Digital care is not a threat to the quality of care, but an opportunity

Digital care is not a threat to the quality of care, but an opportunity

In NRC on Thursday, February 20 Sarah Ouwerkerk and Karlijn Saris describe well how Dutch pharmacies circumvent the law by collaborating with foreign doctors. For example, both journalists, pretending to be a non-existent person, prove that it is possible to order prescription medication with a few simple clicks. The healthcare providers involved seem to be evading any form of their duty of care here.

This poses a significant risk to the health of these ignorant patients. After all, among other things, there may be a dangerous contraindication.
It seems obvious that these bad apples should be banned from healthcare offerings.

Yet there is a dangerous assumption in the criticism. Namely, that all online providers of care are rogue. And that offering care online would not be qualitative. This is a misconception. In reality, digital care can actually be a crucial addition to healthcare offerings.

We can no longer stick to the idea that every care request should be treated exclusively through the regular doctor. The reality is that the pressure on healthcare is only increasing. Ageing is leading to a growing demand for care, while, according to the National General Practitioners Association, there is already a “structural and extensive shortage” of GPs. Long waiting times make access to care problematic.

In this form, sticking to the regular doctor does not help the quality of care. Moreover, digital care appears to open roads to care that are not possible for traditional 'offline' care. For example, research shows that a significant group avoids doctors because of taboo or discomfort. As a result, the patients keep walking around with these complaints. Take sexual problems as an example. A study by Utrecht University shows that 9 out of 10 men with sexual problems do not go to the doctor, avoid care and sometimes resort to illegal medication. It is precisely these complaints that online clinics often treat. This group greatly benefits from the possibility of online care, provided that it is provided qualitatively and in accordance with applicable Dutch standards.

Given this reality, the solution proposed by the IGJ in the NRC article simply stating that patients should go to their own (general) doctor or pharmacist for “medical advice” is therefore a false solution. The inspectorate is thus blind to reality. If patients do not have access to reliable online care, they independently search for information via Doctor Google or unsafe foreign providers. This is a risk that we should actually prevent.
Digital care as an addition to the current healthcare offer is certainly not a luxury, but a bitter necessity.

However, the fact that digital care is a necessary addition to current care offerings does not mean that we should let rogue healthcare providers have their way. A solid solution is necessary to prevent a proliferation of digital healthcare providers and an online wild west.

However, the Netherlands cannot cure this problem in isolation. By definition, the digital market is cross-border, and so should legislation. Currently, patients can order medication online from (foreign) providers without much effort, without a thorough assessment by a doctor or proper supervision of the drug use by a pharmacist.

We are therefore calling for European legislation that requires that a general practitioner can only prescribe medication online if the patient is registered in the same country as the treating doctor. In addition, the doctor must be registered in a recognized medical register, such as the BIG register in the Netherlands.

We can also learn from the United Kingdom, where there is already successful regulation in this area. A special control body, the “Care Quality Commission”, monitors the quality of care that is delivered online. This proves that digital care can indeed be provided in a controlled and responsible manner. The Netherlands and the rest of Europe should follow suit.

To get there, it must be realized that digital care is not a threat to general care, but an opportunity to support it. Online clinics can play a crucial role in less complex care needs, provided that strict conditions are met. This means that a BIG-registered doctor assesses the complaints, makes a diagnosis and draws up a personal treatment plan. Pharmacists, in turn, must ensure medication safety by consulting the current medication history.

In this way, digital care can contribute to safe and efficient health care and, on the contrary, ensure that patients do not keep walking around with care questions, complaints or even resort to illegal alternatives. And digital care is not a substitute, or surrogate, for physical health care, but rather an addition to it.

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