3 April 2017

The doctor will see you … never

General Practice Technology

I’m The young woman was in tears. When she came in she had initially asked for a referral to a surgeon for a breast augmentation. During the conversation it turned out that her partner had made it clear her breasts were too small.

We ended up having a chat about relationships and body image. At the end of the consultation she decided she needed some time to think things over and talk to good friends, and that she would come back if she needed further assistance.

The problem with online referrals

At first sight, the Qoctor website seems an easy, convenient online medical service that provides sick certificates and referrals.

The site tells visitors: “(…) we understand that a well person who simply needs a letter to see a specialist should be able to get one without requiring a GP consultation.”

I’d like to challenge that. The woman in the example above was well but did she need a referral to undergo an expensive procedure that would change her body?

There are many issues with a system that allows access to specialist care without a review by a primary care doctor. Unnecessary referrals, increased costs and further pressure on the hospital system are just the beginning.

Once a visitor has selected a specialist the system asks a few simple questions about allergies and previous surgery and there are some boxes to tick (see below). I wonder how many people will just enter through to get to the section where you pay and automatically receive the referral letter (as pdf file).

How many people will just enter through to get to the section where you pay and receive the referral letter?

Good telehealth principles

Sometimes writing referrals is a straightforward process but often it is not. What is missing here are the safeguards with regards to other management options, coordination of care, the communication between the usual doctor and specialist, and follow-up. What about whole patient care?

Interestingly the service seems to assume that – after automatically cashing in the online referral fee – the patient’s usual GP will be responsible for the follow-up if required.

The Royal Australian College of General Practitioners (RACGP) has developed some common-sense principles for telehealth services, including on-demand online health services. These principles include the following:

  • On-demand telehealth services should preferably be provided by a patient’s usual GP or practice
  • On-demand telehealth services to unknown patients should only be provided when the patient’s usual practice cannot provide care for them, either in person (at the practice or by a home visit) or online, and no other general practices are physically accessible
  • Patient notes should always be sent to the patient’s usual GP or practice (with the patient’s permission). This ensures continuity of care and centralises patient records.

Commercially enticing

I suspect that most people are aware of the risks of online health services and will consult their GP first. At the same time there will always be people who are attracted to these services because they are quick and easy. It is also commercially enticing: if you sign up for Qoctor you may win a $100 Coles Meyer gift card.

The patient testimonials on the website, which probably go against AHPRA’s advertising guidelines for regulated health services, seem positive. The question is usually: are these real testimonials?

As always with disruptive technologies there is the convenience aspect for consumers – but is bypassing the most efficient and cost-effective part of healthcare by printing out an online ticket to the expensive part in the best interest of Australians? I doubt it.

The (patient) case discussion in this blog post is fictional and based on similar consultations. Disclaimer and disclosure notice. Follow me on Twitter: @EdwinKruys.

This article first appeared on the Doctors Bag website

Something to say?

Leave a Reply

3 Comments on "The doctor will see you … never"

Notify of
avatar

Sort by:   newest | oldest | most voted
Lou Lewis
Guest
Lou Lewis
1 year 1 month ago

Why in God’s name would any medical student or young doctor even consider going into general practice when nearly every aspect of our work is so denigrated that many people find us a nuisance rather than a trained professional.
Fortunately for me I am approaching retiring age, have a boutique type practice, and really don’t give a stuff anymore about the politics of medicine especially when I read about former presidents of the AMA and the RACGP selling us out to the government and the corporations.
Lou

Dogboy
Guest
1 year 1 month ago

” At the end of the consultation she decided she needed some time to think things over and talk to good friends, and that she would come back if she needed further assistance.”
She immediately went online to Qoctor, and got her referral, without having to put up with some paternalistic doctor trying to prevent her from controlling her own body.

TigerC
Guest
TigerC
1 year 1 month ago
I work in rural setting in ED , am a GP also work in GP practices Only last month I had an ambulance transfer arrive, little notice, from a town 160km away where the nurse had seen the patient 3 days before, over the telephone talked to the mother of the breast fed infant, she then rang the area MO who said the child needed admittting to a tertiary centre. My hospital was on the way. The child arrived. A not febrile, no evidence of weight loss of 2kg, 400g only, breast feeding well, slept well overnight (they arrived just… Read more »
wpDiscuz