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One of the most common questions I hear from veterinarians who are looking into or have just begun offering telemedicine is: What cases are appropriate for a virtual visit? Indeed, proper case selection is imperative if we are to achieve success in veterinary telemedicine.
But taking a step back, we DVMs soon realize we already know which cases are good fits and which are not. Every phone consult we’ve ever performed during our skipped lunches and end-of-day call backs falls under the guise of telemedicine. We are, in fact, admirably able to decide from a chief complaint, signalment, and history whether we can provide proper care through client communication alone or a hands-on physical exam with diagnostics.
The real question my colleagues have, then, is rather:
“Is there a list of cases that our CSRs and veterinary technicians can use to schedule telemedicine visits appropriately?”
Yes, but first, let me highlight two things I’ve just done:
The Paradigm Shift
Your CSRs, who are already drowning in curbside phone calls on top of their other duties, have NO FORMAL MEDICAL TRAINING. Yet we are tasking them to triage calls in order to fill our telemedicine schedules. Wouldn’t it make more sense to use your trained-to-the-gills RVTs (and superbly experienced veterinary assistants) to determine if questionable cases can be directed to a virtual visit? For a deeper dive into this idea, check out Dr. Jessica Vogelsang’s delightful interview with Liz Hughston, RVT, here.
The 4-Step Telemedicine Decision Tree
a. The CSR conveys telemedicine is being offered to increase client convenience and decrease patient stress.
b. The CSR also informs the owner that the DVM may desire an in-clinic exam based on the telemedicine visit if deemed necessary.
4. When a client presents a questionable case, the CSR transfers the call to the vet tech “telemedicine liaison” for further evaluation and scheduling.
In this scenario, realize the initial clinic guidelines for automatic telemedicine cases will adjust as exceptions arise and as staff members gain confidence. In the beginning, keep your list of default telemedicine visits small and rely heavily on your RVTs to fine-tune your case selection.
According to the GuardianVets FAQs, telemedicine MAY be appropriate for the following situations, provided that a valid VCPR is in place and that professional services can be safely provided to your patient. (Note: I’ve listed these in order—from most straightforward to least—to aid the drafting of initial clinic guidelines.)
* Conditions for which telemedicine can be superior to the in-person exam.
Telemedicine is NOT appropriate for the following situations:
It will take years of compiled case studies to establish a list of specific diagnoses for which telemedicine proves useful, but here’s a start, nose to tail:
Feel free to grow the list as you gain experience. The guiding principle for case selection is simple: if you can see it, you can probably telemedicine it. If you have to smell it, feel it, auscult it, image it (or cytology, skin scrape, Schirmer, fluorescein, tonometry, or lab work it), you can’t. In addition, most dental disorders cannot be properly assessed through cell phone video due to patient movement and needing five hands to get the job done.
Nonetheless, as long as we rely on well-honed clinical judgment to provide the best care possible, our clients, our patients, and our staff will all benefit from the tool of telemedicine.