Online doctor consultations take off in Canada

Virtual medical services that connect family physicians and patients with minor illnesses and injuries are popping up online in Canada, leading to questions about the quality of care and universality.

Questions raised over quality of consultations and universality principle

Clinicians need to have access to a patient's regular medical record to have high-quality care, says Prof. Aude Motulsky. (CBC)

Virtual medical services that connect family physicians and patients with minor illnesses and injuries are popping up online in Canada, leading to questions about the universality and quality of care.

More than half a dozen technology companies have launched apps in the last year to provide virtual consultations, or a "doctor in your pocket" to text, call or video chat.

Emergency room physician Dr. Brett Belchetz is the CEO of Maple, a Toronto-based telemedicine platform that facilitates consultations between Canadian doctors and patients.

People using the Maple service receive a diagnosis for common ailments such as urinary tract infections, as well as prescriptions for non-narcotic medications. About 6,000 patients have used the platform.

Maple's fees start at $49, with annual family memberships offering unlimited consultation for $580.

"It's an Uber model," said Belchetz. "The doctors are billing the patient but we are a facilitator."

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The biggest issue with such services is quality of care when physicians don't have access to a patient's medical history, said Aude Motulsky, a research scientist at the University of Montreal Hospital Research Centre and a professor at the School of Public Health.

"Do we have any guarantee that everything is in place so we can have a high-quality consultation?" Motulsky asked.

Breach of universality

Motulsky is concerned about access to primary health care and sees challenges from online telemedicine platforms.

"We have to understand that this is a breach in the universality principle of the health-care system, because in most of these applications you have to pay to have access to the service," Motulsky said.

About 6,000 patients have used Maple's telemedicine service, the company says. (Maple)

The universality principle says access to medical care should be based on your needs and not on your ability to afford it.

"You have to remember, these clinicians when they're busy answering or doing these consultations, they're not taking care of their own patient or they're not seeing new patients."

Lack of continuity of care — not having an ongoing relationship between the doctor and patient — is another issue.  

"It is really important in some cases, for chronic conditions, for example," Motulsky said. "Some patients have a tendency for doctor shopping, so it is really important to make sure these clinicians are going to have access to [medical record] information to have high quality of care."

More care isn't always better care, said Dr. Monika Dutt, a family physician in Sydney, N.S., and past chair of Canadian Doctors for Medicare.

"Just because you can access something quickly and get a prescription faster, and get care faster, it's not necessarily a good thing," Dutt said. "We need to make sure it does benefit the patient and makes sense within the system."

Just as doctors in the community provide appropriate advice and counselling, Belchetz said, Maple will guide people to care but they aren't able to refer to specialists. 

With files from CBC's Vik Adhopia