The guidelines call ‘tick-and-flick' online prescription mills ‘not good practice’. That’ll show ’em.
The Medical Board of Australia has released new telehealth guidelines that describe “tick and flick” services that prescribe medications without a real-time direct consultation as “not good medicine”, but stop short of specifically prohibiting or punishing them.
“Prescribing or providing healthcare for a patient without a real-time direct consultation, whether in-person, via video or telephone, is not good practice and is not supported by the Board,” say the new guidelines.
“This includes asynchronous requests for medication communicated by text, email, live-chat or online that do not take place in the context of a real-time continuous consultation and are based on the patient completing a health questionnaire, when the practitioner has never spoken with the patient.
“Any practitioner who prescribes for patients in these circumstances must be able to explain how the prescribing and the management of the patient was appropriate and necessary in the circumstances.
“The Board recognises that it may be appropriate for a patient’s usual medical practitioner or another health practitioner with access to the patient’s clinical record to prescribe without a consultation in certain circumstances.”
RACGP vice president Dr Bruce Willett welcomed the new guidelines, which haven’t been updated in 10 years.
“I think the concern is that prescriptions get seen as a kind of clerical issue, whereas they really are a clinical assessment,” he said.
“There should be a proper assessment, so I think having some rigour around that is actually a good thing.”
Dr Willett said that while the new guidelines stopped short of banning prescribing without a real-time direct telehealth consultation, most doctors were risk-averse and conservative about doing it anyway.
“I would be too nervous to do that myself,” he said.
And he did say he believed the guidelines might need to be strengthened in the future.
“I think it is a step in the right direction,” he said. “I do think it will need ongoing evaluation to ensure it does provide the safety that we require for patients, and looking at it in the future, we may need something around autonomy framework.”
The new guidelines will take effect from 1 September this year.
“Telehealth is here to stay,” said Medical Board of Australia chair Dr Anne Tonkin.
“It plays an important role in healthcare in Australia and has opened great opportunities to improve access to and delivery of care, including to rural and remote patients and people living with disadvantage.
“The interaction between a doctor and their patient is an important element in all consultations, including telehealth consultations.”
Additional reporting by Amanda Sheppeard
