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MOH aims to curb 'excessive issuance' of MCs by telemedicine platforms following feedback

MOH intends to impose a requirement that every MC issued for a patient must include the name and medical council registration number of the issuing medical practitioner.

MOH aims to curb 'excessive issuance' of MCs by telemedicine platforms following feedback

A patient booking an appointment for an online visit with a doctor. (File photo: iStock)

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SINGAPORE: The Ministry of Health (MOH) is looking to tighten the rules over the issuance of medical certificates (MCs) as telemedicine platforms come under scrutiny.

In an Apr 22 joint circular with the Singapore Medical Council (SMC) that was sent to doctors, MOH said it had received feedback from various employers and government agencies about the "excessive issuance" of MCs following outpatient medical service consultations, particularly teleconsultations. 

The feedback alleged that MCs were issued "solely based" on patients' self-reported reasons for consultation, without proper clinical assessments and follow-ups to determine if there were any underlying medical conditions that warranted MCs. 

"MCs were issued when patients mentioned that they had just wanted a certification to skip work or school, but they were not sick," the circular read.

MCs were also "repeatedly issued" to the same patients without referring them for physical consultations for further assessments or follow-ups to check if they were unwell, with the authorities calling this "malingering and abusing medical leave privileges".

MEDICAL CERTIFICATES IN DOUBLE-QUICK TIME

CNA first reported in July last year that getting MCs via telemedicine apps was a breeze with three different apps tested. 

Consultation for all three apps – ManaDr, MyHealth360 and Doctor Anywhere – lasted less than two minutes. 

In response, a spokesperson for Doctor Anywhere then said MCs are issued only after proper clinical assessment, adding that the assessment is "heavily reliant" on symptoms reported by the patients.

In Febuary, MOH said Medstar Medical Clinic & Surgery was under investigation for issuing medical certificates MCs without any audio or video consultation on its telemedicine website, PocketCare. 

Investigations found that the clinic, which is located along Serangoon Road, had been "providing consultation through a self-service text-based questionnaire". MCs were subsquently issued without any audio or video interaction with patients.

The PocketCare website was also found to have featured claims that patients could "Get Your MC or Get a Refund". 

Dr Viknesh Shanmugam, the medical practitioner who issued the MCs following the consultations, has been referred to SMC for investigations into possible breaches of its ethics code.

MOH also issued a notice to Medstar, stating Director-General of Health Kenneth Mak's intention to take regulatory action, including a three-month suspension of its telemedicine services and the need to rectify its consultation services before it can be resumed. 

PROPOSED AMENDMENTS 

Teleconsultation services by registered practitioners have been regulated since Jun 26, 2023, read the circular. 

According to the regulations, real-time, two-way interactive audio-visual communications like video consultations must be utilised when teleconsulting with new patients.

"MCs should not be issued via teleconsultations to new patients solely based on the patients' requests without proper assessment by a medical practitioner to determine if the issuance of the MCs is warranted," said MOH and SMC. 

The recognition of MCs issued by registered medical practitioners is a "professional privilege", the circular added, noting that this reflects the "high regard for and the trust" that society has placed in the profession.

While noting that the issuance of MCs is a "clinical decision", the circular stressed it is "imperative" that the issuance of MCs adheres to the guidelines in SMC's ethics code. 

The guidelines state that MCs "must be issued to patients only on proper medical grounds arrived at through good clinical assessment" – regardless of the mode of the consultation.

As such, MOH intends to impose a requirement on all licensees to ensure that every MC issued for a patient must include the name and medical council registration (MCR) number of the issuing medical practitioner. 

This means that "the onus is also on the licensee to ensure it puts in place appropriate processes and protocols for the medical practitioners to ensure that MCs issued contain their names and MCR numbers". 

Any licensees found advertising or allowing the practice that the issuance of MCs under their approved services could be "anonymised" will be in breach of this proposed requirement, the circular read.

MOH is seeking feedback from doctors on this new requirement, adding that it may conduct inspections, audits or request for the relevant procedures and policies with regard to the remote provision of outpatient medical services.

Those who breach the regulations may have their licences suspended, shortened or revoked. They may also be fined or issued a direction to rectify the breach and take steps to prevent it from occurring again. 

Registered medical practitioners who are found to have failed to adhere to SMC's ethics code may also be referred to the council for further action.

In response to queries from CNA, Doctor Anywhere said on Monday (May 13) that it welcomes and supports MOH's efforts to further regulate the issuance of medical certificates.

"We recognise and understand the concerns from employers and government agencies on this, and are committed to leveraging telemedicine to improve healthcare access while maintaining the highest standards of compliance and clinical appropriateness," said Doctor Anywhere spokesperson Dr Andrew Fang.

ManaDr said on Tuesday that it is committed to complying with all regulatory requirements.

"We are actively reviewing the proposed regulations and will integrate any new guidelines into our operational procedures," it said.

Source: CNA/at(sn)

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