What do you think about the removal of the need to perform a physical exam?

RE: What do you think about the removal of the need to perform a physical exam?

Anthony Dennison — Thu, 13 Apr 2023 16:00:54 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30554/what-do-you-think-about-the-removal-of-the-need-to-perform-a-physical-exam/241129#241129"]IVC have already moved into this area with the arrival of 24/7 VetsNow teleconsultations.[/quote]

When we were desperately short of vets last year and the beginning of this year, this service was quite useful as it weeded out an awful lot of the panicky people or the things that didn't really need seeing. Those that did were given a time scale of when they needed to be seen - the same day, within a few days, longer etc.

When we were fully booked bar emergency on the day slots for 4 or 5 weeks in advance, it was a useful service to have.

RE: What do you think about the removal of the need to perform a physical exam?

Lucy Fleming — Mon, 27 Mar 2023 11:50:28 GMT

From 8am - 11pm...

Speaking as a mixed GP that does "traditional" OOH, that doesn't even provide (me) the one small benefit of most of these online consults - of triaging things that want help in the middle of the night without me having to wake up and try and do it over the phone...

RE: What do you think about the removal of the need to perform a physical exam?

Bob Russell — Tue, 21 Mar 2023 16:46:35 GMT

IVC have already moved into this area with the arrival of 24/7 VetsNow teleconsultations.

Perhaps I am getting a tad paranoid!

RE: What do you think about the removal of the need to perform a physical exam?

Rob Loxley — Tue, 21 Mar 2023 14:49:31 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30554/what-do-you-think-about-the-removal-of-the-need-to-perform-a-physical-exam/241124#241124"]Of course the coroporates want this to go ahead[/quote]

I think this is a rather broad brush picture, as a number of 'corporates' have made known their position on proposed changes to remote prescribing (e.g. Concerns over ‘inappropriate prescribing’ after ‘under care’ vote | Vet Times ), and to suggest this is all driven by corporates I don't see the evidence?

RE: What do you think about the removal of the need to perform a physical exam?

Bob Russell — Tue, 21 Mar 2023 11:57:18 GMT

No real change to the so called guide.

Of course the coroporates want this to go ahead. It is a marketing dream and the consumer will take it on board until things go wrong.

Our GP practice is now getting patients to write in. Not emails but standard old fasioned snail mail!

The medical profession at the coal face is well and truly broken and the veterinary profession is only lagging slightly behind!

RE: RCVS to remove requirement to perform a physical exam

Arlo Guthrie — Tue, 21 Mar 2023 10:42:36 GMT

Latest update about remote prescribing here:

https://www.vetsurgeon.org/news/b/veterinary-news/posts/rcvs-tightens-guidance-for-remote-prescribing

The main change doesn't really address the main issue that most vets seem to have with remote prescribing ... ie the issue of missed diagnoses and misdiagnoses:

https://www.vetsurgeon.org/news/b/veterinary-news/posts/93-of-vets-say-prescribing-meds-without-a-physical-exam-will-harm-animal-welfare

I wonder whether you think it would be helpful to have a reporting system through which you can report incidents of misdiagnoses and missed diagnoses caused by remote prescribing?

RE: RCVS to remove requirement to perform a physical exam

Bob Russell — Wed, 01 Feb 2023 09:44:34 GMT

The Welsh government have opened some form of investigation regarding the 'corporatisation' of the veterinary profession.

The FDA have got it right. The RCVS have got it completely wrong.

At what point do they worry? 90%, 95% corporate?

A few independents will continue and grow but then comes the offer that is too good to refuse?

Edit; As it is the responsibility of the VMD to ensure proper use of POM products, I would like to hear their views.

Why was one legal opinion allowed to drive a decision that could lead to distruction of practices and real compromises to welfare?

Yet another edit!!!

"require veterinary surgeons to carry out a physical examination where notifiable diseases are suspected, and when prescribing antimicrobials (as defined by the World Health Organisation to include antibiotics, antivirals, antifungals and antiparasitics) and controlled drugs unless there are exceptional circumstances."

This is from the RCVS website. No idea where and when this appeared but it seems to exclude ears, skin, fleas, ticks and almost anything else you can think of being prescribed without a physical examination.

