Nine Lives with Dr. Kat

In today's show, we are lucky to have 2 special guests, a regular contributor, Steve Dale and Dr. Gail Golab from the American Veterinary Medical Association here to explain the role of telemedicine for our own pets.

Did you know there are legal issues that may limit its use? If you want to take the supurr best care of your cats, you need to check this show out and find out if you can take advantage of the convenience of telemedicine with your own vet.

Listen to Episode #136 Now:

BIO:

Dr. Gail C. Golab is director of the American Veterinary Medical Association’s Animal Welfare Division and the first U.S. veterinarian ever to be credentialed in animal welfare.

Dr. Golab has a long history of commitment to ensuring the welfare of animals, starting as an undergraduate student engaged in biomedical research, when she served on a predecessor to today’s institutional animal care and use committees, which protect the welfare of laboratory animals. As a graduate student at Texas A&M University, she co-founded a student chapter of the Society for the Prevention of Cruelty to Animals in order to provide education directed at reducing the number of students relinquishing pets at the end of semesters. After graduation from the University of Illinois College of Veterinary Medicine in 1991, she provided medical and surgical services, and assisted with policy development, for local humane societies. She serves on several scientific advisory committees developing guidelines and standards for the care of animals used for agricultural purposes.

Dr. Golab earned her membership level credential in the Australian College of Veterinary Scientists’ (ACVSc) Animal Welfare Chapter in 2008. Australia is the only country that offers an animal welfare certification for veterinarians.

A longtime AVMA staff member, Dr. Golab worked for several years in private practice before joining the association as a scientific editor for the Journal of the American Veterinary Medical Association and the American Journal of Veterinary Research. She moved to the AVMA Division of Education and Research as an assistant director in 1998 and became an assistant director in the Communications Division in 2001. She moved to the newly created Animal Welfare Division as associate director in 2006 and was named Animal Welfare Division director in 2007.

Steve Dale, certified animal behavior consultant (CABC), has reached more pet owners over the past few decades than any other pet journalist in America.

He is the host of two nationally syndicated radio shows, Steve Dale’s Pet World and The Pet Minute (together heard on more than 100 radio stations, syndicated Black Dog Radio Productions, since 2005). He’s also a special contributor at WGN Radio, Chicago, and program host of Steve Dale’s Pet World(since 1997). He formerly hosted the nationally broadcastAnimal Planet Radio.

For 21 years, his twice weekly newspaper column was syndicated by the Chicago Tribune. Steve was a contributing editor for USA Weekend (2002 to 2014), and regular columnist at Cat Fancy magazine (2006 to 2014). He has written for a long list of magazines, from People to Dog World (where he was a columnist).

He’s currently a columnist and contributing editor for CATster, andauthors a column called Steve Dale’s Vet World for Veterinary Practice News. 

He also contributes blogs for various websites, including for Victoria Stilwell and the Pet Health Network.

On TV, he’s appeared on The Oprah Winfrey Show, National Geographic Explorer, Pets: Part of the Family(PBS), Fox News, various Animal Planet shows, and many others. For several years, Steve was a regular contributor to Superstation WGN-TV morning news, then appeared regularly on WMAQ-TV, Chicago. Currently, he’s a contributor to nationally syndicated HouseSmarts TV. Steve’s also a frequent host of satellite media tours.

In print, he’s been quoted in the Wall Street Journal, USA Today, Los Angeles Times, Redbook, various veterinary publications, and dozens more. He has also appeared as an expert guest on countless radio programs.

Steve co-edited Decoding Your Dog, written by the American College of Veterinary Behaviorists (Houghton Mifflin Harcourt, 2014). Steve’s the author of ebooks, Good Dog! and Good Cat! (Chicago Tribune, 2013). He’s the author of several other books, including DogGone Chicago and American Zoos.

He’s written introductions or contributed chapters and forewords to many books, including Bonding With Your Dog, Dog Spelled Backwards, The Compassion of Dogs, Raising My Furry Children, Christmas Cats, and Angel Animals and the Kids Who Love Them.

