Ban on virtual consults with new patients dangerous, doctors say
Unlike the rest of the world, SA will not allow medical doctors to use telemedicine for new patients during the Covid-19 pandemic
Medical organisations representing tens of thousands of doctors and therapists are unhappy that they are only permitted to use video or phone calls to only treat existing patients during the Covid-19 outbreak, saying the restriction is “wrong and dangerous”.
The Health Professions Council of SA (HPCSA), the regulator of doctors and therapists, had previously banned all forms of telemedicine except for allowing doctors to give a prescription over the phone.
Amid the coronavirus pandemic, doctors worldwide have embraced virtual consults to protect patients and reduce their need to come into waiting rooms and possibly be exposed to those infected with Covid-19.
Since mid-March, SA doctors have been lobbying the health minister and the regulator to ensure the ban on telemedicine is lifted. With many doctors self-isolating for two weeks at a time after diagnosing an infected patient, it is better for the constrained health system to allow much-needed doctors to work from home.
Last week, the HPCSA relaxed its restriction on telemedicine for the period of the coronavirus outbreak, as long as doctors, physio and speech therapists only help existing patients via video call. The new guidelines only permit psychologists to use video or telephone calls to counsel new patients.
The groups of outraged doctors and medical aids include the SA Medical Association (Sama), the Board of Healthcare Funders of SA, the Health Funders Association, the SA Private Practitioners Forum, the SA Society of Anaesthesiologists, and the United Forum of Family Practitioners.
“There is no rational basis for the guideline ... why would a doctor need a prior relationship with a patient to give advice about the coronavirus?” asked Sama president Dr Angelique Coetzee, speaking on behalf of all the groups.
The groups say forcing doctors to only treat existing patients “creates risk for patients who should ... comply with the national lockdown, rather than risk travelling to see a doctor who may have a roomful of sick patients”.
They also say the restriction “perpetuates the deep inequalities in the healthcare system by not allowing patients who, because of financial barriers ... have not had the opportunity to establish pre-existing relationships with doctors who are now willing to offer their services to them”.
The restriction means doctors or occupational therapists treating new patients via Skype or phone are not insured against negligence claims or cannot claim the costs of appointment from some medical aids.
The doctors say the ban restricts the reach of those who want to offer their clinical expertise beyond their existing patient base “at this crucial time”.
Doctors are trained to know that if a patient requires examination and then they can refer them to doctors rooms or hospitals.
The groups argue that the HPCSA’s guidelines are incongruent with telemedicine regulations around the world.
“Every country we are aware of is actively encouraging teleconsultations to protect the health of their critically needed, front-line medical doctors, as well as to prevent patients from unnecessary travel and exposure to potential cross-contamination and infection.”
Acupuncturists, chiropractors, homeopaths and Ayurvedic therapists have been permitted to practise telemedicine with new and old patients.
“We do not understand why [these] allied health professional are allowed to use telemedicine but medical doctors are restricted to do so?” Coetzee asked.
The medical aid and doctors’ organisations want the HPCSA to completely review its position on telemedicine once the pandemic is over, and to allow doctors to consult virtually, when they believe it appropriate, as in most other countries.
In light of global trends, Discovery Health Medical Scheme encourages GPs to treat existing patients using a video telemedicine platform.