{"id":9373,"date":"2020-12-01T00:00:30","date_gmt":"2020-12-01T08:00:30","guid":{"rendered":"https:\/\/todaysveterinarybusiness.com\/?p=9373"},"modified":"2022-06-15T17:46:42","modified_gmt":"2022-06-15T17:46:42","slug":"telemedicine-otitis-pets","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarybusiness.com\/telemedicine-otitis-pets\/","title":{"rendered":"See for Yourself"},"content":{"rendered":"

Conventional wisdom says veterinary dermatology is more telemedicine-friendly than, say, internal medicine because the patient\u2019s problem is on the outside rather than the inside. This means lesions, redness, pustules and the like can be visualized in photos, videos or a live camera feed and shared with a practitioner.<\/p>\n

However, with otitis, the problems can reach deep into the ear, requiring the use of an otoscope. And, of course, there\u2019s often the need for cytology, which isn\u2019t something that can be performed electronically.<\/p>\n

Does that mean telemedicine can\u2019t play a role in treating otitis<\/a>? Hardly. The key, experts say, is to be fully aware of the limitations that telemedicine imposes and to work within those parameters in full transparency. This means focusing on communicating with the client and, often, making the patient comfortable until an in-person exam can be performed.<\/p>\n

Here are the insights of three veterinarians \u2014 two general practitioners and one dermatologist \u2014 who build bonds with clients by using telemedicine in ear cases.<\/p>\n

Dr. Stacee Santi:\u00a0If It Quacks Like a Duck \u2026<\/h3>\n

Stacee Santi, DVM, of Durango, Colorado, is the creator of the Vet2Pet app that lets veterinary practices customize how they engage with clients through mobile devices. She has a long history in general and emergency practice and no shortage of otitis cases.<\/p>\n

Many otitis patients are what Dr. Santi calls \u201crepeat offenders\u201d or \u201cfrequent fliers,\u201d and these are the cases she thinks are best suited for telemedicine.<\/p>\n

\u201cIf this is a golden retriever that I\u2019ve seen every spring for six years in a row and I have a history of cytologies<\/a>, I would absolutely be comfortable looking at a few telemedicine photos, asking some questions and starting therapy,\u201d she said. \u201cThat could rattle some veterinarians, but it wouldn\u2019t rattle a lot of us, because 99 out of 100 times we\u2019re going to nail it.\u201d<\/p>\n

To rule out urgent conditions like a ruptured eardrum, head tilt or severe pain, Dr. Santi might ask a client to send a video of the pet. Is it running around the yard or standing quietly with its head down? If the latter, the pet needs to be seen in person.<\/p>\n

She sometimes uses the Kleenex test, meaning the client puts a tissue in the pet\u2019s ear, swirls it around and sends a photo of the tissue.<\/p>\n

\u201cIf it\u2019s black and it smells like your kid\u2019s gym socks, it\u2019s probably yeast,\u201d she said.<\/p>\n

To be sure, the client can put that tissue in a baggie and drop it off at the clinic, where a technician can do a cytologic examination. \u201cInstead of a fecal sample, it\u2019s a cytology sample,\u201d Dr. Santi said.<\/p>\n

She tells veterinarians to use their comfort level.<\/p>\n

\u201cIf I was a new grad, I wouldn\u2019t be comfortable with this,\u201d she said. \u201cBut I\u2019ve been out 20 years and I\u2019ve seen many otitis cases, so I would give that a whirl. If it quacks like a duck and walks like a duck, it\u2019s probably a duck.\u201d<\/p>\n

Offering telemedicine can be a boon both to busy clients and busy practitioners.<\/p>\n

\u201cTelemedicine isn\u2019t going to drive revenue,\u201d Dr. Santi said. \u201cWhat it does do is give clients a more enhanced experience with you. It also helps you manage your schedule better. If you don\u2019t allow that golden retriever to come in on the telemedicine channel, and the only option is to have them come into the clinic as a walk-in\/work-in, then you\u2019re going to work overtime and miss lunch. Which one do you want?\u201d<\/p>\n

Of course, most telemedicine episodes need to be followed by an in-person exam to make sure the treatment is working and the pet is healthy. But here\u2019s where a veterinary professional can really blow clients\u2019 minds and use telemedicine to drive business.<\/p>\n

