RCVS Telemedicine consultation

RE: RCVS Telemedicine consultation

Beats — Tue, 17 Mar 2020 13:57:37 GMT

I have been experimenting and WhatsApp Business on your own mobile phone allows you to assign contact number to your work landline and separate it from your personal whatsapp (if you have one already installed). It can't do video calls from a proper computer though.

You can add clients as contacts quite easily, e.g. "Fluffy Gwen Smith" with just their phone number and then whatsapp video call them. On the few calls I've done to date (mostly for testing purposes) the quality has been excellent from my wifi at home but not the wifi at work - so could be pretty hit and miss.

You can also ask folk to press the button on the bottom left of the screen to switch from "selfie-mode" to them seeing what they are showing you. I have not been able to find a similar feature on Skype while calling my mother on her iPad, however the one advantage of Skype was that I could do it from my laptop. Also if you swipe the little picture of you that the client is seeing to have it nearest to the camera bit on your phone it doesn't look so much that you have your eyes closed when you are trying to check what the client is seeing to ensure you are "active listening". Only one person talking at a time works, so if you're used to saying things such as "yes, I see", then try a little head-nodding instead.

Facetime and Facebook video calls are other services that may be readily available, at least for now.

There are also services available through some companies directed at vets, I have no experience ot these to compare.

WhatsApp business may not be a long-term or sustainable solution, but if you have a smartphone it is an easy (and free) way to set up quickly to allow a video service to self-isolating owners immediately.

I think it may be helpful to have photos emailed to you, and ensure you can access the history if working remotely - again email can be fine in short term - before the video call. Setting up a dedicated gmail or alternative web email address may or may not be helpful.

Having never used WhatsApp in my life before last week (and not owning a SmartPhone myself), I wouldn't say I'm a reliable source of information or experience though...

RE: RCVS Telemedicine consultation

Bob Russell — Tue, 17 Mar 2020 13:38:40 GMT

We are setting up 'video consultations' but being ciueless. What are people using?

RE: RCVS Telemedicine consultation

Gillian Mostyn — Tue, 17 Mar 2020 10:42:55 GMT

My doctor's (and I assume most?) are not doing face to face appointments at all unless you are specifically told to come in. They are doing everything they can by photo, video and telephone.

I know this because my mum became very ill yesterday at 5.30pm with non-Covid19 symptoms. I rang the GP practice for advice as mum is 70 and I didn't really want to risk having to take her to an urgent care centre, but assumed it would be impossible to see a GP. The doctor rang her back and decided she did need to be seen. As appointments have all been cancelled we were at the GP clinic at 6.45pm and it was completely deserted... no staff or clients anywhere to be seen other than one cleaner mopping the floor. We had to be buzzed in. We were seen immediately and mum given a prescription to take to a late night pharmacy.

I was very impressed. The GP clinic has found a way to treat urgent cases with minimal risk of social contact. All of the conversations and interaction, except by the doctor herself, were done remotely.

RE: RCVS Telemedicine consultation

Arlo Guthrie — Tue, 17 Mar 2020 09:37:28 GMT

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/26913/rcvs-telemedicine-consultation/220393"]If I was in practice, I'd be installing video consult facilities before some shyster "vet" with no ethics and no responsibility for the case gets in there first. If all practices had video consult, it would kill remote prescribing.
Telemedicine is fine within ans establish vet-client relationship[/quote]

Hear Hear. 100% totally and completely agree.

[quote userid="3094" url="~/001/nonclinical/f/life-in-practice-discussions/26913/rcvs-telemedicine-consultation/220192"]If a practice is practising telemedicine, how does you then treat theanimal?[/quote][quote userid="3094" url="~/001/nonclinical/f/life-in-practice-discussions/26913/rcvs-telemedicine-consultation/220192"]At what point do we say, no it is not worth any risk at all?[/quote]

It is, of course, a question of not eliminating ALL risk, but getting it down to an acceptable level, which is difficult with a novel virus because of the unknowns.

I think sensible steps are a) yes, posting drugs - I think the risk of transmission that way is probably vanishingly small and b) handing over pets at the door.

Here at Guthrie Towers, we're having to make all sorts of risk decisions now. For example, we have sent one of my daughter's carers home because her partner works somewhere people have been getting it.

RE: RCVS Telemedicine consultation

Beats — Tue, 17 Mar 2020 09:34:09 GMT

I did a consult via WhatsApp business video call from a mobile phone yesterday for self-isolating owner with female cat with signs of cystitis. It worked fine. No fancy software needed. I knew the lady, and cat, well from previous encounters.

RE: RCVS Telemedicine consultation

Iain Richards — Tue, 17 Mar 2020 09:15:25 GMT

If I was in practice, I'd be installing video consult facilities before some shyster "vet" with no ethics and no responsibility for the case gets in there first. If all practices had video consult, it would kill remote prescribing.
Telemedicine is fine within ans establish vet-client relationship

RE: RCVS Telemedicine consultation

Julian Earl — Tue, 10 Mar 2020 10:09:51 GMT

If a practice is practising telemedicine, how does you then treat theanimal? By posted tablets etc? If so, will you wipe down all packages with spirit first? Even telemedicine is not transmission-proof!

