WELCOME TO THE ERA OF CYBERMEDICINE

WELCOME TO THE ERA OF

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.

HEALTH ISSUES

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.

SUPPORTING ABSENTEEISM?

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.”

GLOBAL RISE OF CYBERMEDICINE

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.