Pharmacy not conducive to assessment, says online doctor

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Online doctor service Qoctor has also taken aim at pharmacy sick notes, as it celebrates its 10,000th medical certificate

Earlier this month, Innex Willox, chief executive of the Australian Industry Group, told News Corp media that “some bosses would be sceptical of notes obtained from a chain store pharmacy”.

“Pharmacists are not doctors and the Fair Work Act makes no reference to them being appropriately qualified to issue medical certificates for the purposes of personal/carer’s leave entitlements,” Mr Willox said at the time.

On a later Channel Seven report, the AMA’s Dr Chris Moy said that he was concerned that patients might not be able to be adequately assessed in a “busy shop”.

Now Dr Aifric Boylan, CEO of Qoctor – formerly known as Dr Sicknote – has told the AJP that she has similar concerns.

“I can understand the apprehension around sick notes being issued by pharmacists—the physical environment of a pharmacy may not always be conducive to a thorough and confidential assessment,” she says.

“Furthermore, pharmacists receive very different training to doctors, and whilst a medical certificate may seem like a simple matter, it’s vital that the healthcare professional who issues it has robust clinical training and experience, so if something more serious is underlying, it’ll be picked up on.”

Qoctor (which News Corp still referred to as Dr Sicknote) had also come under fire from Mr Willox, who said that employees would be wise not to use such services as “for obvious reasons, in most cases a doctor will be unable to conclude that a person is genuinely sick without having any physical contact with the person”.

Meanwhile, Qoctor has just celebrated its 10,000th sick note, which it says makes it the largest distributor of medical absence from work certificates in Australia.

Since its launch two years ago it has added the provision of specialist referrals, prescriptions and delivery of medication through its online hub.

It says prescriptions for conditions like chlamydia, erectile dysfunction, premature ejaculation and hair loss in men, as well as contraception, are expected to be top sellers for consumers in 2018 based on sales data.

“Qoctor’s online doctor service continues to expand—we are now offering online consultations, including assessment for prescription medications where appropriate- with home delivery available if the patient wishes,” Dr Boylan says.

“It’s growing very rapidly, as it allows patients to access treatment for contraception, sexual health and multiple other common health issues, without the need to take time out to visit a doctor in person.

“We are looking to expand our network of partner pharmacies in the coming months, throughout Australia.”

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  1. Patrick Mahony

    We have written >9,000 PMCs (Pharmacist Medical Certificates) in our pharmacies. The major points I raised in a paper I presented to the PSA17 in Sydney were;
    1. 92% of PMCs were for Vomiting, Diarrhoea, Colds and Headaches (migraine). Conditions we as pharmacist treat every day.
    2. Almost all applicants did not have a regular GP and were not on any long term medication.
    3. Most were males,18 to 35 years of age, and not regular attenders of a pharmacy. Many were not long term residents of our area.
    4. We also collect information about where they work. Most worked in industry but we had employees from the local hospital, retail (including McDonalds) and schools.
    5. We liaised with the major employers to ensure they were accepting of our certificates. They expressed confidence in our process and were particularly favorable because were allocated a single day where GPs would give anything up to a week.
    6. My biggest concern is that the PSA did not consider this as a professional service and as such did not publish PMCs as a Professional Standard in its 2017 document.

    In conclusion, we developed a process which documented everything and could provide copies of the signed “Triage form” if an employer requested.

    I am concerned that MedAdvisor does not collect the full details we do in our system nor do they provide a level of feed-back and recommendation to the applicant. Also linking it to the dispense program has some advantages but as most applicants do not have prescription history is an unnecessary step.

    • DDsouza

      Vomiting, diarrhoea and headaches are symptoms, not diagnoses. How many of your 9000 “consultations” did you refer on for more qualified opinion? Did you perform a clinical examination? Was there a plan for follow up? How many had a more serious underlying illness that resulted in delayed diagnosis or treatment?

      My biggest concern is that in these modern times the pursuit of convenience has compromised the safety of the patient.

      • chris

        just goes to show that only two things in this world sell – sex and fear. this is no different.

      • Notachemist

        A sick certificate only certifies that the person is unfit for work there is no need for a diagnosis. Most people with minor ailments do not need to see a doctor but they may need a sick certificate for their employer.

        • DDsouza

          I would argue that there is always a need for a diagnosis. How else could you be satisfied that a patient’s symptoms are attributed to a minor ailment and therefore within your scope of practice?

          • Notachemist

            But there are many times when people are unwell with simple symptoms which resolve without a diagnosis. These are the cases requiring an unfit for work certificate. As the saying goes if symptoms persist see your doctor. Even then a diagnosis may not be found but more serious conditions are excluded. In life and medicine there are so many diagnostic uncertainties. Generally we do not need a diagnosis we just need to know it is not a serious condition.

      • Patrick Mahony

        How little confidence you have in fellow pharmacists. I have 50 years of experience in managing diarrhoea and vomiting in a pharmacy setting.
        What is more disturbing is that you judge your approach to what happens in your limited experience in other pharmacies. In our pharmacy, we have a full triage process where all patient details, symptoms and treatments are recorded. We then have a discussion in a semi-private (and in some cases a private clinic) about their symptoms.
        We make recommendations, we provide back-up information and we also provide them with a hard copy of all our recommendations which acts as a referral to their/a GP, if required.
        We know where they work and what conditions they are enduring.
        Nothing is taken for granted and it is certainly not just about convenience, we provide a timely supportive process for the client. This is the reason local employers accept our system.
        We keep records, we analyse data and we get feed-back from the major employers.
        PMCs are a professional practice for community pharmacists. The PSA should set a practice standard. I believe we have a good and relevant standard.

        • Jarrod McMaugh

          I’m pretty confident that this person is not a pharmacist, especially given that they have registered for the comment section using a temporary (burner) email address.

    • Dani

      Hi Patrick,
      I’m a pharmacist that works at MedAdvisor and am really keen to better understand how we can improve the platform as part of our continuous improvement. If you could send me an email at that would be much appreciated. Thanks, Dani

  2. Toby

    What else would a call-out doctor service say? Especially if they want to protect their Medicare call-out fee, which last time I checked was well over $100 per visit. If someone is questioning whether a busy pharmacy is the right environment for a consultation, try this as a rebuttal: I have had call out doctors to my house, and some stayed about 3 minutes. On separate occasions. If doctors feel entitled to question the professionalism of some pharmacists, we are also entitled to question the professionalism of some doctors.

    • Notachemist

      Toby Qoctor is an online service not an after hours home visit.

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