A fear of technology is holding back an effective, affordable future for general practice
Telehealth can help save Australian healthcare, despite brazen plans from Healthcare lobby groups to unwind patient experience
Click here to read our submission to the Medical Board of Australia
Regulation deserves understanding, not ideology
Doctors are trained to collect and assess information before providing careful and reasoned opinions. In the current debate about telehealth, the RACGP seems to have forgotten this training.
The Royal Australian College of General Practitioners and the equivalent lobby group for pharmacy owners, the Pharmacy Guild, are usually engaged in unedifying turf wars involving name-calling and hysteria about who should have the right to prescribe medicines.
But recently, they've focused their attention, and criticisms, on the telehealth sector. Eucalyptus is Australia’s largest telehealth platform and so has received plenty of critiques from the RACGP and other bodies about the standards and outcomes of telehealth. We thought it was time to offer some actual evidence about how telehealth operates and how it can deliver healthcare just as safely as GP clinics.
There are three main avenues of attack from opponents of telehealth platforms: their supposed focus on profits; their fragmenting of GP-patient relationships; and their lack of safety standards. All are misconceived.
Profits over patients?
First, the President of the RACGP, Dr Nicole Higgins, recently described the telehealth sector as pursuing “a business opportunity versus a healthcare opportunity”.
Dr Higgins is implying that quality patient care and profitability are diametrically opposed. But then how does she explain that Australian GPs, almost all of whom run private businesses, enjoyed median gross profits of over $120,000 in 2021? What about the fact that Sonic Healthcare, the country’s largest operator of medical services (whose clinics contain over 2,000 doctors, and whose biggest shareholders are American investment firms), last financial year produced a record net profit of over $1.5 billion? And what about the revelations late last year about doctors gaming the Medicare rebate system to boost their bottom line?
Of course, we're not suggesting that GPs in these clinics prioritise money over patient care. For the overwhelming majority, the reverse is true. But if it is unfair to cast such aspersions over GPs in clinics, then why is it permissible to do so for telehealth companies? It's already clear that quality care can be provided profitably.
And who are the prescribers on telehealth platforms? They are the very same hard-working GPs who also work in those clinics.
Eucalyptus has delivered over 700,000 consultations, without relying on Medicare rebates, for an average cost to patients of $20 out of pocket. It does this by using technology to improve administrative efficiency and let doctors focus just on treating patients. Compare this to the increasingly expensive and inaccessible GP consultation model, which has resulted in doctors pleading for increases to Medicare rebates, instead of investigating how technology can improve access to care.
Telehealth can provide continuity of care
The second form of attack relates to continuity of care, and the suggestion that telehealth breaks up patients’ relationships with their regular doctor.
The starting point is to recognise that Australians are increasingly not obtaining primary healthcare from the same GP. This trend predates the rise of telehealth and is driven in part by the same access issues just described: as more GPs stop bulk billing or have full schedules of appointments, their patients look elsewhere; similarly, as young people are more and more mobile, their doctor changes with their location. And for patients suffering from stigmatised conditions, they may feel uncomfortable seeing their regular GP (if they have one).
Every day of the week, GPs in community practice are faced with new patients whom they have not previously consulted. They are nonetheless able to treat those patients safely by obtaining a sufficient medical history from them (in the absence of an effective My Health Record, which almost no one actually uses).
The very same process can be undertaken by telehealth. Indeed, a central tenet of Eucalyptus’s platform is that a team of health practitioners works from a single patient profile, using tools to administer monitoring and follow-up to a level that is quite simply impossible in an in-person setting. The average patient of one of Eucalyptus’s brands receives as many as 10 to 20 pieces of follow-up communication from the medical team (which includes doctors, nurses, pharmacists, dieticians and health coaches) during the initial phase of treatment.
Don’t assume that telehealth is unsafe
The final and perhaps most misconcieved argument advanced against telehealth is that it is uniformly unsafe.
The lobby groups describe telehealth platforms as full of “cowboys” in the form of inexperienced doctors who engage in “tick and flick” exercises. In fact, Eucalyptus is the only telehealth company in the country to have been independently certified by the Australian Council on Healthcare Standards with the EQuIP6 accreditation. We collect, analyse and respond to safety data, and use it to improve services to patients, in a manner unrivalled by physical clinics.
Eucalyptus employs multiple methods to ensure these standards of safety:
It's selective in offering healthcare for only a small set of medical conditions. Telehealth is clearly not appropriate for all conditions, and we only provide it following specialist consultation in order to design rigorous clinical protocols.
It has extremely detailed pre-screening requirements for all consultations. Many conditions involve more than of 50 such questions, which are then followed by further communication between the doctor and patient, ensuring that a comprehensive patient history is recorded.
Eucalyptus currently only recruits Australian GPs who are Fellows of the RACGP (meaning that they have passed additional exams entitling them to practise independently), almost all of whom also work in GP clinics. We don't recruit trainees or medical graduates.
Not all patients receive a script: up to 50% of patients for certain medical conditions are determined by doctors to be unsuitable for treatment via telehealth. Far from being a “pill mill”, this statistic shows that our strict eligibility guidelines work.
The RACGP’s unreality
The RACGP appears to be living in a 19th century utopia in which every patient and their family sees the same doctor for their entire lives, appointments are always readily available, consultations involve at least 15 minutes of carefully probing questioning, and medical records are kept meticulously. Anyone who has recently fought their way into an appointment at a busy GP clinic will understand the fallacy of that position. It cannot seriously constitute the standard against which telehealth is to be judged.
Instead, the reality of the situation is that models like Eucalyptus’s are used around the world to safely improve access to care. While they ought to be regulated properly, regulation can only be effective if it is based on a sound understanding of what is being regulated.
We call on the RACGP and other peak bodies to collaborate on, not criticise, this process: the sooner we achieve a framework which acknowledges telehealth’s potential, the sooner we will be able to overcome the issues facing primary care in this country today.
Senior Legal Counsel
About the contributors
Tim Doyle, Founder
Lyndon Goddard, Senior Legal Counsel