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  1. 1

    Dr Tim Smyth

    The now restricted access to Medicare GP telehealth is throwing out the baby with the bathwater. No one would disagree that the telehealth “cowboys” needed weeding out. And encouraging everyone to have a “home” in primary care with a general practice that provides quality care is goal we need to pursue.

    The “no telehealth with any GP unless you have been a patient of that GP or their practice in the previous year” will certainly cut the escalating Medicare bill for government. But as many others have commented, it will seriously disadvantage many patients and families, people in places where there is limited access to bulk billing practices and who now face an out of pocket expense of $50 or more, towns where GP practices have “closed their books” to new patients and vulnerable groups who do not have a regular GP (and this is not just the homeless who have been exempted).

    While trying to put the “cowboys” out of business, the restriction will also undermine quality after hours telehealth triage services and innovative service models that are proving their value across Australia. GPs, like the rest of us, sensibly want a work/life balance and increasingly they rely on these after hours services to provide care to their patients. These services are also supporting a growing number of residential aged care facilities and home palliative care services.

    Rather than “stage seven of telehealth reforms” as the government’s media release describes the change, this blunt edged restriction is a missed opportunity for Australia to embark on a journey to build a much better health system for all Australians. Telehealth presents great opportunities and is much more than just telephone consultations. As has been shown in other parts of the world, the intelligent use of telehealth, online and app triage, hospital in the home remote telehealth monitoring and other forms of virtual healthcare does deliver quality care, cost effectiveness for government (and we taxpayers) and patient satisfaction. It also utilises the skills of all the health care team, especially nurses and allied health professionals.

    Due to our federation, the multiple and often conflicting health service funding models, general practices so reliant on fee for service for their revenue and survival and private health insurers being unable to find a revenue stream to support out of hospital care for their members, Australia has lagged behind in adopting the good things that virtual healthcare can provide. Covid-19 must not keep us locked into the past.

    Telehealth and virtual healthcare is not the enemy of quality general practice and better healthcare. Applied sensibly across general practice, other specialist care, hospitals and home and community care, telehealth is an essential part of our toolkit to make Australia’s health system better, providing quality care where you need it, when you need it.

    Let’s hope a rethink of stage seven of the telehealth reforms gets us back on track to achieving this.

  2. 2

    Mark J Diamond

    Well said Tim – I agree. A missed opportunity indeed. Let’s hope there is some serious consideration of how to enable the advantages of what telehealth in all its forms can achieve. Especially for people in remote and very remote Australia.

  3. 3

    asd woman

    I was able to connect with my gp, a nurse and a psychiatrist via telehealth, before the recent changes. My GP had just moved clinics and was not seeing people face to face face. If i hadnt found her name online and been able to register my details entirely over the phone with the new clinic… Id not have seen a dr at all, let alone the one i trust and knows about my disabilities and cancer treatments. My poor immune system, history of abuse resulting in ptsd and botched emergency surgeries that led to extreme anxiety of all things medical, along with my ASD and ADHD already make it next to impossible to make myself leave the house, let alone do so to attend a clinic with new people or somehow despite the panic attacks that begin days before…have much chance of making it there on time…

    This issue has made it too difficult to want to follow up tests to track cancerous cells. The surgery i needed when i finally made myself go..4ish years later.. was traumatic. Sent home not even told i had stitches… my written consent restrictions ignored… a simple procedure that i should have recovered from in days- instead had be in agony, unable to move, bedridden for months..the hospital unable to read the notes to see what the surgeon even did… this brought back memories of waking up in another surgery for a few seconds… Ive been too scared to return for follow up treatment.

    I did however make it to one Psychiatrist app. It was hard, i was late, i wasnt comfortable, he joked that he expected to see me on time next week, now i knew where to go..Next week i felt sick with anxiety, and had no one to drive me in. I was 35mins late. Parked outside the clinic in a one way street, I went to pay with my note, only to see the meter only accepted cards. i had no money on my card. I cried, I went home and felt hopeless. People are angry when you are late, they reprimand you, or feel you dont respect them. They often refuse to see you or refuse to book you in again. They dont understand the hours you spent trying to get there.. that you dont mean it..and when you have anxiety about getting medical help, and about getting there, being on time and the appointment being of value, the events not influenced by staff being annoyed at you, rushing or telling you off repeatedly until you want to just leave and the reasons you came fade, and you dont get to mention all of them..

    Then i didnt call them, i felt so rude and pathetic i didnt know what to say. So i suffered on for months, even after a close friend died, my health deteriorated as i also avoided another clinic with app i really needed to attend.. as it was at the same hospital i had received the cancer treatment for.. I searched again and again trying to find a service with telehealth that bulkbilled or accepted clients that were not living in rural areas. Never was i eligible.

    Then covid-19 came, and I heard about telehealth services being expanded. I put aside my fear and emailed the psychiatrist receptionist, apologising and explaining what had happened and asking if the Psychiatrist would see me via telehealth. The next week, i picked up the phone, on time, sitting at my kitchen table, surrounded by my familiar, comforting environment and talked easily with him for an hour. I could answer honestly, not uncomfortable as i didnt need to worry about looking in someones eyes or them watching me do things i do when im nervous, that easy betray so.. It was easy and it made me hopeful, i could finally receive the help I needed without the factors that prevented me getting it for years..

    Even back then though, there were limits, as we made our next appointment, he advised he really did need to see me face to face until he got to know me atleast. Crestfallen and bemused that he had infact been able to talk to the real me that hour, an event that never would eventuate no matter how many times he saw me, anywhere else, as my home is the one place i feel comfortable,rational; unclouded by fears. I agreed, knowing full well it would take a damn miracle. i wanted to…i didnt.

    I had a telehealth app with my gp once i was ready to try again, for a telehealth Psych clinic that actually agreed to take on Melbourne city area patients.. it wasnt bulkbilled, its just usually you need to be rural even to access the service. But i needed a refferal first before they would even check Dr availability and disclose the fee. My GP agreed, but had just moved clinics so no longer had access to the two years of my seeing her records, or the ten years of previous records i had transferred there. She wanted me to come in before she would issue my regular prescription, bring in the records and then she would write the referral. So months later having not been able to go in, both from concern for my health due to chronic health issues, and reduced immunity but also from anxiety and other asd linked issues.. i still havent been able to get my prescription, Or book in with an Psychiatrist to help me via the only way my conditions would allow me to access that help.. via telehealth.

    Recently i also finally had a long app over the phone with a nurse, to finally address issues caused by the last surgery, that ive been too uncomfortable to address in person.. all because i knew i didnt have to go in. when she called via facetime unexpectedly, I panicked, i stuttered speaking to her as seriously i was considering just hanging up on her. Instead i managed to ask her if she would call me back normally as i would find it much easier. She happily obliged, and the rest of the appointment we t smoothly and was helpful.

    I am aware that my situation is unique to my situation, as many others will think im just being ridiculous or difficult and stupid for not accessing the help i need that is out there. I agree, but the issues from asd and ptsd are many and their voice louder than the one of reason, when it comes to seeking medical help. And i think explaining my experiences can give people and understanding into atleast two groups in the community that will benefit from ongoing telehealth without the new restrictions, in ways not often spoken about and that is access to people with disabilities, physical, developmental and emotional or mental health issues that have services in place already… but many of the people needing them.. like me.. wont get that help under the current system.


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