant ethical and medico‐legal issues in telehealth practice with emphasis on the following areas: duty of care; communication and contingency; patient‐centred care and informed consent; limitations and standard of care; keeping medical records, privacy, and confidentiality; and cross‐territory practice. Whilst existing ethical and legal obligations of practicing medicine are not changed when telehealth is used as opposed to in‐person care, telehealth practitioners are advised to familiarize themselves with the ethical guidelines, to keep abreast of the medico‐legal developments in this area, and to observe the licensure requirements and regulatory regimes of both the jurisdiction where they practice and where their patients are located.

The UK Supreme Court decision in Montgomery v Lanarkshire Health Board has overturned the use of the “accepted practice test” (Bolam) in deciding breach of duty cases related to risk disclosure and informed consent. Following Montgomery, a doctor is under a legal duty to take reasonable care to ensure his patient is aware of any material risks involved in the recommended treatment, and of any reasonable alternative or variant treatments. Based on Montgomery and a number of relevant published cases, this article highlights some practice caveats for surgeons to take note of when they participate in the consent process with the following headings: the objective and subjective elements of the legal test of materiality of risks; postoperative risks, follow‐up and management; timing and adequacy of risk disclosure; withholding information and therapeutic exception; and the incorporation of Montgomery into local professional code and case law. In order to minimize legal risks, surgeons are also encouraged to keep abreast of the medico‐legal development in this area, to reflect on their own practices, and to take proactive steps to enhance their interactions with patients.