Reader's Digest Asia Pacific - - Contents - MARC MCEVOY

How on­line doc­tor ser­vices are chang­ing the GP–pa­tient re­la­tion­ship.

New dad Matt Shaw woke up one morn­ing with a nag­ging cough and a nose run­ning like a tap. The 35-year-old hos­pi­tal­ity worker from Mel­bourne knew he was un­fit for work, but his em­ployer, a city restau­rant, de­manded med­i­cal cer­tifi­cates from staff tak­ing just one day of sick leave.

“I’ve had many colds and I knew I didn’t need to see a doc­tor,” says Matt. “A doc­tor would have told me just to go back to bed and get some rest.”

So Matt searched on­line us­ing his phone and found a health­care ser­vice that pro­vides vir­tual con­sul­ta­tions with a doc­tor. “I was sit­ting in bed hav­ing a Skype video call on my phone with a doc­tor talk­ing about my symp­toms,” says Matt. “He said if my symp­toms per­sist I should go and see a doc­tor. He sent me a med­i­cal cer­tifi­cate through email and I didn’t need to leave the house.” Matt thought the on­line doc­tor, who was based at a doc­tor’s day surgery in Mel­bourne, asked all the right ques­tions to as­sess his con­di­tion. For­tu­nately, he did not need med­i­ca­tion, just rest, and his em­ployer ac­cepted the cer­tifi­cate.

Onl ine health­care is grow­ing around the world. We all have ac­cess to hun­dreds of thou­sands of web­sites and apps about health­care. Smart­watches even mon­i­tor our heart rate, kilo­joules burnt and sleep­ing pat­terns, and who hasn’t re­sorted to ‘Dr Google’ when we sus­pect we have an ill­ness?

Be­fore long we may have re­mote di­ag­nos­tics aided by home- based de­vices, in­clud­ing elec­tro­car­dio­gram ma­chines to mon­i­tor our heart, blood pres­sure, blood glu­cose and weight, in­for­ma­tion that helps treat hy­per­ten­sion, di­a­betes and heart dis­eases. One day we may even have com­plex med­i­cal pro­ce­dures per­formed in the com­fort of our own homes through ro­bot­ics.

A big ad­van­tage of on­line health­care, also called cybermedicine or tele­health, is the time it saves. Peo­ple seek­ing treat­ment for mi­nor ail­ments no longer need to visit a doc­tor or waste time in wait­ing rooms. They sim­ply log on to a web­site or app

from their sick bed and dis­cuss their ill­ness with a doc­tor via video on their com­puter or smart­phone.

And it is cheap. On­line ser­vices of­fer con­sul­ta­tions for a fee that can be sig­nif­i­cantly lower than what gen­eral prac­ti­tion­ers charge for see­ing pa­tients in their surg­eries. In Aus­tralia, a ten-minute on­line con­sul­ta­tion typ­i­cally costs $19.99 and while it doesn’t get a Medi­care re­bate it can still be less than the gap that pa­tients pay for a face-to-face con­sul­ta­tion that gets a $37.05 re­bate. Most on­line ser­vices use the free video-chat app Skype and is­sue pre­scrip­tions and med­i­cal cer­tifi­cates via email.


But at the same time, there are con­cerns about the ef­fi­cacy and safety of on­line health­care.

While an on­line con­sul­ta­tion may seem con­ve­nient and cheap, med­i­cal pro­fes­sion­als are con­cerned pa­tients may be pro­vided with a med­i­cal cer­tifi­cate or pre­scrip­tion with­out a full ex­am­i­na­tion or med­i­cal his­tory. Far from wor­ry­ing about a doc­tor’s time be­ing wasted when is­su­ing med­i­cal cer­tifi­cates, Aus­tralian Med­i­cal As­so­ci­a­tion (AMA) pres­i­dent Dr Tony Bar­tone says most GPs are happy to have peo­ple come into the surgery for a piece of pa­per. Why? It cre­ates an op­por­tu­nity to dis­cuss other po­ten­tial health is­sues. He be­lieves this is par­tic­u­larly per­ti­nent for men who are not fans of vis­it­ing the doc­tor.

“Med­i­cal cer­tifi­cates are an im­por­tant le­git­i­mate and le­gal doc­u­ment,” says Dr Bar­tone. “It is about putting your health first and un­der­stand­ing your need to take time off. For some peo­ple, com­ing in to their GP for a med­i­cal cer­tifi­cate is the only time we get to see them. It’s an op­por­tu­nity for op­por­tunis­tic pre­ven­ta­tive care. In­ter­ven­ing at an ear­lier stage and mak­ing changes for bet­ter long- term health­care.”

The most com­mon ail­ments on­line doc­tors treat in­clude the com­mon cold, sore throat, gas­troen­teri­tis, mi­graine, pe­riod pain, un­com­pli­cated lower back pain and mi­nor in­juries. Treat­ment for con­tra­cep­tion, sex­ual health, men’s health is­sues (such as pre­ma­ture ejac­u­la­tion and erec­tile dys­func­tion), asthma and hayfever are also reg­u­larly pre­scribed.