Steve was an external reviewer for the 2005 Feline Behavior Guidelines (American Association of Feline Practitioners) and is a contributor to textbooks “The Cat: Clinical Medicine and Management” (edited Dr. Susan Little, 2011) and “Treatment and Care of the Geriatric Veterinary Patient” (edited Dr. Mary Gardner and Dr. Dani McVety, 2017).

He’s the primary author of the CATegorical Care: An Owner’s Guide to America’s Number #1 Companion (reviewers include AVMA, SAWA), published American Humane Association/CATalyst Council, 2010). He co-authored (with Dr. Sagi Denenberg) the American Veterinary Society of Animal Behavior Position Statement on Breed-Specific Legislation (2014).

Steve is a founder of the CATalyst Council and served on the Board of Directors from 2008 to 2012. He’s also on the Board of Directors of the Winn Feline Foundation (2007 to present), and Tree House Humane Society in Chicago (2005 to 2016). In 2012, after six years, he cycled off the Board of the American Humane Association and served as a National Ambassador. He’s an Advisory Board Member SPCA Puerto Vallarta (2016 to present),

Steve is also a part of an AVMA/AAHA initiative to encourage preventive care veterinary care, called Partners for Health Pets.  In 2014, Steve co-founded Veterinary Professionals Against Puppy Mills. Steve is on the Pet Partners Human-Animal Bond National Advisory Board (2015 to present);  National Advisory Board Member Angel on a Leash (2005 to 2016);  National Fear Free Advisory Board (2013 to present); Task Force on Feline Sterilization (2015-present).

In Chicago, Steve created the Chicago Task Force on Companion Animals and Public Safety (2000-2010), where three-times proposed breed bans were over-turned and twice over-turned proposed mandated pediatric spay/neuter, as well as proposed pet limit laws. The Task Force also created guidelines for ‘doggy day care.’ As a pet advocate, Steve has testified many times against breed specific bans, pet limit laws, etc. Steve personally advised Illinois Governor Pat Quinn regarding pet-related issues.

Among Steve’s many awards, the AVMA Humane Award (the only AVMA honor bestowed to a non-veterinarian), Editor and Publisher syndicated newspaper Feature Writer of the Year Award, AKC Responsible Dog Ownership Public Service Award, HSUS Pets for Life Award, and has been honored with over 15 Maxwell’s Awards from the Dog Writer’s Association of America and over 15 Muse Awards from the Cat Writers’ Association of America. He’s also been honored by the Chicago Veterinary Medical Association, University of Illinois College of Veterinary Medicine, and was the first recipient of the Winn Feline Foundation Media Appreciation Award, and many others.

In 2012, Steve became the youngest person ever inducted into the Dog Writer’s Association of America Hall of Fame.

After his beloved cat Ricky passed away in 2002 of feline hypertrophic cardiomyopathy (HCM), Steve created a fund to raise money to research this often-fatal disease. He’s raised well over $100,000 – and as a direct result a genetic test was created to determine if a gene defect for HCM exists for two breeds.

Steve’s a regular speaker at veterinary and shelter conferences around the world, and for shelter fundraisers, and other special events. Steve’s presented at each of the major U.S. veterinary conferences (numerous times), and at state and regional meetings as well as veterinary schools, and several times for the International Association of Animal Behavior Consultants. He’s also spoken at the World Small Animal Veterinary Association Conference (Sydney, Australia), Latin  American Veterinary Conference (Lima, Peru), Congreso Veterinario de Leon (Leon, Mexico) Caribbean Veterinary Conference (Sr. Kitts) and others.

Steve’s persistence convinced the Chicago White Sox to allow dogs at a major league baseball game – today, ball parks around America have periodic “dog days” promotions. In 2004, he suggested Mercury Skyline Cruiseline create “The Canine Cruise,” a dog-friendly architecture cruise for dogs on Lake Michigan/Chicago River, also replicated in other cities.

