Dr Wynand Goosen, Chair of the SGFP
In 2007, there were 104 peer-reviewed definitions worldwide for telemedicine. In their 2010 report on the second global survey on eHealth, the WHO has adopted the following broad description: “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interest of advancing the health of individuals and their communities.”
The executive summary states that telemedicine should overcome geographical barriers and increase access to health care services. This would be beneficial for rural and underserved communities in developing countries and offer remote doctors access to otherwise unavailable specialist opinions, decreasing the number of referrals to off-site facilities.
Four fields were examined, namely teleradiology, teledermatology, telepathology and telepsychology. Globally, teleradiology has the highest rate of established service provision (33%). To my knowledge, it is currently also the most utilised telemedicine service in SA, especially in private practice.
The Society of General/Family Practitioners (SGFP) wholeheartedly supports the following statement from the report: “Ultimately, telemedicine should strengthen, rather than compete with, other health services.” Herein lies the crux of the problem we have with the services promoted by Hello Doctor.
Hello Doctor launched their services in April, stating in press releases that:
- They offer telephonic consultations with sick leave sent by sms to the patient.
- They will repeat every second chronic prescription, the other done by the patient’s doctor.
- They will diagnose disease based on the examination of patients by third parties such as nurses and pharmacists within a pharmacy, communicated telephonically to their medical practitioners.
- They will supply telephonic prescriptions of up to schedule five drugs on the basis of this diagnostic model.
On the initial website of Hello Doctor, the services above were also promoted to medical schemes, promising the schemes substantial savings on unnecessary expenditure towards doctor visits. Given the above, it is clear that Hello Doctor would have used telemedicine to go in direct competition with doctors, and especially GPs. These services have all since been removed from their website, after complaints from the SA Medical Association (Sama) and the SGFP (also a special interest group of Sama) to the Health Professions Council of SA (HSPCA) lead to the latter releasing a press statement warning doctors not to participate in Hello Doctor, as it is referring the matter to the undesirable business practice committee for investigation.
On 4 May, the HPCSA assured the SGFP that draft guidelines on telemedicine have been send to the boards for their input and that the guidelines have been drafted in line with existing ethical rules as they relate to consultations, sick notes and the issuing of prescriptions. Because the HPCSA has no jurisdiction over companies such as Hello Doctor, the SGFP suggests that a national telemedicine agency or department within the Department of Health be instituted to register and monitor all future business in this field.