Video consultations

RE: Video consultations

Thomas Johnson — Thu, 23 Apr 2020 11:41:40 GMT

I've been using Care Connect (web site is kry.care ). It usually has to be paid for but they have made it free during the coronavirus pandemic. I've been really impressed, once you've registered and want to start a consultation you put the clients mobile number in and it sends them a text message with a link in it, they click on the link and it opens in their browser, they don't need to install any additional software or apps, and they don't get my mobile number! I use it on my ipad and you can pinch to zoom in and out to see things more clearly.

RE: Video consultations

Rob Loxley — Tue, 21 Apr 2020 19:29:41 GMT

[quote userid="4747" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations/221928"]Yes I agree consulting is taking longer[/quote]

A reason why we aren't doing remote consults at a discount to a standard consult

RE: Video consultations

Charlotte Marshall — Tue, 21 Apr 2020 15:58:59 GMT

Yes I agree consulting is taking longer. Anthony, your clients must be better at pointing their cameras than mine! Even lameness ones where they are standing back from the animal half the time I am seeing the top of it's head or the dog just wants to sit on their feet rather than walk! Uncomplicated post op checks I agree are not too bad, also the dog with cystitis which demonstrated by stooping every 2 yards on the lawn - though you can certainly argue I have not checked her for a bladder mass or palpable stones at first assessment which I would have done in clinic.

RE: Video consultations

Glen McIntosh — Tue, 21 Apr 2020 12:26:22 GMT

[quote userid="11308" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations/221909"]As a team we were saying how we're enjoying not having clients in the consult room with us. [/quote]

Living the dream

RE: Video consultations

Rob Davis — Tue, 21 Apr 2020 11:31:07 GMT

Same here, but everything does take a whole lot longer....

RE: Video consultations

Anthony Dennison — Tue, 21 Apr 2020 11:28:52 GMT

I'm quite enjoying them if I'm honest, but maybe I've been lucky with who I've seen. Lameness consults are a doddle - explain how to switch the camera around on whatsapp, watch the dog limp, prescribe an NSAID and check up in 5 days by phone. If I can't tell too much or the dog is barely moving on the video they bring the animal in. Same with photos by email and phone calls.

I honestly think post op checks for routine neuterings could be done this way long term if there are no issues. Photo of the wound to check it, phone call with the owner, all done. Uncomplicated POCs take 30 seconds.

As a team we were saying how we're enjoying not having clients in the consult room with us.

RE: Video consultations

Chris Barker — Tue, 21 Apr 2020 09:22:23 GMT

[quote userid="9239" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations/221874"]We almost always find things that were ignored, considered irrelevant or, rarely, hidden by owner. [/quote]

We ran a study in our practice just before Xmas recording issues detected at routine boosters/prescription checks for animals age 7 years or older - ostensibly healthy or under care for a single medical problem. More than half of the ‘normal’ animals presented to the clinic were found to have previously undocumented health issues (Cats 51.2% [22/43] Dogs 55.6% [40/72]). And interestingly, for those animals identified with new or progressed conditions owners seem less able to recognise issues with their cats than their dogs (Cats Owner identified 27.3% [6/22} Vet identified 72.7% (16/22); Dogs Owner identified 42.5% [17/40] Vet identified 57.5% [23/40])

The range of conditions identified either by the owner or the veterinary surgeon was quite varied. Dental disease was the condition most commonly identified (Cats 8/43 Dogs 14/72), with owners regularly and worryingly unaware of its’ significance to the health and welfare of their pet. Other problems identified included: neoplasia (5/115), arthritis (5/115), cardiac disease (3/115), pruritus/dermatitis/otitis (9/115), weight loss/gain (9/115), urinary tract conditions (3/115), sight deterioration (2/115), and one-off issues such as cough, epilepsy and lymphadenopathy.

In essence our brief study showed that it would be foolish to presume ‘health’ in animals seven years of age and older, and that without proper clinical examination there is a significant risk of misdiagnosis or missed diagnosis, either of which could profoundly affect the welfare of the patient involved.

We've submitted the study as a letter to the Vet Record; not published as yet but will push again for its publication when the 'Under care' consultation is opened as it has huge bearing on any claimed 'reliability' of remote assessment

RE: Video consultations

Beats — Tue, 21 Apr 2020 09:05:20 GMT

Bucking the trend here, but I rather enjoyed them myself (I'm now furloughed and banned from such fun). Not particularly profitable sadly, but fun nonetheless. The clients seemed to enjoy themselves too. These were clients who had self-booked online, so perhaps self-selecting for those wanting and able for video calls. I was working from home, so wasn't trying to fit in to busy schedule at work and had little else to do - not being hurried tends to make anything more fun...

