Trying an online doctor for the first time- what makes people nervous?

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For many people, consulting an online doctor is now a fairly routine option. But sometimes, when I am speaking to a new patient online, they admit that they had been feeling a bit nervous about the idea of using an online doctor for the first time- and whilst they were obviously willing to take a chance and “give it a go”, they were not sure if it was actually a genuine service! So, here are a few points that may help with such concerns:

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Firstly, any doctor, whether online or in a clinic, must be registered with AHPRA- the Australian Health Practitioner Regulation Agency, and they should have a registration number which can be verified at www.ahpra.gov.au. To be registered with AHPRA, a doctor must meet very strict standards- so if their name appears here, you can assume they have been properly assessed and vetted. For instance, I work as an online doctor with www.drsicknote.com.au , and all our medical certificates display the AHPRA registration number of the relevant doctor, so both the patient and employer can verify the doctor’s credentials if they wish.

Whilst the idea of an online doctor may seem very new and ground-breaking, the idea of “telemedicine” has been around for a while, and many doctors are routinely covered by their professional insurance to provide services in this way.

I have also heard people ask whether a doctor can properly assess a patient without seeing them in person. I think this is a very reasonable question. But, having worked as a GP for many years, I can safely say that a large part of day to day work is done by taking a good history. Certain conditions, such as migraine, viral illnesses, gastroenteritis, period pain (to name but a few), are easily diagnosed by asking the right questions.

Sometimes, a few tests are needed at the start, but if a person has already had the proper baseline investigations, then ongoing care, such as prescriptions or medical certificates for missed work-days can be safely issued without having to visit a doctor every few months. Unfortunately, if a person is going to lie about an illness to get a sick day, they can just as easily do that in person as online. In the end, anyone who behaves in this manner is their own worst enemy- as they will quickly run into trouble with their employer. It’s also important to point out, that sometimes a person who is taking a lot of sick leave may be suffering from stress, anxiety or depression, for example- so, if a patient returns for medical certificate after medical certificate (whether that be to an online doctor or a regular GP), usually the pattern will be noticed and a good doctor will ask if everything is OK.

I’ve also had a few patients who were a little shy about appearing “on camera” at first. However, all of these people soon relaxed when they realised that, just as in a surgery, an online doctor is not there to judge their appearance, nor indeed the appearance of their home- the focus will be on the health problem.

Most of us are already comfortable using Skype, Viber, Facetime or other similar “virtual” methods of communication – therefore, using an online doctor is quite a natural step to take, and one that can offer a lot of choice and convenience to people in their busy lives.

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Online medicine : How your smartphone can help you avoid the doctor’s waiting room

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At this time of year GP surgeries are packed to the rafters with patients suffering from viral illnesses. Most people are well aware that an antibiotic won’t help a viral infection, and that the best treatment is simply time and a little TLC.

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Yet many employers still insist upon a medical certificate. And so, instead of curling up in bed with a hot drink and a good box set, a journey to the local doctor is required, and unwell people find themselves sitting in crowded waiting rooms, queueing for a piece of paper and a signature! It can be quite frustrating!

However, times are changing. Nowadays, nearly everyone has a smartphone and these devices are becoming more and more useful in our daily lives. Sure, they allow us to do simple things like order a pizza, grab an Uber or chase a Pokémon! But smartphones are also starting to revolutionise how healthcare can be accessed- and I’m not talking about Dr Google!

In Australia there are already several online services offering medical certificates. This can be particularly helpful when a medical problem is simple and doesn’t require a physical examination. The common cold, gastroenteritis, sinusitis, period pain, migraine and viral illnesses are all self-limiting health problems- and an online doctor can safely issue a medical certificate for these ailments, following a brief consultation.

Some online doctors also offer prescriptions for simple medical issues, and repeat prescriptions for certain long term medical conditions. Most people are used to seeing their local GP to get their medications, as often some sort of examination is needed. But technology is advancing all the time- and will allow a lot of health measurements to be done without needing a doctor or nurse present.

Wearable health devices such as “Fitbits” have become very popular and are just the start of what is possible. In time, a lot of the health information a doctor needs will be attainable via such devices and smartphone apps, and healthcare professionals will be able to prescribe remotely.

So, the next time you need a medical certificate or a simple prescription, have a look at the growing number of online options- it might prove to be a very easy and economical way to avoid queues and waiting rooms this winter!

