A year ago, my husband gave me a telephone number and said his insurance company now had phone consults available. 24/7, from the privacy of my own home, I could call in and get “seen” for ear infections, get a prescription for Ambien for travel, even get marriage counseling, should I desire it. I only used it once, but I was amazed that at 10 pm I could just call and talk to some random person and 15 minutes later pick up a prescription at the 24/7 Rite-Aid. I’m not going to lie, I think it was pretty cool.
For the past five years, I have said the same thing over and over to people in the veterinary profession: telemedicine is coming. How are we going to handle it? And over and over the response has been the same: no it’s not. This is only half true: it’s not coming from inside the vet profession.
But it is coming, as this piece from dvm360 goes into. And not just Vet on Demand. I’ve been approached about 10 times in the past year to sign up to be a telemedicine/internet consultation vet, and I always say the same thing: I am bound by my state practice act’s definition of valid client-patient relationship, which says that I must examine an animal in person to establish that. Anything outside of that and I’m breaking the practice act, which is why my FAQs are so clear on the topic.
Veterinarians make excellent points as to why telemedicine for us differs so much from telemedicine for people:
- Doctors get a lot more out of history than we do. People can describe symptoms they are experiencing; pets cannot say, “I have chest pain radiating down my arm”. Veterinarians rely much more heavily on physical examinations.
- Human medicine is incentivized to keep people out of the clinic to keep costs down, since general practitioners are already in short demand. Vets aren’t that slammed. Come on in.
And while we are perfectly content to say “This is a terrible idea,” others are not, and are trying to reap the benefits of it. People with background in restaurateurism see a chance to make a few bucks and throw an app together, paying a vet some pittance like $5 to put their license on the line. Why not? They don’t have anything to lose. They get around it by saying things like, “oh, we’re offering general advice, not specific diagnoses,” or take the old Miss Cleo approach:
For entertainment purposes only. Riiiiight.
This is from the VetonDemand website. I dunno guys, sure sounds like diagnosing to me. (By the way, my favorite saying is a lump is a lump is a lump. No biopsy, no diagnosis, unless the lump was a tick or a piece of sticky kibble.) That’s wasted $$ right there.
To sum up: individual veterinarians are bound by their state practice acts in terms of whether or not diagnosing over the net is legal, and it’s all over the place in terms of who can do what. This is reason enough for people to fold their hands together and say, “See, it’s not going to work.” I disagree.
My husband called the human telemedicine line to ask about a cough, and they refused him antibiotics and told him to get a chest x-ray. They were clear in their limitations. I think there are opportunities for veterinarians to use telemedicine to our advantage in responsible ways:
- consults for pre-existing clients
- Online ER consultations in coordination with local clinics for things like post-op questions: “My pet’s incision looks puffy, can it wait or should I come in?”
- With clearly defined limitations and expectations, it has its place. Truth is, most of the time the answer is, “It could be x, y, z…you should be seen,” but that’s still better than what I see happening now.
I don’t have all the answers, certainly, but I think it’s a huge mistake and a missed opportunity for the veterinary profession to not take this on proactively. It’s not a matter of if, it’s when, and if we pass up our ability to drive the bus then two restaurant entrepreneurs from Nashville are going to take the wheel instead, and we probably won’t like where they take us.
I love technology. I think we can use it, we just need to be a little creative and stop digging in our heels like those old guys who still- STILL- insist on fax over email for sending records over. Give up, man, the world is moving on.
What do you think? Would you use a service like this if you could?
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