Ireland's first online doctor does not like the term 'online doctor'. "We actually hate the word if I'm honest," admits Stephen Bourke, managing director of Lloyds Online Doctor Ireland, which launched here last summer and has grown quickly, adding about 500 new customers every week.
Yet, like it or not, the reality is that because the business model is so new, to communicate it effectively it needs to be very clear. And an online doctor is, after all, an online doctor. It’s the Ronseal approach.
Bourke, it should be said, does not dislike the name of his company, rather he dislikes what the term has come to suggest and disarming this connotation, as much as delivering a high level service, is very important to Lloyds, its brand and its future.
The success after just six months is a measure of how any notions are quickly being left behind – 12,000 customers since last summer have decided the online GP visit can be a very healthy alternative.
Beginning with primarily sexual health concerns under the previous name Dr Thom, Lloyds Online Doctor has expanded into new areas – erectile dysfunction, asthma and cholesterol – and there is no telling what the future might bring.
For now though, this dynamic business model faces a frontline public relations war, particularly as general practitioners remain in equal measures mistrustful and disapproving of the concept. It is in this context that Bourke dislikes the term.
“When you say online doctor to people the first thing they think of is spam, Viagra etc,” he says. “They immediately jump the gun and assume that we are just dishing stuff out and that it’s a sharp practice and the doctors aren’t registered and that kind of thing. The main thing is when people don’t take the time to actually look at what we do and when they do there are a lot of nods of recognition. There is a lot of kneejerk stuff.”
Central to the company’s message is that while patients can access GP consultations via the internet, it is a “very, very limited service”, treating a handful of conditions with a handful of medications.
Antibiotics, sleeping pills, antidepressants and other such drugs are not on offer here, nor are medications for conditions that require thorough physical examinations. Patients register, fill out detailed questionnaires and await the opinion of one of the four London-based GPs hired by the pharmacy chain to treat these limited ailments. The consultation costs €25 and prescriptions, where they are issued, are delivered in the post.
An algorithm is built into the software designed to measure consistency of answers and detect anything that should raise an eyebrow.
The slightest sign of concern, or a “red flag” as Bourke calls it, will immediately prompt a phone call from the doctor (at no additional fee) and, more often than not, a recommendation to revert to the traditional in-person appointment.
“I guess it’s the way health care is going: to fast-track triage and then make more consistent decisions. But there is no technological equivalent to face-to-face consultations so we have to limit it,” says Bourke.
“We are trying to set the bar very, very high for our practice and make ourselves bullet proof if you will. If we try to cut any corners that could be the end of us very, very quickly.”
The company says it is an adherent of the Medical Council of Ireland’s guide to professional conduct and ethics of registered medical practitioners. “This states that medical services can be provided remotely as long as certain requirements are met. These requirements mostly concern patient data – something we take very seriously.”
Lloyds Online Doctor is an offshoot of the 75 pharmacy branches the company has scattered around Ireland – the UK company is a wholly owned subsidiary of the Celesio Group which deals in wholesale and retail pharmaceuticals. Its virtual doctors' office is already profitable.
Most common among its customer base are women, average age 29, seeking prescriptions for the pill. These are followed by both men and women aged around 35 looking for test kits for sexually transmitted infections and finally by 55-year-old men seeking tablets for erectile dysfunction.
The service is not covered by health insurance, although it is trying to change that, and says half of its customers have medical cards but still opt for the service over visiting their GP.
"It has grown much faster than we thought," says Bourke, who holds up the three pillars of the business model as convenience, affordability and discretion.
And yet despite the company's strenuous efforts to push the message that it only deals in a very limited area of treatment and that it operates a strict fail-safe system when dealing with patients' medical histories, it continues, perhaps unsurprisingly, to have its detractors.
Dr Ray Walley, chairman of the general practitioner committee of the Irish Medical Council (IMC), says that the existence of an alternative, lower cost service is a symptom of problems in the overall healthcare system: if it was affordable and efficient, people wouldn't need to go online.
“The whole tenet of general practitioners is personalised continuity of care,” he says from the off as if chanting a medical mantra. And he probably is. No matter how good a doctor is that is dealing with [these patients], they are looking at a computer.”
While visiting a GP may be more expensive, he says, the patient gets that continuity; they have an informal chat about life and health that may throw up any other manner of concern aside from say, a requirement for cholesterol medication.
“You are building up a bond with them as opposed to a faceless computer. There shouldn’t be a need for it at all if you have a properly funded healthcare system.”
While the differences may be obvious, Dr Walley says that they simply reflect poor medical investment and infrastructure (the Dutch healthcare system for example includes online and telephone contact with GPs).
In Ireland, he explains, €160 million has been stripped from GP funding in the last four years; it now stands at 2.3 per cent of the overall healthcare budget.
Dr Darach O’Ciardha, of the Irish College of General Practitioners (ICGP) is also sceptical, saying that forms with predetermined questions can be helpful but are “open to potential misinterpretation, particularly in an online format, especially if the patient is not known to the prescriber”.
“Convenience shopping via the internet has revolutionised our purchasing decisions. However, medications are not books or electrical items.”
Professional prudence and solicitude are important but ultimately Lloyds’ service is within the regulations and says it strives to maintain and even strengthen standards for a burgeoning industry.
Ultimately, it will be down to the patients where they go and who they see, at least for a certain number of problems.