How many times have you been at home sick, knowing why you’re sick, but dragging yourself out of bed and going to see a doctor anyway just to get a certificate for work?
Or at home with an unwell child you need to drag to a doctor’s surgery for a simple prescription?
If only there was a way for you to get your hands on that necessary proof without leaving your bed. In fact, what if there was a way you could get the prescriptions you regularly use (like the Pill) refilled, without needing to book a doctor’s appointment?
Well, there is. It’s called Qoctor (as in, quick, online doctor) and it provides medical certificates with just a few clicks and a Skype chat, plus prescription medication delivered to your door.
Sounds great, right?
Well, as Australian medical bodies point out, it may not be as great as it seems. There are some very real implications to consider about online doctor and prescription services.
So is Qoctor the answer time-poor consumers in an increasingly busy world have been looking for, or a potential threat to patient’s safety? We wanted to find out.
How does Qoctor work?
Qoctor CEO Aifric Boylan told Mamamia the service, which was originally called Dr Sicknote, began as an idea to provide patients with an option to get some of the simple things they needed, online, without having to visit a clinic or doctor’s office.
“We started off with medical certificates, but we quickly realised that there’s a whole range of simple medical issues that patients are often required to see the doctor for, when often they don’t need a face-to-face consultation,” Dr Boylan says.
“Some of the health issues are ones that sometimes might be a bit embarrassing for people. They’re also services that have people traditionally taking time out of a busy day when they’re not actually unwell. So things like their contraception or their hayfever medication.”
Qoctor also provides medication for chlamydia, genital herpes, asthma, acne, hair loss, erectile dysfunction, premature ejaculation, migraines, bacterial vaginosis, delaying a period, acid reflux and cold sores.
For medical certificates, patients are asked a few questions before booking a time to have a Skype chat with a doctor, who'll confirm they're sick but don't need further medical intervention, and issue a certificate for $19.99.
When it comes to prescriptions, patients are offered information about the condition and asked to choose what medication they would like to buy or get a prescription for (and fill at their local chemist) and then asked a series of questions to check the medication is right for them.
There is certainly a demand for services. Since it's inception in late 2015 more than 8000 medical certificates have been issued and following the launch of prescription services in September, Dr Boylan says they have issued about 10 to 15 a day, and the number is growing. Qoctor was also recognised by Finder.com.au in its annual awards as the Best Tech Innovation winner this month.
AMA: "It's not in a patient's best interest."
Qoctor has plans to expand into offering online doctor's appointments, so you could potentially hop online for any complaint and never physically see a doctor again.
It's also a tempting option for time-poor mums, who could use the service for sick kids. But is it a good idea?
It's this ability to circumvent the traditional in-person, face-to-face doctor's appointments that has GPs like Tony Bartone concerned.
"Anything which tries to fragment a continuous, lifelong GP-patient relationship has got to be not in the patients best interest," Dr Bartone, who is the Australian Medical Association's vice president, told Mamamia.
"The best relationship anyone can have with their GP is one that's as continuous as possible.
"That's going to prepare you in the best sense possible from a primary health care perspective, be it preventative health care, be it the management of unexpected illnesses and providing appropriate care at the appropriate stages."
For many of us, though, gone are the days of seeing one trusted doctor your entire life. However, Dr Bartone insists face-to-face is the best way to pick up on any other issues.
"At least with GP hopping you're still going to have a face-to-face consultation and a physical examination that goes to boot," he says.
"There are many things that potentially may be missed by not actually examining the patients."
Dr Bartone contends a once-yearly doctor's visit wasn't overly difficult to manage, and that it has its benefits, such as potentially preventing other health issues from developing.
"Doctors are very busy so they're not going to create a situation where they'll have you running backward and forward every two months.
"The prescription for the pill...is 12 months. In my opinion that would not be an onerous need to go back in 12 months and have that consultation again and to actually see what other things might have happened in the year, not just in relation to the pill prescription, but what other sleep disorders, what other weight management issues, what other stress issues developing at work. The list goes on."
"Each visit is an opportunity to further create and enrich (a doctor-patient relationship) and hopefully prevent any future illnesses or untoward events."
Dr Bartone said he was not opposed to medical services moving online altogether, but that he'd like to see them used by doctors with existing and ongoing relationships with their patients.
"In that kind of situation, the benefits Qoctor talks about can be applied to a limited number of consultations where there is a strong pre-existing relationship."
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Meanwhile, Royal Australian College of General Practitioners president Dr Bastian Seidel says he's concerned patient safety could be compromised when a doctor prescribes medication for a patient they don't have any prior knowledge of. In the case of Qoctor, there is no personalised doctor involvement required to order prescriptions, but a series of questions compiled by a team of doctors.
"Completing requests via an online survey can easily result in misdiagnosis due to a range of factors," Dr Seidel says. "Without access to the treating GP's notes, the doctor has no means of otherwise confirming the information provided."
Dr Boylan says for many prescriptions, patients are asked if they have been diagnosed with the condition the medication treats and then if the product they are trying to purchase has been previously prescribed to them, and if not it directs them to see a GP instead.
In cases of chlamydia, through, the treatment would not be a repeat. However, Dr Boylan says if knew you'd have contact with someone who'd had chlamydia then by the medical guidelines you would be treated.
This all sounds straightforward enough, but what if patients ticked the wrong box or ordered the wrong medication? When Mamamia tested Qoctor we found we could easily order asthma medication without ever being diagnosed by falsely answering a few questions.
Dr Boylan admits the service does require the patient to answer questions and choose medications correctly, but says she trusts people to take care when it comes to their and their family's health. It's also worth noting that antibiotics and prescription painkillers are not available via Qoctor.
"Of course it does involve a bit of trust and it involves a bit of common sense on the patient's part," she says. "I personally believe most people have a lot of common sense. Most people don't want to put their health at risk and will take that advice on board."
Dr Boylan pointed to research out of the US that found oral contraception medication, in particular, should be available to women over the counter after they filled out a questionnaire.
"And that was the consensus, that a questionnaire and self-screening means nothing gets missed, where as with a doctor you're relying on a human to ask the right questions."
She added that some people were already buying medications through non-regulated services online, but this service is Australian, has the input of Australian GPs and customers know what they're getting.
"It might not be for everybody," she says. "But for some people who are very busy, who've had the health checks that they've needed and their fine, this just gives them a bit of flexibility.
"It means that the patient is in charge and the patient has more autonomy rather than always having to go back to the doctor for something quite simple."
And that's just it: Qoctor provides a choice to consumers, an option they can either take up or ignore.
For Dr Bartone though, it's the unknown implications if a generation turned online for doctor services that has him concerned.
"I'd be disappointed if such a service became the norm, not only because of what I think is a lesser service for patients, but also because many future possible unintended consequences."