Issues arise when patients consult a doctor overseas

Technology has removed geographical barriers and is making it possible for patients to consult doctors globally. With more care options available at patients’ fingertips, it is natural for doctors to have concerns about the quality of online care provided to their patients.

The following are some factors you and your patients should be aware of if they seek telehealth services offshore.

Q: What standard of care is expected of overseas-based doctors providing telehealth services?

A: Overseas-based doctors who provide telehealth services to New Zealand-based patients are regarded by the Council as practising medicine in New Zealand. As such, they should be registered with us and hold a current practising certificate.

All our current standards apply to telehealth consultations with overseas-based doctors. This means that the standard of care provided to a patient via a telehealth consultation should be the same as that provided in an in-person consultation, within the limitations imposed by the telehealth modality.

Q: Can overseas-based doctors prescribe medication to New Zealand-based patients?
A: Our standard on good prescribing practice applies when doctors prescribe medication to New Zealand-based patients. However, where the overseas-based doctor is not registered with us, the prescriptions they issue cannot be filled at a New Zealand pharmacy.

This is a limitation patients should be aware of. In these situations, it is important that the overseas-based doctor liaises with the patient’s regular doctor - especially when managing any ongoing medication the patient may need.

Q: What are some practical considerations with telehealth services when the doctor is based overseas?
A: Providing telehealth services from overseas involves coordinating care across different jurisdictions. Where the patient needs follow-up care, doctors providing telehealth services are expected to take into account the services available in the patient’s locality.

If they are unaware of the patient’s local services, they are obligated to take reasonable steps to find out. However, this could be challenging, especially if the overseas-based doctor is unfamiliar with New Zealand’s healthcare system.

A further challenge is that doctors who are not registered with us cannot order tests and investigations from a New Zealand laboratory. When a patient requires ongoing tests and monitoring, the overseas doctor must discuss this with the patient’s regular doctor who may need to organise some of the follow-up.

Depending on the patient’s concerns and medical history, at times, a physical examination could help to provide information that will affect the patient’s diagnosis or management.

If a physical examination is usual best clinical practice, this needs to be arranged within an appropriate timeframe. That may involve asking another health practitioner in the patient’s local area to conduct a physical examination. In such situations, the overseas-based doctor needs to obtain the patient’s consent and liaise closely with the other health practitioner.

Summary:
While technology opens up care options beyond New Zealand, there are practical considerations patients should be aware of when consulting a doctor based overseas. Where patients are likely to need follow-up, they should involve their regular doctor to ensure continuity of care.

📎 Current standards
📎 Good prescribing practice.

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