Technology has the capability of increasing accessibility to medical and veterinary care. Seniors, disabled, or pet owners without transportation, in particular, can now share videos remotely with veterinarians. The veterinarian can view the video and ask other questions. The vet can then offer advice on whether the pet needs immediate hospital care or just more time to observe, or even advise conservative home treatment.

 

Yet recently, a veterinarian offering pet owners advice from an internet site lost his license to practice veterinary medicine in the state of Texas. Other websites and phone apps offering the same services are also coming under fire and may face possible legal problems. Why is this happening?

 

State Veterinary Practice Acts

 

Despite the benefit of technology in increasing patient care, the legal definition of practice does not apply to remote veterinary relationships. In all states here in the U.S., the practice of veterinary medicine is only legal if there is a physical doctor/client/patient relationship. Internet relationships are not physical, especially without video. Without the relationship, offering medical advice is illegal.

 

All state boards prohibit the practice of veterinary medicine without a state license. So a veterinarian giving internet advice to a pet owner in a state where he or she does not have a license is considered to be practicing without a license in that state.

 

So why do state veterinary boards mandate this physical relationship? There are some good reasons:

  1. By giving a pet a thorough physical examination, a veterinarian often will pick-up subtle things that help in the diagnosis and treatment that the owners were not aware of, or were not aware of their importance. By smelling, touching, and listening, the vet may find things that are not possible to find remotely, even with a video.
  1. Owners often don’t know which symptoms or observations are important and may not be representing the problem correctly, especially remotely without video. Even in my direct office calls I find I am constantly asking or re-asking probing questions to really understand why my patient is in my office today. I am more a member of a CSI team than a vet sometimes.

 

But there are some legitimate rebuttals to the above:

  1. Most pet owners complain that their vets do not give complete physical exams at every office visit and could easily miss things even with the pet in front of them.
  1. Many pet owners also complain that their vets ask very few questions and hastily jump to offering diagnostic and treatment plans without the benefit of probing and really understanding why the pet was brought into the office.

 

These rebuttals have true merit. How is this better practicing of veterinary medicine? I don’t think it is. A cursory exam without a complete history and discussion with the owner is poor veterinary practice. Simply making it physical doesn’t make it better if it is incomplete.

 

There is no way to enforce good “exam room practices,” yet we cast a blanket assumption that all online veterinary consultation is inadequate and illegal by virtue of state practice acts. In fact, monitoring online veterinary performance would be much easier than monitoring a vet’s office. Why? It can be accessed. A vet’s office is off-limits unless it is bugged.  

 

So how can you make remote information from an expert legal? Let me give you my example.

 

I am only licensed to practice medicine in California, but I formulate special medical homemade diets for dog owners all over the U.S. How can I do that?

 

Only the owner’s veterinarian has the legal physical doctor/client/patient relationship. But if I contact the veterinarian directly, explain my plan to aid his patient and make suggestions for monitoring the effectiveness of the diet, I am now a consultant working on behalf of a legitimate doctor/client/patient relationship. I can make a plan in conjunction with the owner that the veterinarian endorses, making the process legal.

 

Medicine, whether human or veterinary, is a conservative institution and always behind the times. The scarcity of electronic records in our human medical field is a perfect example. But this will not always be the case.

 

Consumer demands will change the way state veterinary practice acts are written to adjust to the times and technology. Licensing will not always be as restrictive as it is now. Change will be slow, but it will happen. Technology is just too powerful.

 

What do you think of your vet’s physical exam? Does your vet do enough, and would you take advice from a veterinarian over the internet? Share your experience in the comments.

 

 

Dr. Ken Tudor

 

 

Image: ThamKC / Shutterstock