Steve is also the host (since 2015) of a popular WGN Podcast,Steve Dale’s Other World(about topics generally unrelated to pets).

Two of Steve’s favorite honors: Commencement Speaker at Madison Square Garden for Ross University School of Veterinary Medicine (2008), and appearing (in 2012) as 59 across in a TV Guide Crossword Puzzle (pet journalist Steve _ _ _ _).

Transcript:

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Announcer: This is Pet Life Radio.

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Announcer: Let's talk pets.

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Dr. Kathryn Primmm: Hey there, cat lovers.

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Dr. Kathryn Primmm: Welcome to Nine Lives with Dr.

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Dr. Kathryn Primmm: Kat.

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Dr. Kathryn Primmm: I'm your host, Dr.

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Dr. Kathryn Primmm: Kathryn Primmm, and I'm a small animal veterinarian and crazy cat lover.

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Dr. Kathryn Primmm: Today, I have a really exciting episode for you.

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Dr. Kathryn Primmm: We're gonna be talking about a topic that's gaining a lot of attention in the veterinary world and beyond, telemedicine.

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Dr. Kathryn Primmm: So, as our technology evolves, the way we care for our pets is kinda changing, too.

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Dr. Kathryn Primmm: And I have two incredible guests with me to help us unpack what telemedicine means for veterinary medicine.

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Dr. Kathryn Primmm: So, we're gonna take a quick break and come right back.

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Dr. Kathryn Primmm: Hey there, cat lovers.

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Dr. Kathryn Primmm: It's Dr.

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Dr. Kathryn Primmm: Kat.

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Dr. Kathryn Primmm: From Nine Lives with Dr.

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Dr. Kathryn Primmm: Kat, you know the expression, cats have nine lives.

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Dr. Kathryn Primmm: Well, what if you can give them one more?

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Dr. Kathryn Primmm: The Give Them Ten movement is on a mission to help give cats an extra life.

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Dr. Kathryn Primmm: How?

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Dr. Kathryn Primmm: With spay and neuter.

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Dr. Kathryn Primmm: Spaying or neutering your cat helps them live a longer, healthier life.

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Dr. Kathryn Primmm: And it helps control free-roaming cat populations, too.

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Dr. Kathryn Primmm: Learn more about the benefits of spay and neuter and meet Scooter, the neutered cat, at givethemten.org.

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Dr. Kathryn Primmm: That's givethemten.org.

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Announcer: Let's Talk Pets on petliferadio.com.

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Dr. Kathryn Primmm: Welcome back to Nine Lives with Dr.

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Dr. Kathryn Primmm: Kat on Pet Life Radio.

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Dr. Kathryn Primmm: Today, first we have Steve Dale.

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Dr. Kathryn Primmm: He's been a guest with us before.

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Dr. Kathryn Primmm: Steve is a certified animal behavior consultant and kind of a household name in pet advocacy.

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Dr. Kathryn Primmm: Thanks for being here, Steve.

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Steve Dale: Oh, it's always a pleasure to talk with you, Dr.

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Steve Dale: Primmm.

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Dr. Kathryn Primmm: So much fun.

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Dr. Kathryn Primmm: We also have Dr.

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Dr. Kathryn Primmm: Gail Golab, who is the chief veterinary officer at the American Veterinary Medical Association.

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Dr. Kathryn Primmm: She's an expert in veterinary standards and practices, and we're really excited to welcome her to Nine Lives today.

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Dr. Kathryn Primmm: Hi, Dr.

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Dr. Kathryn Primmm: Golab.

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Dr. Gail Golab: Good morning, Dr.

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Dr. Gail Golab: Primm.

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Dr. Gail Golab: It is such a pleasure to be here.

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Dr. Gail Golab: I've been looking forward to this, so can't wait to get started.

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Dr. Kathryn Primmm: Well, I'm really excited.

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Dr. Kathryn Primmm: I want to go ahead and dive into veterinary telemedicine, and there's really a lot for us to talk about.

