RVC consulting on remote veterinary consultations

[ycbm]

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.

Really interesting. Thanks.
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[ycbm]

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 ?

Most vets I know no longer do their own out of hours stuff anyway, so all that would happen, presumably, is that the emergency cover would go 24/7?
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[cauda equina]

My horse vets still do their own emergency stuff

If corporate owned practices (or others) are set up for, and pushing for, remote consultations they will probably be creaming off the easier, less costly work leaving traditional practices to deal with the more complicated and more expensive stuff.
I don't know if that will result in the expensive stuff becoming even more expensive if there's isn't the bread and butter work to balance it out

 

[quizzie]

Most vets I know no longer do their own out of hours stuff anyway, so all that would happen, presumably, is that the emergency cover would go 24/7?
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…the problem there is where are you going to find the staff to cover the emergency 24 hour service….there is already a shortage.
….plus where are they going to work from….many overnight emergency services run from practices that are “normal” vets in the daytime, and they are already running at full stretch dealing with their own clients.

 

[Birker2020]

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.

Me too

 

[Lyle]

I'm in Aus, I have a good relationship with my clinic. I've often rung, after hours And then sent photos through for an opinion. They are super, if they think it needs ABs they will leave them and I can run into town and collect them. I don't think any vet worth their salt would attempt to diagnose something serious or complicated that would require comprehensive diagnostics over the phone. I'm thinking it's for minor injuries and ailments, but I'm sure if the vet was in doubt they'd say to bring the pet in to a clinic.

 

[iknowmyvalue]

Another vet. I think telemedicine has its place, but I’m worried about things going too far. It would be incredibly useful for us as a practice, as a rural practice covering a large area (1-1.5hrs radius of the practice, and no for most of our farm clients and some equine ones we are pretty much the closest ones) whilst being understaffed (we are trying to recruit, but we’ve been trying for months with no suitable applications)

As far as I understand, technically vets shouldn’t be giving medication out if they haven’t seen the animal for that specific condition/injury. And they have to have seen the animal within the last 6mo even if it’s a chronic condition.

I think it’s useful to be able to dispense a limited amount of medication/prescription items from a phone/photo consult, especially when doing a visit would mean trying to rearrange multiple pre-booked visits into an already busy diary.

For example:

wound not near a joint, horse isn’t lame, photo looks not stitchable but vet thinks would benefit from antibiotics to prevent infection.

Pony who we saw for vaccination 3mo ago, owner suspects now has laminitis. Would like some bute, we are able to give 7d of bute and advice without seeing pony but needs seeing if no improvement or gets worse.

Sheep with mastitis, farmer doesn’t have any suitable treatment in. He knows it’s mastitis, we know it’s mastitis, can dispense appropriate treatment but will see it if doesn’t improve.

In all of those cases, if they really want it seen, we will more than happily see it. Or arrange an appointment when convenient to check diagnosis.

 

[fidleyspromise]

I phoned emergency vet few months ago due to a massive lump and handily it was one of the partners on call.
I explained the symptoms and he asked me to send a photo. Sent and we both agreed what we thought it was with the plan for me to phone the surgery during work hours to book an appointment so we could look into it. (This saved me an emergency call out. 3 Sundays in a row i phoned them for 3 different animals and the advice each time was spot on).

I've no issues with phone appointments provided I can visit instead if I prefer it.

 

[ycbm]

…the problem there is where are you going to find the staff to cover the emergency 24 hour service….there is already a shortage.
….plus where are they going to work from….many overnight emergency services run from practices that are “normal” vets in the daytime, and they are already running at full stretch dealing with their own clients.

But this isn't an argument against remote consultation, is it? It's probably one for it. There's a vet shortage, it needs sorting.

Perhaps we could start by stopping them sitting in abattoirs doing a job which used to be done by a meat inspector technician.
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[smiggy]

Most vets I know no longer do their own out of hours stuff anyway, so all that would happen, presumably, is that the emergency cover would go 24/7?
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the way it works is that practices that don’t do their own out of hours, contract an out of hours provider, paying an amount per month, to cover for the clients of that practice, so it’s not a free for all service. they do this because at the moment there is a legal obligation to provide 24 hr cover for animals under your care.
where are the animals under the care of the remote vets going to go in an emergency.

