The quality of healthcare in Australia is undeniably deteriorating. Medicare, our once-universal-healthcare system, has been strangled by years of policymaking and, while the 2023-24 Federal Budget included the biggest investment into the system since its inception in 1984, patients claim doctors are increasingly exploiting new technology to make up for deep funding gaps.
Complaints to Australia’s medical board about poor or no communication between doctors and patients have risen dramatically since telehealth was expanded in 2020 and, more recently, spurred concerns about the use of artificial intelligence for prescriptions.
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A spokesperson for the Medical Board of Australia told VICE Australia it had received 550 complaints since 1 July 2020 specifically related to poor practice from GPs via telehealth and online services that don’t involve any consult between doctor and patient to get a prescription – a new and concerning phenomenon in Australia.
Complaints detailed instances of practitioners not adequately assessing a patient before handing out a script or advising treatment, including doctors not checking medical history, not asking about the patient’s other current medications and not advising about possible side effects of prescription drugs.
A number of complaints also claimed their prescribing processes felt like they were managed by an algorithm or AI process, as opposed to being undertaken by a prescriber only after carefully considering the clinical need for a medication.
Of the complaints, 45 resulted in the Board taking regulatory action against a practitioner.
“Good medical care can involve a mix of in-person and telehealth consultations,” the spokesperson told VICE.
“Telehealth is generally most appropriate in the context of a continuing clinical relationship with a patient that includes in-person consultations. Interaction between the doctor and their patient is an important element in all consultations, including telehealth consultations because they enable a doctor to ask follow-up questions that help identify the best treatment for a patient.”
But recent investigations by the Australian Health Practitioner Regulation Agency have found some new online models of patient care do not meet the standards of care as the Board expects in traditional consultations.
What is telehealth?
According to the Department of Health, “telehealth involves you consulting your healthcare provider remotely when they have determined a physical examination isn’t needed, and you can’t see them in person”.
Telehealth has existed in Australia in various forms for a while but was expanded to Medicare in March 2020 as a result of COVID-19. It meant anyone could book a virtual or phone appointment with their GP to comply with lockdown restrictions. Those expansions were made permanent the following year.
What isn’t telehealth?
“The Medical Board of Australia has made it very clear that algorithms are no substitute for consultations in good medical practice,” Dr Anne Tonkin Chair of Medical Board of Australia told VICE.
Online prescription services are relatively new in Australia and surprisingly easy to access and use. If you need a vape prescription or a script for medical marijuana, you can do it without talking to a single person.
But Dr Elizabeth Deveny, the head of the Consumers Health Forum of Australia, said the model of online, no-consumer-contact prescribing didn’t meet a lot of the safety features she normally sees or expects.
“Telehealth is a great model that helps consumers access a health practitioner using a phone or computer, allowing them to have important conversations in a way that better suits them,” she said.
“What we’re seeing [with some online services] is not telehealth, and we think it has potential for significant harm.”
The Board spokesperson said many of the instances documented in patient complaints detail types of remote healthcare services that it do not consider good practice under its code of conduct.
Guardian Australia has reported on the rise of online services and noted one who offers vape prescriptions, Dr Carolyn Beaumont, stated that her website, medicalnicotine.com.au, “utilises innovative proprietary AI to effectively achieve its aims” – though she said the AI was not related to prescriptions.
What are the benefits of telehealth?
The department claims telehealth has been “transformational to Australia’s universal healthcare program, Medicare” by giving more people access to care.
“Often, Australians living in rural and remote areas need to travel long distances to see their healthcare provider. Telehealth improves their health care by improving access to timely services,” it said.
“Telehealth consultations are not only convenient, they also ensure the safety of others by reducing the spread of illness”.
What are the negative side effects?
One 2023 research paper into telemedicine more broadly found, while it had a great potential to reduce health inequities, it had a number of drawbacks.
“One is that the medical professional must make a diagnosis without being able to conduct a thorough physical examination and, in certain cases, without even seeing the patient. This can jeopardise patient safety,” the report said.
Another 2022 paper from the Australian journal of General Practice found a number of barriers to accessing telehealth also existed for patients, including a lack of technological infrastructure and privacy concerns.
But according to the Royal College of General Practitioners one of the biggest concerns for telehealth’s efficacy and sustainability in Australia was inadequate funding models under Medicare and the decade-long rebate freeze that sucked $4 billion from the primary care sector and effectively spelled the end of bulk billing in Australia as doctors needed to cover their rising costs with patients’ money.
“Providers required resilience and flexibility to adapt to telehealth,” it concluded.
“Funding models must reward providers from an outcome focus, rather than placing limits on telehealth’s use. Hybrid approaches to service delivery will best meet the needs of the community but must be accompanied by support and education for primary health care professionals.”
Aleksandra Bliszczyk is the Deputy Editor of VICE Australia. Follow her on Instagram.
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