There is perhaps a question in people’s minds as to whether online consultations between pet owner and veterinarian will continue after the pandemic. I’m referring to tele-medicine which lets veterinarians provide a consultation remotely i.e. without actually being in the same room as the pet. I believe that the old way of doing things has gone forever. The old way was that you phoned your veterinary clinic, made an appointment and then visited the clinic at the agreed time. It was simple and direct. And the same method mainly applied to visiting your general practitioner.
However, there is a lot of sense in extending the triage of both animal and human patients to remote methods such as telephone conversations, Internet form filling, videoconferencing and so on. This would be more efficient because it would eliminate a lot of time wasting at the clinic. It would filter out those medical issues which can be dealt with remotely and therefore far more quickly and efficiently. It not only benefits the veterinarian or doctor in terms of time expended but also the patient because it avoids the necessity of having to travel to a clinic.
I have personal experience of this because I obtained a prescription for myself by completing a form online from my GP’s website in which I told them my symptoms and a doctor telephoned me the next day and after a consultation on the phone they prescribed the medicine I needed. The whole process took about 20 minutes whereas it would have taken three or four times that if I had to visit in person. Although the illness was on my records which precluded the need for a personal visit.
The issue with remote consultations and diagnoses is that it is vulnerable to error. There is no question that diagnosing on the phone or through a zoom conference is more likely to result in a misdiagnosis. And therefore, I would argue that remote consultations should by and large apply to triage, repeat prescriptions, follow-up consultations, existing illnesses and straightforward consultations and treatments such as day-to-day illnesses such as the flu. All of these can be dealt with remotely.
I know that in the UK, doctors are instructed to “avoid directly booking patients who telephone the practice into an appointment”. What that means is that the old method of doing things is going to be over and patients will be filtered by the severity of their illness via the methods mentioned above.
Update: in today’s The Times there is a report that the online-only GP service has been scrapped after a backlash from doctors. They feel that remote consultations “can make it harder to pick up on softer cues which can be helpful for making diagnoses”. Those are the problems I have highlighted in this article essentially. It’s about making accurate diagnoses but I think remote triage has a strong future both for veterinary care and human medicine.
I believe that the same system will be in place to varying degrees for veterinarians. And as long as it is done sensitively with common sense it will be beneficial to cat and dog owners. It should result in more treatments for cats, for example, because historically cat owners are reluctant to take their cat to a veterinarian. The reasons are obvious: the stress of it and slightly neglectful cat ownership, and of course the cost. But the stress element can be taken out of the equation through a zoom consultation.
I think we will find that veterinarians will allocate a couple of days a week to practice tele-medicine and the remainder of the week would be face-to-face. I would expect something like a 30% to 70% split between telemedicine and face-to-face medicine respectively. I’m speculating but a segment of a vet’s work will be given over to remote consultations and diagnoses.
Petriage is a system which supports the ideas I mention. It is a smartphone app which uses an algorithm to diagnose symptoms. It allows a cat and dog owner to obtain instant actionable information about their pet’s health. It tells them whether they need to see a veterinarian as soon as possible by analysing the severity of the symptoms. In other words, it is a form of self-help triage, hence its name.
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In America it appears veterinarians are warming to this smart phone app. For example, Dr. Suess in Rochester, Washington is an enthusiastic user of Petriage.
I’m sure that with respect to people medicine, there has been a massive falloff of attendances at accident and emergency receptions at hospitals in the UK because of the Covid-19 pandemic. This is because people have resisted going to hospital for fear of getting coronavirus and therefore they have performed some self-help diagnosis and decided that their illness is not serious enough to go to hospital. In the past they would have just gone but now they are curing themselves at home in different ways. Ultimately this is a good thing but there are risks.
This is because there is likely to be more neglected symptoms which point to serious disease which require urgent or fairly urgent attention. Remote triage is efficient but the counterargument is that it is vulnerable to error. This applies to both people and animal patients.
The coronavirus pandemic, although ghastly, has forced change upon systems and people, and many of these changes are highly beneficial. There is a silver lining and we must remain optimistic.
Triage: (in medical use) the assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties.
SOME MORE ON VETERINARIANS: