‘Farcical’: Instant medical certificates criticised for cutting corners

The proliferation of online medical certificate providers, and the absence of any direct consultation, has raised concerns with GPs.
 
With the cost of one-day certificates starting from just $13.90, and several companies popping up online, questions are being raised about the validity of these services in establishing if there is a medical condition.
 
Online medical certificate providers ask patients to fill out a form, declaring that they are not in a medical emergency, and to pay a private fee – with the medical certificate landing in their inbox often a few hours later.
 
The Terms and Conditions on one website refers to patients being connected with a ‘medical practitioner’, whereas they advise people to ‘contact a general practitioner’ for testing or follow up care, if required.
 
Speaking to newsGP, RACGP Vice President Associate Professor Micheal Clements questioned the value of these certificates for employers.
 
‘What’s the point in these medical certificates, if all you need to do is ask for one and this company is just willing to give one, what benefit is it to the employer?’ he said.
 
‘If the employer is asking for confirmation that there is a medical illness, then this obviously doesn’t meet that requirement.’
 
Chair of RACGP Expert Committee – Quality Care Professor Mark Morgan told newsGP he is aware that ‘pop-up’ businesses offering patient convenience for ‘a narrow range of services’ are becoming increasingly common.
 
‘These services are often making use of loopholes in legislation,’ he said.
 
‘To make money, they need to provide lots of items of service in the shortest timeframes.
 
‘Where there is a Medicare rebate for a service, the GP generally needs to have seen the patient within the last 12 months.
 
‘This rule does not apply to other doctors or nurse practitioners, so many of the online providers make use of this rule to offer a patient a consult with a substitute provider who does not have a GP’s level of training.’
 
Any clinical decision making by practitioners in these companies would likely be hampered by a litany of factors, according to Professor Morgan.
 
‘There would be a lack of comprehensive medical records, no personal knowledge of the person or their context, a limited picklist of management options to choose from, short consultations, lack of follow-up opportunities,’ he said.
 
‘Patients also miss the opportunity for preventive care that can be provided by a GP.’
 
Professor Morgan said he would be keen to work with jurisdictions and industry to remove some of the demands for these kinds of certificates.
 
‘Why can we trust individuals to handle deadly machinery, drive our children around in buses, teach, maintain law and order, handle large accounts but we cannot trust people to decide they are too sick to work and take a modest amount of time off?’ he said.
 
‘Why do we instead require a certificate written with minimal clinical input in the case of a telehealth certificate providing service?’
 
Professor Morgan said carving primary healthcare into a variety of limited-service providers breaks continuity of care, and that he fears the current direction drives ‘low-value piecemeal services’.
 
‘Substituting highly trained GPs with apparently cheaper and more numerous alternative providers is a false economy,’ he said.
 
Meanwhile, Associate Professor Clements said he would not be surprised if employers stop accepting them.
 
‘The employers may just start saying, “No, we don’t accept online medical certificates”, because it’s farcical, it’s a joke,’ he said.
 
‘I’m not suggesting that GPs should be seeing everybody that’s got a runny nose just because the employer wants that, but something’s got to give.’
 
Of even more concern, Associate Professor Clements said, are online providers ‘pretending to provide a medical service when they’re really not’.
 
‘Whether it’s a doctor or nurse practitioner or anybody – the fact is when they’re writing a medical certificate, they’re still accountable to the Medical Board and they’re still accountable for good medical practice,’ he said.
 
‘In the case of somebody that asked for a medical certificate for chest pain, or for mental health, and they weren’t appropriately assessed, and appropriate due diligence taken, and something happened, then that doctor could certainly be held to account by the coroner or by the Medical Board.’
 
Online medical certificate providers Hola Health, UpDoc, Dr Jimmy and Our Sage were contacted for comment.
 
The RACGP’s position statement on telehealth is available online.
 
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