For those who fall ill, just getting out of bed can pose a massive hurdle, let alone getting to a doctor’s appointment.
Key points:
- Online healthcare is growing, helping busy Australians get around GP wait times
- New guidelines will make telehealth use harder without real-time consults
- A peak business body says online services make it too easy for people to get medical certificates for time off work
But now growing online healthcare options means Australians can have prescriptions or medical certificates sent to their inbox within minutes.
They may be convenient, but the rise of these digital platforms has also caused a new crackdown and left experts concerned.
How do these services work?
Richard Skimin, the chief operating officer for one of these burgeoning services, InstantScripts, says the site can help with anything from prescription renewals to blood test and specialist referrals.
He says the service is “complementary” to GPs and helps alleviate demands on doctors and emergency rooms.
“While COVID increased the number of people who became familiar with telehealth, the returning and growing number of people using our service shows that there is a need for convenient, affordable digital healthcare services in Australia,” he said.
According to Mr Skimin, more than 1 million Australians have used the platform since its 2018 inception.
Prospective patients can access services such as a doctor consultation or prescription in just a few clicks.
This includes the distribution of medical certificates, where patients are directed to a short questionnaire that is assessed by an Australian-registered doctor — a practice questioned by employers’ groups.
These questions may ask for a patient’s symptoms, and whether they promise to see an in-person doctor if their symptoms do not improve.
“This service is for patients who are too unwell to leave their home or unable to access a doctor on the day of their illness,” Mr Skimin says.
“We have strict guidelines in place for the issuing of medical certificates and we decline 36 per cent of medical certificates requested due to not meeting our eligibility criteria.”
Big changes introduced this month
From the 1st of September, the Australian Health Practitioner Regulation Agency (AHPRA) Medical Board made it harder to provide healthcare without a real-time consultation.
Patients are no longer allowed to go online to ask a doctor for medical certificates or medicine unless they have already met face-to-face.
In cases where these methods are used, GPs now have to explain why telehealth consultation “was appropriate and necessary in the circumstances”, according to new guidelines.
The crackdown is aimed at targeting online telehealth services that use website and questionnaire methods to prescribe medication.
It is expected to have limited effect on traditional telehealth such as a phone or video call with your regular doctor when you cannot meet in-person.
A patient’s usual GP, or another health practitioner with access to their clinical record, can still prescribe without a face-to-face appointment.
“Prescribing medication is not a tick and flick exercise,” AHPRA board chair Anne Tonkin says of the changes.
“It relies on a doctor’s skill and judgement, having consulted a patient, and recognises that prescription medication can cause harm when not used properly.”
‘Not enough doctors to go around’
But for some Australians, the digital phenomenon is one of the only ways to seek medical help amid growing GP wait lists.
Maitland resident Laney Jordan says she has used online telehealth for issues such as chest infections or antibiotic prescriptions.
The mum of two says her use of digital telehealth was “borne out of necessity”.
Mrs Jordan says there are no bulk-billing doctors left in the region and her usual GP’s waitlist could be over a week long.
“We’ve had this population explosion since COVID and there’s just not enough doctors to go around,” she says.
“It’s certainly not something we’d use for major issues but when you really need to get into someone with a sick kid it’s just virtually impossible.
“For us, it’s just been a godsend knowing we’ve got access to a doctor when we actually need it.”
She believes more Australians will consider digital healthcare as the cost of living crisis cuts deeper.
“If I wanted to take my kids to the doctor it would have to be after-hours unless I take time off work,” Mrs Jordan said.
“These days for a doctor visit, you’re pushing the $80 mark, [where] we can actually have a conversation with a doctor on the phone and it’s $50.
“I think it will be something that will be taken up by more and more people.”
Mrs Jordan says it’s not in “your best interest” to hide health factors when completing the online questionnaires.
“All things can be abused and I guess it’s just a matter of who’s using it and how it’s regulated.”
Employers concerned over ‘inappropriate’ use
Medical experts are not the only ones concerned about the growing use of these sites.
The Australian Chamber of Commerce and Industry fears they may make it easier for employees to fake medical certificates.
Director of Workplace Relations Jessica Tinsley says “employers are right to be concerned that online certificates could be inappropriately issued.”
“If a certificate appears genuine, with the name and address of a doctor, their provider number and the date of consultation, then employers expect to take that at face value,” she says.
“Employers are not expected to be regulators of the health profession.
“It is essential that regulators ensure that doctors working on online platforms are carrying out their responsibilities in the same thorough way they would for face-to-face consultations.”
Australian Medical Association (AMA) vice-president Danielle McMullen says she would instead like to see more workplaces allow employees to “self-certify and stay home” without certificates.
“Mild illnesses can be a big burden on the health system when people can often be trusted to know that they’re just sick and don’t want to spread it around the workplace,” she says.
There is no strict Fair Work ruling on what type of evidence an employee needs to provide for sick leave, except that it has to convince a reasonable person.
Hard to provide ‘comprehensive healthcare’: AMA
Dr McMullen says the industry needs to more closely examine what “safe and effective” online telehealth is.
She noted many services, like sexual health advice, would remain unaffected by the AHPRA changes.
“While some of these websites might seem convenient, some of the website setups make it hard to provide comprehensive healthcare,” she says.
While affordability is a major incentive for users, Dr McMullen says many sites are ineligible for medical rebates and fail to take a whole-health history into account.
“We think that with all health concerns that need medical treatment or medication, you should have a consultation with a doctor, who will ask you about your symptoms and make sure you’re being offered the full range of medical options,” she says.
Mr Skimin says his company is already developing new processes that complied with the AHPRA changes.
“Asynchronous prescribing is just one of the services provided by InstantScripts,” he said.
“It is underpinned by a sound clinical governance framework, which is best emphasised by the fact that 35 per cent of requests for prescription are initially declined and referred to a telehealth consultation.”