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Telemedicine – the threat in the opportunity
  1. Iain Richards, BVSc, CertVA, CertSHP, MVetSci, MRCVS

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Iain Richards is an independent veterinary consultant at Lakesvet Consultancy, based in Heversham, Cumbria

Since the RCVS held an Innovation Symposium in 2017, there has been wide coverage of telemedicine in the veterinary press, mostly commending the overall concept. This is broadly welcome; undoubtedly telemedicine has the capacity to greatly enhance veterinary care. But, there are some aspects that sadly represent an abrogation of that care.

It is important to consider what, precisely, is meant by telemedicine, because within the current debate, the term is used somewhat loosely. At its simplest, telemedicine is no more than an extension of the use of the telephone. Anyone who has had a pony owner call them regarding a cut leg would be grateful for the ability to view the location of the wound and decide how urgent the call may be. Farm practice would also be lost without phone advice. Equally, we’ve consulted colleagues via phone, and perhaps emailed radiographs for a second opinion. Phone ECG has been available since the early 90s, providing an ability to diagnose unusual rhythms in an emergency. The key factor with all of these examples is that the telemedicine is taking place within the normal vet-client relationship and continuity and care of the animal is assured. Digitisation of images and computer-aided diagnostic packages can only improve this aspect of practice, something all vets would welcome.

The aspect of telemedicine that gives the greatest cause for concern is that of remote prescribing; in particular, a change to the code of conduct, which would permit prescribing outside of the normal vet-client relationship. It is curious why this topic has remained under consultation within the college for so long, not least as the college’s own survey in 2017 showed that the majority of the profession felt such practice was ‘high risk’ or ‘not appropriate’. I hope that the promised review of the definition of ‘under his care’ enshrines that important principle. Prescribing should only take place within the vet-client relationship, not least for support in case of ineffective treatment or adverse reactions.

Prescribing should only take place within the vet-client relationship

However, in concentrating on remote prescribing, the more important debate on how video consultations, ‘wearable tech’, and artificial intelligence (AI) will affect veterinary care is being ignored. Video consultations are already on the market and providers claim that these offer a useful adjunct in cutting down on unnecessary vet visits. A better scenario would be if video consultations were simply taken within normal surgery sessions, making them merely an extension of a phone call. The use of AI as a diagnostic tool is of greater concern, not least in regards to its accuracy. Human diagnostic apps have come under severe criticism regarding their diagnostic accuracy and if mistakes occur for one species with a large clinical database, then the margin of error for animal diagnostics is surely much greater. The same concerns apply to wearable monitors and to animal-side diagnostic devices. A client testing their animal’s faeces, declaring the presence of salmonella and requesting antibiotics is perhaps one awkward scenario we might face. And how long will it be before a lay scanner requests medication for the cardiomyopathy they have diagnosed by measuring the heart?

Despite these concerns, there might also be great opportunity in the use of AI. Imagine the ability of a program to sift through the notes of a complex case, compare lab results to known sensitivities and specificities of the tests, and to produce a differential list to add to that of the clinician’s.

The review of ‘under his care’ should take place alongside a discussion on diagnostics in a changing world. A key part of the review is that any new technology has to consider the benefits for animal welfare alongside the integrity and trust the public rightly expects from the profession. The RCVS recently made a commendable statement regarding vets not relying on untested remedies; the same caveat should apply to untested diagnostics.

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