RE: Video consultations

Arlo Guthrie — Tue, 21 Apr 2020 08:11:23 GMT

Rob Loxley er, I don't quite understand, I thought that is what I did!

I said ^^ 'video might offer perceived added value over a telephone conversation'

RE: Video consultations

Rob Loxley — Tue, 21 Apr 2020 07:47:05 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations/221875"] I did always think video consults would be for things like post-op consultations and simple things like flea and worm consults. Things where they might offer a perceived added value (which you can charge for) over a telephone conversation[/quote]

I think you need to be clear if you are comparing video consults to telephone or in-person consults?

RE: Video consultations

joanne mcallister — Mon, 20 Apr 2020 11:03:58 GMT

I have found them to be useful in certain circumstances, such as talking an owner through clipping cat claws and another injecting her dog with cartrophen. Also found them to be useless in others, eg examining skin lesions, teeth and find asking for photos to be emailed better in these cases

RE: Video consultations

Arlo Guthrie — Mon, 20 Apr 2020 09:41:06 GMT

[quote userid="9239" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations/221874"]Arlo, I have no intention of patronising you[/quote]

I doubt I would ever read anything you have to say as patronising .... you don't strike me as that sort of person!

[quote userid="9239" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations/221874"]because you don't understand how we reach a diagnosis[/quote]

Well, I have an idea, but you are right, I am not trained in it, so yes, you are right that I am not qualified to judge.

However, I did always think video consults would be for things like post-op consultations and simple things like flea and worm consults. Things where they might offer a perceived added value (which you can charge for) over a telephone conversation.

I think this is important to try and measure, because if you don't then the people who have a vested interest in rolling out the tech will just argue that there is no evidence of missed diagnoses or misdiagnoses.

RE: Video consultations

Dinu Catilina — Mon, 20 Apr 2020 09:30:03 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations/221872"] I've been a champion of the idea of video consults for clients under the care of their normal vet, because I could see how it would save time and money not having to go to the practice,[/quote]

Arlo, I have no intention of patronising you but this is because you don't understand how we reach a diagnosis. A video consult is more likely to lead to pattern recognition and mistakes will happen. After this last month I can genuinely say that almost everything I provided medication through telemedicine would have been better off seen, except for the occasional cut in the pad, mild diarrhoea or some of the repeat prescriptions.

We almost always find things that were ignored, considered irrelevant or, rarely, hidden by owner.

RE: Video consultations

Arlo Guthrie — Mon, 20 Apr 2020 07:57:48 GMT

This is fascinating ... I've been a champion of the idea of video consults for clients under the care of their normal vet, because I could see how it would save time and money not having to go to the practice, and whilst I always thought I'd have to visit the practice if there was a lump for example, I thought there could be many other situations where it would work.

Like everyone else, I have now been using video conferencing software rather a lot more myself.

Actually, I've been impressed with it as a way of keeping contact with friends. Sure the quality is variable. People occasionally freeze with a rictus grin on their face. Sound is usually good, but the image is at best pretty average. I think one of the biggest problems (even when you're just chatting to friends, let alone examining the dog) is holding the camera.

These things are less of a problem when you are having a video call with your doctor about your own health than with a vet about your dog's (where you have to show parts of the dog's anatomy).

I do still think that a video conversation, even with the tech as it is now, is better than a phone conversation - in that you 'connect' with the person more than you do on the phone. But perhaps that is less important with your vet than with your friends.

I also think video conferencing tech still has a way to go yet. The quality will improve massively. In a few years time, you'll be looking at a 4k image where you can pick out if someone didn't trim their nostril hair that morning.

And as I said in my review of video conferencing, when people have a fixed camera in one of the rooms of their house, and you can zoom in on that nostril hair (or rather, the patch of hair loss on the dog), the whole thing will become much more usuable.

Meantime ...

[quote userid="6353" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations/221870"]Please hold on to these thoughts.[/quote]

I'll go a step further than that. I'm going to do a survey which can be fed into the Under Care review. More than that, it will identify the problems and what needs to be done before this can be a viable tool (if ever it can).

RE: Video consultations

Charlotte Marshall — Sun, 19 Apr 2020 22:57:48 GMT

Yes we were saying at work that this ought to prove what a bad idea it was for the future

RE: Video consultations

Chris Barker — Sun, 19 Apr 2020 21:03:57 GMT

[quote userid="4747" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations"]Is everyone else hating these as much as me?[/quote][quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations/221853"]Done a few but absolutely hopeless. Clients were understanding but almost everything had to be seen anyway![/quote][quote userid="3585" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations/221868"]if the animal is not present, then it is virtually impossible to make any proper clinical assessment [/quote][quote userid="18902" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations/221869"]I think there will inevitably be delays in obtaining diagnosis and very likely an increase in misdiagnosis[/quote]

Please hold on to these thoughts. And when the Covid crisis has abated, and the RCVS Standards Committee has time to organise its consultation on 'Under Care', please feed them back to the RCVS.

