Hong Kong’s medical watchdog has come under increasing pressure to clarify its rules on remote and electronic consultations, as patients turn to technology to reduce social contact and avoid infection during the coronavirus pandemic.
Covid-19, which has infected 157 people in the city and killed four, has driven up demand for telemedicine and reignited debate in the medical sector on the merits of embracing this emerging technology, according to industry advocates.
Telemedicine, or E-consultation, allows patients to be seen and diagnosed remotely by doctors via electronic communication such as video conferencing. Patients can also send photos of their injuries or illnesses to health care professionals to get some quick medical advice.
Hong Kong’s public hospitals have used limited video-based consultation since 1998 for some patients such as residents of homes for the elderly. The method has recently been extended to psychiatric patients and those in need of occupational and physiotherapy, to lower coronavirus infection risks.
While the technology has caught on in the United States and some European countries, it has yet to find the same appeal in Hong Kong, with some experts blaming the lack of a local appetite on high accessibility to family doctors, and unclear rules of the Medical Council, the regulatory body of the profession.
But the coronavirus crisis has shifted the debate in the industry, according to Felix Lee Kar-chung, executive director of UMP Healthcare Holdings, which provides medical and health care services in Hong Kong, Macau and mainland China.
Lee, a long-time advocate of telemedicine, said demand for video-based consultations had soared.
“The public is warming to the idea of telemedicine as many are concerned about getting infected with the coronavirus when visiting clinics and hospitals,” he said.
Henry Yeung Chiu-fat, president of the Hong Kong Doctors Union, also renewed his call for the wider application of telemedicine in primary care settings, and said it could be used for repeat patients with stable and chronic conditions such as high blood pressure, high cholesterol or diabetes.
“General practitioners can talk to their regular patients on the phone and ask about recent symptoms and any changes in their health. If their condition remains stable and much the same, they can just get the same medicine in the clinics and avoid long waiting times and contact with other patients,” he said.
The paediatrician said, for example, jaundice, a condition often found in infants and characterised by a yellowish tinge to the skin, could be diagnosed through video-based consultations.
Medical Association president Dr Ho Chung-ping added the digital platform could also protect medical personnel short of personal protection equipment such as masks and gowns against infection.
Yeung said inquiries about telemedicine from doctors and patients alike had risen by about 10 per cent recently, prompting him to ask the Medical Council to spell out more clearly whether the technology was allowed in the professional code of conduct, but he had so far received no reply.
The council’s ethics committee chairman, Dr Leung Chi-chiu, said the rules did not directly address the use of telemedicine but the body had issued a guideline laying out some broad principles, with further discussions needed to decide on oversight and technical issues.
“Basically, the guiding principles are that the technology used must yield a clinical benefit to the patient, and the medical care provided must not be lower than that of face-to-face consultations,” he said.
Others, however, urged caution and more consideration, and warned of potential pitfalls of the technology. Former Medical Association chairman Dr Gabriel Choi Kin said remote consultations might increase the chances of misdiagnosis and medical blunders.
“Doctors can’t feel the pulse or use a stethoscope on a patient’s chest. In the end, doctors might be held liable for their misjudgments.”
Choi also cast doubt on the long-term value of the remote consultations. “When we have as many family clinics as 7-Eleven convenience stores in Hong Kong, do we really need such widespread use of telemedicine.”
Tim Pang Hung-cheong, spokesman of the Patients’ Rights Association, said while telemedicine could most benefit bedridden patients and those in residential care, the council needed to do a tough balancing act between regulation and promoting the technology.
“The council needs to make patients aware of their rights, and doctors of their duties even though a consultation is done through unconventional means.”
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