The Daily Maverick recently painted a stark picture of South African healthcare: qualified doctors unemployed due to frozen government posts, public sector practitioners seeing 40 patients a day in 15-minute slots, and emergency room waiting times stretching to 40 hours. Against this backdrop, telemedicine (telehealth) platforms are emerging not merely as a convenience, but as a pressure valve for a system under strain.
Yet, write Dr Yash Naidoo, dento-legal consultant, and Dr Volker Hitzeroth, medico-legal consultant, at Medical Protection, as doctors increasingly turn to virtual consultations (whether to escape an overburdened public sector or to reach patients who cannot afford transport costs and time off work), questions about professional liability have emerged.
They write:
One healthcare professional indemnity insurer was reported to have said in the Daily Maverick article that “a primary examination should always be physical, because understanding your patient and obtaining a thorough history cannot be fully achieved virtually”.
While we respect this perspective, Medical Protection takes a different view, one which we believe is aligned with HPCSA guidance.
The regulator’s vision
The HPCSA’s position on telehealth has evolved considerably, particularly since the Covid-19 pandemic, which demonstrated that quality healthcare could be delivered remotely when circumstances demanded it.
The most recent version of Booklet 10 (General Ethical Guidelines for Good Practice in Telehealth, revised December 2021) provides clear guidance that contradicts the notion that initial consultations must be face-to-face.
The HPCSA explicitly acknowledges that “telehealth can contribute to achieving universal health coverage by improving access for patients to quality, cost-effective health services wherever they may be”. Further, the regulator notes that telehealth is “particularly valuable for those in remote areas, vulnerable groups, and ageing populations” – precisely the patients who benefit most when doctors can practise across multiple platforms and geographies.
Critically, while the HPCSA acknowledges the desirability of having an established professional relationship before conducting telehealth consultations, it explicitly states that “this is not a compulsory requirement”, depending on existing conditions.
The regulator’s guidance is clear: telehealth should replicate physical consultations as far as possible and is recognised as appropriate for various types of consultations, including routine care, specialist consultations, and even emergency situations where practitioners must make clinical judgments based on available information.
The decision to offer a remote rather than face-to-face consultation should be guided by clinical judgment in accordance with the HPCSA’s framework. The regulator’s guidelines specifically direct practitioners to consider the need to assess symptom severity, their existing knowledge of the patient and their medical history, whether physical examination is clinically necessary, and the patient’s broader social circumstances.
Technology as healthcare infrastructure
The transformation we are witnessing extends far beyond healthcare. We renew our car licences online rather than spending hours queuing at government departments. We conduct business via virtual meetings. The HPCSA itself conducts inquiries and consultations virtually.
Even our banking, commerce, and government services have migrated (or are slowly migrating) online – not because physical alternatives disappeared, but because digital delivery often proves more efficient, accessible, and in many cases, is safer.
For patients, the barriers to conventional healthcare are considerable: transport costs, time off work, childcare arrangements, exposure to infections in waiting rooms, and of course, the consultation fee itself. For a patient in a rural area, or a single parent, or someone working hourly wages, these barriers can mean the difference between seeking care and suffering in silence. Telehealth does not eliminate all of these barriers, but it does meaningfully reduce them.
The professional indemnity question
The liability considerations for telehealth consultations are, in principle, the same as those for face-to-face consultations. The fundamental obligation remains unchanged: practitioners may only perform professional acts for which they are adequately educated, trained, and sufficiently experienced, and they must do so under proper conditions and in appropriate surroundings. This aligns with both the HPCSA’s Ethical Rule 21, and its telehealth guidelines.
What does this mean practically?
First, telehealth must be conducted within your scope of practice. A virtual consultation does not expand what you are competent to diagnose or treat – it simply changes the delivery mechanism. The HPCSA distinguishes between routine telehealth, specialist consultations, and emergency telehealth where practitioners may need to make clinical decisions based on sub-optimal information.
In all cases, proper triage must be conducted, and practitioners must ensure their clinical judgment is not compromised by the limitations of the medium.
Second, you must understand and comply with the HPCSA’s ethical rules and telehealth guidelines. Importantly, the guidelines stipulate that no practitioner may render professional services exclusively through telehealth – a balanced approach that acknowledges both the value and limitations of virtual care.
