As technology continues to change virtually everything consumers do, it’s not surprising that a small but growing number of companies are offering online veterinary consults directly to pet owners. Their business models vary and some are an outgrowth of what’s happening in human medicine. where the desire to minimize costs leads to a strong preference to keep people OUT of the doctor’s office. For example, the average ER visit for a diabetic human costs about $15,000, so it’s not surprising that doctors and insurance companies are looking for ways to minimize these expensive, frequently avoidable visits.
In veterinary medicine, things are quite different. Not only are there three legs to the relationship in our profession (Veterinarian/Client/Patient relationship; VCPR) rather than two (physician/patient), but also the relationship is compounded by the fact that our patients can’t speak for themselves. This is highly relevant, and is the main reason why the “Well, they’re doing it in human medicine….why can’t we do it in veterinary medicine?” argument doesn’t really work. Because our patients can’t speak for themselves, can’t give a really accurate history, describe their symptoms, any teleconsult requires veterinary professionals to rely on a layperson’s description of what they THINK is happening with their pet.
Garbage in/Garbage out
While we don’t have HIPAA in veterinary medicine, we do have state practice acts and they are quite specific on the issue of what constitutes a valid VCPR. The AVMA has also recently released language that, while not carrying the weight of a true “regulation” should still inform our behavior as veterinary professionals. The position of these organizations can be simplified to the following: a valid VCPR can not be established telephonically or electronically. So how are we to adhere to this in the age of video chats and in light of the recent Texas Supreme Court ruling? I think there are two categories for our response.
So I can’t give advice to a client on the phone?
Read strictly, the answer is no. If a client calls asking for advice about their vomiting dog and you make recommendations based solely on that phone call, you’re relying on the owner’s assessment of attitude, hydration, level of pain, etc.. The same can be said for a video chat, though certainly the information gleaned from a video conference is more robust than what you can derive from a phone call. While technically telephone consults can be problematic, the reality is that state boards of veterinary medical examiners are overworked and under-resourced and they have to prioritize their activities. If they start going after every veterinarian who gives advice on the phone, they’ll never get anything else done. (This is where I include the standard disclaimer that I am by no means an attorney and that you should consult with one who specializes in veterinary law. Email/call me for recommendations should you be interested, or attend a lecture on this topic at your next conference.)
What about online consults between a doctor and pet owner who don’t have a VCPR?
This is the model that we’re starting to see pop up now at trade shows and on advertisements in veterinary magazines and journals. The typical scenario is that a company hires veterinarians to sit by the computer and answer questions/give advice. Whether or not they charge for this fee is actually irrelevant, as we found out in the above referenced Texas case: giving free advice doesn’t obviate the requirement for a valid VCPR.
This is a much more clear-cut example and, by virtually all readings of applicable law, is NOT legal. Why? Because there can be no valid VCPR in place between a doctor and a patient he/she has never examined. Remember that the laws were written to protect our patients who can’t advocate for themselves. It’s really hard to argue you’re providing top-notch care for a pet you’ve never seen if all you have to go on is a layperson’s description instead of a hands-on physical exam.
Certainly this is an area that the law needs to be refined and updated to reflect the growing quality of video conferencing and the client’s natural preference to avoid a trip to the veterinarian if they can avoid it. As understandable as that desire is, as of now the law is pretty clear on what is and what is not an appropriate level of care.