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Dr. Kathryn Primmm: So I want to start, Steve, you're always really kind of the voice of pet parents, and you talk to a lot of pet parents and really veterinary professionals.

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Dr. Kathryn Primmm: So what have you been hearing about telemedicine?

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Steve Dale: Well, telemedicine is increasingly being utilized, which not only in veterinary medicine, but for ourselves, right?

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Steve Dale: It began during the pandemic.

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Steve Dale: The American Veterinary Medical Association says, yes, it's a great idea.

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Steve Dale: However, there are parameters, and that is a veterinary-client-patient relationship.

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Steve Dale: You know, there are so many, so many direct-to-consumer choices regarding telemedicine.

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Steve Dale: I mean, you buy everything from carpeting to a car, and certainly certain pet products, like pet insurance, and you may get six months or a year of free telemedicine.

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Steve Dale: But there are so many concerns I have.

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Steve Dale: Dr.

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Steve Dale: Primm, I've got a question for you.

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Steve Dale: So someone calls you who you've never met, you've never met their pet before, you have no records in front of you, and the question is, my cat is throwing up.

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Steve Dale: I want a diagnosis, I want a prescription, and I want it right now.

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Steve Dale: How do you do that?

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Dr. Kathryn Primmm: Well, you know, it's funny that you mentioned that, because that actually comes up in my practice almost on a daily basis.

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Dr. Kathryn Primmm: And I just try to explain, I really don't want to create a situation for your cat where I give you bad advice because I don't know you and I don't know your cat and I'm unable to examine it.

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Dr. Kathryn Primmm: So I think that's an important point, that there are limitations to telemedicine.

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Steve Dale: Dr.

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Steve Dale: Golab, I'll let you pick it up from here.

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Dr. Gail Golab: Yes, you know, it's really interesting.

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Dr. Gail Golab: Dr.

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Dr. Gail Golab: Prem, you mentioned the importance of knowing the owner as well as knowing the pet.

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Dr. Gail Golab: And that is really an astute comment because when we have that in-person visit with a pet and its owner, we not only learn from the physical exam about the pet, right?

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Dr. Gail Golab: So we're able to touch the pet.

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Dr. Gail Golab: We can see the pet.

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Dr. Gail Golab: Sometimes even, you know, with some diseases, odor can be very telling sign.

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Dr. Gail Golab: And so, and we also have the opportunity to use specialized instrumentation there as well, right?

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Dr. Gail Golab: So we can use an otoscope to look in the ear.

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Dr. Gail Golab: We can use a stethoscope to listen to the heart and lungs, et cetera.

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Dr. Gail Golab: But the other thing that happens during the visit is we get to meet the owner.

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Dr. Gail Golab: And so, from that owner, we learn about what their expectations are for their pet.

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Dr. Gail Golab: We learn what the relationship is with their pet.

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Dr. Gail Golab: You know, how easy is it for them to handle that pet?

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Dr. Gail Golab: And so, cats, for example, sometimes it can be a challenge to pet.

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Dr. Gail Golab: And so, if we're having challenges like that, we need to know that so that we can recommend a treatment plan that actually works to help that pet, but that the owner can also undertake.

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Dr. Gail Golab: And so, that in-person visit is just incredibly important.

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Dr. Kathryn Primmm: I agree.

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Steve Dale: Yeah.

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Steve Dale: So, I want to jump in here for one second.

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Steve Dale: I believe Dr.

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Steve Dale: Golab would agree, telehealth is a good or great idea.

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Steve Dale: The issue is, have you met that pet before?

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Steve Dale: Have you met that client before?

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Steve Dale: And do you have the records of what happened in front of you?

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Steve Dale: Because clients don't always remember everything.

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Steve Dale: Five years ago, I thought I was given this pill, but maybe it was that pill.

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Steve Dale: I'm not sure.

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Steve Dale: Or my cat had an adverse event, a reaction to whatever, but I don't remember what it was, you know?

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Steve Dale: Or they get it wrong, which means you're going to get it wrong.

