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While telemedicine as a venue for client-patient interaction is relatively new in the veterinary field, our fellow MDs famously implemented remote patient monitoring and video conferencing all the way back in the 1960s for NASA’s Space Program astronauts. If you’ve ever seen The Right Stuff, you’ll surely recall the scene when Mission Control, after interminable launch delays, tells Alan Shepard to urinate in his space suit and then watches his medical data sensors short-circuit. Over the last few years, MDs have employed synchronous (real-time) patient visit technology in earnest, partially due to increased accessibility and partially due to patient demand.
COVID-19 quarantines have shortened the timeline to implementation of telemedicine in the veterinary space. But even without this disrupter, telemedicine has the potential to catapult veterinary medicine to an entirely new level of patient care. Let’s take a moment to think about how we can maximize the success of each virtual visit.
1) Select The Right Cases.
a. Telemedicine is appropriate for recurrent atopy but not complicated pyoderma, initial limp evaluation but not acute trauma, colitis but not chronic diarrhea. Common sense must prevail.
b. The one instance in which telemedicine may outshine in-patient evaluation is ongoing behavioral consultation, because it will allow you to see that pet in its native setting.
c. With Fear Free techniques gaining traction across the country, telemedicine provides another tool to decrease fear, anxiety, and stress in severely affected patients.
2) Set Client Expectation.
a. If the virtual visit leads to an in-person evaluation, communicate your protocol and prices from the start. No standard practices currently exist in veterinary medicine. You can institute a recheck-level telemedicine fee that graduates to an adjusted in-hospital exam fee, or begin with a full exam fee (due to the convenience telemedicine provides) and then progress to an adjusted “further assessment” fee, etc. By way of precedent, some MDs charge their own cash copay (regardless of the insurance company copay) for the added convenience of the virtual visit.
b. If technical issues arise, ensure that you and the client have each other’s contact information and establish the best way to continue the conversation, whether that be you re-establishing the connection through the app, calling them on their phone, or vice versa.
3) Build Rapport Through The Screen.
a. If you participate in real-time, two-way video chats, place the screen at eye level, maintain eye contact, and nod at appropriate times to demonstrate your focus on the task at hand. If you look down to write notes, tell the client what you are doing to further reinforce the fact that they have your undivided attention.
b. Without the benefit of a physical exam, establishing the patient’s history becomes even more critical. Ask open-ended questions and repeat back to the owner what she has said, in your own words. This type of reflective listening strengthens the bond between you and the client like nothing else—and is especially crucial when a screen divides you.
c. Clearly explain the action plan that has resulted from the visit. Since no one involved in the telemedicine visit is a seasoned pro, extraneous energy is going to be spent navigating the novelty of it. The more concise and direct your recommendations, the better the client experience and compliance will be.
4) Don’t Forget the Nitty Gritty.
a. Make sure your volume is on.
b. Plug in your digital device (and use a wired internet connection) whenever possible.
c. Conduct the virtual visit in a quiet room without distractions.
d. When using two-way video chat, ensure no lights in the room flicker and do not wear loud patterns, pinstripes, or over-bright colors (including, possibly, a bleached white lab coat), as all of these can make the viewer on the other end feel nauseated.
e. Speak up if the client needs to provide better lighting for you to evaluate the patient.
While our patients may not be hurtling through space in a Mercury capsule with the world looking on, we nonetheless can harness the power of telemedicine to improve our patients’, clients’, and own lives. Technology has changed our paradigms in medicine a thousand times already. Buckle up. This ride is going places you never dreamed—maybe even back to your den sofa.