At the time of writing we are six weeks into lockdown. The unprecedented situation the world finds itself in due to the COVID-19 pandemic can feel upsetting, overbearing and far from a resolution. For many people during this time, trying to cope with the present often involves searching for any positives within the situation: perhaps finding resolve in the sense of community established on the back of such tragic circumstances or the creative offerings of many to help entertain us all during these times of isolation.
Many optimists may look to the positive effect reducing our daily activities is having on the environment – reduced greenhouse gas emissions and improved air quality may be some of the few positive things to appreciate during this global tragedy. However, these environmental gains due to country lockdown measures are not to be met with complacency – as economies regain momentum these benefits will diminish and now is the time to consider how we rebuild ourselves, ideally or rather critically, in a more sustainable manner.
We too as veterinary professionals have an opportunity to contribute to this. There is one particular aspect of the profession’s response to the situation so far (aside from the incredibly adaptive, downright amazing qualities of the veterinary community) which could be utilised going forward as part of such a green initiative, and that is telemedicine.
Telemedicine allows healthcare to be delivered outside of the normal healthcare facilities using telecommunications and virtual technology. Its use is not intended to entirely replace face-to-face consultations, but to deliver healthcare remotely when and if appropriate.
Its uptake in the veterinary world in comparison to the human sector has been relatively low. Only last year, a mere 22.4 percent of practitioners reported sometimes utilising telemedicine (the most common modality for this being the telephone) (Watson et al., 2019). However, during the COVID-19 pandemic, telemedicine has allowed veterinary practices to continue to provide appropriate care to their patients under BVA and RCVS guidance, whilst also protecting their staff and members of the public. As such, the demand for veterinary telemedicine services has seen an upward turn.
Whilst not appropriate for every clinical scenario, it has assisted with both telephone and video triage, consultations and where appropriate prescription of medication, using either commercial veterinary telemedicine suppliers or adapting the use of existing video calling technologies. Other veterinary fields have also risen to the challenge, from holding virtual “Lunch and Learns” in the pharmaceutical world, to increasing online CPD content where physical congresses have no longer been able to proceed. The demand for online CPD increased.
The use of telemedicine within the human health sector has been studied and it has been shown to have a beneficial effect on the environment. A reduction in carbon emissions by 40 to 70 times, following replacement of face-to-face visits with telemedicine consults, is possible (Holmner et al., 2014), the variation in benefit being influenced by factors such as meeting duration, bandwidths and use rates.
Within the NHS, telemedicine is considered a useful method to help reduce overall emissions, with travel thought to contribute up to 18 percent of the total carbon footprint of the UK health sector (Holmner et al., 2014). Taking this into account, alongside the fact that the healthcare sector in developed countries is reported to contribute 3 to 8 percent of total emissions (Holmner et al., 2012), anything that can be done within the healthcare sector can have significant overall impact. We too as veterinary professionals have a responsibility to reduce our profession’s impact accordingly.
The statistics are very favourable, but it would be naive to disregard the emissions generated in producing, using and discarding the equipment used for telemedicine consults. The development of LCD screens is implicated as the foremost environmental impact of virtually held business meetings (Borggren et al., 2013). The services would therefore have to be used frequently, with some consideration to the equipment used in order to balance emissions and financial costs of set-up. Fortunately, much of the computer equipment is likely to already exist within the veterinary practice setting.
We don’t yet have a centralised measure of carbon emissions from veterinary practices in the UK on which to measure ourselves and track progress collectively. But we can look to efforts from our human healthcare counterparts to provide some guide as to how telemedicine might help reduce our emissions. Any tool the veterinary profession can utilise in our attempts to encourage sustainable practice should be explored further, particularly in a time when its usage has already seen a sharp increase and there is now increased familiarity from both clients and practitioners. Additionally, sustainability benefits such as reduced air pollution as well as social benefits for clients less able to travel exist. It is an exciting area in need of further study.
This is definitely not to say that telemedicine should entirely replace our in-person consults, and care must be exercised so that it is not used inappropriately – it would need to adhere to guidance from our governing body and ensure the health of patients remains paramount throughout. However, it remains food for thought during this time of lockdown reflection, that telemedicine has helped us maintain our professional obligations through a difficult time and holds exciting potential for a more sustainable veterinary future.