Confused?

RE: RCVS to remove requirement to perform a physical exam

Richard Carter — Sun, 29 Jan 2023 11:13:17 GMT

December 21, 2022

On Dec. 21, the Food and Drug Administration announced its withdrawal of Guidance for Industry #269, “Enforcement Policy Regarding Federal VCPR Requirements to Facilitate Veterinary Telemedicine During the COVID-19 Outbreak.”

The effective date of the decision is Feb. 21, which means that the FDA will again hold veterinarians to the federal requirements for the veterinarian-client-patient relationship beginning on that date. As stated by the FDA, the federal VCPR definition “requires animal examination and/or medically appropriate and timely visits to the premises where the animal(s) are kept” and “cannot be met solely through telemedicine.”

Knew I hadn’t dreamed it up..

RE: RCVS to remove requirement to perform a physical exam

George Cooper — Thu, 26 Jan 2023 12:26:59 GMT

A passing observation, largely borne out by recent developments at RCVS HQ.

Over the years a number of dedicated and enthusiastic VSs, GPs in the main, have been voted on to Council where they have expressed the desire to influence proceedings as their own personal experience has "guided" them, and to a man and woman they have lasted far less time in their seat of "power" seemingly ground down by the system and power struggles that are cloaked in the blanket of secrecy that pervades all emanating from RCVS. I'll not name names, chiefly because I'd be unable to recall them accurately, but also because most followers of Council behaviour are aware of each departure as it has happened.

One would have thought that it would have been spotted at HQ and analysed instead of the faux hand-wringing and crocodile tears at the lack of practitioners with their common sense putting themselves forward for office.

RE: RCVS to remove requirement to perform a physical exam

Clare Tapsfield-Wright — Wed, 25 Jan 2023 21:38:01 GMT

Seen on social media

IVC have appointed a vice president of eCommerce , his mission is to
“build an e-commerce strategy to deliver products and prescriptions to millions of IVC evidensia clients. “
and so it begins

RE: RCVS to remove requirement to perform a physical exam

Cool — Wed, 25 Jan 2023 16:52:08 GMT

Thank you Clare. The next thing will be online training to have a primary vet degree. All can be done online don't you think? Imagine all the gross anatomy dissection lessons, histology, gross pathology, surgery etc. I just can't believe it has come to this. I agree with you Clare that big business only cares about the bottom line and that is what this is all about.

RE: RCVS to remove requirement to perform a physical exam

Cool — Wed, 25 Jan 2023 16:45:52 GMT

Your last paragraph is succint. That is the truth and no more needs to be said. Big organisations usually want power and monopoly and that is what we are seeing unfold in this case. Part of the long term effect of this is that we will end up with many poorly skilled vets in 10 years from now.

RE: RCVS to remove requirement to perform a physical exam

Chris Barker — Wed, 25 Jan 2023 14:31:49 GMT

[quote userid="6353" url="~/001/nonclinical/f/life-in-practice-discussions/30554/rcvs-to-remove-requirement-to-perform-a-physical-exam/240557#240557"]And the VMD have announced an imminent review of the VMRs.[/quote]

Potentially of course this could have an immense impact on the alterations proposed for our Code of Conduct.

Imagine if the VMD opens a consultation and receives the same weight and flavour of comments from the Profession as did the RCVS...

They might, just might conclude that the correct way to protect the welfare of animals and to ensure the proper use and supervision of POM-Vs is to restrict their prescription to those animals with an existing VCPR...

We can dream, eh?

RE: RCVS to remove requirement to perform a physical exam

Bob Russell — Wed, 25 Jan 2023 12:06:50 GMT

The most depressing thing is the total lack of interest from the RCVS regarding the views of its members.

It was clear from the start what the outcome was to be and it was followed through to plan.

RE: RCVS to remove requirement to perform a physical exam

Dinu Catilina — Wed, 25 Jan 2023 11:01:31 GMT

I am sorry to say but talking about the financial implications for independent practices is a distraction from I believe to be the real issue, the potential long term welfare implication. Of course I might be wrong.

The market continues to change and what made money 20 years ago does not make money now. Nothing new. To be honest I dream of a day when we can follow the Swedish model and make money from fees and procedures and let pharmacists make money from selling drugs and pet shops from selling dog food and collars.

