RVC consulting on remote veterinary consultations

[southerncomfort]

I've just completed a YouGov survey regarding the RVC allowing vets to carry out remote consultations and prescribing treatments without seeing the horse in the flesh.

I have 3 issues with this

1. Many complaints and conditions can present with very similar symptoms. The risk of misdiagnosis is pretty high and could lead to paying for unnecessary medication and a delay in appropriate treatment.

2. Equine veterinary fees are steep and rising. If I'm paying good money for a service, I want the vet to be there in person making a thorough examination of the horse.

3. I don't like communicating via video/Internet etc and feel better able to ask questions etc face to face.

While being able to ask quick questions via email when a consultation isn't really necessary would be welcome, I would feel pretty unhappy with remote consultations.

 

[meleeka]

I already receive advice by phone if it’s something that the vet doesn’t need to examine for. Examples of this are “I’m not sure about this, do you need to see them, or what should I do?” The difference being is this is a free, goodwill service that most vets offer and an important part of the relationship between the client/vet.

I don’t think remote diagnosis works very well with people and we can verbalise how we feel, so I can’t see it being effective with animals at all.

 

[ycbm]

I've had many phone consultations over the years. When my horse was coughing and snotty, then got better, then started coughing again it didn't take a genius to guess that he'd caught a virus which he had resolved, then got a secondary bacterial infection, and a dose of antibiotics was dropped off by a passing employee. Sorted in 3 days. Likewise, a cut that didn't need stitching/ is now too late to stitch which gets infected needs antibiotics. I think experienced owners and people who live in remote places probably get this kind of consultation all the time. There seems little harm in diagnosing, for example, ringworm, remotely since a ringworm treatment would probably be tried first in any case as it's so common. The horse has to be seen in person once a year. I think that rule should stay.

Point number 1, no vet should diagnose without hands on unless they are sure of what they are diagnosing.

I don't see your point number 2 or 3. If you want a vet in person, insist on a vet in person. I'm grateful not to pay a callout and constantly on at my vet to charge for the service!

 

[maya2008]

Not sure how it would work really. Most things I have called out for, required the vet to do something e.g. clean and stitch a wound, palpate to look for sources of pain, x-ray, nerve block etc. If I don’t need them to do something, I don’t usually need to call them. Stuff like more bute is just a phone call. Is it maybe about them being able to charge for those phone calls?

 

[southerncomfort]

I've had many phone consultations over the years. When my horse was coughing and snotty, then got better, then started coughing again it didn't take a genius to guess that he'd caught a virus which he had resolved, then got a secondary bacterial infection, and a dose of antibiotics was dropped off by a passing employee. Sorted in 3 days. Likewise, a cut that didn't need stitching/ is now too late to stitch which gets infected needs antibiotics. I think experienced owners and people who live in remote places probably get this kind of consultation all the time. There seems little harm in diagnosing, for example, ringworm, remotely since a ringworm treatment would probably be tried first in any case as it's so common. The horse has to be seen in person once a year. I think that rule should stay.

Point number 1, no vet should diagnose without hands on unless they are sure of what they are diagnosing.

I don't see your point number 2 or 3. If you want a vet in person, insist on a vet in person. I'm grateful not to pay a callout and constantly on at my vet to charge for the service!

I think the problem with the survey is that their was no context as to when they feel it would be appropriate, and in my head I'm comparing it to all the times I've been forced in to accepting a telephone consultation with a Dr.

I don't communicate well over the phone and I'm always kicking myself afterwards for not asking the right questions or listening to the answers. It always feels very rushed and unsatisfactory.

 

[Red-1]

I'd love that to be an option. My dogs are on long term medication (they are both ancient) yet to jeep their prescription live, I have to drag them to the surgery every 6 months. I would much prefer not to have to stress them out going to the vets.

The GP is different as that is NHS, if you wish to pay for a vet visit, I bet you can choose to do so still, and pay for it. It is just offering options. As a professional, I would expect a vet to also be able to insist on a personal visit as opposed to virtual if they were unsure of the diagnosis.

 

[DizzyDoughnut]

I'd like this for recurring things where I already know what it is, the vet already knows, but they have to see the horse before they can prescribe what we both already know is needed. It would have saved me a fortune in call out fees for my old pony before we lost him. For ongoing things my vet already just asks me to email photos and then calls to discuss, then he can come out if he thinks its necessary or if he's just prescribing something I can call in to collect.
I'm assuming if it was something that needed physically examining you could request the vet come out or they would say it's not something they can do remotely and book you an appointment.

 

[Dexter]

Drs have been doing this since covid began and they dont even see you, just talk on the phone to you.

 

[Widgeon]

I'm grateful not to pay a callout and constantly on at my vet to charge for the service!

