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Telehealth Good Practice

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Medical Ethics

 

Telehealth Ethical Guidelines (HPCSA)

These ethical guidelines for healthcare practitioners in South Africa regarding the practice of telehealth, emphasising professional conduct, patient care, and the use of technology in healthcare delivery.

The Spirit of Professional Guidelines

The HPCSA emphasizes the importance of trust and ethical practice in healthcare.

  • Good clinical practice is rooted in a trust relationship between patients and healthcare professionals.
  • Practitioners must commit to ethical standards and prioritize patient well-being.
  • These guidelines serve as a framework for evaluating professional conduct.

Definitions of Key Terms

The document defines essential terms related to Telehealth and healthcare practice.

  • Telehealth refers to healthcare services delivered through electronic means across distances.
  • Social media encompasses various online platforms for sharing content.
  • Key roles include “practitioner in charge” and “consulting practitioner,” each with specific responsibilities.

Introduction to Telehealth Guidelines

The HPCSA outlines the purpose and objectives of the Telehealth guidelines.

  • The HPCSA regulates healthcare provision to ensure qualified practitioners deliver services.
  • The term “Telehealth” is preferred over “Telemedicine” for inclusivity.
  • The guidelines aim to improve healthcare access, especially in underserved areas.

Applicability and Use of Telehealth

Telehealth is applicable in various contexts, emphasizing secure communication.

  • Telehealth replicates traditional consultations using secure technology.
  • Practitioners must adhere to principles of patient consent, confidentiality, and record-keeping.
  • Social media is discouraged for patient interactions due to ethical concerns.

Types of Telehealth Services

Different categories of Telehealth services are identified based on their context.

  • Routine Telehealth involves established practitioner-patient relationships and is an adjunct to traditional care.
  • Specialist Telehealth addresses capacity challenges in rural areas, ensuring ethical guidelines are followed.
  • Emergency Telehealth focuses on immediate patient care and stabilization.

Ethical Guidelines for Telehealth Practice

The guidelines provide a framework for ethical Telehealth practices.

  • Practitioners must be registered and competent to provide Telehealth services.
  • The practitioner-patient relationship is established through informed consent.
  • Practitioners are responsible for maintaining detailed records and ensuring quality care.

Considerations for Remote Consultations

Key factors must be evaluated before offering Telehealth consultations.

  • The severity of symptoms and the need for physical examination should be assessed.
  • Previous knowledge of the patient and their medical history is crucial.
  • Social circumstances may necessitate face-to-face consultations.

Evaluation and Treatment Protocols

Protocols for evaluating and treating patients via Telehealth are outlined.

  • A documented medical evaluation is required before treatment.
  • Treatment based solely on online questionnaires is inadequate.
  • Informed consent must be obtained for prescriptions issued through Telehealth.

Professional Duties in Telehealth

Practitioners must uphold their professional duties while engaging in Telehealth.

  • Duties include acting in the patient’s best interest and maintaining confidentiality.
  • Informed consent is mandatory before providing treatment.
  • Verification of practitioner and patient identities is essential.

Informed Consent Requirements

Informed consent is critical for Telehealth practices.

  • Consent can be obtained in writing or recorded orally.
  • Documentation must include patient identities, consent for Telehealth, and security measures.
  • Patients should be informed about who accesses their information and the implications of Telehealth.

Ensuring Patient Confidentiality

Confidentiality must be maintained during Telehealth consultations.

  • Patient confidentiality is protected under various laws and guidelines.
  • Policies for documentation and transmission of records must meet face-to-face standards.
  • Electronic communications must be secure and stored appropriately.

Quality, Security, and Safety of Patient Information

Practitioners are responsible for the quality and security of patient information.

  • Quality assurance measures must be in place for Telehealth services.
  • Patient information should be transmitted securely and only with consent.
  • Safety protocols must prevent accidental loss or alteration of patient data.

Compliance with POPIA Regulations

Practitioners must adhere to the Protection of Personal Information Act (POPIA).

  • Adequate safety measures for patient information processing are required.
  • Compliance with POPIA ensures the protection of personal data in Telehealth practices.

