If you have ever remotely communicated with a doctor, you have used telemedicine! But be careful, as you might unknowingly be at risk. In 2021, a doctor was suspended for trying to sell erectile dysfunction medicine via telemedicine in Singapore. Here, we reflect on this case and teach you how to make sure your telemedicine providers are safe and legitimate.
Doctor suspended for 5 month for selling erectile dysfunction medicine in Singapore
Dr Ho Tze Woon, a registered doctor under Singapore Medical Council (SMC) was suspended from practicing for 5 months after he tried to sell erectile dysfunction (ED) medications via telemedicine.
He was found trying to sell an ED tablet called “Cialis” via text messaging.
Why is this considered illegal, even though telemedicine is becoming a norm in Singapore?
For clarity, telemedicine refers to the process of engaging a health service remotely through any means (eg. text messaging, phone call, video call).
Here’s what happened to Dr Ho, and the factors that influenced the medical council’s final verdict, when he tried to sell ED pills virtually.
Selling regulated erectile dysfunction medication to a “non-patient”
Erectile dysfunction medications are considered to be “prescription-only” by HSA regulation. Meaning that a doctor must provide a prescription before the medication can be dispensed to the patient.
Through the tribunal, it was stated that the buyer in question (Mr C) was not a patient under the doctor’s care.
In the Singapore Handbook on Medical Ethics (2016 Edition), it states that “(Doctors) are obliged to prescribe or dispense medicines only to patients under your care and not to persons with whom you have no professional relationships”.
How should it be done?
This usually starts with simple administrative processes such as registering the patient with his clinic and confirming his/her identity.
Above that, a certified direct telemedicine provider in Singapore would also ensure that the first consultation is done over a video call. Not only does this enable safer care and assessment, but it also allows for both parties to build rapport and trust.
The doctor failed to establish a formal doctor-patient relationship with Mr C. Instead, he chose to communicate with Mr C via text messaging, which the tribunal concluded as “a purely business transaction”.
Erectile dysfunction medications were his own and were damaged
The doctor stated that he had obtained his ED pills from clinics in Singapore and Malaysia. These were supposedly for his own medical issues.
However, the tribunal felt that he had the clear intentions to re-sell them.
The first transaction failed only because the buyer had refused to accept the Cialis, as the packaging was damaged.
How should it be done?
The source of your medication is very important, especially when purchasing them via telemedicine.
Mishandling of medications may actually reduce its efficacy. If improperly stored, unregulated temperature and humidity might actually result in defective pills!
How do you tell? A damaged packaging is a telltale sign that you might be receiving medication that may have been mishandled. If so, you should ask for a refund or replacement.
But to give the benefit of the doubt, minor dings and dents can happen even if you procure via a reliable delivery service. For that, you can ensure that your order is properly labelled with the clinic that has sent you the medications.
Price bargain for ED medication – Patient’s interest or purely business?
After the first deal fell through, the doctor repeated the conduct for the second transaction.
This time, the conversation involved some haggling. He initially quoted Mr C $203 for a box of Cialis and included GST.
Mr C: How many per box this time?
Dr Ho: Included gst 203. But 200 will do
Mr C: How many pills?
Mr C: Last time per box was 14
Dr Ho: 28
Mr C: Btw, why r u charging GST?
Dr Ho: Not me, its supplier
Mr C: Supplier? I’m not even getting a receipt!
Mr C: Like this it’s not much diff from buying from clinic!
Dr Ho: Ok 190 is ok. U coming or not?
Mr C: Otw. $180?
The second transaction was again not successful because the price could not be agreed upon after rounds of bargaining.
The tribunal concluded that the process of haggling demonstrated that the doctor was being opportunistic. Whether or not he was interested in managing Mr C’s erectile dysfunction concerns, that was not established.
How should it be done?
It is not wrong to inquire about the cost of medication or consultation at a clinic. In fact, you should know what you are paying for!
Just be aware that if the price is too cheap, it is likely too good to be true.
If you agree with the doctor, but find it a little over your budget, don’t be shy to share your concerns. Your doctor may discuss with you cheaper alternatives. For example, generic Sildenafil is a more affordable alternative to branded Viagra for erectile dysfunction.
The Final Verdict
Ultimately, he was charged and fined for his multiple attempts to supply medicines to patient not under his care for profit, which breaches the ethical guidelines set forth by Singapore Medical Council (SMC), and impacted the trust the public have in doctors.
This case serves as a good reflection not only for the doctors, but also for the public who uses digital solutions to seek medical care.
How can I protect myself and ensure the telemedicine is safe?
In Singapore, telemedicine has brought much convenience and discretion for sensitive conditions like men’s health or erectile dysfunction.
Still, you should still expect the same standard of care as you were to expect from a physical clinic in Singapore.
Here are some steps you can take to ensure a safe telemedicine experience.
|What are the potential signs of an illegitimate telemedicine provider?
||As a patient and telemedicine user, what can I take note of?
|1. The provider is not a licensed medical practitioner in Singapore.
||Check if the doctor is licensed under SMC here.
|2. The provider supplies medicines to patients informally without providing standard of care.
||Ensure the provider is offering the medical care you’d usually experience in a face-to-face setting (e.g., proper registration to establish first consultation, video call or health survey as medical assessment, discussion of desired health outcomes, etc.)
Be mindful if the provider appears to sell health products or regulated medicines (e.g. Cialis) informally to you for profit without any form of consultation.
|3. The source of medicines is dubious with questionable quality (e.g., open seal, damaged packaging).
|Check if the provider operates under a clinic registered with MOH here.
Operating under a business entity allows the provider to procure medicines from a legitimate source (e.g., licensed pharma companies) and to store medicines in a proper infrastructure. This safeguards your safety when consuming the medicines.
You can also check if the medicines offered to you are approved by the Health Sciences Authority (HSA) here.
|4. The provider allows you to bargain the price of medicines down.
|Most of the time, the prices of medicines sold at clinics are not negotiable.
If the provider allows you to bargain your cost down repeatedly, this should raise an alarm about the source of the medicines and the profit motive of the provider.
|5. The provider did not ask for your consent to the policy, terms and conditions of the telemedicine service.
Ensure your provider is in the list of direct telemedicine providers published by MOH.
Stay vigilant in the growth of telemedicine
In the telemedicine landscape, nothing is more important than finding a trusted and reputable provider – who makes patients feel secure in the end-to-end process from consultation to receiving treatment.
For example, Sire is a digital men’s health service in Singapore which provides convenient virtual consultations with licensed doctors, along with affordable erectile dysfunction treatments (e.g., Viagra, Cialis) that are shipped to your doorstep discreetly.
Sire is powered by The Cloud Clinic, which is a licensed medical clinic registered under MOH and direct telemedicine provider.
Remember, never trade your health for convenience by engaging with any “claimed” telemedicine provider.