Ol­lie Ap­ple­gate is a Bri­tish cit­i­zen, who has lived in Aus­tralia for over two years on a part­ner visa. He is seek­ing res­i­dency so he can live here with his Aus­tralian wife and their daugh­ter, who was born last year. Ol­lie, a 37-year-old project man­ager,

How­ever, there are con­cerns about the ef­fi­cacy and safety of on­line health­care

has ac­cess to Medi­care through a re­cip­ro­cal ar­range­ment with Bri­tain’s Na­tional Health Ser­vice, but when he came down with a cold and couldn’t go to work, he tried an on­line doc­tor.

“I had a cold and a headache, but I knew it wasn’t flu. I phoned an ­on­line ser­vice and they did a re­quest call back and Skype video call,” says Ol­lie. “The doc­tor asked a series of ques­tions to con­firm what was wrong with me then a course of ac­tion, which was to stay in bed and take parac­eta­mol for my headache.”

Ol­lie’s con­sul­ta­tion was done on his mo­bile phone and he was emailed a med­i­cal cer­tifi­cate for work. He thinks on­line health­care would suit trav­ellers or for­eign stu­dents who don’t have ac­cess to Medi­care.


Em­ploy­ers re­main wary about the ease with which on­line doc­tors is­sue med­i­cal cer­tifi­cates. Ac­cord­ing to ­Peter Wil­son, chair­man of the Aus­tralian Hu­man Re­sources In­sti­tute, Aus­tralian work­ers av­er­age 110 mil­lion sick leave days a year, with each tak­ing about nine days an­nu­ally. Sick leave costs the Aus­tralian econ­omy more than $30 bil­lion a year in lost pro­duc­tiv­ity and leave costs.

Wil­son warns that is­su­ing on­line med­i­cal cer­tifi­cates dis­ad­van­tages em­ploy­ers. “It sets a low bar on whether some­body is sick or not,” he says. “We ad­vise em­ploy­ers not to ac­cept th­ese types of prac­tices for sick leave be­cause it’s not the most ef­fec­tive way to come to terms with a per­son’s health and fit­ness for work.”

About 400,000 med­i­cal con­sul­ta­tions are con­ducted each day in Aus­tralia. On­line con­sul­ta­tions cur­rently make up only a tiny frac­tion of this. The AMA says it is con­cerned that “on­line ser­vices com­pro­mise pa­tient care for the sake of con­ve­nience”, while the Royal Aus­tralian Col­lege of Gen­eral Prac­ti­tion­ers (RACGP) says some on­line ser­vices frag­ment health­care and this can be a risk to pa­tient safety. RACGP pres­i­dent Dr Bas­tian Seidel says this can hap­pen when a pa­tient seeks help from, for ex­am­ple, five doc­tors. “One is phys­i­cal and four are on­line, and we have no­body there putting things to­gether,” he says. “That leads to poorer health out­comes.”


While de­mand for on­line and re­mote med­i­cal ser­vices (such as Qoc­tor, Doc­toroo and Doc­torsOnDe­mand) in Aus­tralia may cur­rently be small, the same isn’t true over­seas. Te­ladoc, based in New York, be­gan ser­vices in 2002. To­day, it claims to have 20 mil­lion mem­bers and pro­vides on­line con­sul­ta­tions 24 hours a day. An­other Amer­i­can tele­health provider, Bun­doo, a pae­di­atrics ser­vice for par­ents, claims to have 850,000 unique users a month.

In Canada, Ask­theDoc­tor re­port­edly

has 250,000 doc­tors world­wide pro­vid­ing on­line con­sul­ta­tions to five mil­lion pa­tients in the US, Canada, Bri­tain and In­dia. Sim­i­lar ser­vices in­clude Se­hat in In­dia and Pak­istan, Dr Fox in the UK and We­bDoc­tor in Ire­land.

In New Zealand, Swiftmed of­fers video con­sul­ta­tions and pre­scrip­tions for con­di­tions that don’t re­quire a phys­i­cal ex­am­i­na­tion, such as asthma, hayfever, thrush and in­som­nia, while Doc­tor2Go of­fers on­line care from GPs, nurses and men­tal health pro­fes­sion­als 24 hours day.

Ad­vances in tech­nol­ogy will even­tu­ally al­low more med­i­cal con­sul­ta­tions and pro­ce­dures to be per­formed on­line. “As tech­nol­ogy ad­vances and al­lows pa­tients to up­load their own ex­am­i­na­tion find­ings via re­mote di­ag­nos­tics, it will mean that more com­pre­hen­sive as­sess­ment will be pos­si­ble with­out a doc­tor need­ing to be in the same room,” says Aus­tralian dig­i­tal doc­tor ser­vice ­Qoc­tor CEO Dr Aifric Boy­lan.

In a world where time and money are stretched, tech­nol­ogy is in­creas­ingly be­ing ask­ing to chal­lenge the sta­tus quo with on­line so­lu­tions. With the next decade set to see pa­tients per­form­ing sim­ple tests such as blood pres­sure on them­selves and up­load­ing the read­ings to a doc­tor lo­cated any­where in the world, the pos­si­bil­i­ties are end­less.

The med­i­cal break­throughs of the fu­ture are fast be­com­ing the re­al­ity of to­day, and per­haps the world of the on­line doc­tor con­sul­ta­tion is sim­ply set­ting us up for what lies ahead.

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