We are in an extraordinary moment in history. The veterinary profession has never been asked to fundamentally change the way we practice in such an immediate and profound way as we have in the past couple of weeks. January: telemedicine is viewed with skepticism. March: Oh never mind, please implement it yesterday.
Change has never been something the risk-averse healthcare industries embrace easily, and with good reason: it’s important to take the time to do things right when the stakes are life and death. But what do you do when you don’t have the luxury of time, when you’re thrown in headfirst, and there’s no official guidance from the powers that be because they’re trying to figure it out in real time just like you are?
What do you do?
Just help them.
Who? Whoever needs it. How? However you can.
We live by rules and regulations and things like the VCPR, which we collectively assumed would never ever be something veterinarians could establish remotely. In the past week alone three states have made emergency allowances for a remote VCPR to be established without an in person exam. The FDA also temporarily lifted their requirement for a physical exam for a VCPR- and while state regulations still have precedence, it’s a strong indicator that things turned upside down already,
Does it matter? Not really. Why? Because the most important things you can do right now have already been legal.
When this all shakes out the biggest changes in the profession won’t be in how we do or do not establish a VCPR but what we do with it once we already have one.
We’ve already had tremendous leeway with telemedicine with those clients with whom we already have an active VCPR, it’s just very few veterinarians have elected to go that route. Why? Because having people come in has always been the default answer.
Last year, it made sense to ask the 80-year-old client with an atopic dog to come in for the hotspots they get like clockwork in the spring. Now that we’re in a pandemic and the client is in a stay at home mandate, would you entertain the possibility of looking at a photo or video and discussing it online before making her risk her health by coming in? Would the fact that a lot of your colleagues are successfully doing telemedicine dermatology visits change your mind? Or that MDs are doing it for babies who, like dogs, also cannot talk? Just help them.
The other biggest change will be in how we value the advice we give outside of the VCPR.
No one’s saying telemedicine is a panacea. Emergencies will always require emergency care. But speaking of that- telehealth can help there too.
We’ve always held ourselves to this idea that the only thing that matters and is worth being paid for is a diagnosis or prescription, when the truth is the most valuable service we offer is all the work and knowledge that it takes to get to that point. Advice has value. Triage has value. A telehealth consult for an emergency situation will not result in a diagnosis, but that doesn’t make the conversation worthless.
Many clients have no clue that dyspnea is, in fact, an emergency. Many clients also mistake a nipple for a mass that requires an ER visit right this second. Your input is very helpful in both cases, and the only reason people haven’t paid for it up to this point is because we haven’t asked. If the only silver lining in this worldwide tragedy is us waking up to the idea that our guidance and advice is worth something, I’ll take it.
It is so easy and so human to talk about all the things we can’t do and all the things that have been taken away. But in those moments between breaths and sadness and fear, we’re also seeing all the small incremental victories happening when people pause for a moment, think small rather than big, and ask: what can I do to help? We help pets and we help each other. Veterinarians are rolling ventilators into hospitals and engineering ventilators that can help nine people instead of one. We’re propping each other up and offering support and encouragement or, if nothing else, commiseration. Helping is what we do best. It always has been.
There are many more things I can’t do right now than can. What can I do? Write. My colleagues want to start doing telemedicine and don’t know how. How can I help? Start conversations.
Just help them doesn’t mean doing things you’re not comfortable with or put the patient at risk. It’s the exact opposite. We’re all being called to re-evaluate what we can do to improve patient outcomes in extraordinary times. You won’t have everything. But you’ll have something. Use it.