Some equine practitioners appeared to have second thoughts on whether telemedicine will be an entirely benign influence on the veterinary profession’s future, after a session at BEVA Congress in Birmingham on 13 September 2019. A debate on the question “Telemedicine: friend or foe?” borrowed the format of the long-running BBC radio programme The Moral Maze, with advocates speaking for and against the proposition and then interrogating a panel of six witnesses.
Victoria Johnson, director of the radiology service VetCT, spoke on the value of a vet-to-vet service, allowing practitioners to consult with specialist radiologists on their conventional radiographs, MRI or CT images. “This has the advantages of putting two brains together; it reduces the error rate and improves outcomes. There are other benefits as well in providing CPD opportunities for general practitioners and improving their job satisfaction.”
The availability of expert advice can reduce the stress that a practitioner experiences in dealing with difficult cases, but the biggest beneficiaries are the animals themselves. “I am in absolutely no doubt that the ability to get a rapid report from a remote vet has saved lives,” she said.
One witness, Huw Griffiths from the Liphook Equine Hospital, argued that using mobile technologies to seek advice from senior colleagues, within or outside the practice, can boost the confidence of inexperienced vets. Another, Marianna Biggi, head of VetCT’s equine service, noted that long-distance supervision has become an essential element in the training of veterinary radiology specialists.
Simon Staempfli, director of the Sussex Equine Hospital, believed that an increasing reliance on telemedicine technologies was inevitable in first opinion practice. The ability to download images and documents from home base has revolutionised the way that ambulatory clinicians operate over the past decade, he said.
It would not be long before consultations with clients via Skype (or similar platforms) become routine, he said. There were generational differences in attitudes to these technologies but millennials have grown up with them and will apply them to other professional tasks.
Patrick Pollock, senior lecturer in equine surgery at the Edinburgh veterinary school, argued that colleagues have little appreciation of the challenges facing vets in more remote parts of the country where veterinary services are only maintained through government support. “Relying on telemedicine in areas like the Highlands and Islands is not a choice, it is an imperative – and it would be a mistake to think that this hasn’t been happening for years,” he said.
Jonathan Pycock, claims consultant with the Veterinary Defence Society, took a stand against this emerging consensus. “While these technologies do have many advantages, there will be a price to pay,” he warned.
He was supported by David MacGuinness, president of Veterinary Ireland, who said he did not recognise the service described by Victoria as telemedicine: “it sounds like what we would call a second opinion,” he said.
Instead, he was more concerned about veterinary professionals offering remote consultations with animal owners that aren’t regular clients, and issuing prescriptions without a proper physical examination. BVA President at the time, Simon Doherty, acknowledged the possibility of owners having consultations with a vet lying on the beach in a distant country was the worst-case scenario and a major concern for the profession’s regulatory bodies. He insisted that any consultation must take place under the aegis of an existing vet–client relationship.
Jonathan warned colleagues to be careful when asked, even by an established client, to examine an image taken on a mobile phone. “It is irrelevant whether you have charged for this; as soon as you have passed your professional opinion, it is possible that you will be held accountable.”
Huw suggested that looking at a phone image was some-thing that he would be prepared to consider, but only to give guidance to a client that he knew well. Simon Staempfli said this would not be regarded in his practice as a chargeable service but when there is suitable software available to incorporate images into the clinical records then it will become chargeable.
Phil Cramp from the Hambleton Equine Clinic, North Yorkshire, wondered if the next step would be an “Uber vet” system in which horse owners might find a vet available to visit when their practitioner is not. But Jonathan warned against “cherry-picking” those aspects of telemedicine that a practitioner likes and disregarding the rest. Vets need to know more about the clinical, economic, legal and ethical aspects of new technology before adopting them.
His warnings clearly sowed seeds of doubt in many minds. While nearly 100 percent of respondents at the beginning believed that the technology would be the profession’s friend, another poll later produced a different result – 54 percent were more, and 46 percent less confident about the potential benefits. The issues raised in the debate will also provide plenty to mull over as part of the RCVS review of the “under our care” concept announced in June.