 

Brought to you courtesy of Better Practice Management.

Practice Numbers Info

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đź©ş Why Every South African Doctor Needs a Valid Practice Number

 

 

In South Africa, a practice number isn’t just a formality—it’s your legal gateway to private healthcare billing. Issued by the Board of Healthcare Funders (BHF) via the Practice Code Numbering System (PCNS), this unique identifier confirms your registration with a statutory health council and enables claims processing with medical schemes.

A valid practice number signifies professional legitimacy, regulatory compliance, and eligibility to operate independently. Without it, practitioners cannot legally invoice patients or insurers.

To apply:

  • Register with your relevant council (e.g., HPCSA or AHPCSA)
  • Download and submit the correct PCNS application form
  • Provide supporting documents within 30 days
  • Await BHF accreditation and issuance

đź’° The 2025 annual subscription fee is R472.00, payable to maintain your listing.

✅ To verify any practitioner’s number, visit PCNS Verify.

Stay compliant. Stay credible. Your practice number is your professional passport.

Doctor or Healthcare Provider

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a woman holding a baby in a hospital room

Medicine loses its soul when it becomes mechanical.” > — Dr. Ellapen Rapiti, September 3, 2025

 

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> “Medicine loses its soul when it becomes mechanical.”

> — Dr. Ellapen Rapiti

In today’s clinical landscape, protocols dominate. Algorithms dictate decisions. Time pressures reduce patients to checklists. But healing is not a transaction—it is a relationship. Ethical clinicians must reclaim the heart of medicine by thinking critically, questioning outdated norms, and innovating with dignity.

🔍 What Is Mechanical Medicine?

– Treating symptoms without understanding context

– Following guidelines blindly, even when they conflict with patient needs

– Prioritizing efficiency over empathy

– Ignoring the ethical implications of standardized care

—

🧭 What Does Discerning Practice Look Like?

– Listening deeply, even when time is short

– Asking: “Is this protocol serving the patient—or the system?”

– Advocating for reform when systems fail

– Innovating with compassion, not just compliance

đź’ˇ A Call to Clinicians

You are not just a technician. You are a healer, a thinker, a moral agent. Every time you choose principle over protocol, you restore medicine’s soul. True progress begins with ethical defiance.

> Are you healing—or just complying?

> Principled care begins where blind obedience ends.

To think differently is not defiance, but to apply one’s mind before acting.

All patients are not the same, so treatments must be indivilualised for best outcomes.

—

đź–‹ Authorship & Legacy

This flyer is part of the Ethical Medicine Series by Dr. Ellapen Rapiti.

Growing Healthcare Funding Woes

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Rising Mega Gap Claims Signal Growing Healthcare Funding Woes

The South African private healthcare sector is experiencing a worsening funding crisis, highlighted by a surge in mega gap claims (exceeding R50,000). Between 2020 and 2024, these claims increased by 512% in volume and 437% in value, with the average large loss gap claim reaching R63,000. This escalation is attributed to medical schemes reducing benefits, transferring risk to members, and provider costs outpacing inflation. Specialists’ charges can be over 500% higher than medical scheme reimbursements.

Key Trends and Statistics

  • Increase in Claims: From 2022 to 2024, large loss claims volumes increased by an average of 35% year-on-year.
  • Cost Drivers: Covid-19 and deferred surgeries significantly contributed to a 118% increase in claims value paid in 2021 compared to 2020.
  • Age Distribution: While the highest claims (over R200,000) were for ischaemic heart disease in the 50+ age group, the under-49 age group accounts for 23% of large loss claims.
  • Claim Distribution:
    • 62% of claims fall between R40,000-R60,000
    • 30% fall between R61,000-R100,000
    • 6% fall between R101,000-R150,000
    • 2% fall between R151,000-R210,000* Condition Types: Musculoskeletal conditions account for over 51% of claims, with spinal stenosis being the most common. Cancer and circulatory conditions each represent 10% of large loss claims.

