When telehealth is, and isn’t, appropriate.

A brief, honest history

Telehealth in Australia existed as a niche service before 2020. The pandemic forced it into wide use almost overnight. The temporary Medicare items that funded it became permanent in stages, with progressively tighter rules: most importantly, that a telehealth consultation with a GP is rebatable under Medicare only where there is an existing relationship between doctor and patient (in most cases, at least one face-to-face consultation in the preceding twelve months).

The honest summary: telehealth is a real tool, but it is not a replacement for a clinic. Knowing which problems it serves well is the difference between a useful consultation and a frustrating one.

When telehealth works well

The presentations where a telehealth consultation is often the right tool include:

• Follow-up of a known issue. The blood pressure you and I have been managing for three years. The medication review at the six-month mark. The chronic disease care plan check-in.
• Discussing results. Reviewing pathology or imaging that has already been done, deciding next steps.
• Repeat prescriptions for stable conditions where in-person review is not clinically required and a video conversation is enough to confirm nothing has changed.
• Referrals. If the clinical question is already settled and the referral letter is the deliverable.
• Brief mental-health touch-ins for patients with an established therapeutic relationship who are between scheduled in-person reviews.
• Travel medicine pre-departure planning where examination is not required.
• Logistical access. Aged-care residents, people in regional areas, anyone for whom getting to the clinic is a real barrier.

When telehealth doesn’t work

The presentations where telehealth falls short, in my view, include:

• Anything that requires examination. Skin lesions, lumps, abdominal pain, joint pain, chest pain, headache being investigated for the first time. You cannot examine someone over a screen, and the cost of pretending you can is missing things.
• Initial mental-health assessments where the first job is to read a room you are not in. There are excellent telehealth mental-health services, but the first conversation often goes better in person.
• Children under about 12, for most things. The history is incomplete without the parent and the child together in a room, and the examination is half the diagnosis.
• Complex multi-problem visits. When you have five things going on at once, the careful work of unpacking them and prioritising is much harder over video.
• Diagnostic uncertainty. Anything you cannot pin down on the phone. Telehealth handles certainty; it does not handle ambiguity well.
• Procedural work. Skin checks, biopsies, joint injections, cosmetic consultations — in person, always.

Healthdirect vs your own GP’s telehealth

There are two distinct things in Australia that both get called “telehealth” and they are quite different.

Healthdirect is the federally funded national health-advice service. It runs a 24-hour nurse-led telephone triage line (1800 022 222) and a network of doctors providing telehealth consultations to the public, particularly for after-hours, urgent-but-not-emergency situations. It is free at the point of use. The clinician you see is one of several on shift; they are not your GP and they do not have your medical record. They are excellent for what they do — safety netting, triage, after-hours advice — but they are not a substitute for continuity of care.

Your own GP’s telehealth is a different model. The clinician on the other end of the line is the one who has been looking after you. They have your record open. They know your history. The Medicare requirement that you have an existing relationship with them exists for exactly this reason.

Both have their place. They are not interchangeable.

Rebate and billing considerations

The general rule, with some pandemic-era exceptions that have since unwound: a Medicare rebate for a GP telehealth consultation requires an existing doctor-patient relationship, usually evidenced by an in-person consultation within the previous twelve months. Healthdirect is its own funded service. Cosmetic consultations are never appropriate for telehealth (the Medical Board guidelines effectively require an in-person assessment).

The practical implication: if you have never seen me before and we have no record, a Medicare-rebated telehealth consultation is generally not possible. The right first step is an in-person appointment.

How to get the most from a telehealth consultation

• Be somewhere private and quiet. Hard to discuss anything sensitive from a moving car.
• Have a good connection — ideally video where the consultation requires it, phone where audio is fine. A bad video call is often worse than a phone call.
• Have your medications, recent results, and a list of what you want to discuss within reach.
• Pick one to three things to address. A telehealth consultation rarely has time for ten.
• If you sense the question is too big for the format, say so. Switching to an in-person appointment is not a failure; it is the right call.

When to insist on coming in

A short rule: if your gut says “I think I should be examined for this”, you should be. Don’t let convenience win that argument. If a doctor cannot or will not examine something they should, the safest assumption is that the consultation has not finished.