We all know about Fomites, correct??

At what point do we say, no it is not worth any risk at all? When does the rik to peoplre, bearing in mind that it is usually a non-dangerous llness, supersede our oath to protect animal welfare? Does the RCVS need to draw up guidelines do you think?

RE: RCVS Telemedicine consultation

Arlo Guthrie — Tue, 10 Mar 2020 08:37:34 GMT

[quote userid="4181" url="~/001/nonclinical/f/life-in-practice-discussions/26913/rcvs-telemedicine-consultation/220183"]Maybe those in favour will use it to push their case, introducing what will become a longterm change to address an emergency, temporary situation?[/quote]

Well, I think it is important to keep distinguishing between companies set up to provide online consultations only. ie limited service providers. I think they'd be an unmitigated disaster. I really do. But what Susie Samuel is doing is completely and utterly different. She is providing a service which allows existing bricks and mortar practices to offer online consultations to existing clients, and schedule them, and charge for them. That requires no change to the regulations as everyone is allowed to do it already.

That I am 100% in favour of. As a pet owner myself, I would use that service if my practice offered it.

RE: RCVS Telemedicine consultation

Rob Loxley — Tue, 10 Mar 2020 08:27:16 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/26913/rcvs-telemedicine-consultation/220182"]Wondering how you think coronavirus could affect the remote prescribing debate, and in particular whether you think this could be useful for practices if we have to start practising social isolation[/quote]

Maybe those in favour will use it to push their case, introducing what will become a longterm change to address an emergency, temporary situation?

RE: RCVS Telemedicine consultation

Arlo Guthrie — Mon, 09 Mar 2020 17:50:30 GMT

I mentioned this in the corona thread but thought it might be worth resurrecting this thread too ...

Wondering how you think coronavirus could affect the remote prescribing debate, and in particular whether you think this could be useful for practices if we have to start practising social isolation: https://www.vetsurgeon.org/news/b/veterinary-news/posts/coronavirus-veterinary-video-consultation-service-rolled-out-early

RE: RCVS Telemedicine consultation

Iain Richards — Wed, 11 Dec 2019 10:01:33 GMT

[quote user="Arlo Guthrie"]Yes, but I thought the manufacturer had some say in whether a drug went OTC, regardless of pharmacovigilance.[/quote]

They do, but after a certain period. Andrea Tarr will know better

RE: RCVS Telemedicine consultation

Arlo Guthrie — Wed, 11 Dec 2019 09:48:43 GMT

[quote user="Iain Richards"]As I understand it, any new active ingredient has to go POM-V first. Presumably because vets will do better pharmacovigilance. Then they all go POM-VPS.[/quote]

Yes, but I thought the manufacturer had some say in whether a drug went OTC, regardless of pharmacovigilance.

RE: RCVS Telemedicine consultation

Iain Richards — Wed, 11 Dec 2019 09:45:03 GMT

[quote user="Arlo Guthrie"] I'm just saying that if this debate shows the animal doesn't need to be seen in order to prescribe a wormer or a flea treatment, then why is it POM?[/quote]

As I understand it, any new active ingredient has to go POM-V first. Presumably because vets will do better pharmacovigilance. Then they all go POM-VPS.

RE: RCVS Telemedicine consultation

Arlo Guthrie — Wed, 11 Dec 2019 09:17:15 GMT

Must say, I've been watching this develop since I reported on the first council debate a year ago ... https://www.vetsurgeon.org/news/b/veterinary-news/archive/2018/11/07/remote-prescription-could-redefine-what-it-means-to-be-a-vet.aspx

... and in all that time, I haven't heard a single sensible argument for why it makes any sense to allow remote prescriptions for animals not under care.

Not one.

I do think the debate raises two points worth discussing ...

First, as Iain mentioned earlier, is in getting conventional practices to adopt the software and systems to offer remote consultations NOW! And I don't mean just skype. I mean putting systems in place to manage remote consultations so that existing clients will know when they can be 'seen' etc.

The second is whether some drugs should be POM at all. I am not saying they shouldn't. I'm just saying that if this debate shows the animal doesn't need to be seen in order to prescribe a wormer or a flea treatment, then why is it POM?

RE: RCVS Telemedicine consultation

Julian Earl — Mon, 02 Dec 2019 18:21:47 GMT

A Good post Ian. Sadly likely to be true!

RE: RCVS Telemedicine consultation

ian bates — Mon, 02 Dec 2019 17:59:20 GMT

I think I will apply for a job working in telemedicine. No need to concern myself with aggressive animals trying to tear my arm off, no avoiding the various bodily fluids aimed at making my day wetter / smellier or generally just muckier, no need to become involved with difficult / argumentative clients complaining about X/Y/Z as I can just turn the screen off and blame a dodgy connection, I can work the hours I choose - and I'll make them the easy ones, and if anything is presented that looks remotely stressful / worrying I will immediately refer to a proper vet working at the coalface for that poor overworked, stressed sod to have to deal with. Then I'll make another cup of tea.