Same here. I appreciate not having to pay a callout fee when it's a known quantity and all the vet needs to do is drop off the appropriate medication. But I agree with the other posters who have said that surely vets already do this.

Is it maybe about them being able to charge for those phone calls?

I suspect this too!

 

[Fly_By_Wire]

Hi all,

I'm a (very!) infrequent poster here, but frequent lurker! I am also coincidentally a vet. I'm following this thread with interest, as this review is currently a hot topic of conversation in our industry, and it is interesting to hear some client opinions on it.

Just to give some context to the review; current RCVS code of conduct mandates that a patient must be 'under our care' before a prescription drug can be used, and that anyone prescribing must have 24 hour emergency provision. Currently, this is accepted to mean a physical vet must see a physical patient (/flock/herd) to prescribe. The review proposes a change to this in the form of removing the requirement for physical examination. The new proposal, whilst offering advantages to those clients who struggle to get to a practice or get a vet out to them, and flexibility to vets to extend intervals between medication checks, does open the door for telemedicine providers with no physical premises or ability to see a patient in case of an emergency to diagnose and prescribe remotely. Whilst phone and email conversations are hugely helpful with clients and patients that we know well, this is not the necessarily the case with unfamiliar clients/unknown patients. I am not alone in the profession in having concerns that this is a system which offers no vet-client-patient relationship, and have learnt first hand when remote consulting was forced on us during covid how inaccurate a method of diagnosis this is!

I would urge anyone who can to fill out the yougov survey (apologies, I don't have a link!), as this result could shape the future of veterinary care.

 

[Bonnie Allie]

This is my hot button, I am a technologist and spent most of Covid lockdowns leading clients through their digital transformations.

Im also a big user of veterinary services. Working with vets is like doing business in the 1980’s. Everything is transactional, everything is a manual process, limited sharing of IP between vets and ecosystem service providers.

In May this year I lost my s*** completely with my vet clinic of 15 years and moved to another equine clinic that is owned by a global company and actually run as a commercial business. They even a Chief Digital Officer!!!

The coolest thing is how they use multi-modal engagement with me as a client. I can have them onsite, I can take my horse to clinic but the best bit is we do Teams/Zoom consults where appropriate with them taking me through data, x-rays, outcomes and a roadmap for rehab. They attach videos and documents to help me understand what I need to do as an owner. Then they set up the next virtual catch-up for us. It’s amazing!

So I’m all for remote consults where appropriate BUT as with all Digital Transformations you take existing processes and just digitise them, you then have gone from rubbish manual processes to rubbish digital experience.

Vets are brilliant at what they do - but they are very poor business people and have no clue on CX. If they are to bring themselves into what is now a changed world post Covid where we expect a level of data and digital to be part of everything we do - they need help.

With the level of mental health and suicide in the Vet profession something must change quickly. How they operate is not sustainable.

 

[meleeka]

Hi all,

I'm a (very!) infrequent poster here, but frequent lurker! I am also coincidentally a vet. I'm following this thread with interest, as this review is currently a hot topic of conversation in our industry, and it is interesting to hear some client opinions on it.

Just to give some context to the review; current RCVS code of conduct mandates that a patient must be 'under our care' before a prescription drug can be used, and that anyone prescribing must have 24 hour emergency provision. Currently, this is accepted to mean a physical vet must see a physical patient (/flock/herd) to prescribe. The review proposes a change to this in the form of removing the requirement for physical examination. The new proposal, whilst offering advantages to those clients who struggle to get to a practice or get a vet out to them, and flexibility to vets to extend intervals between medication checks, does open the door for telemedicine providers with no physical premises or ability to see a patient in case of an emergency to diagnose and prescribe remotely. Whilst phone and email conversations are hugely helpful with clients and patients that we know well, this is not the necessarily the case with unfamiliar clients/unknown patients. I am not alone in the profession in having concerns that this is a system which offers no vet-client-patient relationship, and have learnt first hand when remote consulting was forced on us during covid how inaccurate a method of diagnosis this is!

I would urge anyone who can to fill out the yougov survey (apologies, I don't have a link!), as this result could shape the future of veterinary care.

Why on earth do they want to fix what isn’t broken?

 

[Gamebird]

Just to point out (sorry for being pedantic, but it is actually quite important), this consultation has been done by the RCVS, not the RVC. The RCVS is the Royal College of Veterinary Surgeons, which is the regulatory body for vets. The RVC is the Royal Veterinary College, which is a vet school and hospital based in London.

 

[Gamebird]

I am not alone in the profession in having concerns that this is a system which offers no vet-client-patient relationship, and have learnt first hand when remote consulting was forced on us during covid how inaccurate a method of diagnosis this is!

