The Doctor Will See You Now
“ We must always tell what we see. Above all, and this is more difficult, we must always see what we see.”
We may fear the future that technology can bring into our daily lives, but what is already here is probably around to stay. It’s been roughly 40 years since telemedicine was introduced into human healthcare, and for many purposes, its exponential progress has been embraced and accepted. Its role in veterinary medicine has been slower to evolve, partly because of some different challenges when using remote-access capabilities in daily practice. An advisory panel for the AVMA recently released a report on telemedicine; however, at this stage, the report is for informational purposes, not a policy statement.1
So what is this technology, and should we embrace it or fear it?
The American Telemedicine Association briefly defines telemedicine as “the remote delivery of healthcare services and clinical information using telecommunications technology [that] includes a wide array of clinical services using internet, wireless, satellite, and telephone media.”2 This broadly encompasses much of what we already do and accept: telephone consultations with colleagues, telephone updates with owners, and remote imaging3 and ECG interpretation services, to name a few. The AVMA advisory panel defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.”1
Based on these definitions, we could simplistically divide telemedicine into consultation services (teleconsulting), which assist us with decisions about diagnosis and care, and diagnostic services, which at the extreme can directly offer a medical diagnosis from a remote situation. The former is widely accepted—for example, a consultant may provide advice about a particular case. The latter seems fraught with complications and lacks the “hands-on” approach that so many of us feel uncomfortable without. Surely just “seeing” is not enough to believe?
Many feel certain that the correct use of telemedicine can enhance animal health by facilitating communication, diagnostics, treatment, and education.4–7 In the field of human medicine, telemedicine has become successful because of its convenience and accessibility, enabling the provision of healthcare in remote, underserved areas. Some healthcare plans now even include access to a doctor via video call; however, there are some very clear guidelines and laws defining this interaction. The healthcare provider must be licensed in the state where the patient resides; an established doctor-patient relationship must exist; and it must be clear to the patient that the healthcare provider is indeed qualified! All of these requirements are included in the AVMA’s advisory panel recommendations.
The question that the use of videoconferencing prompts is, can an accurate diagnosis can ever be achieved “over the phone”? In human medicine, videoconferencing has intuitive benefits, including convenience, reduced costs, and improved access to specialists. Long-term study of these benefits is limited, but it is suggested that outcomes are at least as good as those achieved through traditional models of healthcare delivery.8
So why do we fear this technology? Possibly we fear where it all could lead. The fast growth of telemedicine has legal and ethical standards struggling to catch up. This is where we need to be careful—the rules of the game don’t change because a consultation occurs electronically rather than face to face. The standards of care and laws of healthcare provision do not change, but with appropriate oversight, the continued advancement, implementation, and acceptance of this technology could help veterinary medicine augment animal health and welfare. We will see!
- AVMA Practice Advisory Panel. Final Report on Telemedicine. January 13, 2017. Accessed April 2017. avma.org/KB/Resources/Reports/Documents/Telemedicine-Report-2016.pdf.
- American Telemedicine Association. Q&A. Accessed April 2017. americantelemed.org/main/about/about-telemedicine/telemedicine-faqs.
- Poteet BA. Veterinary teleradiology. Vet Radiol Ultrasound 2008;49(1 Suppl 1):S33-S36.
- Mazan MR, Kay G, Souhail ML, et al. Patients without borders: using telehealth to provide an international experience in veterinary global health for veterinary students. J Vet Med Educ 2016 Sep 30:1-8.
- Sims MH, Howell N, Harbison B. Videoconferencing in a veterinary curriculum. J Vet Med Educ 2007;34(3):299-310.
- Mtema Z, Changalucha J, Cleaveland S, et al. Mobile phones as surveillance tools: implementing and evaluating a large-scale intersectoral surveillance system for rabies in Tanzania. PLoS Med 2016 Apr 12;13(4).
- Mars M, Auer RE. Telemedicine in veterinary practice. J S Afr Vet Assoc 2006;77(2):75-78.
- Taqui A, Cerejo R, Itrat A, et al. Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis. Neurology 2017;88(14):1305-1312.