Getting Doctors’ Consultations, Medicine Without Leaving Home In A Pandemic

DoctorOnCall says it should not be seen as competition with traditional GP clinics and pharmacies, as it is offering free listings for these facilities to boost their digital presence through the telehealth platform.

KUALA LUMPUR, Dec 8 — Amid public fear of visiting clinics during the Covid-19 pandemic, telehealth platform DoctorOnCall allows Malaysians to seek medical attention and purchase medication safely from their homes.

DoctorOnCall stressed that doctors’ consultations and prescriptions are necessary for anyone who purchases medicines from its e-pharmacy, including patients with chronic diseases who have repeat prescriptions.

DoctorOnCall co-founder Maran Virumandi explained that typically, patients get medicines from the digital health platform in two ways: either after a teleconsultation with a doctor, or directly from the online pharmacy to replenish long-term medications.

In the first scenario, patients typically seek a teleconsultation with a doctor on DoctorOnCall — either through video or audio calls — for minor ailments like the flu, fever, conjunctivitis, or mild food poisoning, during which the physician will diagnose one’s condition and prescribe medicines if necessary.

DoctorOnCall automatically shares medical prescriptions with patients through email and its app and sends the prescription to a pharmacy from DoctorOnCall’s nationwide network of 200 partner pharmacies, after which the nearby pharmacy delivers medication to the patient’s home.

“Patients sometimes use their prescriptions to get medication from a nearby pharmacy. We allow separation of prescribing and dispensing,” Maran told CodeBlue in an interview.

DoctorOnCall only does same-day delivery in major metropolitans, with delivery of up to three to five days, depending on movement restrictions and logistics capacity, for areas outside those cities.

“If you have a nearby pharmacy outside your taman, go ahead and do that. We’ve clearly given them the option. Our doctors are not compelled to make money — they offer consults, and the pharmacy will dispense,” said Maran.

DoctorOnCall typically sees three groups of patients: people who usually visit general practitioner (GP) or primary care clinics for common conditions; patients with chronic disease; and people with sexual and reproductive health issues.

For chronic patients who want to refill their long-term medications from DoctorOnCall’s e-pharmacy, they usually have prescriptions from their own health care providers. Before DoctorOnCall’s partner pharmacies dispense medication, DoctorOnCall doctors will give these patients teleconsultations.

At these consultations, DoctorOnCall doctors will issue, if necessary, a drug prescription for a maximum of three months, based on the chronic patient’s medical history. DoctorOnCall doctors and in-house pharmacists also check that chronic patients’ existing prescriptions from outside the platform are not more than six months’ old before they refill their medicines at DoctorOnCall’s e-pharmacy. The digital health platform rejects requests from patients who want to buy medicines in bulk, such as 10 months’ worth of diabetic medication in one case, prior to seeing a doctor.

“We have been subject to patients’ anger because we can’t fulfill more than three months’ prescription,” DoctorOnCall co-founder Hazwan Najib told CodeBlue.

DoctorOnCall may also sometimes offer people with long-term conditions home-based or laboratory screenings first, before deciding on medical prescriptions. If no medicines end up getting prescribed or dispensed for the patient, money spent on these tests and consultations will be refunded to the patient.

“One of the key things we do is we don’t list and we don’t sell the classes of medicines which should be under lock and key, such as certain antipsychotics.”

Maran Virumandi, co-founder of DoctorOnCall

He added that to prevent abuse of the e-pharmacy, DoctorOnCall checks for multiple accounts being set up in the same location for drug delivery, purchases of the second item across multiple accounts, and the interval between purchases, such as buying three boxes of medications each day for three straight days.

DoctorOnCall also validates patients on their platform by verifying their identity card number with third-party administrators, corporations, and insurers, as most individuals who visit the telemedicine platform are covered by these entities.

“We also have pharmacists who, based on their judgment, in some cases will correlate medicines to individuals, and they do not want to dispense. We have a 100 per cent refund policy based on our doctors’ and pharmacists’ discretion,” Maran said.

“We have had situations where pharmacists pick up and say they are the ones who know medicines best, and in some cases, we confer back with the doctors and tell doctors to change medicines.”

Maran Virumandi, co-founder of DoctorOnCall

About 60 per cent of DoctorOnCall’s customers are patients on long-term medications.

“They like our affordable prices and they like the concierge-like services, doctors’ consult, prescription reminders, health newsletters, and the fact that doctors can refer home visits by nurses for screenings and lab screenings near your place. Our retention rate is fairly high,” said Maran.

He explained that DoctorOnCall’s e-pharmacy offers standard medicine prices, while most teleconsultations are charged at RM19.99. Drug delivery is charged to the patient or payer, although DoctorOnCall occasionally provides free delivery for large purchases. The telehealth platform also has promotions and campaigns with discounted consultations, based on insurance partners and products and services.

