[Telemedicine at a Crossroads]② Hair Loss and Cold Medicine Prescribed at First Visit... Some Doctors Say "Just Follow the Rules"

Seoul A Pediatric Clinic recently conducts non-face-to-face consultations for 5 to 6 child patients on weekdays and about 10 on weekends due to a surge in cold patients. After asking about symptoms such as whether the child has a fever, cough, or sore throat, they double-check with the guardian. Explanations about medication intake are always provided without fail. They advise visiting the hospital if the condition appears like COVID-19, pneumonia, or worsens. Since most mild cases were treated through non-face-to-face consultations, there were no adverse effects. However, diseases requiring direct examination by a doctor, such as dermatitis, growth disorders, and obesity, are treated face-to-face. The director of Clinic A emphasized, "As long as medical staff follow the principles, the scope of non-face-to-face consultations does not necessarily have to be limited to follow-up visits."

Some doctors who have tried non-face-to-face consultations say that initial examinations can be conducted without meeting patients in person. There is growing support for attempting initial consultations for diseases with many cases and no adverse effects by analyzing 34 million medical data of non-face-to-face consultations accumulated over three years of COVID-19. Representative examples include cold medicine, allergy medicine, and hair loss medicine, which patients are reluctant to visit medical institutions for.

The government's decision to impose restrictions on initial consultations in the pilot project starting next month reflects the medical community's view that there are limitations to consultations conducted solely through digital devices such as smartphones. However, even in temporary non-face-to-face consultations, examinations requiring inspection, auscultation, percussion, and palpation are practically not performed. The director of Clinic B in Suwon, Gyeonggi Province, said, "When chronic disease patients such as hypertension and diabetes apply for non-face-to-face consultations just to get prescriptions, we carefully check when their last hospital visit was and their recent blood pressure and blood sugar levels," adding, "We refuse consultations that exceed the capabilities of non-face-to-face care." According to data released by the Ministry of Health and Welfare in March titled 'Three Years of Non-Face-to-Face Consultations Protecting the Health of 13.79 Million People,' there were only five minor patient safety incidents (omissions or errors in the prescription process) from 2020 to November 2022.

As non-face-to-face consultations are being used as a supplementary means to face-to-face care, there is criticism that the pilot project plan is an excessive regulation. In particular, the clauses 'follow-up visits only' and 'prohibition of medication delivery' are pointed out as reflecting only the medical community's stance. Until now, the Korean Medical Association and the Korean Pharmaceutical Association have doubted the effectiveness of non-face-to-face consultations due to concerns about misdiagnosis risks and the collapse of the medical delivery system. Regarding the pilot project plan for non-face-to-face consultations, they voiced that "the allowed scope is too broad."

The platform industry views the government's reversal on allowing initial consultations only for pediatric care during nights and weekends?from initially permitting it to "under review" on the day of the pilot project announcement?as "cautiousness toward the medical community." A representative of the Remote Medical Industry Council criticized, "Despite non-face-to-face consultations filling the medical gap during the Omicron surge early last year, they were discarded like a used item in the endemic phase."

Busy Pediatrics
[Image source=Yonhap News]

Among frontline doctors and pharmacists, there are also remarks that "there is a significant gap in opinions between medical and pharmaceutical organizations and medical staff who have conducted non-face-to-face consultations in the field." Especially since the fee includes a basic consultation fee, medication cost, and a 'pilot project management fee' of about 30% of the general consultation fee, non-face-to-face consultations are an attractive option among young doctors and pharmacists. Korean Medicine doctors prescribing herbal medicine through non-face-to-face consultations express similar opinions. The Korean Medicine Doctors Association also abstained from a statement by medical and pharmaceutical organizations expressing concerns about the non-face-to-face consultation pilot project on the 19th, saying, "We have not yet decided on our position."

If non-face-to-face consultations focused on follow-up visits begin, consumer attrition is inevitable. According to a survey conducted by the Korea Health Industry Development Institute in September last year targeting 1,707 users of non-face-to-face consultations, 91.7% of residents in towns and villages and 87.9% of residents in large cities expressed willingness to reuse non-face-to-face consultations in the future. However, Mr. Gu (31), a resident of Dongjak-gu, Seoul, said, "If hospital choices are limited and I have to pick up medication myself in non-face-to-face consultations, I probably won't use it frequently anymore."

Professor Sung Tae-yoon of Yonsei University's Department of Economics said, "Non-face-to-face consultations and platforms, which were useful during the COVID-19 pandemic, should not become ineffective due to excessive regulations," emphasizing, "It is necessary to set standards and allow initial consultations for diseases proven safe in non-face-to-face care."