Telemedicine Providers Emphasize the Importance of Ethical Practices After MaNaDr Incident
SINGAPORE – The recent issues surrounding MaNaDr Clinic have raised concerns about ethical standards in the telehealth industry, with health authorities flagging incidents where doctors conducted teleconsultations lasting less than a minute and issued multiple medical certificates (MCs) within short periods. These actions have led to public mistrust and sparked discussions about maintaining clinical integrity in the telemedicine sector.
Industry Reactions
Doctor Anywhere, a major telehealth provider, reported a slight decline in business following the news of MaNaDr Clinic’s practices in August. However, Dr Andrew Fang, its director of medical affairs, expressed confidence in the long-term recovery of telemedicine, asserting that it remains a vital part of Singapore’s healthcare system.
Speedoc, another telehealth platform, highlighted the importance of thorough documentation and patient-centered protocols. Dr Shravan Verma, Speedoc’s CEO, emphasized that their team is committed to transparency and actively supports requests for MC verification from employers.
Other telehealth operators like Raffles Medical Group, Fullerton Health, and Pinnacle Family Clinic have stringent internal audits to monitor teleconsultation practices, such as consultation duration and MC issuance, to ensure ethical compliance.
Clinical Standards and Practices
Telehealth platforms use digital records systems to monitor patient consultations. For example, Fullerton Health flags patients who have multiple consultations for the same condition within a short period. According to Dr Marcus Lee, Fullerton Health’s medical director, if a patient requests three or more consultations for the same issue in a month, they are flagged for review.
While there is no universal standard for how long a teleconsultation should last, the general consensus among healthcare providers is that sessions lasting less than one minute are inadequate. Dr Mok Boon Rui, founder of Pinnacle Family Clinic, stated that three to four minutes is typically the minimum required for a thorough consultation, with more complex cases needing additional time. For common conditions, consultations rarely exceed five minutes.
Addressing Abuse of Telemedicine
In response to concerns about MC abuse, Dr Mok explained that Pinnacle Family Clinic charges fixed rates for teleconsultations, regardless of their duration. This approach helps prevent manipulation, where patients may rush consultations to avoid additional charges. Other platforms with duration-based pricing could incentivize shorter, insufficient consultations.
Regulatory and Ethical Concerns
The case has also prompted concerns about moonlighting among doctors, particularly locum practitioners. MaNaDr Clinic employed doctors who were also working in public healthcare institutions, which violates regulations prohibiting moonlighting. The Singapore Medical Council has referred 41 MaNaDr doctors for potential professional misconduct.
Telehealth providers like Raffles Medical and Pinnacle Family Clinic do not employ locums for telehealth work, while other platforms rely on doctors providing their Medical Council Registration (MCR) numbers for verification. However, Dr Fang from Doctor Anywhere pointed out that telehealth platforms depend on doctors’ self-disclosure regarding their employment status, as they do not have direct access to public sector employment records.
Conclusion
The MaNaDr Clinic incident underscores the critical need for telehealth providers to maintain high standards of clinical practice, ensuring that consultation duration, patient records, and MC issuance adhere to ethical guidelines. While telemedicine continues to play a crucial role in healthcare, the industry must remain vigilant in monitoring practices and ensuring that doctors uphold the trust and quality expected by patients.
