Australian medical authorities have instituted measures designed to prevent online medical clinics from prescribing drugs to patients without ever having seen them or spoken to them, in a regulatory crackdown on “tick and flick” medicine.
The Medical Board of Australia has instructed doctors not to prescribe medicine via quizzes, text or email if they have never spoken to the patient, reports The Sydney Morning Herald.
That model has become popular at start-ups such as InstantScripts, Eucalyptus and Mosh, which used it to attract customers who enjoyed the convenience.
Board chair Dr Anne Tonkin said that telehealth, which surged in popularity during the pandemic, was important to patients struggling to get to a doctor, including people in remote areas. But she said there was a gap between online drug companies and good medicine that algorithms could not breach.
“A doctor who has not consulted directly with the patient and does not have access to their medical records is unable to exercise good, safe clinical judgment,” she said.
“Consultations enable a doctor to ask follow-up questions that help identify the best treatment, including when they have previously been given a script by another doctor.”
The changes, which come into effect on 1 September, will not prevent a patient from consulting a new doctor over the phone or via video call – and being prescribed medicine – though the medical board has told doctors that video calls are better than telephone calls.
The new guidelines also have some ambiguity about the circumstances in which a doctor, who has spoken to a patient, or whose colleague has, can then prescribe via a form.
“The board recognises that it may be appropriate for a patient’s usual medical practitioner or another health practitioner with access to the patient’s clinical record to prescribe without a consultation in certain circumstances,” the new instructions read.
The provision is intended for a patient’s long-term local GP providing services like a repeat script of a birth control pill. If scripts are provided via telehealth, the doctor must be able to explain it was “appropriate and necessary”.
Eucalyptus chief executive Tim Doyle said his company supported the guidelines.
“We will, of course, implement the changes within the required timeframe,” said Doyle, whose start-up previously criticised the guidelines as “misconceived” and based on “mistaken assumptions” when they were in a similar draft form.
Many of the purely telehealth companies opposed the changes, arguing that their practices were safe and expanded patient access to medicine.
But gaps have previously been found in prescribing practices, with Eucalyptus and another company, Midnight Health, sending out weight-loss medication without having a photo or a video call with a patient to verify they required it.
Midnight Health’s majority owner NIB has since said it would require a video call or photo and backed the board’s changes, while Eucalyptus has asked its doctors to get a photo, but not mandated one.
InstantScripts’ chief operating officer, Richard Skimin, noted the guidelines and said they would not mean a significant change for his company because it already conducted 1000 live telehealth consultations every day.
Data show that across the entire medical industry, complaints about telehealth have jumped 400% since 2019-20 as the practice has grown since the onset of the pandemic.
The Medical Board opened consultation on a draft version of its changes late last year and received 770 submissions, with more than 650 from customers of two companies whose prescribing method was under threat.
See more from MedicalBrief archives:
Free 24/7 telehealth service relaunched in Western Cape
Doctors see benefits of telehealth — concerned some patients may get left behind
COVID opened the telemedicine door. Now to embed it