While telemedicine has become a fundamental tool during the Covid-19 pandemic, SA doctors fear if they miss something during virtual consults they could open themselves up to possible litigation.
The Medical Protection Society (MPS) — which represents 32,000 health care professionals in SA — recently conducted a survey among 512 doctors.
Fifty-six percent agreed the benefits of telemedicine had been unquestionable during Covid-19, and it would remain a fundamental tool in practice.
However, 94% raised concerns about patients whose access to remote services may be impacted by factors such as digital literacy, disability, language, location or internet connection.
Ninety-three percent of the doctors surveyed expressed concern that if some patients felt excluded from telemedicine, this might result in a breakdown in the doctor/patient relationship, or conditions being left untreated.
Ninety-five percent also said they were generally worried about missing something in a remote consultation, with 79% saying they were worried about a claim or investigation arising.
The society’s Dr Graham Howarth said: “Telemedicine is not a new concept and the use of technology in delivering medical services has been slowly evolving over the years.
“However Covid-19 has fast-tracked large scale adoption and SA’s entrepreneurial spirit has seen many innovative telemedicine solutions offered to doctors and patients.
“While there have been undoubted benefits during the pandemic, there are naturally concerns around its limitations, the need for support and training due to the different skills required when consulting in this way, and the desired role of virtual care beyond the pandemic.
“A key concern for doctors is the potential for vulnerable patient groups to be left behind and for health inequalities to grow if there is desire for more patient consultations to be delivered online after Covid-19.
“Access to remote services could be impacted by different levels of access across the country, as well as digital literacy and other factors.
“As doctors have highlighted in our survey, if patients feel excluded from telemedicine, this could lead to a breakdown in the doctor/patient relationship or conditions going untreated.
“A significant number of doctors are concerned about the potential for medico-legal disputes and investigations that could arise from this and other limitations of telemedicine.
“At earlier stages of the pandemic, MPS was vocal in seeking updated guidance from the Health Professions Council of South Africa (HPCSA) which provided greater certainty on the use of telemedicine — or tele-health — during the pandemic.”
Howarth said MPS has been working with doctors to help them “adapt to the significant increase in telemedicine and mitigate risks through our risk prevention programmes on the medico-legal, ethical and communication challenges which telemedicine creates.
A significant number of doctors are concerned about the potential for medico-legal disputes and investigations to arise from this and other limitations of telemedicine.
— Graham Howarth
“But the burden should not be on doctors to address the digital inequalities across society.
“The government, hospitals and healthcare system as a whole must take a long-term strategic approach when considering the role of virtual care beyond the pandemic.
“This should be based on the experiences of patients, an ongoing evaluation of the barriers to accessing telemedicine, and the concerns raised by doctors,” he said.
Durban doctor Rafiek Rodriquez told Sunday Times Daily he was not keen on teleconsults for Covid-19 patients, “as the clinical examination is important.
“Assessing the patient’s oxygen saturation levels, respiratory rate, heart rate, temperature, chest examination is extremely important.
“These clinical findings are missed when doing virtual consults.
“Reviews are also done frequently to assess if the patient’s clinical signs have deteriorated.
“Bloods are done timeously and repeated to assess whether there is deterioration or improvement,” he said.
The SA Medical Association’s Dr Mvuyisi Mzukwa said while telemedicine was useful for “minor ailments”, it lacked the human touch which was important to many patients.
“I think telemedicine was timely with Covid-19, especially with social distancing. But it is a general concern among doctors that they miss something in the virtual diagnosis.
“It does have its pros and cons ...” he said.
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