The first message I received was in Ukrainian. I swallowed, nervous. I asked a colleague to translate the text message. Meanwhile, I cycled through worst-case scenarios: Gunshot wound? A crush injury after a missile strike? A traumatic brain injury after a bomb explosion? I received the translation: “My cat, Мурчик, is peeing outside the box. What can I do?”
“Oh, that’s not so scary,” I thought. I asked whether anything had changed in the cat’s home or neighborhood.
“Yes, we have daily air raids here.”
Well, that’ll do it.
That was the day Russia’s war against Ukraine became real for me. The humanitarian organization Animal Help Ukraine had put Ukrainian pet owners in touch with U.S. veterinary professionals. I was one of the volunteers giving advice.
The cat owner I communicated with was asking about a familiar concern for a surreal reason. But even being a world away, I could help. If you took away the air raids, shootings and crumbled buildings, we were just a pet owner and a veterinarian discussing a cat’s potty behavior. I took a history to investigate for signs that something else might be causing the inappropriate urination. When I found nothing suspicious, I told the owner what to try at home to help the cat feel less stressed.
The plight of Мурчик (pronounced Moore-cheek) wasn’t unique. A year into the project, our team of volunteers had used telehealth to assist an additional 10,000 Ukrainian pets. I was proud that, in a time of war, we could offer peace of mind to our Ukrainian friends that their furry companions were not sick or suffering.
The Veterinary Definition of Care
The success of the Animal Help Ukraine project was eye-opening. A randomized sample of the engagements revealed that 71% were resolved remotely, leading me to question the conventional boundaries of care defined by the American Veterinary Medical Association and many veterinary professionals.
In the October/November 2023 issue of Today’s Veterinary Business, AVMA President Dr. Rena Carlson stated: “Let’s be realistic. Often, when people talk about access to care, their thoughts go to basic care. The basic care most animals need is preventive care tailored to an animal’s specific circumstances. That requires an in-person visit.”
Admittedly, I used to think the same thing until I started working full time in the world of telehealth. (I have performed tens of thousands of consults since then.) I quickly realized that, based on their presentation and history, pets can receive valuable services that don’t require a physical exam. From triage to post-treatment support, telehealth has revealed its crucial role in the continuum of care.
Those who push back hardest against telehealth often have a narrower definition of care, further bolstering barriers to veterinary access. Limiting the definition to the education, diagnostics and treatments that occur only during and after a physical exam discounts the countless health care decisions that well-intentioned yet medically untrained pet owners make throughout an animal’s life.
This narrow definition prevents veterinarians from exercising their skills, knowledge and experience to fill in the gaps of what most traditional clinics don’t have the time or bandwidth for. That is, helping pet owners make medically appropriate decisions between in-person appointments.
Irrespective of whether we get the support we need from our representative body, pet owners will continue to demand easier access to veterinary care. People use telehealth for their human children, so isn’t it reasonable to expect a similar service for their fur children?
Pursuing Alternative Care
One thing I learned in my years of telehealth work is that when pet owners have questions, we can achieve the best patient outcomes by meeting people where they are. That might mean:
- Technologically: A text message versus a phone call.
- Geographically: What to do about a tick found on a pet during a hike.
- Temporally: Sending a daily check-in text for several days after surgery.
- Emotionally: Talking to a worried pet owner whose dog is vomiting profusely after taking antibiotics.
If in-clinic veterinary care doesn’t meet pet owners where they are, they will continue to turn to alternative sources of information, such as Google and social media.
Telehealth proponents have tried to intervene for years. They have seen alternative mechanisms of pet care develop and have been somewhat successful in bridging the gap between pets and vets. When veterinary care is easily accessible, pet owners don’t have to turn to the inaccurate, misleading and sometimes dangerous information sources found elsewhere. When veterinary care is easily accessible, many people prefer to run their care decisions through us, the veterinary professionals. Let’s invite pet owners to work with us by meeting them where they are.
Redefining Telehealth
Because the definition of telehealth is so broad, some service providers use the term in ways that aren’t aligned with the original intention of increasing access to care. I’ve seen telehealth services built entirely to answer members’ questions. I’ve seen telehealth services answer calls from clients with the sole intention of telling them to go to their veterinarian, regardless of the presenting complaint. I’ve also seen telehealth services devolve into fronts for selling as many prescription or over-the-counter products as possible.
Telehealth has become a potpourri of “things I can do remotely to help my business” instead of a mechanism by which we can increase access to veterinary care. It’s time to part ways with the muddied term “telehealth” and decide how we can provide services that address the broader definition of care. I propose the phrase “decision support.”
If we expand the definition of veterinary care to address the full needs of the pet and client, then our most impactful role will shift to helping pet owners make better decisions about when and where to seek in-clinic care. That role means listening to and empathizing with pet owners when they tell us they can’t go to a clinic (for whatever reason) and helping them by using our knowledge and skill set. That role means implementing technologies, embracing innovation and utilizing remote monitoring devices such as wearables and smart litter boxes.
It also means sometimes telling pet owners they don’t need in-clinic care. In that case, we should educate them on what to look for at home that would indicate the need for in-clinic or emergency care. We can still use our “scientific knowledge and skills for the benefit of society,” as the Veterinarian’s Oath says, if we agree to adapt.
A PICTURE OF INCOMPLETE CARE
My stepmother had knee replacement surgery a few years ago. She developed a post-surgical infection and was sent home with a three-antibiotic regimen. The medications caused profuse vomiting that prevented her from keeping food down for weeks. Her medical team didn’t follow up with her and expressed no concern when she asked for help. She was in such a bad condition when she arrived at her next appointment that she was checked into a hospital because of severe dehydration.
Her story is like those I hear from pet owners: a lack of timely follow-up, confusing treatment directions and a sense of abandonment. Such experiences sow seeds of distrust, not just with a single veterinarian but with our industry as a whole.