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Steve Dale: So knowing the pet, knowing the client, and having the records in front of you of what has happened historically with that animal, I say is incredibly important.

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Dr. Gail Golab: I just want to follow up on that a little bit, because once you have all of that information, and particularly if you have an animal for example, with a chronic illness, say something like diabetes, being able to combine in-person visits with the use of telemedicine is amazing, because you can actually easily check up on that pet with its owner, see how the pet is doing.

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Dr. Gail Golab: And sometimes you can find out things about issues with administering medications, or maybe things aren't quite perfect, and so an adjustment may be needed.

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Dr. Gail Golab: But being able to follow that pet through telemedicine and being able to intervene more quickly if something is going on is amazing.

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Dr. Gail Golab: But that initial visit and making sure that you have visits at the appropriate times after that initial visit is incredibly important to having telemedicine work well.

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Dr. Kathryn Primmm: So can we back up just a really quick minute because I get a lot of questions in my practice.

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Dr. Kathryn Primmm: Steve mentioned the veterinarian-client-patient relationship, and I get a lot of questions about why can I not just call you and have you prescribe something for this perceived illness that I have, my cat maybe has a urinary tract infection or whatever.

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Dr. Kathryn Primmm: Can we back up a little bit, Dr.

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Dr. Kathryn Primmm: Golab, and talk about what that really means?

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Dr. Gail Golab: Sure.

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Dr. Gail Golab: What that relationship is, it is something that is important both in terms of how we interact with our patients and clients, but it's also important legally, right?

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Dr. Gail Golab: So again, the key word is relationship.

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Dr. Gail Golab: So that is familiarity between the veterinarian and the patient and the client.

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Dr. Gail Golab: But the veterinarian-client-patient relationship has legal pieces as well, and so the VCPR is defined at the state level, and it is also defined at the federal level.

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Dr. Gail Golab: And most of the time, those definitions are the same.

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Dr. Gail Golab: And a lot of those definitions will actually require that you see that patient in person as part of establishing that relationship.

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Dr. Gail Golab: However, there are a few states where you can actually create the relationship electronically.

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Dr. Gail Golab: And where that becomes a challenge is not only for the reasons that we already discussed, but it's also a challenge because at the federal level, veterinarians have to follow requirements as well.

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Dr. Gail Golab: And at the federal level, when we're prescribing certain types of medications, the federal government requires that we establish that relationship in person.

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Dr. Gail Golab: So, for example, if I was going to treat a dog, and I needed to prescribe two medications, and one of those medications had a label that was specific for what it was that animal had, and I didn't change the dose, and I didn't change how often the drug was administered, I could go ahead and do that even if my state allowed me to create a relationship electronically.

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Dr. Gail Golab: If, however, I needed to change the dose of that medication, or because your pet needed something a little more frequently than what might be indicated on the label, as a veterinarian, I can do that, but according to federal law, the only way that I can do that is if I have met you and your pet in person first.

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Dr. Gail Golab: And so veterinarians, when they are following the legal requirements for practicing veterinary medicine, have to follow those requirements both at the state level and at the federal level.

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Dr. Gail Golab: And sometimes that can be confusing if those definitions are different.

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Dr. Kathryn Primmm: That is very confusing and it actually comes up a lot in our practice.

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Dr. Kathryn Primmm: So Steve knows already, and Dr.

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Dr. Kathryn Primmm: Gail Golab, you may know as well that I am a Fear Free Certified Professional.

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Dr. Kathryn Primmm: And I would like for Steve to kind of touch a little more on how telemedicine sort of plays a role in decreasing anxiety for pets.

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Dr. Kathryn Primmm: Would you go into that for us, Steve?

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Steve Dale: Oh yeah, I can say it in one word, Kat.

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Steve Dale: You know, so despite all our efforts, there are many Kat's and it doesn't need to be this way, Dr.

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Steve Dale: Primm, you know that, I know that.

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Steve Dale: However, it is this way still realistically for a lot of Kat's.

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Steve Dale: So once they go in, once that initial veterinary visit that Dr.

