Singapore urged to order 5-minute minimum for telemedicine calls

A local clinic’s license will be revoked after being probed for short teleconsultations.

Singapore should mandate a five-minute minimum for first-time telemedicine consultations after patient safety and care were put in the spotlight with the possible revocation of a local clinic’s license due to unethical practice.

Shin Thant Aung, director at management consulting firm YCP's Thailand office, said five minutes aligns with the average length of face-to-face consultations and should be enough for an accurate diagnosis.

For second or third-time consultations via telemedicine, the minimum duration could go down to three minutes, he added..

The Ministry of Health (MOH) in October said it would revoke the license of MaNaDr Clinic Pte Ltd for failing to provide outpatient medical services in a clinically and ethically appropriate manner. The agency probed the clinic for its short teleconsultations, with some lasting less than a minute.

It also said it would refer 41 doctors who conducted teleconsultations for MaNaDr to the Singapore Medical Council (SMC) for possible professional misconduct.

Beyond the issue of consultation duration, Shin said the MaNaDr case exposed flaws in the issuance of medical certificates by telemedicine providers, adding that there should be “very strict control” over it. 

One issue raised by the Ministry of Health against MaNaDr was its frequent issuance of medical certificates to the same patients within a short period.

“People are turning to telemedicine because they want a medical certificate at the cheapest cost. The issue is, how long do telemedicine providers need to understand the patient’s symptoms before they can issue the medical certificate?” Shin asked.

Before issuing a medical certificate, Shin said telemedicine providers should conduct thorough consultations. Telemedicine should not be limited to one-minute calls, nor should it be conducted without video or phone calls, or symptom checks.

Ruch De Silva, head of Patient & Payor Solutions and M&A lead at DKSH Patient Solutions, said telehealth should be integrated with in-person care to ensure accurate consultations and findings during online checkups. “Some telemedicine platforms do not provide a designated doctor for their user. Instead, doctors are randomly assigned on an ad-hoc basis,” he pointed out.

“Integrating telehealth with in-person care enables continuity and familiarity in the patient provider relationship,” he said.

“Patients who can see the same doctor both virtually and in-person build stronger,  ongoing relationships with their healthcare providers.”

An integrated telehealth system also distributes patient demand more effectively, reducing the high virtual consultation volumes that often lead to doctor burnout, De Silva pointed out. “In-person visits can be reserved for more complex cases or follow-ups, creating balance and helping providers manage their time more effectively, reducing fatigue and stress.”

Shin said health facilities should also improve the documentation process in telemedicine, noting that many doctors rely on handwritten notes
and paragraph-based format during consultations, instead of standardised templates for patient records. 

He said telemedicine providers should use dedicated documentation software systems rather than having doctors rely on Microsoft Word for note-taking.

Meanwhile, both the state and the industry should hold audits and inspections at least every six months to ensure compliance with standards, Shin said.

The gaps exposed by the MaNaDr case stemmed from insufficient protocols, not regulatory shortcomings, according to De Silva and Shin. Singapore’s telemedicine regulations are among the strictest globally and align with international standards, they pointed out.

The MaNaDr case could affect the growth of telemedicine but would ultimately lead to better quality of service, Shin said.

De Silva said the government’s “rigorous enhancement of  standards and quality control within the telemedicine industry should serve as a reflection to the high standards that telemedicine providers must be able to reach and maintain following the MaNaDr case.”