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Telemedicine – are we reaching stalemate?
  1. Josh Loeb

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Like it or not, perception often matters just as much as reality.

As the governing body for the organisation that regulates the veterinary profession, RCVS council must not merely behave in a way that is beyond reproach, it must also be seen to be behaving in such a way.

That is particularly true when council is making decisions about controversial topics – and few would deny that remote prescribing is controversial.

At its most extreme, the nightmare vision is of vets dishing out last resort antibiotics ‘willy nilly’ to treat animals they’ve never even seen. Some critics of remote prescribing fear that relaxing rules around ‘under his care’ could open the way to the ‘Uberisation’ of the profession, whereby tech disruptor companies would do to vet practices what Uber has done to the licensed black cab trade. Basically, the fear is of a general loosening of prescribing rules.

Remote prescribing does indeed raise thorny questions. Who’d be held accountable if a vet, perhaps one based in another legal jurisdiction, remotely misdiagnosed a patient or prescribed the wrong medicines? Who’d pick up the pieces when things go wrong? Would a multi-tier system ultimately develop whereby there’d be different rules for different types of vets practising in different ways in the same marketplace?

Even supporters of remote prescribing acknowledge that these are ‘issues’, but they argue that solving such problems is not impossible, and – since technological change is happening anyway – it is better to get ahead of and control its impact. Change to stay the same, in other words.

There is, surely, scope for compromise between the two rival camps, but as Vet Record reports this week (see pp 286-287), a disconnect appears to have arisen between the college and some members of the profession.

Some vets evidently perceive there to be something questionable about how the college is operating. There are mutterings about conflicts of interest and lobbying by corporates (but there is no evidence of any wrongdoing by the RCVS).

This vague perception that there is something not quite right afoot is hardly quelled when RCVS meetings at which remote prescribing and telemedicine are discussed are held in private – as has happened – and when it transpires that a council member who said she always declared her interests ‘at every single stage of the proceedings’ turns out not to have done so (see VR, 7 September 2019, vol 185, p 249). That was quite possibly an innocent oversight – and it’s hardly Watergate – but that’s not the point. Perception matters, and these acts and omissions don’t look good.

Then there’s the external legal advice that the college has received but won’t publish, citing ‘legal privilege’ even though this is not in and of itself a reason to keep it private.

There’s a wider issue about trust

There’s also a wider issue about trust. In April last year the RCVS published a review of the use of telemedicine within veterinary practice. It found that a clear majority (69 per cent) of respondents to a survey sent to members of the veterinary professions thought the current definition of ‘under his care’ should not be extended to allow vets to prescribe medicines where there has been no physical examination of the animal.

Yet now the RCVS is planning another review relating in part to guidance around ‘under his care’.

This review could influence the regulatory framework within which vets must operate – more fodder for conspiracies. Some may ask why the RCVS is persisting in reviewing something that a majority of vets have already said they don’t want to see change.

A certain amount of suspicion and scepticism is, of course, only healthy, but as Vet Record explores this week, the true situation is – ironically – more mundane. In short, nothing is happening. RCVS council is deadlocked. Things are ping-ponging back and forth between different committees because no-one can make a decision.

In that sense, those who want the status quo to continue are winning. But is the profession losing out as a result?

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