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Steve Dale: Golab has spoken about occurs, then there can be another question, whatever it might be.

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Steve Dale: It can be behavior.

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Steve Dale: Behavior is a wonderful, wonderful thing to do as far as telemedicine is concerned.

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Steve Dale: You already know the pet.

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Steve Dale: You already know the scenario.

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Steve Dale: Maybe the Kat has a history or not of, I don't know, thinking outside the litter box, scratching and all the wrong places.

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Steve Dale: And behavior takes some time, as you know.

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Steve Dale: If you're going to do it right, you need an exam room for maybe an hour to sit and talk with that client about what's going on with that Kat.

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Steve Dale: Does it do any good, really, to have the Kat in the practice necessarily?

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Steve Dale: Once you've examined the Kat and have ruled out a medical possibility for that behavior, what a great opportunity it is actually to do follow-up where you can actually see the home.

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Steve Dale: And yes, I've scooped the litter box, but in back of the person, you see that litter box hasn't been scooped in at least a month, you know?

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Steve Dale: So there are many opportunities for telehealth that, you know, if you have an older client, you know, is 192 years old, maybe it is difficult to get to the veterinarian.

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Steve Dale: I know you, Dr.

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Steve Dale: Primm, where you happen to be, also have clients that are further out in rural places, and it's a longer drive to see the veterinarian.

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Steve Dale: Those are just some examples of the advantage of telehealth, but still, I maintain, and I agree with Dr.

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Steve Dale: Golab, that initial visit is essential.

00:12:19.009 --> 00:12:22.269
Dr. Gail Golab: And I think, you know, I just want to file up on that just a little bit, Steve.

00:12:22.269 --> 00:12:36.769
Dr. Gail Golab: There are, telehealth and telemedicine can be terrific, and we can do a lot with information that we receive when we get pictures, when we see video, when we have those Zoom-type calls, but there still are limitations, right?

00:12:36.769 --> 00:12:48.849
Dr. Gail Golab: And so sometimes what ends up happening is a cat owner may send us a picture of a sore on a cat's skin, but they send the picture of the sore.

00:12:48.849 --> 00:12:51.629
Dr. Gail Golab: They don't send the picture of the entire animal.

00:12:51.629 --> 00:13:03.109
Dr. Gail Golab: And so we don't see that in addition to what's going on on the back end of that animal, we have similar sores on the front end of that animal, and or we may have ears that obviously have an issue.

00:13:03.109 --> 00:13:25.949
Dr. Gail Golab: And so making sure that you have had that physical examination first, and that you know that pet and that owner is so incredibly important, and it's also really important that when you're doing tall medicine that you have a conversation with the veterinarian to talk about what that set up needs to look like and what the limitations and abilities are of using audiovisual in the practice of medicine.

00:13:25.949 --> 00:13:29.329
Dr. Kathryn Primmm: So we're going to take a quick break and come right back.

00:13:32.129 --> 00:13:35.129
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00:15:16.189 --> 00:15:17.349
Announcer: Let's Talk Pest.

00:15:17.349 --> 00:15:18.249
Dr. Kathryn Primmm: Let's Talk Pest.

00:15:18.249 --> 00:15:19.309
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00:15:19.309 --> 00:15:20.609
Dr. Kathryn Primmm: PetLife Radio.

00:15:20.609 --> 00:15:22.809
Announcer: petliferadio.com.

00:15:31.515 --> 00:15:33.755
Dr. Kathryn Primmm: Welcome back to Nine Lives with Dr.

00:15:33.755 --> 00:15:36.095
Dr. Kathryn Primmm: Kat on PetLife Radio.

00:15:36.095 --> 00:15:38.615
Dr. Kathryn Primmm: Today, we have Steve Dale and Dr.

00:15:38.615 --> 00:15:39.695
Dr. Kathryn Primmm: Gail Golab.

