“KEEP STILL!”
Telemedicine sounds simple – talk to your vet, never leave your chair. And sometimes it is. But sometimes it isn’t.
Like right now. Have you ever tried to hold your dog while you pulled his lips back to expose his back molars while trying to point your cell phone camera at that tooth? With only the three hands you were born with? While not cursing loud enough for the mic to hear? Just one more challenge on this day of COVID-19 isolation when I was trying to show my vet Pepe’s suspicious tooth – my first telemedicine appointment!
“The vet needs to see him …” has always been the standard BC answer (before COVID-19) whether the question was “My dog has tapeworms – can I get worm medication?” or “He burped – could he have puffed up?” And it still is – only now can the vet see him without you leaving the house. At least sometimes. Pepe had to pay a visit, but at least we tried to “stay home” first.
App time
Telemedicine for humans has gently led veterinary medicine to follow suit with slow progress for years. The COVID-19 crisis has replaced that gentle nudge with a boot on the back, bringing telemedicine to thousands of practices and homes across the country. Sure, there has been some kind of telemedicine for years, if you count the phone follow-ups or quick questions. However, this traditional, informal type of telemedicine has disadvantages.
For starters, informal phone calls can get out of hand. A “quick question” turns into “just one thing” in 20 minutes. As much as your vet wants to be helpful, she can’t afford to spend her days as a free counseling center, or worse, a lonely hearts club member. On the other hand, there is the possibility of miscommunication. Not every customer takes good notes over the phone. To counteract this, the vet has to transcribe her advice and increase the time factor again. And notes need to be added to the patient record – all of this is done “off the clock” for the customer.
This is where telemedical apps come into play. Depending on the app, they can automatically bill the customer for the session or in steps of 10 or 20 minutes, enable bidirectional messages or video chats, and record the transcript or session. In addition, you can run a number of add-ons such as: B. Schedule appointments and refill prescriptions – all in a private and secure system. About 15 such apps are currently used in veterinary practices in the USA. According to spokeswoman Christine Gately-Evans, PetDesk, one of the largest companies, has seen two-way messaging volumes grow 300 percent since the crisis began. “Last week we exceeded 47,000 messages in one week, and our message volume per clinic has increased 47 percent since March 16,” she says.
Legal Limits
Lori Teller, DVM, DABVP, directs the telemedicine program at Texas A&M College of Veterinary Medicine. She reports that the popularity of veterinary telemedicine has grown exponentially since her telemedicine program began just weeks before the pandemic broke out. She warns that telemedicine is not always the case. And don’t expect to start a new clinic just because it offers telemedicine. A veterinary-client-patient relationship (VCPR) has long been required by law before a veterinarian can treat a dog or dispense medication. That means a veterinarian must legally examine your dog, usually within a year or so, and keep records of the dog. “Many states have temporarily waived the requirement for a physical exam to set up a VCPR, but not most states,” said Teller. “A VCPR is still a requirement in almost all countries. However, several states allow the VCPR to be set up remotely (via telemedicine) to meet the needs of owners and their pets, while also catering to the needs of the public to maintain social distancing. … The FDA and DEA have also temporarily relaxed some of their requirements for the establishment of the VCPR regarding the prescription of certain drugs. “
Telemedicine may seem like the wave of the future, but it has its limits. It’s best used as a triage – to determine if the situation is emergency, if a pet needs to come to the clinic at all – or as a follow-up. Sharon Lomnicki, DVM, recently integrated telemedicine into her Cape Coral Veterinary Clinic in Cape Coral, Florida, due to the COVID-19 situation. “I cannot do blood tests or listen to a heart on the computer, nor can I diagnose the cause of vomiting,” she warns. “But I looked in one ear, checked the course of a skin disease and counted the breathing.” Although she didn’t have the cause yet, she adds that she could also examine the gum color or capillary refill time, and even do a visual exam on a urine sample.
A good dog helps
Assuming, of course, a cooperative patient. (Read: Not Pepe). That’s another downside of telemedicine: you don’t realize the importance of a vet technician until you don’t have one to help. There is also a tendency to focus only on the owner-defined problem – or where the owner is pointing the camera – so it is easy to overlook some other seemingly unrelated cause or problem. And owners unfamiliar with computers need to practice using a camera, speaker and microphone, and possibly download an app, before an appointment. Ideally, they should do it now, before an emergency can arise if they needed it.
While not perfect, the benefits of veterinary telemedicine still outweigh the cons (unless you factor in my frenzied cleaning session so the vet doesn’t see my messy house in the background). You know how your sick dog is suddenly the picture of health when he is at the vet? Now the vet can see what you are seeing while in their home environment. And if you have a dog that is stressed out in the vet’s office, here is his chance for a fear-free “visit”. Not only is this good for the dog, it’s nice for your veterinarian to finally see your dog’s personality at home. Teller giggles and remembers a bulldog who got very excited when he heard people talking about them over the computer. “The customer used treats to get the dog to sit still, and the bulldog ended up kissing the camera!”
But then what about all the real kisses that will never land on the vet’s cheeks? Maybe one day there will be an app for it.
Caroline Coile is the author of more than 30 books on dogs and is a two-time winner of the AKC Canine Health Foundation Award.
Originally appeared in the July / August 2020 issue of AKC Family Dog.