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/30554/rcvs-to-remove-requirement-to-perform-a-physical-exam/240631#240631"]

Well it may not bother me because I don't run a practice myself, but anything which disadvantages independent practices bothers me, because as I have said many times, I like the colour and variety and choice that independent businesses of all sorts bring to life.

[/quote]

Please feel free to call me paranoid but look at this scenario. Owners who call for an online consult and pay for it will be offered a free of charge consult in a brick and mortar practice if the initial consultation is not helpful. This will of course funnel clients towards the same corporate who owns that particular online consult company. Vets Now will gradually decide not to cover OOH for independent practices, they already started doing it in certain areas. This will box independent practices in and together with a good financial reward for their owners will make selling more appealing.

Where is that variety and choice you are talking about? In some area we already see available only a "large" variety of 3 corporates.

Corporates are generally speaking already more expensive that private practices and with less competition the prices will go up even more.

So no, I am not worried about losing the consultation fee. Most consultation fees are anyway loss leaders and we would not make any money if we were a consult only practice. What I am worried about is the long term implications and how rules evolve to support the corporatisation of the profession in the name of modernisation.

And the most upsetting part is the feeling that regardless of who goes on the council nothing ever changes.

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/30554/rcvs-to-remove-requirement-to-perform-a-physical-exam/240631#240631"]I think the problem is that everyone has got so fixated on "remote consultations" - ie the ability for the owner to call a vet any time and have a consultation - with all the problems remote consultations bring with them, that you're all just shouting NO NO NO, and not thinking: "OK, well I may not think remote consultations are a good idea, but how else can I use this form of communication?"[/quote]

Arlo, what everyone keeps saying is that we ALL already do remote consultations for our clients. We already make phone calls and accepted emails and videos and photos and we did it mostly free of charge. I can't think of a situation where a registered client of ours could not come in and we refused to help with advice over the phone or email. They're not a bad idea. But what is happening now is different though.

RE: RCVS to remove requirement to perform a physical exam

Jo Dyer — Wed, 25 Jan 2023 10:31:24 GMT

Speaking as a practitioner.....

Even simpler than that; thinking 'how can I use the new guidance to my advantage?' (Assuming it comes in unchanged from the current agreed proposal). Since the Under Care physical exam obligation will have gone, only clinical assessment is left, for which, currently, physical exam is not mandatory. For low-risk POM-Vs such as parasiticides, vets may feel that an ancillary staff member getting the animal's weight, and getting owners to fill in a brief questionnaire with relevant questions, may provide enough information for their clinical assessment in order to allow them to prescribe.

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/30554/rcvs-to-remove-requirement-to-perform-a-physical-exam/240631#240631"]And as I keep on banging on about, I really do think that selective use of video calls with clients will help maintain the link and strengthen the bond.[/quote]

Currently vets don't have enough staff/time to cover the physical consultations they need to do. Although that will hopefully change in the future, for the time being there is little chance of offering extra services while trying to avoid drowning in the services we are already trying to provide. And anyway, for bricks and mortar practices the telephone is usually a much more useful remote consultation tool, as it has been for about a century.

I'm interested to hear others' ideas about how practices can use the new guidance to their advantage.

RE: RCVS to remove requirement to perform a physical exam

Bob Russell — Wed, 25 Jan 2023 09:49:59 GMT

Frontline sales fell off a cliff but thankfully new and far more reliable products came along.

We now spend quite a time sorting things out when Frontline/fipronil products are failing. I am amazed that it is still such a big seller!

RE: RCVS to remove requirement to perform a physical exam

Arlo Guthrie — Wed, 25 Jan 2023 09:42:21 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30554/rcvs-to-remove-requirement-to-perform-a-physical-exam/240630#240630"]This may not bother Arlo but it is important to us.[/quote]

That said, I remember such a similar discussion going on when Frontline went over the counter. Lots of talk then about how practices should be less reliant on product markup and charge more sensibly for their skills, experience and time.

I thought that increased competition from supermarkets and online had already eroded the value of parasiticide sales to general practice. I wonder how much they are worth to an average practice.

