The prevalence of telehealth has increased markedly in the past two years. It is no surprise that healthcare professionals want clarity on the rules and guidelines they must adhere to when consulting remotely, writes Dr Tony Behrman, medico-legal consultant at Medical Protection Society (MPS).
Dr Behrman writes:
Medical Protection Society (MPS) welcomes the news that the Health Professions Council of South Africa (HPCSA) has published a new version of Booklet 10 dated December 2021, with revisions relating to telehealth.
I suspect many clinicians, who perhaps felt in the dark on the issue of remote consultations, are also glad that Booklet 10 has been updated.
However, while any clarity on telehealth is to be welcomed, MPS has several serious concerns about the latest guidelines, and we recently wrote to HPCSA to seek clarity.
MPS provides expert advice to members who face complaints or claims, while also carrying out extensive risk prevention work with a focus on promoting safer practice though the application of risk prevention techniques. However, to carry out these functions effectively, we believe the profession requires clarification on certain points in the latest guidance release via Booklet 10.
There are several specific areas of inconsistency where we have sought clarity. However, one more general aspect of the guidance stands out among the rest.
A passage of section 3.4 states:
3.4 The usage of social media platforms for the purpose of telehealth is not desirable.
Health practitioners are advised not to interact with patients via social media platforms as a failure to maintain strictly professional relationships with patients could result in ethical dilemmas.
The guidance then goes on to name a variety of social media platforms the use of which is undesirable.
We understand the guidance seeks to avoid failures in maintaining strictly professional relationships with patients. However, is it the use of these and other specific social media platforms to conduct a remote consultation platform that is disapproved, or the potential for misconduct itself?
South Africans are very digitally connected and the HPCSA must be aware of the pervasive use of ‘WhatsApp’ and ‘Telegram’ in this country. Chances are, you are reading this article on a smartphone that also has several of these apps. Given the prevalence of social media, we think this section in Booklet 10 requires more specificity – including to what extent instant messaging platforms and mobile applications are completely prohibited, or just discouraged.
Another area requiring urgent clarification is around the definition of a practitioner. The updated guidelines omit defining a ‘servicing practitioner’ and now instead refer to the ‘practitioner in charge’. While it is acceptable to use a new term, we found that the old term ‘servicing practitioner’ still remains, but is undefined, within the text of Booklet 10 in several places.
Booklet 10 also defines a specialist consulting remotely via telehealth, with a practitioner in charge referred to as ‘consulting practitioner’.
While this may seem an overtly semantic point, in this case the words do matter. As per page 4 of Booklet 10:
“Healthcare practitioner” means a person providing health services, registered in terms of the Health Professions Act No 56 of 1974, to include any other appropriate disciplines as defined in the National Health Act No 61 of 2003.
“Practitioner in charge” refers to the practitioner who conducts a “face-to-face” interview or examination with the patient or refers patient’s information to a remote location for further advice or intervention.
Thus the term ‘healthcare practitioner’ is an umbrella term for both the practitioner in charge as well as the consulting practitioner.
Furthermore, we highlighted to HPCSA that a ‘consulting practitioner’ (the one who offers remote services), cannot be a ‘practitioner in charge’, however there are multiple instances throughout Booklet 10 where each of these terms is used interchangeably.
While the HPCSA is to be commended for updating its guidance on telehealth in the face of unprecedented adoption of remote consulting, the guidance itself contains a number of inconsistencies and unanswered questions.
Plaintiff attorneys will be keenly aware of these inconsistencies, and MPS believes that any guidance must be watertight.
As always, if MPS members have any questions about the practice of telehealth, they can contact MPS for medico-legal assistance.
See more MPS columns from MedicalBrief archives:
Doctors see benefits of telehealth — concerned some patients may get left behind
MPS welcomes ‘essential’ incident and complaint guidance from DoH
MPS launches research initiative to improve patient safety, clinician well-being