When asked if people still found DoctorOnCall affordable, despite practicing dispensing separation, Maran said the combination of their consultation and medication rates were sometimes more affordable than average hospitals or clinics.

“Through the use of digital and business innovations, we can maintain our cost structures low and transfer the cost savings to the patients or payers.”

Free Digital Services For GPs, Pharmacists

Prescription medicine section at a pharmacy in Kuala Lumpur. Picture taken by Arjun Thanaraju on 10/01/2020.

DoctorOnCall stressed that it was not competing with brick-and-mortar clinics and pharmacies, but could instead provide a digital platform to these small facilities amid competition from large clinic or pharmacy chains.

There are currently more than 200 GPs and specialists on DoctorOnCall, as the organisation aims to grow its base to 1,000 to 2,000 doctors. DoctorOnCall pays both doctors and pharmacies for consultations and medicines purchased by patients.

“What we’ve decided to do, we will effectively be the Grab Food for you. We provide the platform where you can list your profile and services. In conjunction with the Malaysia Healthcare Travel Council (MHTC), we’re offering this service for free for the next three months to trial it,” said Maran.

“What we can ensure is that as the platform, we’ll do our responsibility to offer a digital health set of services to doctors, pharmacies, and health care providers that will offer them a fair chance to get into the digital world, without favouring whether you’re a small or big player,” Maran said.

“There’s no way a clinic down the road can beat a billion-dollar organisation in setting up a hospital.”

He noted that starting telehealth solutions from scratch required large investments, while marketing and customer acquisition could also be very expensive for traditional clinics and pharmacies who wish to expand their business.

“We are not their competition.”

Maran Virumandi, co-founder of DoctorOnCall

“We’re offering them a hassle-free platform to sign up; we are connecting them to dispense to patients and we’re giving everyone a fair chance because of allocations based on geographical distribution. And we are allowing them access to new channels – insurers and corporates.”

DoctorOnCall is expanding services to include medical specialists, laboratories, and home nursing services, where nurses can visit homebound people to do blood work or wound dressing. DoctorOnCall plans to add allied medical professionals, physiotherapists, and psychologists to its platform too.

People can search for and book virtual appointments with specialists on DoctorOnCall, like obstetricians and gynaecologists, for example, as the telehealth platform partners with Thomson Medical Centre.

DoctorOnCall Enables Early Diagnosis

Dr Sashini Seenivasagam. Picture courtesy of DoctorOnCall.

Dr Sashini Seenivasagam, a full-time doctor with DoctorOnCall who has been in clinical practice for 10 years, explained that she is able to diagnose minor conditions on a video call through detailed history-taking. Her teleconsultations are usually 10 to 15 minutes’ long. Some patients are also able to give her their temperature and blood pressure reading with thermometres and blood pressure machines at home.

“Here’s the fantastic part about DoctorOnCall — when we do consults, we key in the history or information we get from the patient. It’s recorded and saved under each patient. Each patient has their own file — allergy, medical history, current complaints, everything is inside, and what are the medicines prescribed. In a week’s time, if you’re not feeling well and you’re consulted by another doctor, the next doctor will be able to see your previous record. Everything is recorded.”

She also said teleconsultations on DoctorOnCall increased by 70 to 80 per cent this year during the Covid-19 epidemic.

“From my experience, everyone doesn’t want to leave the house. Almost every person I speak to refuses to go out to a clinic in spite of having a need. They’re so afraid of the pandemic, they’d rather stay at home,” she told CodeBlue in an interview.

Dr Sashini, who worked in the emergency department in the public sector for six years before going into GP practice and subsequently joining DoctorOnCall, cited a patient of hers on DoctorOnCall who was suspected of having a breast tumour, but refused to visit a hospital.

“I had to advise her; she came on board to teleconsult with another situation, but while I was taking her history, I got to know she had a breast tumour.”

What Dr Sashini likes about teleconsultations is the ability to do early management and early detection of medical conditions before they turn serious, citing her experience at the emergency department in the public sector when many people turned up at a late stage of their disease with complications.

“At DoctorOnCall, the patient is able to access us anytime, anywhere.”

Dr Sashini Seenivasagam, full-time doctor with DoctorOnCall

“It’s very efficient and accessible for patients who can’t travel to a clinic. You’re staying in a red zone area now, Covid-19, you can’t go out. All you have to do is make a call. You know what to do, you know if you have to go to a hospital. The medicines reach your doorstep. So it’s definitely futuristic. You want to reach out to as many as possible to provide medical services.”

While GP clinics may have limited medication stocks, Dr Sashini said DoctorOnCall lists over 7,000 medication.

“In a GP practice, if a patient comes to us, the best drug is Drug A, but I don’t have it, so I’ll give you the next best thing, whereas at DoctorOnCall, I give you the best of what I have.”

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