OPEN LETTER PROTESTING AGAINST THE HEALTH PROFESSIONS COUNCIL OF SOUTH AFRICA (HPCSA) GUIDELINES ON TELEMEDICINE DURING THE COVID-19 PANDEMIC
On behalf of medical doctors, medical schemes and medical scheme administrators across South Africa we wish to express our gravest concern with the HPCSA Medical Board Guidelines on Telemedicine which were released on Thursday 26th March 2020.
The HPCSA is maintaining a baseless view that doctors can only consult with patients remotely, using telemedicine technology, if they have a pre-existing relationship with the patient they are consulting. The only exception the HPCSA has allowed for this is for consultations conducted by mental health professionals.
Our view of these HPCSA guidelines are clear. They are wrong and dangerous for the following reasons:
- There is no rational basis for them. The HPCSA has not presented any facts or evidence nor has it explained the basis for maintaining its position. Why would a doctor need a prior relationship with a patient to give advice about the Corona virus?
- This position is incongruent with telemedicine regulations across the globe. Every country we are aware of is actively encouraging tele consultations to protect the health of their critically needed front line medical doctors, as well as to prevent patients from unnecessary travel and exposure to potential cross-contamination and infection.
- It creates immediate and material risk for the doctors of our country. Instead of being able to provide sound advice remotely, they are being forced to see patients in person. By removing infected doctors from the front-line of healthcare delivery, this ruling will also lead to the weakening of our healthcare system as a whole, precisely at the time when we should be doing everything in our power to strengthen it.
- It also creates risk for patients who should stay indoors and comply with the national lock-down, rather than risk travelling to see a doctor who may have a roomful of sick patients.
- It perpetuates the deep inequalities in the health care system by not allowing patients who, because of long-standing financial and structural barriers in our health system, have not had the opportunity to establish pre-existing relationships with doctors who are willing to offer their services to them.
- Related to this, it dramatically restricts the reach of doctors who want to offer their clinical expertise and services beyond their existing patient base at this crucial time for our country.
- It also reduces access to healthcare and undermines the ability of doctors to earn income as patients would rather not consult a doctor in-person for fear of infection during this outbreak. The knock-on effects of this on overall public health and on the flow of income for doctors will be severe.
- It appears to contradict the statements of both the President of the country and our Minister of Health who have advocated the use of telemedicine in our fight against this disease.
- It is also in stark contrast to the Guidelines released yesterday for Allied Health Professionals which allows unfettered use of telemedicine for these healthcare professionals. We do not understand why allied health professionals should be allowed to use telemedicine whereas medical doctors cannot.
We demand that the HPCSA change its guidelines for medical doctors with immediate effect, to allow doctors to conduct consultations remotely and particularly during the current state of emergency and COVID-19 pandemic. We also call on the HPCSA to conduct a thorough review of its position after the pandemic is over, and to allow doctors to conduct virtual consultations as and when the feel that this is appropriate, as is the case in most other countries.
Dr Angelique Coetzee
The South African Medical Association
Date: 27 March 2020
Supported by the following organisations: