Organisations representing medical doctors, medical schemes, and medical scheme administrators, have expressed deep concerns over a guideline by the Health Professions Council of South Africa (HPCSA) relating to telemedicine. The guideline was released by the HPCSA on Thursday (see Med Brief Africa report).

In an open letter protesting the guideline – and asking for the HPCSA to immediately review its decision –the organisations say the HPCSA is maintaining a baseless view that doctors can only consult with patients remotely using telemedicine technology if they have a pre-existing relationship with the patient they are consulting. The only exception is for consultations conducted by mental health professionals.

The HPCSA says the existing guideline has been amended for the period of the COVID-19 pandemic, and will cease to apply once it is over.

However, the South African Medical Association, the Board of Healthcare Funders, the Health Funders Association, the South African Private Practitioners Forum, the South African Society of Anesthesiologists, the United Forum of Family Practitioners, and the IPA Foundation, say the guideline is wrong and dangerous.

“There is no rational basis for the guideline. The HPCSA has not presented any facts or evidence nor has it explained the basis for maintaining its position. Why would a doctor need a prior relationship with a patient to give advice about the coronavirus?” asks Dr Angelique Coetzee, Chairperson of SAMA, on behalf of the group of bodies.

The group also maintains that the position by the HPCSA is incongruent with telemedicine regulations across the globe. It notes: “Every country we are aware of is actively encouraging tele consultations to protect the health of their critically needed front-line medical doctors, as well as to prevent patients from unnecessary travel and exposure to potential cross-contamination and infection.”

In addition the organisations say the guideline creates an immediate and material risk for doctors in the country.

“Instead of being able to provide sound advice remotely, they are being forced to see patients in person. By removing infected doctors from the front-line of healthcare delivery, this ruling will also lead to the weakening of our healthcare system as a whole, precisely at the time when we should be doing everything in our power to strengthen it,” the group says.

Among the other issues the group have with the guideline is that it:

·       Creates risk for patients who should stay indoors and comply with the national lockdown, rather than risk travelling to see a doctor who may have a roomful of sick patients,

·       Perpetuates the deep inequalities in the healthcare system by not allowing patients who, because of long-standing financial and structural barriers in the country’s health system, have not had the opportunity to establish pre-existing relationships with doctors who are willing to offer their services to them,

·       Dramatically restricts the reach of doctors who want to offer their clinical expertise and services beyond their existing patient base at this crucial time,  

·       Reduces access to healthcare and undermines the ability of doctors to earn income as patients would rather not consult doctors in-person for fear of infection during this outbreak. The knock-on effects of this on overall public health will be severe.

·       Appears to contradict statements by both President Ramaphosa and Health Minister Mkhize who have advocated the use of telemedicine in the fight against the disease, and,

·       Is in stark contrast to the guidelines released yesterday for Allied Health Professionals which allow unfettered use of telemedicine for these healthcare professionals.

“We do not understand why allied health professional are allowed to use telemedicine but medical doctors are restricted to do so?” the letter asks.

The organisations are demanding that the HPCSA change the guideline for medical doctors with immediate effect during the COVID-19 pandemic relating to telemedicine. It has also calls on the HPCSA to thoroughly review its position on telemedicine once the pandemic is over, and to allow doctors to consult virtually as and when they believe it appropriate, as is the case in most other countries.


SOURCE: SAMA Communications