This week I received an email that had a picture of a dog’s foot attached. The sutures I placed in the cut footpad three days previously were holding nicely and the wound was healing well. Relief ensued. Then I read the accompanying message – ‘Looking great. Happy here. Do we really need to come back in for the check up?’. And with these simple words, my heart sank.
What’s the harm? It was a simple enough question and the picture was beautifully clear. However, this is (admittedly in a relatively simple form) an example of the somewhat gritty relationship between technology and the veterinary profession.
Under current regulatory guidelines, as a vet, I should not pass clinical judgement based on a picture.
Last month I attended the 60th anniversary of The British Small Animal Veterinary Association Congress. I was invited to the opening press conference and the topic for discussion was the role of telemedicine within the veterinary profession.
‘Telemedicine’ is providing any healthcare service through a remote telecommunication device such as a video call or wearable pet technology.
Currently, there is a ‘zero tolerance’ policy on making a diagnosis through telemedicine. The Royal College of Veterinary Surgeons, our regulatory body for the veterinary profession, is inviting opinion from within the profession and the general public to set up a framework over the coming years to balance this so called ‘disruptive’ technology. And time is of the essence if we, as a profession, are going to steer the direction of these advances to ensure animal welfare remains the absolute priority.
There are a number of examples where technology has already improved the service offered by vets. A lot of practices now use digital radiography. The traditional notion of a vet processing a film, holding it up to a light box and evaluating the grey shadows is almost a thing of the past.
Nowadays the digital image is loaded up onto a screen with an editing function to zoom, pan, darken, lighten, annotate. The list goes on.
But if the diagnosis is complicated and a second opinion is required, instead of physical films being posted to an external specialist for interpretation (the results of which would take days) the vet can now email the images at any time of day to a diagnostic imaging service and a specialist’s opinion is pinged back to the referring vet within the hour.
This access to referral clinicians has revolutionised how first opinion vets approach cases. There is a fee involved but overall the service to the client (and the welfare of the pet) are both improved immeasurably.
This vet-to-vet telemedicine service is essentially a form of referral and therefore is permitted. However, the question is whether this ‘online diagnostic service’ should be made available direct to the pet owning public.
Imagine a hypothetical scenario: an owner videos their lame dog on a smartphone and uploads it with a short history to an online ‘virtual vet’. Within 10 minutes, the owner is at the receiving end of a video call from a vet working for a 24 hour online diagnostic service. A diagnosis is made and the vet emails out a prescription for the owner to purchase the medication from an online pharmacy. The dog receives the appropriate treatment, the owner receives sound advice from the vet and all this without the owner (or dog) having to even leave home.
It is easy to see how attractive this may seem to those owners that are in rural locations or perhaps those that are reluctant to see a vet due to costs. If it were more financially competitive, would more pets receive the veterinary attention they need if access to an online veterinary service was available? If that would improve the overall number of sick pets receiving treatment, then I am in full favour.
However, as with most things in life, all this potential benefit carries with it a degree of risk.
How can a vet successfully conduct a full patient clinical exam remotely? As vets, we are trained to pick up subtle signs from animals to aid our clinical diagnosis and so much of that, whether consciously or subconsciously, comes from using our hands.
As an extreme example, I once had a dog present for a routine vaccination – the client gleefully unaware that her otherwise healthy companion was actually growing a tumour on his spleen, only apparent through abdominal palpation. It is only through physically touching that dog that I found the hidden problem.
Telemedicine is also a hot topic in the human field. However, a major difference between the two professions is that human patients can describe their own symptoms directly.
Our animal patients rely on an owner’s interpretation of signs given out by their pets. And owner interpretation, although well meaning, is not always particularly accurate (a rectal thermometer will give a reading to suggest hypothermia if the thermometer is inserted into a ball of faeces rather than up against the rectal wall - I had to explain to one of my more ‘hands on’ clients!).
Furthermore, there is the dreaded notion of liability. If a clinical decision is made as a result of a remote veterinary consultation and that decision proves to be wrong, who should be to blame, the vet or the owner? The vet has chosen to conclude a definitive diagnosis based solely on the information provided by the owner but the owner may have given the wrong information in the first place. There is a case there for both parties.
Another form of telemedicine is wearable technology (think FitBit for pets). This has huge potential to give vets and pet owners information about their pets that might revolutionise how that pet is treated. Examples could include monitoring devices that track brain activity to predict the onset of a seizure; GPS devices implanted to deter pet thieves; diabetes monitors to remotely control insulin dosages or gait analysis devices to highlight subtle lameness.
We need to ensure that any wearable technology has a proven accuracy before we, as vets, endorse the use of such gadgets to influence our clinical decision making. And all these technologies need to be accredited and proven safe before they are physically implanted into our pets.
Either way, it is clear that pet technology is a booming market. I managed to judiciously encourage the owner of the dog with a cut foot to come back in for a post operative check up (for free and in exchange for plenty of treats!) but I know that is not the last email (or text, or direct message, or tweet) that I will receive of such a nature.
I can’t imagine the virtual vet would ever fully replace a visit to the consulting room. I would suggest the majority of pet owners enjoy having a trusted one-to-one relationship with their vets, especially when it comes to making difficult decisions (such as euthanasia).
However, these technological advances are happening whether we like it or not. New technology can seem daunting, but only if you refuse to keep up with it. There is definitely an opportunity to make technology work for us, as vets, to improve animal welfare but these advances need cautious regulation.
However, in conclusion – I confess, I became a vet because I love interacting with animals. So until we have a structured protocol for telemedicine from our governing body, I don’t mind admitting that I would much prefer to keep treating my patients in my consulting room. And not, perhaps, through the lens of a webcam.