00:15:39.695 --> 00:15:52.575
Dr. Kathryn Primmm: So, I'm gonna bring out the elephant in the room, and neither one of you may have anticipated, but I think that Steve mentioned something about, like, allowing an hour for this consultation in an exam room and so on.

00:15:52.575 --> 00:16:01.735
Dr. Kathryn Primmm: Can we talk a little bit about how veterinarians actually still need to be reimbursed for the time that they spend on a telemedicine visit?

00:16:01.735 --> 00:16:02.235
Dr. Kathryn Primmm: Maybe Dr.

00:16:02.235 --> 00:16:03.955
Dr. Kathryn Primmm: Golab could weigh in on that.

00:16:03.955 --> 00:16:07.675
Dr. Gail Golab: Sure, and there's absolutely, there's no question about that, right?

00:16:07.675 --> 00:16:23.495
Dr. Gail Golab: Whether we are meeting with a pet owner in person, or whether we're meeting with that pet owner online, we are providing expertise to that pet owner, and that expertise is valuable, and so we need to appropriately be compensated for that.

00:16:23.495 --> 00:16:34.895
Dr. Gail Golab: Sometimes, although some of the telemedicine visits may take a very, take a long time, particularly in the behavior area, there are going to be situations where that telemedicine visit may actually be shorter.

00:16:34.895 --> 00:16:44.095
Dr. Gail Golab: And because of the time, for example, that is saved for the pet owner, and also it can create some efficiencies in the veterinary clinic as well.

00:16:44.095 --> 00:16:45.875
Dr. Gail Golab: So it can be kind of a mixed bag.

00:16:45.875 --> 00:16:51.795
Dr. Gail Golab: It certainly can be situations where a telemedicine appointment may be less expensive for the pet owner.

00:16:51.795 --> 00:16:56.515
Dr. Gail Golab: At the same time, depending upon the amount of time that's involved, that might not be the case.

00:16:57.115 --> 00:17:03.855
Dr. Gail Golab: But I think it's really important that what we're talking about here is not necessarily the type of visit.

00:17:03.855 --> 00:17:05.415
Dr. Gail Golab: It's the value in that visit.

00:17:05.415 --> 00:17:12.855
Dr. Gail Golab: And that veterinarian is providing value whether they are meeting with the pet owner in person or whether they are meeting with the pet owner online.

00:17:12.855 --> 00:17:13.715
Dr. Kathryn Primmm: Thank you.

00:17:13.715 --> 00:17:14.515
Dr. Kathryn Primmm: That's helpful.

00:17:14.515 --> 00:17:22.415
Dr. Kathryn Primmm: So, Steve, how would you advise someone who asked you if telemedicine could meet the needs of their pet?

00:17:22.415 --> 00:17:23.995
Steve Dale: That's a broad question.

00:17:24.595 --> 00:17:28.695
Steve Dale: So, I think what we've described is, depends what those needs are.

00:17:28.695 --> 00:17:32.275
Steve Dale: So, if you could rephrase the question, it would be helpful.

00:17:32.275 --> 00:17:33.475
Steve Dale: I'm not sure what you mean.

00:17:33.475 --> 00:17:38.595
Dr. Kathryn Primmm: So, what if someone that you ran across said, my cat has a sore, just like Dr.

00:17:38.595 --> 00:17:40.135
Dr. Kathryn Primmm: Golab was mentioning.

00:17:40.135 --> 00:17:44.375
Dr. Kathryn Primmm: Is there any way for me to avoid seeing a veterinarian for this sore?

00:17:44.375 --> 00:17:47.955
Dr. Kathryn Primmm: Maybe could I do a telemedicine visit or something like that?

00:17:47.955 --> 00:17:49.895
Dr. Kathryn Primmm: What would you recommend to them?

00:17:49.895 --> 00:17:56.755
Steve Dale: That's a great question because a lot of pet parents want to for whatever reason they feel cost.

00:17:56.755 --> 00:18:16.655
Steve Dale: Maybe it is the inconvenience if they live further away, the difficulty of getting to that veterinarian, if they are, as I mentioned, older, maybe they have some physical limitations, or they just don't want to spend the time at the veterinary clinic waiting and then seeing you in person when they can do it via telemedicine.