 

[ycbm]

Dupe

 

[ycbm]

the way it works is that practices that don’t do their own out of hours, contract an out of hours provider, paying an amount per month, to cover for the clients of that practice, so it’s not a free for all service. they do this because at the moment there is a legal obligation to provide 24 hr cover for animals under your care.
where are the animals under the care of the remote vets going to go in an emergency.

I don't see why remote vets shouldn't have similar contracts to the out of hours cover that exist now. Always provided that there are enough vets coming into the profession, which is a separate issue.

 

[Gamebird]

I don't see why remote vets shouldn't have similar contracts to the out of hours cover that exist now. Always provided that there are enough vets coming into the profession, which is a separate issue.

Plenty of vets coming into the profession. However the average length of time people stay in the profession as a practicing vet has now dipped below 5 years.

 

[ycbm]

Plenty of vets coming into the profession. However the average length of time people stay in the profession as a practicing vet has now dipped below 5 years.

Then that's the issue, isn't it? How can that wastage be stopped?

ETA why is this? Is it because they train as vets wanting to help animals and find a big part of the job is to kill them? Or are the owners now expecting too much? Something else?

I know two young vets well. They've stayed in the profession 10 years so far, but they were farmer's children and had no illusions about the death, gore, pain or hard work.
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[Gamebird]

Then that's the issue, isn't it? How can that wastage be stopped?

ETA why is this? Is it because they train as vets wanting to help animals and find a big part of the job is to kill them? Or are the owners now expecting too much? Something else?

I know two young vets well. They've stayed in the profession 10 years so far, but they were farmer's children and had no illusions about the death, gore, pain or hard work.
.

It's very much multifactorial. I don't think that 'killing them' is necessarily part of it though. We are pretty good as seeing it as euthanasia rather than killing - preventing further suffering. Client expectation is a big part of it, as is the hours worked and the on-call. A lot of small animal vets don't do any on call, but they do do very long days and see an awful, awful lot of clients every day. It's pretty relentless, and relatively poorly remunerated compared to other professional jobs (though that is very slowly improving). A lot of people leaving the profession quote stress and/or anxiety. I've survived well over 20 years in the job, but the job itself is very different from the one I started out doing last century! There are a lot of people an awful lot more clever than me looking at the problem, but I don't think that anyone has a definitive answer. Meanwhile our practice is two vets short - I've been advertising for months (and offering big money - a bigger salary than I've ever earned!) with no success, so I am covering the work of three vets, including all the nights and weekends, until we find someone else. I know people in worse situations too, including a friend who has been advertising for a year, and hasn't been able to have any time off in that time.

 

[ycbm]

That is really concerning. We seem OK in this area, thankfully. The local small animal practice has no worries about taking on my 3 cats, and the area has 3 horse hospitals within an hour of each other that I suspect will always be able to attract staff. It must be a huge concern for people in areas where they might not be able to get a vet.

ETA the pay is shockingly low for a profession requiring that level of training!
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[SOS]

If corporate owned practices (or others) are set up for, and pushing for, remote consultations they will probably be creaming off the easier, less costly work leaving traditional practices to deal with the more complicated and more expensive stuff.
I don't know if that will result in the expensive stuff becoming even more expensive if there's isn't the bread and butter work to balance it out

This is highly unlikely. Despite back of house taking up a much smaller percentage of overall sales (think around 12%) it is is still worth more than vaccines/in consult treatments. Having been on the inside of a big corporate on the business and clinical side, pushing back of house (where appropriate I must add) was the aim.

 

[southerncomfort]

One of the other questions on the survey related to the creation of 'single service' practices with no out of hours cover and how likely I'd be to use them.

The only single service I can think of currently is repro and you'd most definitely want 24 hour cover for repro. I wasn't entirely sure what they meant to be honest!

