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From clinical pathology teaching to telemedicine
  1. Anne Pietersma

Abstract

Since moving to the UK from Canada in 2006, Anne Pietersma has set up a telemedicine referral service. Here, she explains how it came about

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I COMPLETED my DVM degree at the University of Montreal (the only French-speaking veterinary college in the Americas) and immediately did a residency and then a Masters in veterinary clinical pathology at Washington State University, USA, on the very different west coast of North America. This was followed by the board exam of the American College of Veterinary Pathologists (ACVP) in the specialty of clinical pathology, before returning to my alma mater where I taught for 10 years. After tenure, I headed the teaching hospital's clinical pathology laboratory for several years. Although passionate to this day about teaching, a long career in academia was not my calling: I was married to a Dutch husband and after one too many yearly trips to in-laws across the pond, the call of Europe came for us and our two daughters (now 10 and 13).

During a one-year stint in the Netherlands in 2004 to help set up a clinical pathology residency at Utrecht, I started working as a consultant in toxicological clinical pathology for the pharmaceutical industry. I also joined in the efforts to shape the emerging European College of Veterinary Clinical Pathology, and I currently sit on several of its committees, holding the post of secretary for a second term. Being part of this young college has been a great opportunity – helping to develop its examination over the years, seeing new and younger colleagues come in, and developing an overview of its activities as well as sometimes struggling to write its newsletters! But the ability to interact with colleagues from all over Europe has been especially interesting. So, all told, promoting the clinical pathology specialty in this continent has proved to be an exciting experience.

Finally, in 2006 my family and I came to the UK, where a greater similarity with Canadian culture than can be found elsewhere in Europe allowed me to dare to call it home.

After working in the pharmaceutical industry for a few more years, diagnostic veterinary medicine beckoned once more. Ever seeking new frontiers, I eventually left the pharma work (still occasionally consulting on a freelance basis) and came to focus on telemedicine in 2009 as my new pet project.

Fuelled by colleagues' enthusiasm for establishing this type of service in the UK, and eventually in the EU, I've had another opportunity to engage with colleagues, this time across different disciplines in the veterinary profession – from diagnostic imaging to internal medicine, to surgery and other organ-specific specialties – and sharing in their experiences in the UK and abroad. This has been very fulfilling. One of the triggers was seeing that some American telemedicine providers were regularly starting to exhibit at small animal conferences in the UK, so I and others agreed that the country had plenty of veterinary specialists and that it should therefore have its own service. As a result, in 2009, TeleVetDiagnostics was born.

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Its aim is to group specialists from across the country and offer first-opinion vets easy access to guidance to assist in clinical case management for those cases where referral is not an option or not deemed absolutely essential. To date, we have amassed a team of more than 20 consultants in the UK, and over 50 worldwide (and growing), in a range of medical disciplines, working in academia and referral centres.

We hope to continue to grow this as a means to form a solid network of veterinary colleagues across as many disciplines as possible. The objective of such a network is to provide a critical mass that links vets with specialist colleagues who can respond to queries promptly. With a fee-for-service option, practices requesting this type of online advice (and written report) can in turn offer it as a service to pet owners. Happily, the feedback received since implementing the service in 2009 shows that a growing number of users do in fact do just this.

Practice managers and owners report that acceptance of the service and its associated fee by pet owners has been excellent, supporting the notion that the concept seems to be readily understood after it is briefly explained by the veterinary surgeon to his or her client. Some vets also use the consultant's reports for their CPD needs, for instance, to assist with case reports that may be required in preparing their RCVS certificate work. So, although telemedicine in the form of seeking a second opinion online is still largely a novel concept, when it's tried by vets, the perception is that it succeeds in creating a triple-win situation for the first-opinion vet, the specialist colleague and the pet owner.

Vets registered to use the service can upload a range of information, from laboratory data to digital radiographs, CT or MRI scans, and even videoclips. These are then passed to the most appropriate consultant on the team, who provides a written report usually within a half day or less. Registration to use the service is free and exclusive to veterinarians. There is no flat fee, with only consulted cases being billed on a pay-as-you-go basis.

■ More information about TelevetDiag­nostics is available at www.televetdx.com.

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