\u201cI can check to see if that pet is due for anything else,\u201d Dr. Santi said. \u201cLet\u2019s say I tell you, \u2018I want to do a recheck in 10 to 14 days. I noticed you\u2019re also due for a wellness exam<\/a>, vaccines and a heartworm test. Should we book all that right now and take care of your semi-annual?\u2019 People love that because it maximizes their time. What they don\u2019t love is to come in for a recheck and then you schedule them for a dental.\u201d<\/p>\n

Taking this approach not only increases compliance with follow-up appointments, Dr. Santi said, it also boosts the perception of value.<\/p>\n

Dr. Jeff Werber:\u00a0Ear Emergencies Often Aren\u2019t<\/h3>\n

Jeff Werber, DVM, the founder of Century Veterinary Group in Los Angeles and creator of the Airvet telemedicine platform, is all about keeping clients out of the emergency room. His service provides after-hours consultations for pet owners who want to know whether a situation is urgent.<\/p>\n

Very few ear infections are true emergencies, but clients don\u2019t know that, Dr. Werber said.<\/p>\n

\u201cBy the time they reach me on Airvet, they\u2019re truly worried,\u201d he said.<\/p>\n

If he can, Dr. Werber looks at the ear through the camera and asks about inflammation levels, discharge and the pet\u2019s apparent comfort level. While respecting the rules surrounding the need for a veterinarian-client-patient relationship, he might offer suggestions for an over-the-counter product like hydrocortisone or diphenhydramine to help the pet feel better until it visits its regular veterinarian.<\/p>\n

\u201cI often hear from them the next morning,\u201d Dr. Werber said. \u201cThey send me a chat \u2014 our cases remain open for three days \u2014 and say, \u2018You were right!\u2019 Clients love it.\u201d<\/p>\n

Dr. Werber\u2019s inspiration for telemedicine grew out of his method of practicing veterinary medicine.<\/p>\n

\u201cI was the idiot who gave clients his cell phone number, so I was providing true concierge care,\u201d he said. \u201cI was never getting paid for it, but I was scoring a lot of points.\u201d<\/p>\n

The payoff was a religiously loyal clientele.<\/p>\n

Dr. Werber recognizes that many millennial veterinarians who value a work-life balance don\u2019t want to be accessible to clients 24\/7. Millennial pet owners, on the other hand, demand that level of accessibility. Telemedicine can fill the gap by providing access to a doctor during those evening and weekend hours.<\/p>\n

Plus, if clients stick with their regular veterinarians the next day instead of making a trip to the emergency room, there\u2019s less chance the ER hospital will send the patients to its in-house specialist the next morning.<\/p>\n

\u201cI hate when these emergency clinics take over a case and never let the primary vet know what happened,\u201d Dr. Werber said. \u201cI don\u2019t like the primary doc losing control of his or her case.\u201d<\/p>\n

Dr. Werber has decades of experience with pet ear problems, so he\u2019s highly confident when he says he would send a patient to the ER only in the case of a laceration with lots of bleeding or something like a snakebite. Other doctors might be less experienced.<\/p>\n

\u201cI say, \u2018If you\u2019re not comfortable or 100% sure, don\u2019t be cocky. Send them,\u2019\u201d Dr. Werber said. \u201cBut I tell them to call ahead to let the emergency clinic know this is what your hunch is \u2014 \u2018Please evaluate this first.\u2019\u201d<\/p>\n

Dr. Werber points to demographics to make his case for telemedicine.<\/p>\n

\u201cWhat\u2019s the largest segment of pet owners? Millennials,\u201d he said. \u201cWhat\u2019s the fastest-growing? Millennials.<\/a> What\u2019s the highest-spending? Millennials. Well, guess what? This is tailor-made for millennials. They want convenience, they want it fast, and they don\u2019t want to travel.\u201d<\/p>\n

Dr. Ashley Bourgeois:\u00a0It\u2019s All About the Client<\/h3>\n

No one\u2019s trying to claim that telemedicine replaces an in-person exam, said Ashley Bourgeois, DVM, DACVD, the part owner and practicing specialist at Animal Dermatology Clinic Portland in Portland, Oregon. \u201cBut there\u2019s still a lot of benefit we can provide if the client can\u2019t get into the building,\u201d she said.<\/p>\n

Like Dr. Santi, Dr. Bourgeois uses telemedicine more with established clients and known-quantity patients with whose issues she is familiar. Some of her clients can\u2019t come in because of COVID concerns, or they\u2019re first responders whose hours don\u2019t line up with the clinic\u2019s.<\/p>\n

\u201cIf they have half an hour open for a telemedicine appointment, being able to walk through the history and have them send pictures ahead of time allows us to care for clients who otherwise might turn to the internet or their friends for advice,\u201d she said.<\/p>\n

