The ASPCA Animal Poison Control Center, staffed by dozens of veterinary professionals, has responded to 4 million cases of pet toxicosis over its 45-year history. Meanwhile, Pet Poison Hotline, under parent company SafetyCall International, employs practitioners, pharmacists and board-certified veterinarians. Those two services and other poison helplines are utilized by animal owners nationwide and incorporated into the workflow of many emergency room practices.
Arguing against the value of those pet poison services would be difficult, and yet none requires an in-person veterinarian-client-patient relationship. In fact, all of them rely on a virtual VCPR, and all trust the judgment of their veterinarians and teams. Furthermore, local, state and national veterinary organizations haven’t objected to the virtual VCPR. Pet owners pay the helpline veterinarians for medical services, and the doctors aren’t accused of practicing veterinary medicine unethically. Such a model is a trusted example of a virtual VCPR’s proven value.
Drawing From the Experience of Others
What about a virtual VCPR for telemedicine in veterinary practice? The U.S. veterinary profession is in the enviable position of being able to draw upon the experience of others. For example, the American Telemedicine Association was founded 30 years ago to advance telemedicine in human health care. Today, the virtual doctor-patient relationship is allowed in all 50 states. Legislatures supporting a virtual doctor-patient relationship were enticed by the benefits of giving their constituencies more access to health care, similar to what veterinary medicine now faces.
Meanwhile, a veterinary experiment occurred in Canada. In 2018, the College of Veterinarians of Ontario revised its Professional Practice Standard on Telemedicine to allow veterinarians to establish a VCPR virtually, requiring them to use sound judgment to determine whether telemedicine was appropriate in each case. In response to the COVID-19 pandemic, the CVO amended its rule in 2020 to also allow veterinarians to prescribe medications when a virtual VCPR was established with “appropriate and sufficient knowledge.” After the COVID threat diminished and veterinarians could see in-person cases again, 81% of the practices continued to use telemedicine.
Notably, the CVO has yet to receive a single complaint from a veterinary client about an adverse outcome resulting from telemedicine or the creation of the virtual VCPR. The same holds in U.S. states that permit a virtual VCPR and those that temporarily relaxed regulations during the pandemic. These real-world examples are testaments to veterinarians using telemedicine and the virtual VCPR and their ability to make sound professional judgments, including when telemedicine is appropriate for patients and when a virtual VCPR is applicable.
Guidelines With Guardrails
The Veterinary Virtual Care Association, on whose board we have served, is committed to advancing telehealth in veterinary health care. Developing the VVCA’s Model Telemedicine Regulations — learn more at bit.ly/3kUbF7a — was a three-year journey. The model regulations were founded on the veterinarian’s judgment and include guardrails addressing concerns about a virtual VCPR.
The model regulations also were informed by the Veterinary Innovation Council’s three Cross Industry Forums, which brought together leaders from across the profession in 2022. Following rich, forthright discussions, the vast majority of forum participants agreed that a virtual veterinarian-client-patient relationship is feasible and desirable with appropriate guardrails. As a result, we expect this inaugural model to evolve as veterinary medicine increasingly adopts telemedicine.
The truth is veterinarians have practiced telemedicine for a very long time by phone. Since the creation of the smartphone, that advice is better informed by high-quality photos and videos. The truth also is we don’t know a single veterinarian who won’t bend laws and regulations forbidding a virtual VCPR when a patient truly needs care. Faced with an animal in need, veterinarians will help.
Unfounded Fears?
Animal poison control centers operate very much like telemedicine services. Some critics contend that a virtual VCPR is appropriate only within the setting of such helplines because the veterinarians and response teams are confronted with an emergency and do not have the luxury of establishing a physical relationship. However, such solid reasoning also can be applied directly to veterinarians in practice. They’re medical professionals who possess the skills and judgment to manage emergency cases through virtual relationships.
Generally, veterinarians entered the profession to help animals and the owners who love and depend upon them. Therefore, it hardly seems fair to accuse veterinarians who use a virtual VCPR of:
- Unethical behavior.
- An inappropriate focus on profits over animal welfare.
- A lack of professional judgment to manage their cases appropriately.
Certainly, unethical veterinarians will abuse the system. For example, prescription drugs are improperly sold off the shelf and online. Those unscrupulous individuals should be dealt with while we permit ethical veterinarians to provide the care they deem their patients need. After all, the government doesn’t eliminate banks because some people rob them.
We must support the ability of dedicated, ethical veterinarians to provide quality virtual care. If we pose too many restrictions on veterinarians doing things the right way in order to prevent abuse by others, we could inadvertently drive clients seeking convenient care to the latter group.
Simply stated, a virtual VCPR works. The entire profession, individually and collectively, should advocate for a virtual VCPR in every state. The VCPR should be a door into veterinarian-guided health care, not a barrier.
WHEN TELEMEDICINE IS APPROPRIATE
The Veterinary Virtual Care Association advises using telemedicine in instances such as:
- Postoperative care and reevaluation
- Triage
- Medical cases, including initial history taking and discussion of diagnostic workups
- Medical case reevaluation
- Palliative, hospice care and quality of life
- Behavioral consultations
- Nutritional consultations
- Management and monitoring of chronic conditions
- Puppy and kitten information sessions
- New client meet-and-greets
- Prescription and pet food refills for current patients
- Veterinarian-to-veterinarian consultations
For more information, read “Best Practices: Evaluation and Treatment of Patients” at bit.ly/3KWnd4l.