Challenges and Implications

Gap insurance is facing exploitation, with healthcare providers potentially inflating charges upon learning of gap coverage. This threatens the sustainability of gap insurance and could lead to unaffordable premiums. Despite these issues, gap cover remains vital due to deductibles, co-payments, and reimbursement limits in medical schemes. Addressing unregulated provider pricing, benefit erosion, and gap insurance exploitation is crucial to prevent further deepening of the healthcare funding crisis.

Sources:
https://www.bizcommunity.com/article/rising-mega-gap-claims-signal-growing-healthcare-funding-woes-391118a#more

 

Will AI Replace Healthcare Professionals?

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Healthcare Professions: Where Empathy Meets Expertise

Healthcare isn’t just about diagnostics—it’s about people. AI can analyse bloodwork, but it can’t build trust with a nervous patient. It can summarise symptoms, but it can’t guide someone through grief. That’s where human caregivers shine.

Why It Matters:

The US Bureau of Labor Statistics projects that healthcare and social assistance will add about 2.1 million jobs from 2022–2032, more than any other sector, accounting for 45% of all new jobs.

AI-proof factors:

  • High-touch, interpersonal care
  • Ethical and legal constraints on automation
  • Growing demand from aging populations

New Perspective:

AI is already changing healthcare—from robotic surgery to diagnostic assistants—but that doesn’t make doctors and nurses obsolete. In fact, it makes them more effective. The smartest practitioners of the future won’t ignore AI—they’ll know how to work alongside it. Learn AI tools, but never forget: AI can’t look at a patient and understand what the unspoken, non-quantifiable symptoms and expressions are saying. You can.

 

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Doctor Gives Advice About ChatGPT and AI

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As an M.D, here’s my 100% honest opinion and observations/advices about using ChatGPT

Educational Purpose Only

BACKGROUND

Recently I have seen posts and comments about how doctors missed a disease for years, and ChatGPT provided a correct, overlooked diagnosis. Imagine a chat bot on steroids, ending the years-long suffering of a real human. If real, this is philosophically hard to digest. One has to truly think about that. I was.

Then I realized, all this commotion must be disorientating for everyone. Can a ChatGPT convo actually be better than a 15 minute doc visit? Is it a good idea to run a ChatGPT symptoms check before the visit, and doing your homework?

So this is intended to provide a little bit of insight for everyone interested. My goal is to clarify for everyone where ChatGPT stands tallest, where it falls terribly short.

  • First, let me say I work in a tertiary referral center, a university hospital in a very crowded major city. For a familiar scale, it is similar to Yale New Haven Hospital in size and facilities.
  • I can tell you right now, many residents, attendings and even some of the older professors utilize ChatGPT for specific tasks. Do not think we don’t use it. Contrarily, we love it!
  • A group of patients love to use it too. Tech-savvier ones masterfully wield it like a lightsaber. Sometimes they swing it with intent! Haha. I love it when patients do that.
  • In short, I have some experience with the tool. Used it myself. Seen docs use it. Seen patients use it. Read papers on its use. So let’s get to my observations.

WHEN DOES CHATGPT WORK WONDERS?

1- When you already know the answer.

About 2 years into ChatGPT’s launch, you should know well by now: ”Never ask ChatGPT a question you don’t know the answer for”.

Patients rarely know the answer. So this no.1 mainly works for us. Example: I already know the available options to treat your B12 Deficiency. But a quick refresh can’t hurt can it? I blast the Internal Medicine Companion, tell it to remind me the methods of B12 supplementation. I consolidate my already-existing knowledge. In that moment, evidence-based patient care I provide gets double checked in a second. If ChatGPT hallucinates, I have the authority to sense it and just discard the false information.

2- When existing literature is rich, and data you can feed into the chat is sound and solid.

You see patients online boast a ”missed-for-years” thrombophilia diagnosis made by ChatGPT. An endometriosis case doctor casually skipped over.

I love to see it. But this won’t make ChatGPT replace your doctor visits at least for now. Why?

Because patients should remind themselves, all AI chats are just suggestions. It is pattern matching. It matches your symptoms (which are subjective, and narrated by you), and any other existing data with diseases where your data input matches the description.