Re: remote consultation, the questions seemed to me at least to be asking about consultation/diagnosis and treatment plan via video/Internet rather than a quick phone call or email regarding a known and existing condition which we can already do. This is most definitely about a big change in the way vets work, although as pointed out earlier, it's probably geared more towards small animals, although some of the questions were equine specific.

I think their is an assumption being made about how much cheaper this type of consultation would actually be. For people who already get cheaper zone visits it probably wouldn't be much cheaper at all.

This is my issue with the survey really. Their are so many unknowns that it's hard to give an opinion. ?‍

 

[Bonnie Allie]

As a client I just want the choice of how I engage with the vet. A clinic/practice that offers a true hybrid model will get my business.

My assumption is that all vets are smart, all have deep technical skills, all can communicate to an acceptable level.

When I call the clinic I am assuming Im dealing with someone who can triage to a high standard to make the best decision for both myself and the vet as to whether the horse needs to come into the clinic, the vet needs to visit my horse on-site or a digital appointment will be sufficient. It will be different each time depending on the situation.

The stress, mental health and attrition rate in addition to poor comparative salaries for vets is making it clear that the current model is not sustainable. There needs to be changes if we care about these vets as people not just as professional hired help. Vets must also move with the times to help themselves as well.

 

[criso]

I phoned emergency vet few months ago due to a massive lump and handily it was one of the partners on call.
I explained the symptoms and he asked me to send a photo. Sent and we both agreed what we thought it was with the plan for me to phone the surgery during work hours to book an appointment so we could look into it. (This saved me an emergency call out. 3 Sundays in a row i phoned them for 3 different animals and the advice each time was spot on).

I've no issues with phone appointments provided I can visit instead if I prefer it.

Was this charged for?

It's a service that a lot of vets do unofficially but doesn't get charged for. Maybe they should but then you get into under which circumstances.

You call about a new issue e.g. an injury that doesn't need stitching or X rays. The vet decides to leave you some bute and/or antibiotics to collect from the pharmacy, you only pay for the drugs.

Another example, horse has ongoing breathing issues. It flares up, call vet, vets says I'm driving past later, I'll drop in some ventipulmin on my way home. You pay for the drugs only.

Another scenario. Vet comes out to see your horse, says give me a call tomorrow to let me know how it's going. This could turn into, everything's fine now, thank you; not improving, think you need to come back; horse had mild reaction to antibiotics and needed a different prescription. In all these cases there is no charge for the phone advice currently though a follow up visit does generate a chargeable service.


If there is a service, called phone consult, would this turn up on your bill and when?

 

[Fabel]

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.

Um no it is really not quicker or easier! Our GP practice’s failings are why my dad is dead! They are now under investigation. I registered with another in the area and they are worse! It’s not even just this area there was a poor lad of 26 who died of and ear infection on the news this week because his Dr’s in a different part of the country to me. Are bloody useless too. Sorry to hijack the thread. Rant over

 

[SOS]

Um no it is really not quicker or easier! Our GP practice’s failings are why my dad is dead! They are now under investigation. I registered with another in the area and they are worse! It’s not even just this area there was a poor lad of 26 who died of and ear infection on the news this week because his Dr’s in a different part of the country to me. Are bloody useless too. Sorry to hijack the thread. Rant over

I’m sorry to hear about your dad, it’s never easy to lose a loved one due to negligence.

But this is my experience at my GP practice. Before it was several weeks for an appointment or ring on the day and be in a queue of 30 people plus to get through and be told try again tomorrow. Now I get to speak to the doctor within a maximum of three working days and seen if I need to be. So in my experience it is quicker and easier.

 

[Fabel]

I’m sorry to hear about your dad, it’s never easy to lose a loved one due to negligence.

But this is my experience at my GP practice. Before it was several weeks for an appointment or ring on the day and be in a queue of 30 people plus to get through and be told try again tomorrow. Now I get to speak to the doctor within a maximum of three working days and seen if I need to be. So in my experience it is quicker and easier.

Every practice in North London is useless

 

[fidleyspromise]

Was this charged for?

It's a service that a lot of vets do unofficially but doesn't get charged for. Maybe they should but then you get into under which circumstances.