Shift work and the online doctor

In my work as an online doctor, I have been struck by the high number of shift workers using our service. There are some obvious practical reasons for this- when a person works unsociable hours, it is always going to be difficult to access a GP during the “normal” working day.

Availability of an online route to obtain a medical certificate or a repeat prescription can be enormously helpful and convenient. A tough shift schedule also means that rest periods are all the more precious so if access to an online doctor can save a person a few hours in a waiting room, that is going to be quite an attractive option.

However, there is also growing evidence that shift work may actually pose a risk to health, in a variety of ways (though further research is needed in a lot of these areas before we can be 100% certain).

Injuries and accidents seem to occur more frequently amongst shift workers- with an estimated increase of 15% on evening shifts and 28% on night shifts.

In 2007 the World Health Organisation classified shift work as a “possible carcinogen” or cancer-causing agent. It appears there may be a link between shift work and an increased risk of breast cancer and there is some evidence of links with other cancers, such as colon cancer. It seems that there may also be a higher risk of heart disease, obesity, raised blood pressure, and type 2 diabetes. Some research indicates an increased risk of preterm delivery, gastrointestinal symptoms, and mental health problems.

So, it may be prudent for a shift worker to see their GP more frequently for checkups than they might otherwise do- to ensure that issues such as high blood pressure or high blood sugar are picked up early, and appropriate steps are taken. And as a doctor online whether  or based in a clinic, it is certainly worth clarifying whether the patient sitting before us is a shift worker or not, as this knowledge may prompt us to more thoroughly explore issues relating to physical and mental health.

For many people, shift work is just a phase, on the way to the next step of their lives. For countless others, it is simply a reality of their career in the longer term. For these people, an online doctor may be of real benefit- to prevent disease through education and lifestyle changes, to diagnose problems early before they become severe, and perhaps most importantly of all- to provide all this in a way that acknowledges the reality of shift work- ensuring that the care accessible to regular 9-5 workers is just as accessible to shift workers, albeit in an online form. In many cases, those who perform shift work are running services without which society would not function- from healthcare to travel and transport, energy provision and law enforcement. As a society, it makes absolute sense to support these people in their vital work, in whatever ways we can.

Sore Throats, Streptococcus, and Sick Notes!

At this time of year, sore throat is one of the most common reasons for people to attend their doctor, for advice, treatment and often a medical certificate for work. In about 90% of cases sore throats are caused by viruses, so it’s all about painkillers, TLC and patience. Antibiotics don’t kill viruses, so are entirely pointless in most cases. Fortunately, people are becoming much more aware of this, and of the dangers of unnecessary antibiotics.  Whilst antibiotics can cause side effects such as rashes, stomach upset and diarrhoea, we now know there are harms to wider society too. We’ve all heard the horror stories of “super-bugs”, which are caused when bacteria are over-exposed to antibiotics and gradually develop resistance to them. These bugs can be very dangerous if they invade the body- as doctors have limited ways to fight them if standard antibiotics no longer work.  Such infections are a particular threat to babies, the elderly, or those whose immune systems are underperforming due to illness, cancer treatment or certain medications.

But what about the 10% of sore throats that ARE caused by bacteria- namely, streptococcus? Well, even in these cases, the body will often clear the infection if given time. It does this by sending white blood cells (known as neutrophils) to attack the invading bugs. Often (but not always) the symptoms of a strep throat will be worse than a viral infection- with high fevers, enlarged tender glands, bad breath and sometimes a skin rash. One of the most useful investigations we can do for our patients- to decide if their sore throat is viral or bacterial- is a rapid or “on the spot” test for streptococcal infection. This involves a quick swab of the throat- the swab is placed in a liquid, which flows into a panel that will, after a few minutes, show if strep is present. It looks the same as a pregnancy test- one line is negative, two lines is positive. This test means we can confidently tell a patient whether or not an antibiotic is needed. It is pretty cheap to run, though it is not (as yet) covered by Medicare. But most patients seem to prefer to spend their dollars on the test rather than similar amounts on potentially pointless, potentially harmful antibiotics. So next time a sore throat strikes, remember to ask your GP if they have a rapid test for streptococcal infection.

It’s also worth remembering that a trip to the GP surgery is not always necessary these days. If the pain is manageable, and you are able swallow and drink enough fluids, then an online doctor can provide your medical certificate, and you can recover in the comfort of home.