What a well-educated, motivated doctor does in daily practice is far more than pattern matching. Clinical sense exists. And ChatGPT has infinite potential to augment the clinical sense.

But GPT fails when:

1- An elderly female patient walks in slightly disheveled, with receding hair, a puffy face and says ”Doc, I have been feeling a bit sad lately, and I’ve got this headache”. All GPT would see is ”Sad, headache”. This data set can link towards depression, cognitive decline, neurological disorders, brain tumors, and all at once! But my trained eye hears Hypothyroidism screaming. Try to input my examination findings, and ChatGPT will also scream Hypothyroidism! Because the disease itself is documented so well.

2- Inconsolable baby brought into the ER at 4am, ”maybe she has colicky abdomen”? You can’t input this and get the true diagnosis of Shaken Baby Syndrome unless you hear the slightly off-putting tone of the parent, the little weird look, the word choices; unless you yourself differentiate the cry of an irritable baby from a wounded one (after seeing enough normal babies, an instinct pulls you to further investigate some of them), use your initiative to do a fundoscopy to spot the retinal hemorrhage. Only after obtaining the data, ChatGPT can be of help. But after that, ChatGPT will give you additional advice, some labs or exam findings you might have forgot about, and even legal advice on how to proceed based on your local law! It can only work if the data from you, and data about the situation already exists.

3- Elderly man comes in for his diabetic foot. I ask about his pale color. He says I’ve always been this way. I request labs for Iron Defic. Anemia. While coding the labs, I ask about prostate cancer screening out of nowhere. Turns out he never had one. I add PSA to the tests, and what? PSA levels came high, consulted to urology, diagnosed with and treated for early-stage prostate cancer, cured in a month. ChatGPT at its current level and version, will not provide such critical advice unless specifically asked for. And not many patients can ask ”Which types of cancers should I be screened for?” when discussing a diabetic foot with it.

In short, a doctor visit has a context. That context is you. All revolves around you. But ChatGPT works with limited context, and you define the limits. So if data is good, gpt is good. If not, it is only misleading.

WHEN DOES CHATGPT FAIL?

1- When you think you have provided all the data necessary, but you didn’t.

Try this: Tell GPT you are sleepy, groggy and nauseous at home, but better at work. Do not mention that you have been looking at your phone for hours every night, and have not been eating. Yes, it is the famous ”Carbon Monoxide Poisoning” case from reddit, and ChatGPT will save your life!

Then try this: Tell GPT you are sleepy, groggy and nauseous at home, but better at work. Do not mention that you are a sexually active woman. But mention the fact that you recently took an accidental hit to your head driving your car, it hurt for a bit. With this new bit of data, ChatGPT will convince you that it is Post Concussion Syndrome, and go so far to even recommend medications! But it won’t consider the fact that you might just be pregnant. Or much else.

In short, you might mislead GPT when you think you are not. I encourage everyone to fully utilize ChatGPT. It is just a brilliant tool. But give the input objectively, completely, and do not nudge the info towards your pre-determined destination by mistake.

2- When you do not know the answer, but demand one.

ChatGPT WILL hallucinate. And it will make things up. If it won’t do any of these, it will misunderstand. Or, you will lead it astray without even knowing it. So being aware of this massive limitation is the key. ChatGPT goes where you drift it. Or the answer completely depends on how you put the question. It only gets the social context you provide to it.

Do not ask ChatGPT for advice about an event you’ve described subjectively.

Try it! Ask ChatGPT about your recent physical examination which included a rectal examination. It was performed because you said you had some problems defecating. But you were feeling irritable that day. So the rectal examination at the end did not go well.

Put it this way: ”My doctor put a finger up my bum. How do I sue him?”

– It will give you a common sense based, ”Hey, let’s be calm and understand this thoroughly”, kind of an answer.

As ChatGPT again about the same examination. Do not mention your complaints. Put your experience into words in an extremely subjective manner. Maybe exaggerate it: ”My doctor forcefully put a finger up my bum, and it hurt very bad. He did not stop when I said it hurt. And he made a joke afterwards. What? How to sue him?”

