Telemedicine promises better access to healthcare, although it comes with trade-offs. (Photo: iStock)
Your family doctor is probably moonlighting across different telemedicine apps, like an e-hailing driver switching between Bolt and Uber. Welcome to the future, where eight years of study reduces highly trained medical professionals to gig economy workers toggling between platforms.
South Africa’s telemedicine landscape is shifting from the scaling of quality healthcare to patients who can’t afford the consultation fee or the taxi fare, to a safe haven for medical careers, absorbing the doctors who have been lost to the state system.
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Discovery Health made its position explicit in a written response to Daily Maverick questions. “Doctors are not exclusively bound to Discovery and are free to consult on other telemedicine platforms if they choose,” confirmed Deon Kotze, chief commercial officer at Discovery Health.
This non-exclusive model is becoming the industry standard, creating a new normal where doctors must juggle multiple systems, logins and patient databases simultaneously.
Trend spotting
The trend is being driven by several converging forces: frozen government posts that have left qualified doctors unemployed, overwhelming patient loads in the public sector and the promise of flexible work arrangements that telemedicine offers.
But as the model evolves, fundamental questions about quality, continuity of care, and professional liability remain largely unanswered.
Discovery Health and the newly launched Videomed (for real, they’re not even a month old, operationally speaking) are two opposite sides of the telemedicine coin, but both are contributing to the same fragmented future for GP employment.
Discovery’s model integrates virtual consultations into its existing health insurance ecosystem through HealthID, a secure digital platform provided to participating GPs at no additional cost. The system offers doctors access to comprehensive electronic health records (with patient consent), including medical history, test results, claims data and specialist reports.
Prescriptions can be emailed directly to patients or pharmacies, with Discovery members able to use the app’s integration with DisChem for delivery or click-and-collect options.
“The secure digital platform [HealthID] gives doctors [with patient consent] access to a comprehensive view of a member’s health records, including medical history, test results, claims data and specialist reports,” Kotze said. It’s a closed-loop system designed for efficiency within Discovery’s member base.
A challenger has entered the arena
Videomed, by contrast, is building something more radical. The platform is focused on giving doctors a virtual practice on the platform and creating what company communications lead Julia Kay, speaking on technical matters, described as a “robust practice management solution”.
The model emphasises multidisciplinary care, where nurses and pharmacists “can assist patients wherever they are with their own laptop and be able to facilitate assessments with the doctor”.
Kay said the company is big on security and compliance. “For doctors, we have password-protected e-scripts. Scripts cannot be used or stolen. It requires the doctor’s OTP and signature to utilise the script functionality.”
The platform runs on Azure, complies with the Protection of Personal Information Act and maintains cloud-based records that allow continuity of care across the network.
“In a lot of ways, we are making our healthcare system more robust, more compliant and more safe because you no longer have the risk of patient files being physically stolen or lost,” Kay said, positioning technology as a solution to systemic failures in record-keeping.
Keeping things professional
Dr Juniene Probart, who heads up doctor procurement and onboarding for Videomed, framed the platform’s mission in almost revolutionary terms.
“I’m choosing my doctor who is compassionate, comprehensive, has a heart for what we’re building and we’re placing them, and we’re taking that [burden] off the state,” she said.
The platform offers doctors a 60% split of consultation fees and has grand ambitions to, one day, serve vulnerable populations through a proposed NGO model, at least once the public-facing business gains traction.
The exodus towards telemedicine is about technology that has finally caught up with the needs of the community, and it’s also an escape. Probart described her experience in the state system with barely concealed frustration: “We would see in the clinic space, in primary care, about 40 patients a day, which means sometimes you can only spend 15 minutes (per) patient.”
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Average waiting times in some emergency rooms reach 40 hours. She spoke of feeling trapped in a system where doctors “can’t really give their best and patients deserve more”.
It’s a South African reality where public health facilities remain “often overburdened and under-resourced”, creating a pressure valve that telemedicine platforms are eager to release.
The trust paradox
But can technology truly replicate the doctor-patient relationship? Dr Grethe van Tonder’s research at Stellenbosch University on app-based primary care telemedicine reveals a surprising finding: patients often prefer the privacy and perceived anonymity of virtual consultations, particularly when they can use text or voice calls instead of video.
“Even though a digital platform is used, the human ability to show empathy, kindness and genuine care is what primary healthcare providers should focus on, to build patient trust and satisfaction during app-based digital consultations,” Van Tonder found.
Her research participants reported that telemedicine experiences were “very different from what [patients] were used to at public healthcare facilities, like clinics, where staff tend to be rude and rushed, leaving patients without a chance to fully explain their symptoms and concerns”.
In this context, telemedicine’s detachment becomes a feature, not a bug.
A liability minefield
Dr Liz Meyer of PPS Health Professions Indemnity is quick to raise the alarm. “A primary examination should always be physical because understanding your patient and obtaining a thorough history cannot be fully achieved virtually. Virtual consultations are better suited for follow-ups,” she said.
Meyer highlighted a crucial legal reality: “When a doctor engages with a patient virtually, they enter into a binding doctor-patient relationship. This means they can be held liable for breach of contract or negligence if they fail to meet expected care standards.”
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“The risk is compounded in a multi-platform environment. Doctors who build strong relationships with patients are “significantly less likely to face litigation,” Meyer says. “Telemedicine inherently lacks the depth and flow of face-to-face engagements, making it harder to establish this rapport.”
What happens when a doctor sees a patient on Discovery on Monday, Videomed on Wednesday, and another platform on Friday? Each with different systems, different record-keeping and potentially incomplete patient histories?
The fragmentation that benefits doctor flexibility may undermine the continuity of care that protects them legally.
Diagnosing the gig economy
Like Uber and Bolt, telemedicine platforms are creating a contractor workforce that carries all the risks of professional liability while the platforms provide infrastructure and take a cut of fees. Doctors gain flexibility but lose the institutional support and continuity that traditional employment provided.
Probart ultimately justifies the model by focusing on patient access: doctors working across multiple platforms can give care to multiple different people regardless of which platform they’re on.
It’s a utilitarian argument. More access is better, even if it comes with trade-offs.
As South Africa’s public health system continues to struggle and the National Health Insurance implementation timeline stretches ahead, telemedicine platforms are filling the gap with a model that treats doctors as interchangeable service providers rather than professionals with ongoing patient relationships.
It’s efficient. It’s scalable. Whether it’s good medicine remains an open question. DM