But there’s reason to be hopeful that this is not a move toward McMedicine.
Patients can now request asynchronous online consults for medical certificates, pathology and radiology referrals with their regular GP via booking engine HotDoc.
But where some have seen it as part of the rise and rise of low-value on-demand healthcare, company founder Dr Ben Hurst sees it as the opposite.
HotDoc’s Quick Consults feature has been around for seven years, but previously only allowed patients to request repeat prescriptions or specialist referrals.
Medical certificates, pathology and radiology requests are new additions.
Only existing patients of a doctor can request one of the quick consults, and it’s up to the individual GP as to whether they send through the script, referral or certificate without a consult, arrange a telehealth consult or ask the patient to book an in-person appointment.
The booking engine takes a cut of the fees for these services.
NSW GP and practice owner Dr Max Mollenkopf was critical of the new offering and publicly questioned how it would square with the Medical Board of Australia’s recent reminder that services where patients receive an emailed medical certificate without a consultation may be breaching professional standards.
“Be digital and flexible in your consult offerings but don’t just sell your provider number for instant consumer gratification,” Dr Mollenkopf wrote on LinkedIn.
“Ordering a Medicare rebateable MTHFR [gene test] on a patient because they ‘read that they should have it checked’ is not providing good care.
“Blindly ordering knee x-rays for people with ‘aches’ is not good care.
“Blindly approving requests through a portal is not good care.”
HotDoc, for its part, told The Medical Republic that the feature supported continuity of care by “unlocking the primary care capacity of a patient’s regular practice”.
“Not every clinical service takes exactly 15- or 30-minutes and requires a pre-scheduled appointment,” it said.
When asked directly to respond to Dr Mollenkopf’s concerns that an offering like Quick Consults encouraged low-value care, the booking engine stressed that it was not intended for acute care.
According to its own statistics, around one quarter of clinical recalls were associated with pathology or radiology testing – i.e. six-monthly cholesterol or three-monthly INR – and up to 50% of pathology requests were not completed by the patient in the intended timeframe.
“By reducing the friction in this process, we believe we can significantly improve patient adherence,” it said.
The third use case it gave was that of patients who have lost their paper-based pathology or imaging request.
HotDoc’s CEO Dr Hurst acknowledged that perhaps this had not been clear in the way Quick Consults had been marketed.
“Perhaps our marketing efforts haven’t done a great job of educating the intention behind this product,” he told TMR.
“But these features are much more geared to existing patients who have screening requirements or who have chronic diseases which need monitoring.
“[Cases] where they have to get a test with some level of frequency – whether it be every month, every three months, every six months.
“I absolutely agree with [Dr Mollenkopf] that any kind of acute presentation where someone just wants a blood test or radiology that’s not related to sort of ongoing care is not appropriate for this service.”
Related
The booking engine’s ethos, Dr Hurst said, was that easier and more frictionless patient experiences would lead to better compliance.
“We’ve done some research with pathology providers, and … there’s about a 50% leakage in the system with any radiology pathology request,” he said.
“It’s possible that a number of those patients just go see a competitor, but there’s still a really, really large number of people who just don’t get it done.
“Let’s just say a patient gets a recall … [and] they see that they need a repeat blood test.
“Instead of having to go and make that appointment, they can just request it then and there … and because that’s just a better patient experience, they’re more likely to just do it.”