Because the Under Care review came about as a direct consequence of an attempt to push forward an initiative to trial remote consultation (+/- remote prescription) in the belief that it could provide a worthwhile service to the public and encourage those who do not normally interact with the profession to access advice/treatment for their animals.

Those of us in practice now have a wealth of experience which is highlighting the limited nature of what can be provided remotely. When the Under Care consultation is eventually opened for comment please make sure that you pass on your experiences, for only if enough practitioners contribute to the consultation will we end up with anything of relevance to the practising profession and the clients we serve

RE: Video consultations

Mary Lu — Sun, 19 Apr 2020 19:28:38 GMT

I'm finding it much easier to request pictures and videos for lameness sent via email then a telephone consult. Sometimes it's easier to assess lameness as I can rewind and check subtle lameness, and in this respect works out better than clients bringing them in as they never walk in a straight line at the vets, and avoids clients fumbling with the phone and never getting a consistent steady view during video consults, same with close up pictures for eyes.

Yes I think there will inevitably be delays in obtaining diagnosis and very likely an increase in misdiagnosis, however for very sickly patients at least all the history is obtained over the phone and when asked to bring the patient down, clients drop them off to be examined and they wait in the car park which reduces client contact.

Yes it feels very odd and sometimes wrong that I'm not able to perform a physical exam on all cases, but this is not normal times and as in fact the news keeps repeating, it's a national emergency. As vets we have a duty towards one health, so we're all really just trying to do the best we can.

RE: Video consultations

Glen McIntosh — Sun, 19 Apr 2020 19:20:36 GMT

Video consults work well when the animal is dropped off at the clinic and you can examine the dog, and use the video call to obtain history from the owner and for the rest of the communication with the owner when the owner is not present in the building.

Otherwise, if the animal is not present, then it is virtually impossible to make any proper clinical assessment and is, at best, going to be a form of triage in most cases.

RE: Video consultations

Julian Earl — Sun, 19 Apr 2020 17:44:11 GMT

What on earth do you do for a mass, if it clearly needs palpating? Especially an intra-abdominal one? Does any advice and initial treatment then just become educated guesswork?

Having said that, I suspect this sort of thing will be part of our future? Rightly or wrongly?

RE: Video consultations

Charlotte Marshall — Sun, 19 Apr 2020 14:04:33 GMT

Not too many complaints about video consult costs. They are told when it is booked that there will be a charge. Also mainly ok with postage charges. There have been a few though. We are not letting people come to the surgery just to collect flea and worming we will only post out.(unless they are collecting other necessary medication at the same time).

No I just find it is not a very good way of doing consultations. We have a couple of practice mobiles and are using whatsapp. It is surprising given I am in Birmingham how poor the connection can be.

RE: Video consultations

Joyce Whitehead — Sun, 19 Apr 2020 12:59:40 GMT

Yes ours are cheaper, no complaints so far. I’ve made a point of saying that I would normally see this animal and it is therefore not the norm to be dispensing over the phone. We also have a post out or delivery facility if required. Only complaint so far was someone wanting worming tablets who thought we would post them out free of charge and was astonished we had charged her. I wrote a strongish email to point out we couldn’t afford to do that and that wormers were not urgent, she could have waited. We haven’t heard more, but our team are making sure people are aware there will be a postage charge.

RE: Video consultations

Dinu Catilina — Sun, 19 Apr 2020 12:51:11 GMT

Exactly my thoughts Rob Loxley, video consults make sense only if the owners as self isolating, we post medication or have a delivery system in place.

[quote userid="6386" url="~/001/nonclinical/f/life-in-practice-discussions/29040/video-consultations/221857"]How are you finding people accepting they have to pay for a phone call? [/quote]

Zero issues up to now. Reception will take details, book an appointment and tell owners they will receive a phone consultation and not just a phone back. Makes a difference. The cost is mentioned at the time of booking the consult. I think it helps that is cheaper than a regular consult.

RE: Video consultations

Kate Richardson — Sun, 19 Apr 2020 12:50:11 GMT

How are you finding people accepting they have to pay for a phone call?

RE: Video consultations

Joyce Whitehead — Sun, 19 Apr 2020 12:44:23 GMT

Yes we are finding phone calls more popular. With photos or videos as requested. Although some people really can’t work their phone camera, sometimes you can’t even tell which bit of animal you are looking at!

RE: Video consultations

Rob Loxley — Sun, 19 Apr 2020 12:40:06 GMT

I do wonder, that if it is likely from the outset that the client will have to travel in to collect medication, then they might as well come in for the medication with the animal so it can have a proper exam?