Sloppy Cases Stand Out in Online Medical Consultation in Japan; Doctors Not Showing Up, Unproper Prescribing

By Ryowa Kashiwabara / Yomiuri Shimbun Staff Writer

7:00 JST, March 17, 2025

There have recently been a string of problems with online medical consultations via smartphones and other devices.

There are cases in which patients are not examined by a doctor or are prescribed psychotropic drugs after initial diagnosis, which they are prohibited from doing. These may have been violations of the medical practitioners law and the central government’s guidelines.

Unless the situation is addressed, serious medical accidents could occur. The Health, Labor and Welfare Ministry is considering revisions to the law to tighten regulations.

Prescription from a nurse

A woman in her 50s living in the Kanto region recently felt mentally unwell and made a reservation for an online medical treatment at a clinic in Tokyo. After she answered simple questions such as about her medication history on the Line messaging app, her cell phone rang. The caller was a woman who said she was a nurse.

As the patient informed the nurse that she had difficulty sleeping, she was told to take sleeping pills. She wanted to try out the pills for a few days to start with, but was told the clinic could only offer the medication for periods of a month or longer. When the patient took the pills delivered to her, she felt dizzy. She got scared and stopped taking them.

“I never saw a doctor or received an explanation about the side effects of the drug,” the woman said.

The medical practitioners law prohibits prescription of drugs without a doctor’s consultation. Under the online medical treatment guidelines compiled by the health ministry in 2018, drugs cannot be prescribed for more than a week to a patient whose pre-existing medical conditions are unknown.

The woman reported the case to a local public health center. An official at the center reportedly told her that they had received several complaints about the same clinic.

The Yomiuri Shimbun sent the clinic operator a letter inquiring about the possibility that it had violated the law, but no answer was received.

An inappropriate case was also found in the prescription of morning-after pills. A female junior high school student sought to purchase a morning-after pill via an online medical visit with another clinic in Tokyo last spring. She was told how to make a purchase and received an explanation of possible side effects, such as headaches, on the Line app.

The student then received a call from a woman who asked the name of the drug she wanted. The woman did not tell the student her occupation or name.

“They should have explained things more carefully to a minor. It’s a problem,” the student’s father said.

Deregulation spurred by COVID-19

Online medical visits reduce the travel burden on patients and were first introduced on remote areas such as islands. In fiscal 2018, public health insurance was extended to cover online examinations. While the visits are convenient, doctors cannot examine the patient by touch or stethoscope, and previously, only patients who had had face-to-face sessions from the same doctor for a set period were eligible to have their online care covered by insurance.

This requirement was eased during the COVID-19 pandemic. Since online medical treatment helps reduce the infection risks that come with waiting rooms at hospitals, the government allowed patients to have their initial diagnosis made online as an exceptional measure. In 2022, this temporary measure became permanent. As of October, about 10% of all medical institutions in the country, or 12,507 institutions, had notified the authorities that they would provide online medical consultations.

Under the ministry’s guidelines, online medical consultations are in principle permitted from the first consultation only with a family doctor whom the patient has visited, but also with other doctors if the patient’s condition can be understood based on health checkup results or other documents. In such cases, identification is required from both the doctor and the patient.

1,700 possible violations

However, there have been many cases where these rules have not been followed. When the health ministry conducted survey on telephone and online medical consultations, it found 1,740 cases of possible violations of the guidelines between January and March 2023 alone. These cases include prescribing drugs for more than a week or prescribing psychotropic drugs at a first session to patients even though their pre-existing conditions were not understood.

In fiscal 2023, consumer affairs centers across Japan received 258 complaints about online medical consultations, about five times as many as in fiscal 2021. These cases are often related to dieting.

“Many hospitals focus on speed, which tends to lead to sloppy patient services,” a senior ministry official said. “Failure to properly understand a patients’s pre-existing conditions or explain the risks of side effects could lead to serious medical accidents.”