RCVS Telemedicine Consultation

RE: RCVS Telemedicine Consultation

Iain Richards — Mon, 13 Mar 2017 13:52:09 GMT

Minded.

RE: RCVS Telemedicine Consultation

J G Wray — Mon, 13 Mar 2017 12:59:00 GMT

[quote user="Iain Richards"]Is there an improvement in vet's well being?[/quote]

Mind your apostrophe

RE: RCVS Telemedicine Consultation

Iain Richards — Mon, 13 Mar 2017 10:42:51 GMT

I've had some further thoughts on this concept of telemedicine and the RCVS consultation. I'll leave aside the clumsy questionnaire that the RCVS have put out, because it is biased towards accepting telemedicine in the concept of remote consultation. I feel there are three aspects to this area.

1. Remote Diagnostics

The use of remote monitoring devices, remote diagnostics, or even remote laboratories and automated processes. The initial vet is still in overall charge of the case and they should ensure that the tests have scientific validity. In reality, these are no more than an extension of how we already work.

2. Remote follow-up

This is already part of normal veterinary practice and there is no difference between telephone advice and video advice. It is, as above, an application of technology to existing practice.

2. Remote first opinion

This is the new and more troubling area. It's very obvious that, for first opinion work, a vet who is remote to the patient can only gain part of the data required to make a diagnosis. The owner is therefore unable to make an informed decision on what should happen to their animal. There are ethical and legal aspects to both of these issues.

Into this I'd like to add a couple of other aspects. Some of this is coming from developments in human medicine and I've discussed this with my wife (Medical Director and oncologist). Within the NHS, resources are tight and it's rare now that a GP will do a physical examination. Much is left to diagnostic work-up or referral, so in some respects a video consultation can lead to further diagnostics and a good result. This relies of course on a being that can communicate effectively. We, vets, are not the NHS. We are private companies whose aim is good customer service so that we retain business and make a living. We therefore don't need to use remote consultation to augment a shortfall. Our surgeries are not stretched to breaking, so finding a way to aid this is not necessary.

A further point, who benefits? Really benefits that is. And who might be harmed?

Is there are real gain for animal welfare or is there possible detriment?

Is there are real improvement in diagnostics or a reduction?

Is there an improvement in vets' well being?

Is there an improvement in veterinary standards?

I have not included, 'Is there a benefit for the consumer?" for that is not within the RCVS remit. What is in their remit is that if the answers to the above are that there is a risk of harm and a risk of poorer standards, then the RCVS must rule against its use. The only real beneficiaries are companies that would set up to run these consultations, all other aspects are detrimental - welfare, vet business and, very important, the local community. We are a social species, we like interacting and losing that interaction helps no-one.

RE: RCVS Telemedicine Consultation

Anthony Todd — Fri, 03 Mar 2017 17:46:22 GMT

[quote user="Iain Richards"]Good Grief![/quote]

I wouldn't worry too much. My experience of descriptions of symptoms, even [sometimes] vet to vet, let alone public to vet, leads to such catastrophic mistakes that, after a few of these, it will be quietly dropped......

RE: RCVS Telemedicine Consultation

Bob Russell — Fri, 03 Mar 2017 13:57:14 GMT

I was quite shocked that antibiotics are being prescribed without a face to face meeting. Similarly crazy that other medication up to and including Lithium are available without any knowledge of the history beyond that offered by the patient on-line.

At least humans can communicate their problems whereas our patients are unable to even do that.

A GP not touching a patient is not unexpected. A vet not touching a patient is pretty much unacceptable (with few exceptions!).

The radio piece suggested doctors are frightened that their role may be reduced. Not much of a problem if it is taking 28 days for a routine appointment!

RE: RCVS Telemedicine Consultation

Utlendigur — Fri, 03 Mar 2017 13:27:58 GMT

Interesting article on BBC website and was on radio 4 this morning about online prescribing services - sounds like a recipe for disaster

http://www.bbc.co.uk/news/health-39134061

Just wondering aswell where the RCVS guidance on succession would fit in to a telemedicine service.

RE: RCVS Telemedicine Consultation

Neil Wheadon — Mon, 20 Feb 2017 19:46:22 GMT

http://www.rcvs.org.uk/about-us/consultations/our-consultations/rcvs-review-of-the-use-of-telemedicine-within-veterinary/

Neil

RE: RCVS Telemedicine Consultation

Rob Loxley — Mon, 20 Feb 2017 16:56:41 GMT

[quote user="Iain Richards"]Good Grief! Anyone else seen this “consultation” [/quote]

Do you have a link?

RE: RCVS Telemedicine Consultation

Martin Atkinson — Mon, 20 Feb 2017 15:33:05 GMT

[quote user="Clive Ansell"] I've recently acquired a sports watch that is supposed to record HR, temp, altitude, and calculate things like VO2 max and lactate thresholds, but it is not at all accurate - if it were not a present, I would probably return it to the retailer. [/quote]Too true they can only ever be a wild estimate based on averages. I'm not sure what technology currently exists that we could use anyway for animals.

I answered the questionnaire but essentially replied that I was dead against this sort of thing. And some of the questions were almost eliciting answers to things we do already every day: existing client phones up wants advice on current/related condition/needs more medication - except we may do it via social media, plus ca change!

RE: RCVS Telemedicine Consultation

Clive Ansell — Mon, 20 Feb 2017 08:07:10 GMT

I agree with Grumpy, I cannot see how one can get around or not carry out a full clinical examination, at least initially.

I not confident that over the counter devices that remote monitor would be that accurate. I've recently acquired a sports watch that is supposed to record HR, temp, altitude, and calculate things like VO2 max and lactate thresholds, but it is not at all accurate - if it were not a present, I would probably return it to the retailer.

I've carried out a consultation via a CCTV camera before. After midnight in an OOH clinic, client turns up drunk and threatening violence through the intercom system, his GSD had "gone off his legs" said dog was running around the car park out of control, cockling his leg to urinate - just told him to p*** off and r/v when sober.

We have a client at one of regular practice, she has a diabetic cat and a dog. She does her own 24 hour glucose curves at home and submits results by email. She is such a good, dedicated and committed client that we probably only see her animals once a year so. One of the few cases I would be happy prescribing without checking every 6 months, plus the cat particularly gets very stressed.

RE: RCVS Telemedicine Consultation

grumpyoldman — Sun, 19 Feb 2017 23:47:48 GMT

When I opened it I was under the impression it was going to be about VetCT etc, and I was hoping they were not going to try and fix something that was not broken or spoil it with a new heap of cumbersome red tape . However it was far more general and none specific. My recurrent response was someone somewhere needs to do a clinical exam first and not rely totally on what clients say because they often massage the history to suit their preferred diagnosis.

RE: RCVS Telemedicine Consultation

J G Wray — Sun, 19 Feb 2017 22:33:42 GMT

Ask a Councillor why don't you?