You are not alone by a long chalk. This is not about it being easier for someone's own vet to prescribe a repeat prescription of Metacam for their chronic arthritic dog without having to see it every time. This is about changing the whole face and structure of veterinary medicine - and probably meaning that a lot of people will lose their 24/7 cover. It is a Pandora's box very similar to the one which was opened when the RCVS allowed non-vets to own practices. Everyone thought it was great as now nurses or practice managers could buy into ownership of the businesses they worked for. However in reality that almost never happened, and what happened instead was the legal change that allowed corporates to own practices - and look where we are now. Be very, very careful what you wish for.

 

[Goldenstar]

You are not alone by a long chalk. This is not about it being easier for someone's own vet to prescribe a repeat prescription of Metacam for their chronic arthritic dog without having to see it every time. This is about changing the whole face and structure of veterinary medicine - and probably meaning that a lot of people will lose their 24/7 cover. It is a Pandora's box very similar to the one which was opened when the RCVS allowed non-vets to own practices. Everyone thought it was great as now nurses or practice managers could buy into ownership of the businesses they worked for. However in reality that almost never happened, and what happened instead was the legal change that allowed corporates to own practices - and look where we are now. Be very, very careful what you wish for.

I have no problem with corporates owning practices it’s worked well for us .
I also have had telephone consults for years .
There’s no point in paying for a vet on the yard when you don’t need one .

 

[stangs]

Does anyone have a link to the survey?

 

[Gamebird]

I have no problem with corporates owning practices it’s worked well for us .
I also have had telephone consults for years .
There’s no point in paying for a vet on the yard when you don’t need one .

And I am a Clinical Director for a corporate practice - it has worked well for me personally, so I am not necessarily anti-corporate - but I am not sure that it is the right direction for the profession as a whole, and nobody can deny that that small change, which was intended to allow something totally different, has completely changed the face of veterinary practice. Like I said above, this is NOT about your ability to phone up and speak to a vet to get some advice and some bute for a laminitic pony without having a visit. That is always going to happen, and is currently perfectly legal, so long as the pony is 'under our care', ie. has been seen by a vet within a defined preceding timeframe (eg. 6-12 months).

This is about telemedicine as a defined entity - for example at the 'worst case scenario' end of the spectrum it could mean 'your vet' existing in a office block in the middle of London with no actual physical clinical premises, and no requirement or ability to be able to come out in an emergency. It is probably going to affect small animal medicine the most, but will spill over into the equine practice.

 

[Goldenstar]

Yes , I understand but other vets and other models will apply from providers who go a different route .
It’s a choice for the customer in fact I think a comparable ability to get consults from a doctor that people day will be very popular .i would happily pay for that in certain situations.
I can think of many situations where I would rather telephone consult for the dogs and indeed the horses many many things don’t need the vet to see the animal .

 

[ycbm]

How well does it work in the Australian outback? Serious question, they must be doing it there. Yes, I know its a necessity, but it will still indicate if its feasible.
.

 

[Goldenstar]

The world is changing the days of James Herriot are a distant memory but in many peoples minds that’s model they think when they think vet .

 

[SOS]

Why on earth do they want to fix what isn’t broken?

Not enough vets to look after the ever growing amount of pets!

As someone within the industry I support telemedicine, in the correct context. My doctors is nearly all video/phone/picture consultations now and it’s actually easier and quicker to be seen now than pre covid. If I do need to be seen in person after the digital comms, it’s often a same day appointment. Yes it is less personable, but so is everything nowadays and it’s part of modern life.

 

[wiglet]

I think we have to move with the times. Remote consultations definitely have a place in todays society.
Recently my horse suffered a laceration to the head. I wasn't sure if stitches were needed so I called my vet who asked me to send her a few pictures via WhatsApp. A general location image, a closer pic of the wound with my hand there for scale and finally a close up of the wound.

I did this, the vet looked at the images and called me back to say stitches would not be necessary and advised me on how best to treat myself. This was all FOC and saved me a hefty call out charge (Sunday and out of hours). As the vet said, they prefer diagnosing remotely on these kind of occasions because it saves them time. Not sure how long it will be before they decide to make this service chargeable??

 

[Gamebird]

I think we have to move with the times. Remote consultations definitely have a place in todays society.
Recently my horse suffered a laceration to the head. I wasn't sure if stitches were needed so I called my vet who asked me to send her a few pictures via WhatsApp. A general location image, a closer pic of the wound with my hand there for scale and finally a close up of the wound.

I did this, the vet looked at the images and called me back to say stitches would not be necessary and advised me on how best to treat myself. This was all FOC and saved me a hefty call out charge (Sunday and out of hours). As the vet said, they prefer diagnosing remotely on these kind of occasions because it saves them time. Not sure how long it will be before they decide to make this service chargeable??