You call about a new issue e.g. an injury that doesn't need stitching or X rays. The vet decides to leave you some bute and/or antibiotics to collect from the pharmacy, you only pay for the drugs.

Another example, horse has ongoing breathing issues. It flares up, call vet, vets says I'm driving past later, I'll drop in some ventipulmin on my way home. You pay for the drugs only.

Another scenario. Vet comes out to see your horse, says give me a call tomorrow to let me know how it's going. This could turn into, everything's fine now, thank you; not improving, think you need to come back; horse had mild reaction to antibiotics and needed a different prescription. In all these cases there is no charge for the phone advice currently though a follow up visit does generate a chargeable service.


If there is a service, called phone consult, would this turn up on your bill and when?

Interesting points. We've never been charged for any of our phone advice/consultations. We've had plenty of them this year due to Sams ill health.

A new issue I've no issue with a nominal charge as I'm still using their time and expertise to diagnose.
I phoned years ago the emergency line (first time using it) described horse and symptoms plus my abscess suspicion. Vet agreed and met me at surgery to give me danilon. I was only charged drugs and was surprised.

I think if vet advice is needed then consult should/could be chargeable. If just an update to say yeah, x fixed it and all good then no but they could say send a text or email. This way record is updated, no charge and no saying oh, he's fine but what do you think of x?

I don't think a phone consult should be as expensive as an in house consult as they're not putting their hands on animal.

 

[fiestiemaestie]

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.

currently it is illegal to prescribe without seeing the injury in person first - that’s what the Rcvs is consulting about. Advice is fine, it’s the prescribing of meds that is currently prohibited

 

[ycbm]

currently it is illegal to prescribe without seeing the injury in person first - that’s what the Rcvs is consulting about. Advice is fine, it’s the prescribing of meds that is currently prohibited

Well that went out the window during Covid, so it looks like an unreasonable restriction.

 

[fiestiemaestie]

Well that went out the window during Covid, so it looks like an unreasonable restriction.

The RCVS relaxed the restrictions temporarily, they have extended this a couple of times but it is currently not allowed.

 

[ycbm]

The RCVS relaxed the restrictions temporarily, they have extended this a couple of times but it is currently not allowed.

It proved a point, though, and also provided a service that many customers want. I don't see this one being able to be put back in the box.


ETA in truth it's been being done for experienced owners for a long time. I've not had a vet visit to prescribe antibiotics for infected mud fever or minor cut for decades, I just pick them up from the surgery.
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[Gamebird]

It proved a point, though, and also provided a service that many customers want. I don't see this one being able to be put back in the box.


ETA in truth it's been being done for experienced owners for a long time. I've not had a vet visit to prescribe antibiotics for infected mud fever or minor cut for decades, I just pick them up from the surgery.
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It's tricky! The actual law does not specifically define the extent of the requirement for clinical exam. So we have to go by the RCVS GTPC interpretation, which is this:

4.9 The Veterinary Medicines Regulations do not define the phrase 'under his care' and the RCVS has interpreted it as meaning that:

1. the veterinary surgeon must have been given the responsibility for the health of the animal or herd by the owner or the owner's agent
2. that responsibility must be real and not nominal
3. the animal or herd must have been seen immediately before prescription or,
4. recently enough or often enough for the veterinary surgeon to have personal knowledge of the condition of the animal or current health status of the herd or flock to make a diagnosis and prescribe
5. the veterinary surgeon must maintain clinical records of that herd/flock/individual

4.10 What amounts to 'recent enough' must be a matter for the professional judgement of the veterinary surgeon in the individual case.
4.11 A veterinary surgeon cannot usually have an animal under his or her care if there has been no physical examination; consequently a veterinary surgeon should not treat an animal or prescribe POM-V medicines via the Internet alone.

I think that with large animals and horses a lot of vets are satisfied that they are abiding by the above providing that they have examined the animal for that condition within a relatively recent period of time. Those that prescribe POM-Vs (which would include Equipalazone and antibiotics) for an animal that they have seen, but for a condition that they haven't are, at the very best, in a grey area. Those that prescribe POM-Vs for animals that they haven't seen within a defined period are risking their ability to practice.