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30554/rcvs-to-remove-requirement-to-perform-a-physical-exam/240630#240630"]Without the parasiticide sales we lose a regular link with clients and the important bond it creates.[/quote]

I'm wondering ...

If you held some parasite clinics for clients online, might you actually end up getting more owners to treat their animal for fleas than if you ask them to come to the practice (which is potentially a faff, when you can buy something you think is going to work in the supermarket).

And as I keep on banging on about, I really do think that selective use of video calls with clients will help maintain the link and strengthen the bond.

Since COVID, I'm now have regular editorial face-to-face meetings with my counterparts at Improve, and there's just no question in my mind that it is a far better and more unifying experience than just speaking on the phone.

I think the problem is that everyone has got so fixated on "remote consultations" - ie the ability for the owner to call a vet any time and have a consultation - with all the problems remote consultations bring with them, that you're all just shouting NO NO NO, and not thinking: "OK, well I may not think remote consultations are a good idea, but how else can I use this form of communication?"

RE: RCVS to remove requirement to perform a physical exam

Bob Russell — Wed, 25 Jan 2023 09:09:42 GMT

We are already facing online pricing at or below our cost prices. We have given up most pet food sales because we cannot buy at a competative price.

Without the parasiticide sales we lose a regular link with clients and the important bond it creates. This may not bother Arlo but it is important to us.

RE: RCVS to remove requirement to perform a physical exam

Alistair Graham-Evans — Tue, 24 Jan 2023 21:42:58 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/30554/rcvs-to-remove-requirement-to-perform-a-physical-exam/240623#240623"]Reality is that acquiring clients via a video vet service is, I think, going to be a slow process. [/quote]

Yes

I think you’re right - however this is just the first step.

The future will be someone like VetsNow having a centralised national 111 type service automated by bots. Any telemedicine service could be aided by diagnostic computer algorithms to provide consistency of assessment. This would help with any legal claims because you just blame the computer!

On Tuesday, the country’s top accident and emergency (A&E) doctor said that NHS 111 is sending too many people to A&Edepartments, because its computer algorithm is “too risk averse” - heaping extra pressures on services.

However many vets are complaining that they are overwhelmed OOH because emergency services providers don’t have enough staff. With the new guidelines there would have to be an agreement about where cases go that can’t be solved by the telemedicine provider. So the hypothetical centralised Vets Now service can’t send them to one of their clinics as they have no staff and can’t send them to another vet as there is no pre- consultation agreement. So the client’s only option is to phone the local clinic which is what used to happen in the dark ages!

What a conundrum.

Although clinics shouldn’t be reliant on food and parasiticide sales and dispensing for financial survival, if these disappear the result is that the cost of services rises. However if big independent groups attract online sales then this cross subsidises cost of providing vet services and the independent vet struggles to compete.

Anyone can offer online product sales - maybe this is the future although those I know who have tried it failed to make it viable as much profit was soaked up by the online sales service. Or maybe they didn’t have the advertising power. Our products a very competitive with local large pet stores ( not with online sources that sell for less than we can purchase!). but folk are attracted by loss leaders and the huge variety of stock beyond the capacity of a clinic.

RE: RCVS to remove requirement to perform a physical exam

Bob Russell — Tue, 24 Jan 2023 10:14:13 GMT

Typical of the new generation of non-loyal clients!

RE: RCVS to remove requirement to perform a physical exam

Arlo Guthrie — Tue, 24 Jan 2023 09:48:20 GMT

[quote userid="4181" url="~/001/nonclinical/f/life-in-practice-discussions/30554/rcvs-to-remove-requirement-to-perform-a-physical-exam/240620#240620"]How about maybe Vets Now, already run a video vet service, expand it to include dispensing allowed under the new rules, attract lots of new customers from other practices, funnel any that need to be seen or for followups into growing IVC bricks and mortar practices?[/quote]

OK ...

Well, I think there is a danger of looking at these things in very black and white. The rules have changed ergo we will go out of business tomorrow. I am not saying you do that, but I know I do, and invariably the impact on business is less precipitous than I expected.

Reality is that acquiring clients via a video vet service is, I think, going to be a slow process.