– It will put up a cross, and burn your doctor on it.

3- When you use it for your education.

I see students using it to get answers. To get summaries. To get case questions created for them. It is all in good faith. But ChatGPT is nowhere near a comprehensive educational tool. Using trusted resources/books provided by actual humans, in their own words, is still the single best way to go.

It’s the same for the patients. Asking questions is one thing, relying on a LLM on steroids for information that’ll shape your views is another. Make sure you keep the barrier of distinction UPRIGHT all the time.

CONCLUSION:

– Use ChatGPT to second guess your doctor!

It only pushes us for the better. I honestly love when patients do that. Not all my colleagues appreciate it. That is partly because some patients push their ”research” when it is blatantly deficient. Just know when to accept the yield of your research is stupid. Or know when to cut ties with your insecure doctor, if he/she is shutting you down the second you bring your research up.

– Use ChatGPT to prepare for your clinic visits!

You can always ask ChatGPT neutrally, you know. Best way to integrate tools into healthcare is NOT to clash with the doctor, doc is still in the center of system. Instead, integrate the tool! Examples would be, ”I have a headache, how can I better explain it to my doctor tomorrow?”, ”I think I have been suffering from chest pain for some time. What would be a good way to define this pain to a doctor?”, ”How do I efficiently meet my doctor after a long time of no follow up?”, ”How can I be the best patient I can be, in 15 minutes system spares us for a doctor visit?”. These are great questions. You can also integrate learning by asking questions such as ”My doctor told me last time that I might have anemia and he will run some tests the next visit. Before going, what other tests could I benefit from, as a 25 year old female with intermittent tummy aches, joint pain and a rash that has been coming and going for 2 weeks?”

– DO NOT USE ChatGPT to validate your fears.

If you nudge it with enough persistence, it will convince you that you have cancer. It will. Be aware of this simple fact, and do not abuse the tool to feed your fears. Instead, be objective at all times, and be cautious to the fact that seeking truth is a process. It’s not done in a virtual echo chamber.

This was long and maybe a little bit babbly. But, thanks. I’m not a computer scientist and I just wanted to share my own experience with this tool. Feel free to ask me questions, or agree, or disagree.

Source:

As an M.D, here's my 100% honest opinion and observations/advices about using ChatGPT
byu/Put-Easy inChatGPT

PAIA for HCPs -Summary of what needs to be done

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Dear Doctor,

There is a no cost way of accomplishing what needs be and it starts with:

1) navigating the information regulator website

2) registering the persons are who will be representative of the practice

3) submitting and uploading the PAIA manual

4) Submit your 2025 incident/annual submission/return form.

 

Alternatively, have a chaperone service do the whole shebang for you at a fee of R1400.

Click here to get started: https://forms.gle/A6zdvwp4ESSiNFNB6

** This is a professional outsourcing service, AND SLOTS ARE LIMITED.

 

Problem is, there are but 10 or fewer fitful days left to the deadline.

 

Hope this helps.

 

Let me know if you have any further questions.

 

0826889610

PAIA For HealthCare Practices

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PAIA Requirement for Healthcare Practitioners

 

Refer to PAIA Memo 29 May 2025, on the Notice from the Information Regulator(IR) to register and submit a section 83(4) PAIA report before 30 June 2025.

Based on the Information Regulator the requirements are that Healthcare Practices, Sole Proprietor and Incorporated, need to submit the Section 83(4) report before the above date.

The objective of the submissions is to determine whether you are receiving and recording requests for access to information in your practice. The report requires you to also indicate whether the requests for information that were received were responded to within the time frames stipulated in PAIA and whether there were any internal appeals and the outcomes of those appeals.

Please take note of important points:

  • All practices need to complete their registration on the IR portal
  • Healthcare information is categorised in POPIA as special personal information.
  • All practices will need to register or migrate their current registration to the new E-service with the IR (Your practice’s appointed Information Officer will be required to register on the IR portal.)

You will require the following information for this registration, as per the addendum.