Dr. Bourgeois won\u2019t prescribe systemic medication without cytology, but if the client is adamant about not coming in, she might try aggressive topical therapy.<\/p>\n

\u201cMaybe I can have them flush the ear once a day with a product I feel is safe without an otoscopic exam and see how they do,\u201d she said. \u201cI\u2019m honest with them that, \u2018Hey, we\u2019re going to try this, but without cytology, we don\u2019t really know what we\u2019re treating. If this doesn\u2019t work, we need to get your pet in so it doesn\u2019t progress and get worse.\u2019\u201d<\/p>\n

In cases where the problem can\u2019t be dealt with over telemedicine, Dr. Bourgeois\u2019 clients usually agree to come in.<\/p>\n

\u201cWhen you can explain your concerns and they can look you in the eyes over video chat and understand why \u2026 they listen. They\u2019re appreciative that you even tried,\u201d she said.<\/p>\n

At Dr. Bourgeois\u2019 clinic, if a doctor does a telemedicine exam and then determines the pet needs to be seen in person, the telemedicine fee will cover the clinic visit as well.<\/p>\n

\u201cIn these cases, we know exactly what we\u2019re going to do \u2014 cytology, maybe a sedated otoscopic exam \u2014 and we can get right to it,\u201d she said. \u201cAnd owners don\u2019t feel like they were double-charged.<\/p>\n

\u201cThis establishes trust for your relationship moving forward.\u201d<\/p>\n

Part of using telemedicine effectively is accepting its limitations, Dr. Bourgeois said.<\/p>\n

\u201cThere are definitely downfalls to it,\u201d she said. \u201cBut you just have to explain that to the owner \u2014 to say you can\u2019t do cytology or look in the pet\u2019s ear. I think telemedicine is more a way of talking to the client to direct where you\u2019re going to go next versus the be-all and end-all of that situation.\u201d<\/p>\n

She echoed what many telemedicine-friendly veterinarians say: It\u2019s a supplemental tool, not a replacement for an in-person exam.<\/p>\n

\u201cIf it\u2019s another avenue where I can talk to that client and I\u2019m managing the case \u2014 the internet is not managing the case \u2014 then I\u2019m happy to offer it,\u201d Dr. Bourgeois said.<\/p>\n

\n

TELEMEDICINE AND OTITIS<\/span><\/h3>\n

Here are some ways that veterinarians can use telemedicine to serve ear patients and their owners:<\/p>\n

    \n
  • Discuss the problem and collect the patient history via a two-way video chat or by phone.<\/li>\n
  • Determine whether a problem is urgent enough to require immediate care.<\/li>\n
  • Evaluate and discuss images showing redness, discharge and so on.<\/li>\n
  • Evaluate and discuss video to check for normal behavior versus, for example, head tilt, pain signals and signs of nystagmus.<\/li>\n
  • Demonstrate a home-care technique such as ear flushing or the application of a topical product. (Record these demonstrations to build a client education video library.)<\/li>\n
  • Recommend an over-the-counter product or home-care technique to relieve discomfort until an in-person exam can be done.<\/li>\n
  • Conduct a follow-up recheck after an in-person exam.<\/li>\n<\/ul>\n
    \n

    WHAT\u2019S BOTHERING PATIENTS<\/span><\/h3>\n

    Your veterinary practice probably gets many otitis cases, but have you ranked all the common conditions afflicting your dog and cat patients?<\/p>\n

    Pet health insurance provider Trupanion reported that an ear issue was the second-most-frequent health condition seen in pets since COVID-19 was declared a pandemic. No surprise, said Steve Weinrauch, BVMS, MRCVS, the chief product and veterinary officer at Trupanion.<\/p>\n

    \u201cEven though we\u2019re in a pandemic, it\u2019s clear to see that the things that our pets are usually impacted by doesn\u2019t change,\u201d he said.<\/p>\n

    From March 1 to May 31, 2020, Trupanion paid about 6,000 claims for otitis.<\/p>\n

    According to Trupanion claims data, the top 10 health conditions for pets during the pandemic are:<\/p>\n

      \n
    • Allergies<\/li>\n
    • Otitis<\/li>\n
    • Vomiting and diarrhea<\/li>\n
    • Lameness<\/li>\n
    • Mass<\/li>\n
    • Urinary tract infection<\/li>\n
    • Arthritis<\/li>\n
    • Cruciate rupture<\/li>\n
    • Seizure<\/li>\n
    • Diabetes<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

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