This appeared last week:
Medical board sets sights on tele-only docs
Prescribing medicine for a patient you have never consulted with in real time is not good practice, according to draft guidelines.
Doctors who prescribe medicines to patients they’ve only interacted with via text, email or online asynchronous appointments should be prepared to justify their actions, the Medical Board warns.
The board, which is supported by AHPRA, laid out its stance on telehealth-only medicine in a draft set of new guidelines for telehealth consults.
The current guidelines for technology-based consults have not been updated since 2013.
Most of the proposed changes are relatively minor – e.g. changing the terminology from “technology-based consultations” to “telehealth” and shuffling the order of sections – but the section on prescribing without live consulting is brand new.
It appears to zero in on a certain style of telehealth that has been adopted by some corporates.
Practice that is not supported by the board “includes requests for medication communicated by text, email or online that do not take place in real time and are based on the patient completing a health questionnaire but where the practitioner has never spoken with the patient,” it said.
“Any practitioner who prescribes for patients in these circumstances must be able to explain how the prescribing and management of the patient was appropriate and necessary in the circumstances.”
While there isn’t a direct penalty associated with bad practice, the board did not rule out the potential for consequences.
“In terms of consequences, there is not an algorithm that links a specific action and consequence,” a spokesman told The Medical Republic. “Medical practice is more nuanced than that.
“Every case is considered on its merits, because every patient-doctor interaction is unique … the impact on a doctor’s practice (through their registration) is linked to the level of risk posed to patients.”
This isn’t the first move by the regulator to rein in telehealth-only services.
In October, the board imposed conditions on the registration of InstantScripts founder Dr Asher Freilich.
InstantScripts advertises its services as a quick and convenient way to manage health services online. Patients can use the site to request scripts for specific medicines via a “digital consultation”, which is essentially a questionnaire. This is forwarded to an InstantScripts doctor, who has the option to either decline the request or write the script.
It also offers phone appointments.
More here:
https://medicalrepublic.com.au/medical-board-sets-sights-on-tele-only-docs/83436
This article made me think back to one of my earliest teachers (the late Prof. Tom Reeve) who drummed into us from pretty much the first day that most serious clinical mistakes are avoidable ‘if you actually go and see the patient!”
The reason for this is that there is so much that can be gleaned merely by seeing a patient, looking at the colour, expression, posture, breathing etc. and hearing them talk and describe how they feel. Any experienced clinician can tell in a minute or less, with very high accuracy, if a patient is seriously ill or not. To miss out on this information makes it both harder and more dangerous to prescribe anything!
Sure it is probably OK to prescribe for a patient you have seen multiple times and know well but for all others it is far safer to ‘just see the patient’ and work out for yourself just how serious things are!
You will never regret actually seeing and listening to a patient! The Medical Board is right this time!
David.
By all means just go and see the patient BUT whatever else you do look but don't touch the patient .... forget about the laying on of hands. We don't do that these days.
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