  1. Incorporated practices – CIPC registration
  2. Sole Proprietor details
  3. Information Officer (IO) and Deputy Information Officer(DIO) – ID numbers (new requirement)

 

Note that submission of access to information Annual Reports will close on 30 June 2025.

 

Additionally, you will not be able to submit your annual report unless your IO, HPB and DIOs are registered with the Regulator.

 

Do whatsapp us if you need assistance: 082 688 9610, or have us fulfill this mandatory  service for you.

 

READ SUMMARY

 

State of the Healthcare Practitioners Market 2025-06-09

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men's beige button-up collared long-sleeved shirt

Why is it that SA health practitioners, right now, a reluctant and reticent to invest in, and embrace, taking steps to grow their practices? What is the root cause. And how can one best rekindle their enthusiasm?

South African health practitioners may be reluctant to invest in and embrace steps to grow their practices due to several root causes:

Economic and Financial Concerns

  • Reimbursement Rates: Many practitioners are concerned about declining reimbursement rates from medical aids and other payers. This can make it difficult to maintain profitability, let alone invest in growth.
  • Cost of Investment: Expanding a practice often requires significant financial investment in equipment, staff, and infrastructure. In an uncertain economic environment, practitioners may be hesitant to take on such costs.

Policy and Regulatory Challenges

  • National Health Insurance (NHI): The implementation of the NHI has been a major concern. Some practitioners are reluctant to work under the NHI due to fears of reduced autonomy, lower remuneration, and increased administrative burdens.
  • Regulatory Complexity: The healthcare sector in South Africa is highly regulated. Navigating these regulations can be complex and time-consuming, which may deter practitioners from making significant changes or investments in their practices.

Market and Competition Factors

  • Market Saturation: In some areas, there may be a high density of healthcare providers, leading to intense competition. Practitioners may feel that there is little room for growth or that the effort required to attract new patients is not worth the potential return.
  • Changing Patient Demands: Patients’ expectations and needs are evolving. Keeping up with these changes, such as incorporating new technologies or offering more comprehensive services, can be challenging and costly.

Professional and Personal Considerations

  • Work-Life Balance: The demands of running a growing practice can be overwhelming, potentially leading to a poor work-life balance. Practitioners may prioritize their personal well-being over practice expansion.
  • Risk Aversion: The uncertainty associated with practice growth, such as potential financial losses or failure to meet growth targets, can make practitioners risk-averse.
To rekindle their enthusiasm for practice growth, the following strategies could be effective:

Financial Support and Incentives

  • Grants and Loans: Providing access to grants or low-interest loans specifically for healthcare practitioners looking to expand their practices can help alleviate financial concerns.
  • Reimbursement Reforms: Advocating for fair and sustainable reimbursement rates from medical aids and government programs can make growth more financially viable.

Education and Training

  • Business Training: Offering workshops or courses on practice management, marketing, and financial planning can equip practitioners with the skills needed to successfully grow their practices.
  • Technology Education: Training on the latest healthcare technologies and how to integrate them into practice can make practitioners more confident in their ability to meet modern patient needs.

Policy and Advocacy

  • Engagement with Policymakers: Encouraging practitioners to engage with policymakers to shape regulations that are more supportive of private practice growth can address some of the regulatory hurdles.
  • NHI Collaboration: Finding ways to collaborate with the NHI that are mutually beneficial, such as through pilot programs or incentive schemes, can help practitioners see the potential advantages of participating in the NHI.

Networking and Support

  • Peer Networks: Creating opportunities for practitioners to network and share experiences can provide support and inspiration. Hearing success stories from peers can help rekindle enthusiasm.
  • Mentorship Programs: Establishing mentorship programs where experienced practitioners can guide and support those looking to grow their practices can be highly beneficial.

Patient-Centric Initiatives

  • Patient Feedback: Encouraging practitioners to actively seek and incorporate patient feedback can help them better meet patient needs and improve patient satisfaction, which can drive practice growth.
  • Community Engagement: Promoting community health initiatives or public health campaigns can increase visibility and build goodwill, potentially attracting new patients.

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