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mHealth and The Sick Note: A Question of Value

An Australian website is gaining attention by offering a health 'evaluation' within five minutes, good for getting out of work or school. Should the healthcare industry criticize this, or figure out why it works?

- An Australian entrepreneur is putting an mHealth-enabled spin on the sick note, and drawing criticism from that country’s medical association.

The website, called The Medic, is the brainchild of Jason MacLulich, who previously launched the Uber-like GoCatch taxi app. It advertises a medical certificate – an electronic version of a doctor’s note that can be used at businesses and universities – within five minutes. A consumer logs onto the site, is connected to one of eight general practitioners scattered across the country, states his or her case and, if the argument is convincing, has the documentation needed to stay home for the day.

The chairman of the Australian Medical Association’s Council of General Practice, noting the process requires no clinical check-up, says the service is “just out to make a quick buck.”

“It’s more appropriate (to get a proper diagnosis) through the local doctor because there’s obviously a history – and ethically and morally it’s a better way of validating the history given by the patient,” Dr. Brian Morton told Australia’s Medical Observer news site.

MacLulich countered that he’s simply providing a service that the public wants – a quick and easy way to obtain a doctor’s note without having to leave home. He noted the service appeals to college students, remote employees and professionals who don’t have the time to visit a doctor and would just as soon work from home when they’re ill. He also argues the service helps reduce crowded waiting rooms and ERs.

MacLulich even admits that his service isn’t binding because there’s no examination done by the doctor, and he questions why a business or university would require a medical certificate in the first place. He noted that the AMA has in the past called the certificates a “waste of time,” while physicians have called them a nightmare, saying their waiting rooms are clogged with people looking for a certificate.

Still, consumers are finding value in it, and The Medic is making money. It truly represents the lowest hanging fruit in the mHealth ecosystem, and could possibly lead to a much larger discussion – not only in Australia, but in the US and elsewhere – as to what constitutes appropriate online medical care.

The U.S. might not have the equivalent of The Medic (yet), but there’s been an ongoing debate over the quality of clinical care delivered online – from mHealth apps that fail to deliver promised outcomes to the court battle in Texas between that state’s medical board and Teladoc, whose practice of delivering care via telephone doesn’t meet the board’s current standards.

These debates generally center on certain standards of care that healthcare providers have to meet to be allowed to practice medicine. With The Medic, the argument isn’t over whether the healthcare being delivered meets acceptable standards, but if it fulfills a public need. Sometimes the consumer has a different idea of what he or she needs with healthcare.

Providers are starting to come around to the idea that the consumer should dictate what healthcare he or she needs, and that providers need to adapt to meet those needs. The American Telemedicine Association, which in the past year began accrediting online direct-to-consumer consultation platforms, reports that 375 different health systems and vendors have applied for the accreditation, some 230 have been declared eligible and six have so far been accredited. Another dozen applications are expected before the end of the year.

“We’re starting to get overwhelmed with the program, but that’s a good thing,” ATA CEO Jonathan Linkous said recently.

Websites like The Medic may appeal solely to the consumer, and in a way that providers would rather avoid (think about how gossip magazines are accepted by the general public and derided by most media outlets), but they serve a purpose. They’re turning the conversation around.  Health systems don’t have to approve of what sites like The Medic offer, but they can’t ignore them.

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