With the recent announcement that the UK’s first veterinary telemedicine service is set to launch, there is much debate over whether this type of service is a good thing.
The major bugbear most vets have with telemedicine is the absence of a physical examination. While teleconsultations (or, indeed, just a telephone call) can allow a vet to gather a history, we all know client histories can be unreliable. Even in the most switched-on of clients, stress can have a significant effect on memory and clients can often provide conflicting information about their pet.
While this can usually be cleared up through rephrasing of questions, nothing beats a physical examination for knowing whether the dog actually does have a temperature, abdominal discomfort, or even fleas.
Prescribing blind
With this in mind, there is the question of whether we really need to physically examine a patient to prescribe some POM-V medications? This is dependent on the medication in question – there’s a big difference between prescribing a flea treatment or giving advice on flea allergy dermatitis and prescribing heart medications.
Even starting an animal on NSAIDs for suspected arthritis gives me a feeling of unease, as the patients that require these are often older and may have comorbidities that would only be picked up through a physical examination.
Plus, to prescribe any medication accurately, a recent weight of the animal is needed. Could this be guaranteed with the owner using his or her scales at home?
In case of emergency
Perhaps the most inappropriate use of telemedicine would be in emergency situations, where the animal very likely must be seen by a vet to receive treatment anyway.
For those that don’t necessarily need treatment, advice can often be given over the telephone by the client’s own vets anyway (in the case of a chocolate-scavenging dog and a client unsure whether a fatal amount has been consumed, for example), and out-of-hours vets or nurses are often happy to triage over the telephone to determine whether the pet needs to be seen.
So where is the need to create a video call service that charges the client for the pleasure of asking a simple question?
Of course, debate exists as to whether we really should be charging for OOH telephone advice anyway, even though I’m sure many practices still don’t.
Soft launch
Independent Vetcare (IVC) is proposing a “soft launch” of the service, which will involve Skype-like consultations. It is offering a “no win, no fee” approach, meaning if the vet advises that the pet needs a physical examination, the owner is entitled to a discounted consultation fee at one of the practices owned by the group. However, if the owner then chooses to go to his or her own practice, which is not part of IVC, he or she would have to pay the full fee.
One concern over this approach is the uneasy feeling of poaching clients, or the between-the-lines encouragement to use a practice that may be further away than their usual vets.
Of course, if the clients are IVC clients anyway, then it’s good for them either way.
Pros and cons
I can understand the benefits for the profession that these services have on paper:
- less staff required
- flexible hours
- the ability to work from home (something very hard to achieve in veterinary medicine)
However, I really struggle to see the situations in which telemedicine would not result in needing a physical examination or initiation of treatment. I have used the equivalent NHS service a few times, with the result always being a trip to an OOH clinic or A&E anyway.
As for the trivial calls, could these not be filtered out over the telephone anyway?
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