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COVID-19 and remote consultations – how we can help

18 March 2020

The current situation surrounding the COVID-19 coronavirus has created a number of challenges, many of which relate to self-isolation and social distancing. For doctors, this has raised the question of whether they should limit patient interactions to remote consultations. South Africa is now in a declared National State of Disaster, and use of telemedicine has been advocated, including by the South African president, as one of the ways of delivering healthcare during the crisis; however, at the time of the writing of this article, HPSCA’s published guidelines around telemedicine have not yet been updated to reflect the current situation.

Medical Protection has received calls from members regarding the safety and suitability of remote consulting – also known as telemedicine – and this article outlines our advice and guidance. 

We recognise this is an extremely challenging time for all healthcare professionals and Medical Protection is here to support you. The treatment of patients is of paramount importance and we want you to be able to deliver this in a safe and effective way.

If you are undertaking a remote consultation  

When considering a remote consultation, you should weigh up whether you can adequately assess the patient remotely. If you have doubts then you should recommend the most appropriate route for the patient to seek medical assistance, in accordance with local public health/government guidance.

Where in-person consultations are not feasible, you need to be satisfied that proceeding in this way is in the patient’s best interests and that you can adequately assess the patient remotely. You should document that you have undertaken this consideration in the clinical records. Unless there are exceptional circumstances, it is preferable that remote consultations will relate to patients already known to you or where you have access to their full medical records.

During any remote consultation, both doctor and patient should be able to reliably identify each other. If an in-person consultation is preferred, but not possible, then you should inform the patient of this and explain why you have, on this occasion, pursued a teleconsultation.

In cases of emergency, patients should be encouraged to seek assistance via the recommended route, in accordance with the most recent government and/or public health guidance.

Remote consultation with an existing patient in another country 

If you are contacted by an existing patient and you hold their medical records, but they are out of the country and unable to return for quarantine or restricted travel reasons, you should recommend to the patient that they follow the most appropriate alternative route for assistance, which may involve seeking local medical care.  

If the patient is calling about a pre-existing condition, you should make a reasoned decision on the safest course of action for the patient. This may include consulting remotely or advising the patient to see medical assistance locally. If the patient is presenting with a new condition, ideally you should recommend the patient seeks medical assistance locally where this is practically possible.

Remote consultation with a new patient in the same country as you  

If you are asked to undertake a remote consultation with a new patient, you should request the medical records from the patient’s previous doctor. If you cannot access their records, you would need to consider whether you are able to adequately assess the patient clinically and document that consideration. If you cannot adequately assess the patient, then you should recommend the most appropriate route for the patient to seek medical assistance, in accordance with local public health/government guidance.

Practising safely and your indemnity position 

As noted above, HPSCA’s published guidelines around telemedicine have not yet been updated to reflect the current situation, but we anticipate that they will address this as soon as possible, in the spirit of the President’s National State of Disaster address and in the best interests of patients and the wider public.

In all remote consultation situations, it is your responsibility to ensure you practise in accordance with any applicable laws and regulations around the diagnosis, treatment, prescription and provision of medication to patients – both within the country in which you practise and, if applicable, within the country in which the patient is based at the time of the consultation. Where members depart from their usual practice they will remain accountable for their actions. 

If the patient is not able to access local, in-person medical advice due to quarantine protocols, and you are satisfied that this is the case and documented this rationale – then you will be able to request assistance from Medical Protection for incidents that arise from the consultation, where the complaints or claims are brought in South Africa (the jurisdiction in which you hold your membership).

However, you should be aware that you will not be able to seek assistance from Medical Protection for remote consultations undertaken on a new patient in another country. If you are contacted either directly by a new patient outside of your normal jurisdiction, or by a practitioner in another country seeking treatment for a patient, you should advise that the patient would need to seek medical advice in the country in which they are based at that time.