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What will future vet consults look like?
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By Claire Read

When Dan O’Neill qualified as a vet, 30 years ago now, he essentially had one source of information when seeing clients: his brain. ‘The only extra information you had was the formulary, to look up dosages.’

It is a situation which already feels alien in contemporary veterinary practice, in which Google and other electronic information sources provide additional information in a few keyboard strokes and the click of a mouse.

But within the VetCompass programme at the Royal Veterinary College – a big data initiative which O’Neill began as part of his PhD and on which he continues to work alongside colleagues – there is a vision to make such support more effective still.

The team is building functionality that would sit within a practice management system and help vets predict rare genetic issues ‘that no vet in practice would necessarily know nor remember’.

It is a perfect illustration of the extent to which technology has already enabled veterinary practice to evolve, but also how much further progress might be made. And with Covid-19 necessitating changes to the way in which care is practised, there is a sense of more rapid acceleration towards that future.

Covid has brought the use of technology to the forefront

‘Covid has brought the use of technology to the forefront, perhaps in a quicker manner than we were anticipating,’ reports former BVA president, now senior vice president, Daniella Dos Santos.

In this context, a Vet Record roundtable discussion held in late June felt simultaneously timely and forward looking. The event, which was run in association with Mars Petcare and the BVA, virtually brought together a small panel of experts to imagine the veterinary consultation of the future.

Panellists were intentionally drawn from a range of perspectives, with expertise in areas including the microbiome, genomics and genetics, big data, and technology such as wearables and virtual reality. And all were keen to emphasise that the question in front of them was one that needed to be considered not only from the viewpoint of the veterinary team, but from that of clients.

As the co-founder and chief veterinary officer of Vet-AI, Robert Dawson is currently working on a project to create an automated gait analysis using video clips. It’s envisaged the analysis could be used in the first instance by animal owners.

‘We have a working model now that can track joints in dogs, cats, and horses. I think that is something that could definitely be used in practice, but also you could give to people to try and engage them in the profession earlier.’

There is hope in some quarters too that wearable technology could in time enable the veterinary team to monitor pets more consistently and intervene earlier.

‘I believe that the next generations in wearables will be smaller in size, and more reliable, which means that we will be able to gather huge amounts of data for animals from the beginning of their lives,’ suggested Timokleia Kousi, a vet and the founder of The Vet Futurist blog.

‘Possibly we could then have artificial intelligence algorithms that can go through this data and can analyse it and we will have early indicators of changes and abnormalities.’

Whether such developments are likely to become widespread – and how swiftly – will of course depend in part on client comfort with the idea that the veterinary team values having more information.

‘Some clients are comfortable with the idea that their vet doesn’t know everything at the moment that you speak to them,’ argued Christopher Queen, a vet at the Umm Suqeim Veterinary Centre in Dubai and known online by his moniker of ‘The Nerdy Vet’.

‘There are other clients who still have this old fashioned idea that you should know all of veterinary medicine – keep it all in your head. So, I think it’s going to take some time to change clients’ ideas of what a good clinician is capable of, and realising that we do have limits and we do have to fall back on resources as well at times.’

Education of clients will be key, panellists suggested, and here Lucy Middlecote saw real opportunities for veterinary nurses to play a role. ‘I think veterinary nursing teams, as well as the vets, are going to be absolutely vital in terms of getting clients on board and helping them to see the worth of these technologies,’ suggested Middlecote, who is student experience manager at Linnaeus Group. ‘I think this could really feed nicely into actually helping nurses to feel their value.’

But if veterinary teams are to be able to educate clients, they are likely to need education themselves. As technologies and research develop, the information available to clinical teams is likely to become even more extensive.

‘One of the things that’s really changing in our profession is just our understanding of animal diseases in general,’ suggested Tim Williams, a practising vet as well as a researcher at the University of Cambridge.

‘We’re learning more about how some diseases that we used to think of as just one disease entity are actually a plethora of different diseases that just present in the same way, and we’re starting to dissect those different diseases out from one another, and come up with better ways to diagnose and also to treat them.

‘The classic example for me would be canine lymphoma. Now we’re doing things like immunophenotyping, so the flow cytometry that we do here in Cambridge, and that’s allowing us to differentiate different sub-types of lymphoma. Our clinicians are starting to treat them with different protocols, and hopefully getting better outcomes.’

So what do such developments mean for the way in which veterinary care will be practised? For Williams, a key theme is the need for greater levels of specialisation. ‘I think that more of us are going to have to sub-specialise in order to keep up with all of these developments, and to give the very best care to our clients. That’s going to involve all vets being comfortable passing cases onto others.’

The idea of an increased need for collaboration was echoed by Cathryn Mellersh. Mellersh, who has spent 25 years in the field of genetics – 17 of them as head of canine genetics research and genetics services at the Animal Health Trust, up until its closure at the end of July – is in no doubt that her field of work can and will make contributions to better treatments. But to do so will, she argues, require greater collaboration between researchers and members of the veterinary team.

‘Studies to understand the genetic basis of complex diseases require large numbers of samples,’ she stressed. ‘That will only really work best if lots of clinicians are contributing and gathering samples. I’d like to see a greater interplay between clinicians and researchers.’

Such conversations would, many panellists argued, help ensure that research is targeted to where it can offer most value to practice – helping erase traditionally unhelpful boundaries between the two.

We need to move into a new world where research is all of us together, and it’s practice-based with an academic side

‘When I was in practice I always felt it was us and them,’ reported O’Neill. ‘It was the practitioner working away at the coalface, and then these really intelligent people who were in universities way above my pay grade and brain level. I think now we need to move into a new world where research is all of us together, and it’s practice-based research with an academic side.’

One of the areas of research which has the most tendency to cause excitement is that on the microbiome. It’s an area in which Jan Suchodolski, associate professor of small animal internal medicine and associate director for research of the GI Lab at Texas A&M University, has worked for some time.

But he too argued that the most value comes from focusing on the common questions practitioners are most likely to encounter on a daily basis. ‘I think there’s no point in doing a microbiome analysis if it doesn’t change what you’re going to do as a veterinarian,’ he contended.

Developments will only ever be useful if they answer a question which the veterinary team wants answering

And when panellists discussed just what it would take for technology and research developments to really inform care – to change standard practice – this was a theme frequently echoed. Developments will only ever be useful if they answer a question which the veterinary team wants answering.

‘There are a huge range of factors that make the use of technology a positive or a negative experience,’ suggested Dos Santos. ‘But above all, it seems to be whether or not it adds perceived value to both the clients and the vets.’

Added Queen: ‘I used to be very much of the opinion: “Great, cool tech, let’s use it”. But I’m rapidly coming to the idea that it’s important not to lose sight of the fundamentals. And those fundamentals don’t change: the importance of a really strong vet-client relationship and clinical examination.’ ●

An animated video from the debate is available now on the Vet Record website. A supplement looking in more detail at the shape of the veterinary consultation of the future will be published in November.

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