Medical practitioners are ill-advised to use social media platforms such as WhatsApp and Twitter when communicating with patients “as it blurs the lines and may lead to ethical dilemma,” Dr Blesset Nkambule, MPS medico-legal advisor, reminded delegates to Sunday’s hybrid Gauteng General Practitioner Forum (GGPF) conference in her presentation on “Telemedicine in GP Practice”.

In this instance she was referring to the HPCSA Booklet 10 on Telehealth.

Practitioner concerns about digital health consultations, Nkambule acknowledged, included “Will I be able to accurately assess and diagnose the patient?”, “How sure can I be that patients understand my advice and are happy with the plan?”, “I am concerned about the digital divide and inequality of access for some patients”, “I don’t feel confident using the technology…I’ve never had any training,” and importantly, “What do I need to cover in order to gain patient consent for having a teleconsultation?”.

Patient consent, she indicated, was among the medicolegal and ethical challenges such as regulatory constraints, legal considerations such as information governance e.g. the POPI Act, professional standards, organisational governance and not least, liability and indemnity.

On legal and governance issues she reminded her audience once again of the April 2020 HPCSA notice to amend Telemedicine Guidelines during COVID-19 (Booklet 10) to assist with the “disruption” caused by the virus in the provision of health care. The HPCSA, she continued, has since issued a revised ethical guideline on telemedicine dated December 2021.

“However, in operation, from my understanding, are the notices of amendment of the COVID-19 guidelines. The last notice of amendment was dated the 3rd of April 2020. These notices preceded the updated booklet 10 which was revised in December 2021 but have not been revoked based upon the new detail contained within the new booklet number 10.

“So it is important to note that these notices (of April 2020) were subject to COVID-19 and the HPCSA has not stated that we are out of the COVID-19 pandemic,” she continued, noting, therefore, that they can still be accessed on the HPCSA website.

“As an organization we are in the process of interrogating the contents of Booklet 10 and will be reaching out to the HP CSA for clarification on issues and will provide feedback to our members once that process is in place and completed.”

In response to a question to what the standard of care the courts would expect in a face-to -face consultation as opposed to a telehealth online consultation, Nkambule replied: “As a starting point the remote consultation should always replicate as far as possible a face-to-face consultation. So the standard of care is quite the same as that of a face-to-face consultation in that you must always be seen to be acting in the best clinical interests of the patient.”

Asked whether she thought a medical practice should have a document drawn up which contains the terms and conditions that the patient should be made aware of in a telehealth consultation “so that they can receive this document and even sign it off prior to the consultation and they may be aware of what is expected and what may not be provided during that consultation, her response was: “Absolutely! That forms part of the whole concept and ideology around informed consent.

“Telehealth being something that is novel it would be appropriate to draw up a document that the patient can peruse at their leisure and be able to interrogate and ask you questions and based on that,  be able to provide an informed consent, or agreement on how you can proceed forward when engaging with them in telehealth consultations.”