Picture: 123RF
Picture: 123RF

UPDATE: The Health Professions Council of SA on Thursday temporarily relaxed its restrictions banning telemedicine, allowing doctors to be paid for online consultations with existing patients.

It sent a letter to medical organisations stating that occupational, speech and physiotherapists can also share rehabilitation exercises or advice over the phone or through a video call with existing patients. Psychologists offering counselling can treat new patients on the telephone. The council's letter made it clear the permission to practice telemedicine was only for the duration of the Covid-19 pandemic.

Doctors are pleading for the medical regulator to allow them to consult via video and voice calls to keep vulnerable patients safe at home and ensure that those with Covid-19 symptoms don’t come into busy waiting rooms.

The rule forbidding such consultations has been contentious for years as "telemedicine" has come into vogue in some parts of the world. And in recent weeks, calls by doctors to relax the rules have reached fever pitch.

The Health Professions Council of SA (HPCSA), which regulates doctors, is yet to make a decision.

The restriction means health professionals cannot bill for video consultations because most medical aids won’t refund them in full.

And there are other risks.

Johann Serfontein, a health-care consultant at HealthMan, says: "Malpractice insurance firms judge health professionals by HPCSA rules and if the rules do not change, psychologists, psychiatrists and other professionals will not have indemnity cover when participating in telemedicine. Many will not accept such financial risk and patients will suffer."

However, Discovery medical scheme encourages and pays its GPs to consult with existing patients over its own video platform and is offering training this week. It told doctors that its platform "is an essential tool, especially with a national lockdown looming".

The SA Medical Association (Sama) has joined calls for the regulator to relax the limitations.

"Telemedicine has emerged as a crucial element of the response to coronavirus in many countries and enables patients to contact health providers from their homes … without endangering health-care workers and other patients," says Sama president Angelique Coetzee.

"In light of the extraordinary situation in which we find ourselves, we call on the department of health as well as the HPCSA to advocate … telemedicine," she says.

HPCSA registrar Kgosi Letlape tells the FM that Sama’s request is being considered. The council is not against dropping the limits, and a decision will be made as soon as possible, he says. However, Letlape cannot give a timeline.

The Trump administration announced last week that it was expanding Medicare services to pay doctors for telemedicine. Medicare provides cover for people over 65 and for the disabled.

At a meeting with health minister Zweli Mkhize last week, members of Sama appealed to the department to ensure the HPCSA relaxes its rules.

And Ames Dhai, head of the Steve Biko Centre for Bioethics at Wits University, who was instrumental in writing the regulations that prevent video consultations, now says an exception should be made for Covid-19 cases.

"The virtual consult is not for all illnesses but for patients that suspect that they could have Covid-19," she says.

Remote doctoring would also offer protection for health workers. And doctors who are exposed to infected people and then self-isolate are at least temporarily lost to the health system. Karin Morrow, a Durban GP, has had more than one patient test positive. To avoid becoming a carrier, she has opened her phone lines to help patients remotely.

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