And then, I'll read the latest RCVS newsletter plugging another initiative about mental health in the profession and the problems of a lack of vets......perhaps they'll all see the light and start doing telemedicine for an easy life. Not sure where that will leave the profession as a whole or the clients and their pets though.......

RE: RCVS Telemedicine consultation

Richard Carter — Fri, 29 Nov 2019 18:24:25 GMT

as I mentioned before, my prediction is this isn't about diagnosis of new cases - this is about pinching your long term parasite control, your stable OA , cardiac, diabetic, HAC, hyperthyroid etc to sell the hitherto restricted POM medicines cheaper than you can buy them for and then to sell a 'package' of nsaids/TT4 bloods / cardiac check/ geriatric check at one of their clinics. Don't think they care at all about an actual 2 am emergency type case - the owner will just be told - find the nearest vet asap (and if it's one of ours great, otherwise just bang on the door until someone turns up) but basically not my problem guv - I am just answering the phone/ internet.

we already have situations where one of the big vet chains with links to a pet shop chain will badger your clients if they purchased a flea or worm treatment from said store and try a mailing campaign with offers linked to their vets as well as insurance companies that actively campaign for their customers to buy from their recommended internet shop and not from the local vet..

RE: RCVS Telemedicine consultation

Iain Richards — Fri, 29 Nov 2019 15:56:36 GMT

SPot on Bob, a message that needs repeating when the review starts

RE: RCVS Telemedicine consultation

Bob Russell — Fri, 29 Nov 2019 14:03:16 GMT

I have not seen anyone argue about vet to vet telemedicine. It is great. We ask opinions from specialists all the time and they seem very tolerant giving their time.

Client to vet telemedicine is where things get to be a problem.

The argument regarding access to veterinary services just does not make sense.

There may be limits to choice especially in very rural places but the vets that do cover these areas need to be viable to survive.

RE: RCVS Telemedicine consultation

Iain Richards — Fri, 29 Nov 2019 12:51:52 GMT

Most of the islands have a vet, I"ve done a locum on Mull so have some understanding. It's not a problem, one justs refers to a colleague just like any other practice. Vet to Vet telemedicine will be a boon here but, and I'll keep repeating this, it's within an existing VACR.

RE: RCVS Telemedicine consultation

Bob Russell — Fri, 29 Nov 2019 11:19:38 GMT

Highlands and Islands clients usually have a vet but he or she may not be available in person in emergency due to geography.

Human patients have access to helicopters etc which clearly are not going to be freely available to pets and livestock. There is complete justification for use of the phone/Skype etc with their usual veterinary practice.

Arrangements have been in place for decades to ensure some veterinary care. How is this going to benefit a client if the practice that does attend periodically no longer does so because it is no longer viable?

Access is available to veterinary care throughout the UK. Sometimes it is limited by geography but that will not change by allowing remote prescribing. There is already a case for limited allowance to be made where the physical presence of a full time vet is not possible.

A part time visiting vet is better than no vet at all!

RE: RCVS Telemedicine consultation

Julian Earl — Fri, 29 Nov 2019 10:59:46 GMT

Hello Iain,

I cannot recall who specifically raised the access point. Not someone that I recognised, for sure. But although maybe not a major or even a common problem? has anyone mentioned the Highlands and Islands as examples? Surely it is a potential problem/solution there, especially in the case of, for example, a complicated skin case, or similar? I think that some types of case are suitable for a non-hands-on approach? Samples can be taken and posted more easily. It is the complex surgical cases where welfare could be seriously compromised?

Thanks.

RE: RCVS Telemedicine consultation

Iain Richards — Wed, 27 Nov 2019 12:47:22 GMT

[quote user="Bob Russell"]We are discussing comments made at the question time session which included comments along the lines that it is a positive for people with poor access to vets. There are very few places in the UK where this is the case and I am sure the DC would take into account the few situations where this mat be the case and things appear to have gone wrong.[/quote]

No apology necessary Bob. The reason I asked who raised access is that this was one of the repeated points that was in the information provided to RCVS council for their discussions. The information was not supported by any UK data. LIke I said, poory handled

RE: RCVS Telemedicine consultation

Bob Russell — Wed, 27 Nov 2019 11:48:31 GMT

We are discussing comments made at the question time session which included comments along the lines that it is a positive for people with poor access to vets. There are very few places in the UK where this is the case and I am sure the DC would take into account the few situations where this mat be the case and things appear to have gone wrong.

Yes I accept I may be a bit paranoid about the whole thing but to be quite honest I really don't understand why things have gone as far as they have already.

I will be profuse with my apologies if I am wrong and the whole thing is dealt with professionally.

RE: RCVS Telemedicine consultation

Iain Richards — Wed, 27 Nov 2019 10:59:57 GMT

You haven't been approached because they haven't started yet.

While there are entirely appropriate questions regarding conflicts of interest, be they real or percieved, since this whole process began, I am not so sure that it is deliberate. To quote Brigader Bertie, cockup is more likely than conspiracy and the college have not handled this at all well. This only makes one more suspicious that there is a cover-up/vested interest.