While an established practitioner-patient relationship remains desirable where practical, the guidelines explicitly recognise that this is not always feasible or necessary, particularly when serving underserved populations.
Third, you must ensure compliance with relevant health and privacy laws, particularly the Protection of Personal Information Act (POPIA). The platforms you use should provide secure, compliant infrastructure for patient records and communications.
Fourth, practitioners should be aware that the HPCSA explicitly advises against using social media platforms like WhatsApp for telehealth consultations, as these may not provide adequate security or maintain appropriate professional boundaries.
Use platforms specifically designed for healthcare delivery that offer proper encryption, secure record-keeping, and POPIA compliance. While these consumer platforms may seem convenient, they expose both practitioners and patients to unnecessary risk.
Fifth, practitioners must ensure proper triage is conducted during telehealth consultations, and that the equipment and platforms used are optimally operational and regularly maintained. This is not merely about technology – it is about ensuring the quality of clinical information you receive is sufficient to make sound clinical decisions.
Whenever considering telehealth, assess not only if there are clinical contra-indications to a virtual consultation, but also whether it is appropriate for the individual patient you are treating, taking into account factors such as age, disability and technological ability.
Only proceed where you feel you can provide the same level of assessment or service that you would be able to provide if seeing the patient in person. The HPCSA’s guidelines also caution against over-servicing and perverse incentives – a legitimate concern in a multi-platform environment where practitioners may be tempted to maximise consultation volumes.
Practitioners working across telehealth platforms should be mindful that flexibility in practice delivery doesn’t justify unnecessary consultations or fragmented care that fails to serve patients’ genuine clinical needs. The goal is expanding access to quality care, not simply increasing transaction volumes.
Medical Protection’s position
Medical Protection is not an insurance company nor are the benefits of membership bound by rigid policy exclusions. Our discretionary indemnity model means we evaluate each matter on its individual merits, considering context and professional judgment rather than applying blanket restrictions.
Our view is that if you are practising telehealth – namely video/telephone consultations or follow-up non-synchronous contact with patients with whom you have a pre-existing real-time clinical relationship – within your scope of practice in compliance with HPCSA guidelines and relevant legislation, exercising proper triage, using appropriate and secure platforms, and maintaining the same standard of care you would provide in person, you should not hesitate to seek our assistance should a complaint or claim arise.
We recognise that South Africa’s healthcare landscape is evolving rapidly. Practitioners are increasingly working across multiple platforms – not because they are being reckless, but because technology is creating opportunities to practise in different and effective ways.
Conversely, we also recognise that many doctors will continue to see patients in person initially because they believe it is the most appropriate course of action for their care.
A progressive approach to professional indemnity means understanding these contexts and supporting practitioners who are meeting genuine healthcare needs while maintaining professional standards.
The question is not whether telehealth can ever substitute for a physical examination – of course there are clinical scenarios where hands-on assessment is essential, and practitioners must exercise judgment about when remote consultation is clinically appropriate.
The question is whether we, as a professional indemnity provider, will support doctors who are using appropriate clinical judgment to extend their reach to patients who might otherwise go without care.
Our answer is yes.
Conclusion
Telehealth represents neither a complete solution to South Africa’s healthcare crisis nor a threat to quality care. It is simply a tool.
One that, when used appropriately and within proper guidelines, can expand access, improve efficiency, and help practitioners sustain viable careers in an increasingly challenging environment.
The HPCSA has provided balanced guidance that recognises both the potential and the limitations of telehealth. Practitioners who follow these guidelines – maintaining professional standards, using secure platforms, conducting proper triage, avoiding over-servicing, and exercising sound clinical judgment – are practising within the bounds of ethical healthcare delivery.
Medical Protection will continue to support members who embrace innovation while maintaining professional standards. We believe the future of healthcare in South Africa requires both, and that practitioners should not have to choose between being progressive and being protected.
*This advice is only applicable to practitioners with MPS South African membership, treating patients located in South Africa. Any practitioners looking to undertake cross-border telemedicine should contact Medical Protection so we can review their individual practice.
See more from MedicalBrief archives:
Seeking clarity from HPCSA on telehealth
Doctors see benefits of telehealth — concerned some patients may get left behind
Should telehealth cost less than in-person visits?