If you want to get a group of veterinarians in a heated discussion start talking about Telemedicine. I have been in several meetings when the subject has come up and it seemed like there were more opinions than people in the room. It truly is a challenging concept in veterinary medicine so let us explore some of the pros and cons of it assuming that there is a valid VPCR in place.
Many people in these discussions think that telemedicine is a wonderful opportunity to keep clients closer to the practice and some look at it as an additional revenue stream. For example, some vets love the idea of clients emailing photos or videos of their pets. They feel it is better they ask their vet and get appropriate advice than whoever they could reach out to over the internet. These vets feel that these interactions lead to more appointments because the vet can tell the client that the condition in question needs to be seen in person. When asked if they charge for these online consultations only a small minority raise their hands.
Those that do charge for online consultations wouldn’t think of offering free advice. They feel that as veterinarians all we can offer our clients is our knowledge, so why would we give this away for free. They worry that as the world becomes more digital the expectation from pet owners will be that we offer online advice and if we don’t begin to charge for these services now the profession will have to play catch up in the future. This line of thought is similar to all of the newspapers that gave away their content for free and are now scrambling to create paywalls. Free is not a business model.
On a medical basis, a shared concern with all vets is that photos and videos don’t tell the whole story. It’s one thing to look at a picture of a laceration but is it just that, or is there something else going on. I learned the limitations of tele-medicine the hard way. I was sent a photo of a cut and I was asked if it needed to be seen as an emergency, or could it wait until the following morning. Based upon what I saw it looked like a small superficial cut that could wait until the following morning. Well, my colleague was not happy with me the next day when he discovered that the tiny innocuous laceration was a penetrating wound that extended far beyond the border of the margins and the poor animal had a significant amount of crepitus and dirt under a skin flap that I could not appreciate in the photo. Lesson learned. Photos and videos cannot explore, palpate or otherwise physically assess an animal. This is fine in human medicine when there are nurse practitioners or a physician on the other end of the line, but we don’t have this luxury with veterinary medicine at this time.
The one scenario where digital exams are appropriate would be for rechecks. Using the wound example, we can look at follow-up photos days and weeks afterwards to see how it is healing. We would ask our clients pointed questions like is there a smell, is the wound draining, etc. Our clients would value having a quick assessment rather than the hassle of bringing their pet to your clinic.
The question remains how veterinary practices deal with the increasing expectation that we offer tele-medicine. First of all, we have to understand the limitations of videos and photos. They are two dimensional and tend to focus on what the client thinks is important. If we passively accept what we see, then we are not controlling the medical care for the animal. Imagine if a client brought their dog or cat to you with a cough but only let you use your stethoscope. We know that is but one tool in our arsenal so we would want to be able to examine the whole animal. It is our role to explain that a complete exam with diagnostic testing is appropriate. The same applies to tele-medicine examinations.
When we are aware of the limitations of photos and videos it creates a path for us to turn most online requests into face to face appointments. Whether you charge for the initial online assessment or roll that fee into the price charged for a physical visit is a matter of preference. The key thing is staff and vet training so that they communicate that there is a fee involved for the digital exam. Rechecks should have a fee associated with them. It may not be as much as an in-clinic visit to account for the decreased resources needed for the exam, but a fee should be charged non the less.
Tele-medicine is in its infancy in veterinary medicine. As technology progresses and the training of support staff changes there is no doubt that it will play an increasingly bigger role in all of our practices in the years to come. In the meantime, it is crucial to recognize the limitations with it and recognize that if we don’t start billing for it now it will be harder to do so in the future. In spite of what we may personally feel most people now recognize that the internet has a cost involved with it, so there is less of an assumption that everything online is free.
This blog was previously published in the Canadian Vet Magazine.