But that's normal, and is currently legal, so no changes in legislation are required for this. What is being proposed is a lot more far reaching.

 

[AShetlandBitMeOnce]

Why could they not retain the rules re: must ve feasibel that the vet could go out and see the animal if necessary (so not 400 miles away) and must have 24/7 hour emergency provision but also then able to make telephone prescriptions without seeing the animal. You would then prevent call centres of vets/nurses in London with no premises or equipment but retain the telephone consultations' benefits for those who wish to make the most of them.

 

[TheHairyOne]

I am on the fence about this one - in theory it sounds great, in practice it may cause much worse care in some scenario's and no option for owners to do anything else. There have been some well publisied cases of GP's failing to identify something on a phone consult that was only picked up later. Now would they have found it in person, who knows, but the issue is that people werent able to go in person.

However, I think something needs to be done to reduce the cost of small animal care. I can not fathom how my horse vet can come out, look at the issue, give pain killers and antib's and it having taken maybe 1.5 hours of his time for about 1/3rd of the cost of 5 mins of a vets time for me to get the same for a cat when Ive had to go! Last time with the cat it was for an abscess for a bite. All i needed was a course of antibitotics since Id already opened and cleaned it (with horse stuff obviously) but it was quite nasty. Cost me nearly £300!

Now obviously I wouldnt cut corners for any of my animals if I could possibly help it, but if affordable medication is avaliable more easily then *maybe* in this world of inflation we are dealing with atm it wouldnt be a bad thing.

Ofc on the flip side they all may just start charging £50 for 5 mins on the phone... No one can look into the future and be certain of the outcome.

 

[Equi]

If it was an option (there fore no call out fee) I’d be happy with it for certain things. I like to think I know enough to know when the vet needs to be there in person.

 

[SilverLinings]

I love their optimism- I don't have good enough internet access at home to make a video call let alone at the yard where I'm lucky if I have enough phone signal to make a quick call without walking up the road to do so. I can't imagine there are many yards/fields around here with a good enough signal, and there are also many homes reliant on just a landline. There were a lot of complaints around here when Drs insisted on it as most of us are too in the sticks for the luxury of a video call.

I'm not bothered as I hate Teams etc for work, although even working in a city we usually have to turn the camera off to make it work properly as the internet access struggles. We tried it for paediatric patient assessments and stopped as it didn't work: patients and parents hated it, and clinicians found it impossible to diagnose or treat properly (or without worrying about the risk of being sued for making a mistake). We found that the Drs, PTs etc would end up needing to see them in person anyway so it meant two appts instead of one. I can't see how it would work any better for animals.

 

[smiggy]

Another vet here, also anti.
I suspect this will have very limited impact on the equine side.
it will be largely small animal, possibly little tweaks in the way that practices operate, ie more flexibility to offer repeat medicine checks remotely, though I think this will be limited as so much can be missed.
I think the big area of change will be faceless tele corporates be able to prescribe medication for patients they have never seen. A lot of insurance companies already have vets you can phone for advice, this would be an easy area for them to ramp up to provide their own first opinion service to avoid paying vets charges.
issue then will be what happens in an emergency ?
I have no financial stake in this, my job is safe whatever so no axe to bring other than a feeling that this is not a good step forward.

 

[ponynutz]

I'd counter this with there'll be more vet appointments etc.

I think it should be an option but should be open to each individual as to whether they want to make use of that option when they call.

 

[Northern]

How well does it work in the Australian outback? Serious question, they must be doing it there. Yes, I know its a necessity, but it will still indicate if its feasible.
.

You seem to think there is such a thing as reception and reliable internet in the Outback

I think in general, the vets servicing the Outback (being few and far between) have good relationships with the stations and leave a cache of necessary emergency medications there. But the reality is, if it isn't treatable on site the animals will get the gun. A few people would float the 5+ hours out to the nearest clinic but generally if its an emergency they'll run out of time anyway.

This is an interesting discussion as the vets I work for have been doing telephone consults for established clients for quite some time. These appointments are generally for simple cuts (not near a joint), suspected abscesses or ongoing greasy heel. We don't do phone consults for small animals nor do they replace a physical exam for ongoing prescription medications (Cushings for example). This has unfortunately become a necessary service here in Australia as we are facing a critical shortage of vets in general due to the lack of overseas professionals coming in. Vets are overworked and leaving the industry in droves and more and more people acquired pets/horses during covid. As an example, I live in the capital city (a city of 400k people and growing) and there were no equine vets available at all one weekend earlier in the year. Clients of the 3-4 equine practices in the area were told to contact equine vets in Sydney (3-4 hours drive away) for any emergencies. In our practice (2 vets) the cases are triaged before arranging a telephone appointment and there is no hesitation to organise an in-person exam if the information and pictures sent by the client indicate one is warranted.