No online medication subscriptions can replace the benefits of holistic GP care
Many aspects of our lives are shifting online for better access and availability, including healthcare – the latest being prescriptions for the oral contraceptive pill – but doctors need to continue to provide the many aspects of patient care that cannot be replicated online.
The aim of an online contraceptive pill prescription service is to take the ‘pain’ out of making a GP appointment, skip the middle man, and to make healthcare more accessible and convenient for people experiencing periods.
While the promise of no more waiting rooms is universally appealing, Australia’s Medical Association doctors warn of the impact of choosing convenience over a face-to-face appointment with a GP, in regards to safety.
But our existing healthcare system should recognise that increased demand for online medical services is because right now, the difficulty of getting a GP appointment outweighs its perceived benefit.
And this is a fundamental issue with the accessibility and structure of our primary healthcare system.
ABS data shows that in 2018-2019, less than 23 percent of people delayed or avoided seeing their doctor - and very few because of cost - down from 27.3 percent in 2017-2019.
Bulk billing rates are being reported as impressively high, at 86 percent in 2018.
But rates of bulk billing services do not necessarily reflect accessibility to GPs. These numbers fail to communicate the reality of many who are deterred from seeing their GP by waiting times and out-of-pocket expenses.
30 percent of people in regional or remote areas (and 17 percent in major cities) report attending their emergency department as their only option to access timely and free healthcare when a GP is unavailable.
Many patients, particularly in the demographic of women seeking contraception, are likely to be balancing work and family commitments, limiting free days where they can afford travel to a clinic, sit in a waiting room or pop over to the chemist.
The increased ease of accessing medication scripts, including the pill, has triggered some concerns and criticisms from the Royal Australian College of General Practitioners.The obvious drawback is the compromise on patient safety when prescribing medication online.
Inadequate primary care is recognised to have significant impact and flow-on effects to poor health outcomes and full hospitals.
GP ‘superclinics’, an initiative to improve accessibility in certain districts by offering walk-in appointments and extended consulting hours, have their own flaws. Patients at these clinics often see a different GP every time, losing the continuity of care required to develop rapport and a good therapeutic relationship.
There have been calls to reform the frozen fee-for-service Australian primary care model for some time, and we can see that funding is a very significant determinant of how well GPs can perform.
It took a coronavirus pandemic to prompt an update of the billing schedule and to value and rebate phone calls and video consults as important for safe community care.
Still, these improvements are not keeping up with the evolving population and this has driven innovators to promote their online alternatives.
These services empower patients to take control of their healthcare, rather than be subject to the currently overburdened Australian primary care system.
The obvious drawback is the compromise on patient safety when prescribing medication online, although many prescription services are targeted at renewing existing scripts and delivering medication rather than initiating a new medication (for which an in-person consultation is strongly encouraged).
Australia’s first pill delivery service, Kin Fertility, have evidently considered other concerns regarding a business model for medication delivery.
Their website promotes empowering and educating women, with links to articles on common issues like miscarriage, endometriosis, and polycystic ovarian syndrome to normalise conversations about reproductive and sexual health.
There is no one-sided blatant promotion of their product, as the website also offers a breakdown of other contraceptive methods including condoms, depot injections, implantable rods or intrauterine devices - none of which would be accessible within their online service.
And although not on their homepage, there are facts and patient testimonials about the pill’s risky side effects such as increased clotting risk, exacerbation of migraines and correlation with worsened depression or low mood.
This review indicates that their subscription fee is refundable if you are deemed unsuitable to use their service, so there is no financial loss if after the text consult with the doctor you decide not to get the pill.
Although the subscription itself does cost more than a bulk billing GP appointment for the script, the convenience offered may be worth it for many.
Online platforms where resources are edited by doctors, like Kin’s, can be useful for health literacy, especially for issues in women’s health where stigma has a history of discouraging patients from seeking knowledge and help.
Phone or text consults, however, cannot and should not replace the intangible benefits of taking the time to sit down with a GP for an in-person consultation.
The phrase ‘just while we’re here…’ is a commonly utilised and worthwhile segue used in appointments by both patient and doctor to prompt conversations on more sensitive or broader health issues, including sexually transmitted diseases or cervical cancer screening.
While these topics can theoretically be discussed over the phone, a doctor’s ability to assess subtleties and physical cues like the patient's complexion, body language and clothing choice is hindered.
A GP could use these clues to identify issues in mental health, carer fatigue or domestic abuse, which a patient may not necessarily volunteer themselves. And if women are no longer prompted to see their GP for their script renewal, they could miss these crucial opportunities for intervention.
Doctors are also invested in their patients – following up and tracking a patient’s progress in multiple aspects of their health and wellbeing is rewarding for the doctor as well.
In the frustration of sitting in a waiting room because your GP is running late, it can be easy to forget that it is because they are looking after a huge breadth of complex issues in each patient appointment.
The reality is that GPs are not granted nearly enough time to do so, especially given the financial constraints of running a practice.
Yes, being able to see a regular GP is a privilege.
Being able to afford non bulk-billing appointments, or take time away from work or family to attend them on weekdays in working hours is also a privilege, but it is not always possible.
And while our primary healthcare system is imperfect, we should continue promoting and providing the opportunity for everyone to sit down with a GP.
We can look to alternative online initiatives to make contraception more accessible, but this in no way outweighs the benefits of building a one-on-one relationship with your GP.