Telemedicine

RE: Telemedicine

Bob Russell — Fri, 10 Aug 2018 09:45:02 GMT

[quote user="Dinu Catilina"]

[quote user="Bob Russell"] A Romanian vet, working in Romania can legally issue a prescription via a UK internet drug supplier therefore it would be a POM-V free for all.[/quote]

Are you saying that Romanian vets have lower ethics than UK based ones?

[/quote]

Actually no idea but the human company prescribing was based in Romania. I have to say I have concerns about the ethics of a minority of vets everywhere. It does seem from the Dogs Trust that falsified documentation for passports is more rife in Lithuania and Hungary so I might as well upset vets from those countries as well!

I should perhaps rephrase along the lines of vets from less regulated countries!

Martin Atkinson's neighbour has up to 3½ years at Her Majesty's Pleasure to reassess the value of falsifying documents in the UK (subject to appeals).

So no I was not particularly singling out Romanian vets.

RE: Telemedicine

Richard Carter — Fri, 10 Aug 2018 09:32:34 GMT

haha - don't think 'letterboxes' were mentioned

RE: Telemedicine

Dinu Catilina — Thu, 09 Aug 2018 21:26:06 GMT

[quote user="Bob Russell"] A Romanian vet, working in Romania can legally issue a prescription via a UK internet drug supplier therefore it would be a POM-V free for all.[/quote]

Are you saying that Romanian vets have lower ethics than UK based ones?

RE: Telemedicine

Gillian Mostyn — Wed, 08 Aug 2018 17:53:36 GMT

I did not say it is a good thing to allow the dispensing of POM-Vs over a website. I simply said that it is right and correct for the RCVS to discuss it, alongside other issues specifically relating to telemedicine.

I, for one, will be amazed if the RCVS thinks remote POM-V dispensing is OK.

And as far as corporates pushing for it....all I know us that CVS will not allow anyone other than a vet to dispense a POM-V flea treatment or dewormer, and even then not unless the pet has been seen very recently. Clients now have to order them in the same way they order all their other meds, for the vet to prescribe. How many practices still allow receptionists to hand them out like smarties? The dispensing rules I now follow are stricter than in most independent practices, including mine.

RE: Telemedicine

Bob Russell — Wed, 08 Aug 2018 17:16:54 GMT

I don't get the idea that telemedicine is a good, modern thing. It may be a good tool where communication is between client and vet in limited circumstances.

Good for one clinician to be able to talk to another, send radiographs, images etc.

It is a disaster for humans! Anorexic ordering slimming pills, opiate addict ordering opiates, antibiotics on-demand. It may take some pressure off GP's which probably explains why it has been allowed. Perhaps of some use for someone wanting to order little blue pills, bi-passing the potential embarrassment of requesting them from the GP.

Why are some so enthusiastic to introduce such a lousy system into animal care? Money of course, nothing to do with animal welfare.

Anything that removes a revenue stream from a proper practice has to be considered a threat as well. This should not be ignored either.

RE: Telemedicine

Anthony Todd — Wed, 08 Aug 2018 12:28:08 GMT

[quote user="robloxley"]

But hey, there's no issues with telemedicine on the human side... https://www.bbc.co.uk/news/health-45084555

[/quote]

You should add "[not]" after I read the link.....

"England's healthcare regulator is calling for a change in the law to protect patients using online doctor sites selling prescription-only drugs."

It's just another example of a perceived need towards "modern" thinking by the powers that be aided, and abetted, by the influential corporates fighting for market share.

20/30 odd years ago it could have been "consults by fax and photo"......

RE: Telemedicine

Bob Russell — Wed, 08 Aug 2018 12:23:07 GMT

A face to face video consultation between a client and his/her vet to save time and stress to those involved is perfectly acceptable in my view. This is an extension of the phone conversation.

More than this is a slippery slide and you can be certain that it will be abused/misused. A vet paid per prescription (as with the human doctor cases) will end up with medicine sales, required or otherwise.

The recent Panorama programme just shows that money talks and prescriptions will be issued on demand for a fee. The QCC does not regulate websites outside the UK nor would the RCVS be able to control any vet based outside the UK. A Romanian vet, working in Romania can legally issue a prescription via a UK internet drug supplier therefore it would be a POM-V free for all.

This will happen if the RCVS allow telemedicine to progress to the point where a 'bricks and mortar' vet is not directly involved.

Is this a risk worth taking for the price of a consultation? Not in my book!

Sadly the RCVS is largely under the control of people with corporate links or no veterinary links at all so I don't believe much will stop this idiocy. Please just wait until I can walk away from what has always been a fine profession.

RE: Telemedicine

Niall Taylor — Wed, 08 Aug 2018 11:46:33 GMT

[quote user="Gillian Mostyn"]I also firmly believe that the RCVS is absolutely right to try to put place some guidelines to cover this[/quote]

I don't buy that argument at all, but it is the line that is being spun by the vested interest groups involved and which RCVS is falling for. There is no need for any RCVS guidelines for vet to vet interraction via 'technology' be it phone, remote ecg or whatever, which they've been doing in one form or another forever.

Also, the RCVS has no control over Dr Google, the majority of whose advice comes from quacks and non-vets. There are some good vet sites out there but the majority are out of the country, again out of RCVS remit.

