Confusion about what can and cannot be done or said it normal! First step- don’t panic. Check with your local VMA and state boards for advice, but in general: If you have a VCPR with a patient, you can do what you feel comfortable with. Telehealth is just a tool, like an ultrasound or blood panel. It’s right for a lot of patients, but not all.
Many, if not all, of the state boards have released statements regarding what is appropriate during the COVID crisis in regards to VCPR and telehealth. Check your state board website; otherwise the AAVSB has a fantastic resource that is compiling the data.
Check also with your Liability Insurance Provider. AVMA PLIT has stated that as long as correct medical protocol/VCPR rules are followed, they will cover telehealth visits the same as in-person visits.
1. VCPR: Do I have a VCPR with this patient? If yes, I can diagnose, treat, and prescribe. If no, I can provide general advice, a plan, and education. General advice can go a long way, though- it’s all in how you word it. For example, a 4 year old dog with one day of diarrhea- For a patient you have VCPR for, you can say: “Oh, no, Fido has BLANK!” – Now, obtain a history, recommend testing, a bland diet, or prescribe OTC/RX and check back in tomorrow if Fido isn’t critical. If you have no VCPR, you cannot say “Fido has BLANK “- that’s a diagnosis. You can say “Sounds like Fido is experiencing the symptom of diarrhea- it’s very common, and many dogs experience this. Here are some things to watch out for (vomiting, lethargy, worsening symptoms), here’s when you know you need to take Fido to the vet, and here is a great article on dog diarrhea for further reading!”
2. Sufficient Information: A second area of concern for many when diving into telemedicine is that they will be forced to provide care without sufficient information. The answer to this: there is no difference between telemedicine and in-person care for decision making. You should never feel pressured to make a diagnosis or treatment plan if you do not feel like you have enough information. If you need more information than can be collected virtually, always bring the patient in to the hospital or provide a resource for in-home data collection (like electronic stethoscopes, wearable collars, etc). If you did not have enough information in person you would send for more tests before making a diagnosis- You should never feel pressured into providing care or making a decision without adequate information.
3. Medical Record: Just because you are treating clients virtually does not change any of the aspects of the appointment. Make sure a proper medical record is maintained during all online consults. Sometimes individuals fall into the trap of not handling telemedicine appointments as professionally because they are online or over the phone. The same detail and accuracy is required in the patient medical record virtually or in-person.
4: Confidentiality: Make sure the platform you use is secure and information is stored to maintain client privacy. While HIPPA is not a requirement, it’s still a good idea to maintain proper confidentiality. Most platforms advertise their privacy features; if not, ask directly. If you are sourcing your own webcam visits or texting, make sure the information is also secure.
5. Be Conservative: Finally, Because of the added ambiguity of providing care virtually, act conservatively. If you have any doubts about the severity of a case or feel like you may need extra information, do not hesitate in asking clients to bring patients in to be seen in person. There is no harm in requesting clarification as it will benefit yourself, your clients and patients in the long run.