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The Medical Board of Australia’s chair has warned health start-ups not to look for loopholes in its crackdown on prescribing drugs via online quizzes and forms, citing a series of cases where patients have got the wrong medicine or dose after a digital consultation.
Some start-ups privately view the rules, revealed by this masthead on Wednesday, as allowing them to keep prescribing via a quiz or form if one of their doctors has previously spoken to a patient over the phone or via video call.
Telehealth has surged since the pandemic, with a growing number of serious problems from it reaching the Medical Board.Credit: Louie Douvis
Board chair Dr Anne Tonkin said that approach may not even be a “minimal standard of compliance” and urged doctors to comply with the spirit of the rules, as well as the letter.
“We are in the process over the last few years really of dealing with … groups of doctors involved with businesses that are looking for loopholes,” said Tonkin, without naming any companies. “That’s not been the case so much in the past. We’ve been able to rely on doctors to behave ethically and to want to behave ethically, not to want to find loopholes.”
A host of start-ups have opened their doors in the last five years that let patients get popular drugs, such as Viagra equivalents and weight loss injections, via an online quiz or form that is checked off by a doctor who can ask the patient written questions.
Customers have prized the convenience and investors have put tens of millions of dollars into the sector, which argues it is expanding access to medicine but has faced intense criticism from GPs, who view it as undermining medical standards.
The new guidelines will be a blow to the industry, which includes outlets such as Eucalyptus’ Juniper and Pilot brands, InstantScripts, Medmate and Mosh among many others, as they increase the cost and time of prescribing medicines in effort to improve patient safety.
None of the industry’s players would say exactly how they will implement the new guidelines, which are very similar to a draft version released late last year.
In a one-line statement, Eucalyptus chief executive Tim Doyle said: “We support the guidelines released yesterday and will be complying with them before the end of the transitional period in September.”
The Medical Board’s guidelines allow a doctor to prescribe without speaking to a patient on the phone or via video if they are the patient’s “usual” doctor or have access to a full clinical history.
Tonkin said that was intended for rare situations where a patient was on a medication that “really shouldn’t be stopped in a hurry” but had forgotten to get a repeat script.
How broadly the rule can be interpreted will likely be determined by the Medical Board if it gets complaints, or by medical insurers who will determine what actions they are willing to cover.
InstantScripts declined to comment, referring to previous remarks by its chief operating officer, Richard Skimin, who said the company would implement the changes but that his firm was already operating safely.
In general comments responding to Wednesday’s announcement, Mosh chief executive Gabriel Baker said he welcomed the changes to the extent that they ensured high and consistent standards.
But he said the board should have adopted a more nuanced approach, and its changes could deter patients seeking healthcare. “As an industry leader, Mosh is continually reviewing and updating its policies and guidelines and will of course comply with the board’s proposed changes,” Baker said. Medmate was contacted for comment.
Tonkin said the Medical Board had seen a series of problems come out of the sector. Some doctors prescribing online from interstate had failed to comply with local laws in the patient’s state.
Others had prescribed the wrong drug, or the wrong dose. “Sometimes a patient situation has changed and a prescription is given based on the way they were a year ago,” Dr Tonkin said.
“So they’re all a bunch of really potentially quite serious situations that are starting to come to our attention.”
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