The low hanging fruit will be pet owners without an existing vet who go online in an emergency, or in response to a perceived need, anyway (perhaps fleas) and find an online vet who gets them to sign up.

Existing clients are, in the main, going to think of their normal vets as their first port of call, and even if they do find an online service, it'll be a bigger job to get them to switch vets (depending on how good the relationship with their existing one is).

And the impact can be mitigated by finding a way to strengthen client relationships or offer your own video consultations

[quote userid="9239" url="~/001/nonclinical/f/life-in-practice-discussions/30554/rcvs-to-remove-requirement-to-perform-a-physical-exam/240569#240569"]

Arlo Guthrie said:
I mean, it’s not like independents wont be able to offer remote consultations.

Not even close. First page of google can only accommodate so many websites, the first ones will always be the large ones with more traffic and advertisement.

[/quote]

Dinu Catilina - I do know a little about the internet and google, and I completely disagree. For a start, Google isn't the only place to market remote consultations. Secondly, for a service that is so location based, there are lots of 'page ones' and ways you can get to the top of those pages, even against stiff competition.

I think if I were running an independent practice today, the thing I would be doing right now is assessing the various video communication platforms, to see which have the best call handling features. Then I would be thinking how I could introduce a system through which I could offer a limited remote consultation service.

The biggest problem, I imagine, is the way in which people searching the Internet need an answer NOW, and if they don't get it NOW, they will go elsewhere (probably one of the 24/7 consulting services).

I presume (but I don't know) that there wouldn't yet be enough demand to recruit another head (even if you could) and rotate staff to provide a remote service 24/7.

So I'd probably be thinking how to protect existing clientele from being poached, and thinking how I could provide them with a remote service.

I am sure that's the starting point.

Funnily enough, this came up in conversation with a (new) friend the other day, who was waxing lyrical about how they had had an emergency with their dog in the middle of the night and turned to an online triage service which they found hugely reassuring. I don't think they needed to actually see someone right then. They just remarked how amazing it was to be able to talk to someone in the middle of the night.

I think if my own dog got ill in the middle of the night, I would be more inclined now to try Vets Now's remote service, because my regular vet does not offer anything similar. If they did, I would.

Is that an option, to say to clients - this is our OOH remote video service for emergencies?

Then if the call requires a physical exam, then refer to the OOH service?

RE: RCVS to remove requirement to perform a physical exam

Bob Russell — Tue, 24 Jan 2023 09:28:35 GMT

Of course they do!

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/30554/rcvs-to-remove-requirement-to-perform-a-physical-exam/240616#240616"]

Richard Carter said:
Those flea treatments pay the receptionist’s wage, the utilities and the insurance bill.

Do they? Still? Serious question. I thought they must have become significantly less important since online pharmacies came along.

And could you not offer online parasite consultations yourself?

[/quote]

RE: RCVS to remove requirement to perform a physical exam

Rob Loxley — Tue, 24 Jan 2023 08:34:38 GMT

[quote userid="19228" url="~/001/nonclinical/f/life-in-practice-discussions/30554/rcvs-to-remove-requirement-to-perform-a-physical-exam/240605#240605"]I would target PDSA staff for recruiting as theg are the largest source of experienced vets already doing this and you are not stealing from your potential clients the corporate[/quote]

Have a look on VSGD; plenty of vets who would like to get out of traditional practice and go down the telemedicine route

RE: RCVS to remove requirement to perform a physical exam

Rob Loxley — Tue, 24 Jan 2023 08:26:12 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/30554/rcvs-to-remove-requirement-to-perform-a-physical-exam/240602#240602"]

james bryson said:
Somebody is going to make a huge success of this

james bryson What do you mean exactly? What form do you think this 'huge success' is going to take? Can you describe to me how you think this successful new remote consulting service will be structured and what service it will offer?

[/quote]

How about maybe Vets Now, already run a video vet service, expand it to include dispensing allowed under the new rules, attract lots of new customers from other practices, funnel any that need to be seen or for followups into growing IVC bricks and mortar practices?

What do you think about the removal of the need to perform a physical exam?

RE: What do you think about the removal of the need to perform a physical exam?

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FDA to resume enforcement of all federal VCPR requirements for veterinary telemedicine

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