Medical organisations – including 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 – 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”.
Business Day reports that 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, South African doctors have been lobbying the health minister and the regulator to ensure the ban on telemedicine is lifted. The report said 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.
“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 groups argue that the HPCSA’s guidelines are not congruent with telemedicine regulations around the world.
Sama said in a letter to the HPCSA:
On behalf of medical doctors, medical schemes and medical scheme administrators across South Africa we wish to express our gravest concern with the HPCSA Medical Board Guidelines on Telemedicine which were released on Thursday 26th March 2020.
The HPCSA is maintaining a baseless view that doctors can only consult with patients remotely, using telemedicine technology, if they have a pre-existing relationship with the patient they are consulting. The only exception the HPCSA has allowed for this is for consultations conducted by mental health professionals.
Our view of these HPCSA guidelines are clear. They are wrong and dangerous for the following reasons:
- There is no rational basis for them. The HPCSA has not presented any facts or evidence nor has it explained the basis for maintaining its position. Why would a doctor need a prior relationship with a patient to give advice about the Corona virus?
- This position is incongruent with telemedicine regulations across the globe. Every country we are aware of is actively encouraging tele consultations 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.
- It creates immediate and material risk for the doctors of our country. Instead of being able to provide sound advice remotely, they are being forced to see patients in person. By removing infected doctors from the front-line of healthcare delivery, this ruling will also lead to the weakening of our healthcare system as a whole, precisely at the time when we should be doing everything in our power to strengthen it.
- It also creates risk for patients who should stay indoors and comply with the national lock-down, rather than risk travelling to see a doctor who may have a roomful of sick patients.
- It perpetuates the deep inequalities in the health care system by not allowing patients who, because of long-standing financial and structural barriers in our health system, have not had the opportunity to establish pre-existing relationships with doctors who are willing to offer their services to them.
- Related to this, it dramatically restricts the reach of doctors who want to offer their clinical expertise and services beyond their existing patient base at this crucial time for our country.
- It also reduces access to healthcare and undermines the ability of doctors to earn income as patients would rather not consult a doctor in-person for fear of infection during this outbreak. The knock-on effects of this on overall public health and on the flow of income for doctors will be severe.
- It appears to contradict the statements of both the President of the country and our Minister of Health who have advocated the use of telemedicine in our fight against this disease.
- It is also in stark contrast to the Guidelines released for Allied Health Professionals which allows unfettered use of telemedicine for these healthcare professionals. We do not understand why allied health professionals should be allowed to use telemedicine whereas medical doctors cannot.
We demand that the HPCSA change its guidelines for medical doctors with immediate effect, to allow doctors to conduct consultations remotely and particularly during the current state of emergency and COVID-19 pandemic. We also call on the HPCSA to conduct a thorough review of its position after the pandemic is over, and to allow doctors to conduct virtual consultations as and when the feel that this is appropriate, as is the case in most other countries.
Meanwhile, a new national medical support hotline has been launched to assist South Africans, reports Business Insider. Called “Doctors on Call” it is offering to provide free medical advice to South Africans from more than 450 medical doctors who have voluntarily committed their professional time and expertise to the initiative.
Callers will still pay the normal cost of the call.
The report says the initiative was launched by Nedbank, the KwaZulu-Natal Doctors Healthcare Coalition, Usizo Advisory Solutions and the University of Cape Town's online collaboration and learning system app Vula to help give support and immediate advice to concerned South Africans who may start showing symptoms of the coronavirus.
“Support for this programme could help flatten the curve, save our health system from being overwhelmed, protect our economy and ultimately save lives,” said project leader Dr Anuschka Coovadia.
Calls will be screened before being routed for a telephonic consultation with a doctor, for advice relating specifically to COVID-19.Full Business Day report SAMA letter Guidelines: Telehealth and Telemedicine as a result of South Africa’s State of Disaster Full Business Insider report
The CMS issues COVID-19 circular on Telemedicine