[quote user="Gillian Mostyn"]You can't stop the runnaway train that is social media. But you can accept it and try to anticipate it's problems.[/quote]

No one wants or indeed would be able to stop social media but 'accepting it' and 'anticipating problems' is not what this is about, we all work with it on a daily basis both personally and in business with no help from RCVS or the need for guidelines. It is, quite specifically, about "... whether to change the Supporting Guidance to the RCVS Code of Professional Conduct regarding 'under care', 'so as to allow veterinary surgeons to prescribe POM-V medicines based on telemedicine alone'"

and...

"... whether RCVS ‘supporting guidance to the Code of Professional Conduct’ should be amended to allow remote examination to take the place of physical examination..."

(From "RCVS review of the use of telemedicine within veterinary practice" March 2018)

No mention of social media or fancy hi tech monitoring there - just vested interest groups looking for a green-light to dispense POM-Vs, after nothing more than a telephone conversation and without having to see the animal. It's a great shame RCVS are blinded to that.

Niall

RE: Telemedicine

Gillian Mostyn — Wed, 08 Aug 2018 11:21:26 GMT

People already Google their pets illness. They already consult 'experts' online. They already search for veterinary advice. No doubt everyone has seen the consequences.

It isn't a bad idea that some practices/groups/organisations provide this service, if only to try to ensure that the advice given is appropriate. People, I'm sure, would be happy to pay for this advice if they knew it was going to be correct.Even if a lot of the time it is 'yes, you need to go to a vet'. But sometimes it may just be 'your kitten is in season' or 'no, a broken dew claw doesn't need a 2am appointment, no matter how much it is bleeding'.

I also firmly believe that the RCVS is absolutely right to try to put place some guidelines to cover this, especially to cover 'under your care.'

You can't stop the runnaway train that is social media. But you can accept it and try to anticipate it's problems.

RE: Telemedicine

Rob Loxley — Tue, 07 Aug 2018 21:19:35 GMT

But hey, there's no issues with telemedicine on the human side... https://www.bbc.co.uk/news/health-45084555

RE: Telemedicine

Niall Taylor — Tue, 07 Aug 2018 17:56:58 GMT

Just for completeness the previous thread on this topic was here:

https://www.vetsurgeon.org/uk/general/f/6/t/26913.aspx

And we're not the only group that is concerned about this subject, other veterinary forms are also discussing this matter with the same concern.

Niall

RE: Telemedicine

Richard Carter — Fri, 03 Aug 2018 18:47:49 GMT

[quote user="Dexter Smith"] the poor souls at the sharp end for their obvious professional shortcomings[/quote] who given the help lines run by various insurances companies are not vets but RVNs who are clearly being asked to make clinical decisions.

I don't really have a problem with me discussing a client referral to an expert and then videoing the exam for the expert to observe and comment, suggest further tests/ exams if the client cannot go to the expert. We do this with xrays, ultrasounds and ecgs already. My concern is when client middle of night emergency is speaking to 'vet' in India trying to see if they should be going to the OOH service - who is professionally accountable for the advice - the company in UK?

On the other hand may be fairly easy - had a client send a photo of their myxo rabbit today - no further tests needed.

RE: Telemedicine

Dexter Smith — Fri, 03 Aug 2018 18:36:04 GMT

[quote user="Anthony Todd"]

Don't worry, after the first catastrophic incident after innocent mis-advice, which there surely will be, the whole edifice will collapse!

[/quote]

Alternatively the RCVS, bowing to corporate pressure from within, could continue to propound the virtues, but sanction the poor souls at the sharp end for their obvious professional shortcomings in the event of any incidents.

RE: Telemedicine

Edward Jones — Fri, 03 Aug 2018 14:13:34 GMT

[quote user="Jill Butterworth"]Is not think what we are doing, [...], a form of telemedicine?[/quote]

Well yes, telemedicine in one form or another is older than many vets, and it's a service that vets have long-provided within the tried, tested and true limits currently set in the code.

The word 'telemedicine' is being used to try to sound modern, which pairs well with the ad hominem attacks accusing the opponents of being technology-afraid Luddites, when actually, it's clear to me, that the intention is really to allow free prescription of POM-V medicines without an examination.

RE: Telemedicine

Jill Butterworth — Fri, 03 Aug 2018 13:49:21 GMT

I think it's going to happen and there will be many unforeseen consequences.

Is not think what we are doing, posting and discussing cases, a form of telemedicine? One day it is likely that we (as human patients) will be able to consult with international specialists. It's clear that it is quickly and easily possible to give and take a very good history and supply good quality images anywhere in the world. We must look to the inevitable changes and adapt business models to thrive.

RE: Telemedicine

Bob Russell — Fri, 03 Aug 2018 13:03:03 GMT

[quote user="Anthony Todd"]

Don't worry, after the first catastrophic incident after innocent mis-advice, which there surely will be, the whole edifice will collapse!

[/quote]

We can only hope!

It is a ridiculous idea but I suspect the pressure from within council will get it through even with a clear lack of support from the bulk of vets.

RE: Telemedicine

Anthony Todd — Fri, 03 Aug 2018 12:41:53 GMT

Don't worry, after the first catastrophic incident after innocent mis-advice, which there surely will be, the whole edifice will collapse!

RE: Telemedicine

Richard Carter — Fri, 03 Aug 2018 12:24:35 GMT

because if I can pinch your clients legally then you will go out of business and leave me with a clear playing field?