The Revolution Will Not be Telephonised

What the Fuck is Updoc? A peek into the booming telehealth industry.

In The Substance (2024, dir. Coralie Fargeat), Demi Moore’s character is given a phone number which connects her with a mysterious, anonymous figure spruiking a novel treatment for ageing. Taking up this offer, she embarks on a wild journey of deposit-box visits, self-injection and multiple phone calls with this enigmatic individual with whom she never meets, with - well - less than desired results.

I’m sure that the perils of telehealth were far from the director’s mind when dreaming up this surreal and frightening tale, but the similarities (if not a little extreme) are uncanny.

In recent years, Australia’s healthcare landscape has boomed with telehealth-only services, with the market dominated by giants like Updoc and InstantScripts. These corporate entities offer telephone-based or even text-based consultations to thousands of Australians daily: providing medical certificates, treating common ailments, and writing specialist referrals and pathology request forms. Many companies like these popped up before the Covid-19 pandemic, but have no doubt benefited from the prolonged period of home-detention the pandemic mandated and the mass agoraphobia that ensued since. In one advertisement for Updoc, a GP waiting room is cast as a gloomy, haunted space, with hooded skeletons floating in the corners and the protagonist is seated next to a corpse. “Don’t get stuck in waiting room hell,” the voiceover instructs.

InstantScripts even offers Mental Health Care Plans via video call, quoting a $49 gap after the Medicare rebate. (How this is possible given telehealth items are only supposed to be claimed if a face-to-face consultation at that practice has occurred within the last 12 months, is mysterious to me.)

On the Updoc website there is a link to request ‘Immune Function Tests’. ‘A strong immune system is the key to staying healthy - it helps our body fend off nasties,’ the text reads, ‘If you’re frequently feeling unwell or finding it slow to recover - you may be in the 5% of Australians with an autoimmune disease.’ Despite this being a complete non sequitur, screening for an autoimmune condition in the absence of compelling symptoms would reasonably expect careful counselling about false-positive or non-specific results. Given the average rate of 40+ patient consultations per day by each doctor working at some services, can we really expect this careful discussion to have taken place? To sift through their past medical and family history? Of course, there is no opportunity for proper physical examination. And who follows up these results? Will it be the same doctor who ordered them and took the initial history? Unlikely, given on many of these platforms, you cannot request to be linked with the same doctor again.

Dr Asher Freilich, who was the managing director of InstantScripts until Wesfarmers bought out the business in 2023 for an eye-watering $135 million, told AusDoc that the idea of continuity of care with a regular GP was “a fictional ideal” for many patients, and that “having a regular GP is always the gold standard of care and InstantScripts is certainly not around to replace that very sacred relationship… but there’s one thing worse than an absence of continuity of care and that’s an absence of care”.