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Doctors see benefits of telehealth – but fear some patients may fall behind

17 December 2020

The past year has been full of challenges and changes for South Africa’s medical profession. A single article could not do justice to the effects of the COVID-19 pandemic on the everyday lives – both professional and personal – of healthcare workers across the country.

While looking back on the year, one particular change that stands out though is the fast-tracked adoption of telehealth, or remote consultation.

Medical Protection has released the results of a survey of South Africa doctors, demonstrating their views and concerns about the adoption of telehealth – and implications for the future.

The results show that more than half of South Africa doctors (56%) see that telehealth has benefits and will remain a fundamental tool in practice. However, strikingly, nine in ten doctors (94%) are concerned that some vulnerable patient groups may be left behind if telehealth increases after the COVID-19 pandemic recedes. Access to remote services may be impacted by factors such as digital literacy, disability, language, location or internet connection.

93% of the doctors surveyed went on to say they are concerned that if some patients feel excluded from telehealth, this may result in a breakdown in the doctor/patient relationship or conditions being left untreated. 95% also said they are generally more worried about missing something in a remote consultation, with 79% saying they are more worried about a claim or investigation arising.

Perhaps unsurprisingly, only 12% of doctors in the survey said they have no concerns around the increased use of telehealth.

Of course, telehealth is not a new concept. The use of technology in delivering medical services has been slowly evolving over the years, and it did not first emerge when the COVID-19 pandemic was declared. However, COVID-19 has fast-tracked large-scale adoption and South Africa’s entrepreneurial spirit has seen many innovative telehealth solutions offered to doctors and patients.

The Independent Communications Authority of South Africa estimated that smartphone penetration exceeded 91% in 2019 and the adoption of telehealth is no doubt helped by this incredibly high rate of smartphone usage.

There have been undoubted benefits of telehealth during the pandemic – helped by the widespread use of smartphones – but there are naturally concerns around its limitations. There is need for support and training due to the different skills required when consulting remotely, and there must be clarity over the desired role of virtual care beyond the pandemic.

While smartphone usage might be widespread, access to remote consulting could still be impacted by different levels of access across the country.

Not everyone with a smartphone will have the same level of digital literacy and as doctors highlighted in our survey, if patients feel excluded from telehealth, this could affect the important doctor/patient relationship or lead to medicolegal disputes. The burden should not be solely on doctors to address these challenges around access.

At the earlier stages of the pandemic, Medical Protection was vocal in seeking updated guidance from the HPCSA, which provided greater certainty on the use of telehealth during COVID-19.

While this guidance was necessary and useful, the notice to amend telehealth guidelines was specifically for “during COVID-19”. Like Pandora’s box, now that the lid has been lifted on telehealth, few would expect it to return to the status quo and the regulatory environment must reflect this.

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 telehealth, and the concerns raised by doctors.

Medical Protection will continue to work with doctors to help them adapt to the significant increase in telehealth and mitigate risks through our Risk Prevention programmes which focus on the medicolegal, ethical and communication challenges which telehealth creates.