Progress is a wonderful thing. A day does not go by without some of my valued clients landing up in my consulting home holding a dog in one hand while waving a smartphone in the other.
Michael Watts MRCVS
No diagnosis can be seriously entered, in their opinion, without thorough veterinary scrutiny of photographs of their dog’s wounds or skin diseases, not to mention snapshots of the faeces passed in the park last night or the vomit found on the kitchen floor this morning.
Now I have been in this game a long time and can tackle most things in life after the second cup of coffee of the day, but presented with such photographs my initial response if often one of bafflement as I attempt to figure which part of the body of what animal I am supposed to be looking.
Photographs of corns on toe pads and most views of the teeth are fairly straightforward, but pictures of angry patches of livid skin and bloodstained wounds often require a little coaching from the corner by the photographer.
This is all fine and dandy if the misfortunate dog is present in person, so that one can correlate the photographs with the evidence of one’s own eyes. A trickier proposition is the guy who pops in to the surgery bearing only a phone, the dog in question being more or less happily ensconced at home.
In such situations you are not in full possession of all the facts, so making an accurate diagnosis may be far from easy. One has to exercise more than a little tact when suggesting to somebody who regards himself as the next David Bailey that his photographs are not very good and not much help to you.
Likewise suggesting that nobody who can do joined-up writing on a good day would be foolish enough to make a diagnosis on the basis of a photograph of an animal they had not seen, even if it had been taken by Don Mc Cullin or Lord Snowden.
While it is undoubtedly better to carry out a clinical examination of the animal in the flesh before committing yourself to even a tentative diagnosis, to say as much in some quarters is to invite suggestions that you are a greedy illegitimate whose only real interest is in trying to wring the last shilling out of each and every hard-up owner.
When push comes to shove, you can do a good job, or a cheap job, but seldom can you do a cheap, good job, although it may be diplomatic not always to remind owners of the fact.
It has to be said that there are situations where photographic evidence fills a gap which would otherwise remain a yawning chasm. Take for example the dog who has had some kind of seizure.
Very often, when examined some time after the event, the dog in question has returned to normal and is as large as life and twice as natural once again. In the past one had to rely heavily on the history of the episode as described by the owner.
Without wishing to be rude, some owners can furnish a more helpful and informative account of such an occurrence than others. One picture is proverbially worth a thousand words, and even a brief and wobbly video of the dog’s actions at the time can be an invaluable aid to diagnosis.
Similarly dogs who display curious and bizarre behaviour patterns at home generally decline to stage a repeat performance in the consulting room so that an amateur video on a smartphone may be the only real evidence on which to base a diagnosis.
Then again there may be geographical reasons why it is difficult for a client to bring an animal to the veterinary clinic for treatment or, by the same token, why it is difficult for a veterinary surgeon to make a home visit to examine and treat a sick or injured animal.
Crofters in the Hebrides for example may be separated from their nearest veterinary practice by many miles and rough seas. There is already a state-sponsored scheme, the Highland and Islands Veterinary Services Scheme, the aim of which is “to ensure the provision of an adequate veterinary service to prevent and eradicate animal diseases for all animals kept for agricultural purposes and belonging to crofters and others of like economic status, where no other provisions are available on the market”.
It is not hard to imagine how the strategic use of webcams and mobile phones could furnish much useful information to a veterinary surgeon who is prevented by long distance and adverse weather conditions from actually visiting such isolated farms.
They call it telemedicine, the remote diagnosis and treatment of patients by means of telecommunications technology. Like a lot of first opinion practitioners, I have been known to use it myself from time to time. For me it represents an opportunity to obtain assistance with difficult cases from those whose knowledge and experience puts mine in the ha’penny place.
Northern Ireland does not currently have a veterinary college of its own and physical referral of complex cases for specialist treatment is not always easy, yet from my base here in Ballyhackmacreevey I can send photographs and digital X-rays to recognized experts half a world away and get their input on my cases here in real time.
There can be no doubt that telemedicine has the potential to revolutionise everyday veterinary practice but as well as the opportunities it creates however, it also presents significant challenges.
As a practising veterinary surgeons working at the coalface, my priority must always be the welfare of the animals entrusted to my care. My clients should expect no less. You should try everything once except Morris dancing, as the man said, and in this spirit I am always prepared to dip my toe into new technological developments of many kinds.
However this particular aspect I approach cautiously. The British Veterinary Association has expressed the opinion that “we know this is a controversial issue, and that telemedicine presents a host of challenges and opportunities for the profession” and I tend to agree on both counts.
As far as challenges go, my main worry is that inherent in the making of a diagnosis based on photographic or video evidence rather than a hands-on clinical examination is an increased possibility of making mistakes.
Common sense would suggest that the best way to establish an accurate diagnosis in any case is to gather up as much evidence as possible, including conventional clinical examination, blood testing, radiography, ultrasound scans and the entire armoury of twenty-first century veterinary practice.
Apart from the crofters in the Hebrides, when push comes to shove most companion animal and livestock owners enjoy reasonably easy access to a wide range of veterinary services and should on the face of it have little need for a technology perhaps more applicable to more far flung communities.
For reasons that frankly escape me however, there seems to be great enthusiasm for telemedicine within the corridors of power and smoked filled rooms of the Royal College of Veterinary Surgeons, an enthusiasm that I for one do not share.
It troubles me that to promote the practice of telemedicine would be to encourage people, perhaps unwittingly, to accept standards of diagnosis and treatment which may be rather less than the best available.
The Royal College has recently announced plans for a review of the provision of a twenty-four-hour service and of the concept of animals under the care of a veterinary surgeon. I am not at all sure that a sick or injured animal at the other end of a webcam is under my care in any real sense.
My generation in the profession was brought up believing that the provision of twenty-four hour care was pretty much a non-negotiable part of the job. I am not old-fashioned, I am old school, and I went to a good school.
I want to offer the animals under my care real care as and when then need it. It is of course good to review working practices but if they ain’t broke, don’t fix ‘em.
©UnderTheRadar2019