00:18:16.655 --> 00:18:23.375
Steve Dale: And a lot of people, by the way, do prefer to communicate via telehealth.

00:18:23.375 --> 00:18:25.235
Steve Dale: But there are limitations, as Dr.

00:18:25.235 --> 00:18:31.715
Steve Dale: Golab articulately described, as to realistically what can be done.

00:18:31.715 --> 00:18:33.835
Steve Dale: But there's a lot that can be done.

00:18:33.835 --> 00:18:35.355
Steve Dale: And there are many usage.

00:18:35.355 --> 00:18:37.715
Steve Dale: I mean, we mentioned behavior.

00:18:37.715 --> 00:18:47.015
Steve Dale: I don't know that the post-surgical is another possibility, is for chronic illness and you want to follow that pet over time.

00:18:47.015 --> 00:18:53.015
Steve Dale: There are, and there are many more, many more opportunities for telehealth that are appropriate.

00:18:53.015 --> 00:19:00.675
Steve Dale: But there are some cases where, darn it, you just need to see that pet, and you need to see that person.

00:19:00.675 --> 00:19:15.095
Steve Dale: But there are many instances, and those many instances are great for the profession, of freeing up exam room space, for example, giving an opportunity for some employees to even work remotely.

00:19:15.095 --> 00:19:18.175
Steve Dale: I mean, there are many advantages for the profession.

00:19:18.175 --> 00:19:23.015
Steve Dale: There are many more advantages for the pet parents, but it needs to be done the right way.

00:19:23.015 --> 00:19:25.075
Steve Dale: Here's what happens if it's not.

00:19:25.075 --> 00:19:28.275
Steve Dale: So let's say there's that sore that Dr.

00:19:28.275 --> 00:19:30.235
Steve Dale: Golab and you mentioned, right?

00:19:30.235 --> 00:19:35.255
Steve Dale: And they go, they meaning the client, to a third-party provider.

00:19:35.275 --> 00:19:44.995
Steve Dale: One of these other opportunistic, and frankly, in general, that's the right word, companies that do offer a veterinary professional.

00:19:44.995 --> 00:19:46.455
Steve Dale: Here's a couple of things.

00:19:46.455 --> 00:19:57.455
Steve Dale: That company or that veterinarian that you're speaking to via telehealth may be out of state and doesn't say it or clients don't know to ask that.

00:19:57.455 --> 00:20:05.155
Steve Dale: If for some reason there needs to be legal recourse out of state, you've got no legal recourse as a client.

00:20:05.695 --> 00:20:09.415
Steve Dale: If there needs to be follow-up, what happened?

00:20:09.415 --> 00:20:16.195
Steve Dale: Sometimes some of those companies do provide something in writing as exactly what they did so your veterinarian knows about it.

00:20:16.195 --> 00:20:18.915
Steve Dale: In many cases, that's not true.

00:20:18.915 --> 00:20:30.555
Steve Dale: So when the client goes back to the veterinarian and says, I talked to this person online who said that I ought to do something or even prescribe the drug, and that's an issue too.

00:20:30.555 --> 00:20:34.455
Steve Dale: They're being pushed, if you will, to prescribe.

00:20:34.935 --> 00:20:35.415
Steve Dale: Now, Dr.

00:20:35.415 --> 00:20:43.275
Steve Dale: Golab can describe even better than I, about how that's not particularly legal, but it's being done.

00:20:43.275 --> 00:20:49.615
Steve Dale: So they're prescribing these drugs, including antimicrobials, antibiotics.

00:20:49.615 --> 00:20:52.135
Steve Dale: Just, okay, let's throw something at it.

00:20:52.135 --> 00:20:53.875
Steve Dale: Is that the best medicine?

00:20:53.875 --> 00:21:00.335
Steve Dale: And as we are moving towards individualized medicine, this is the opposite of that.

00:21:00.335 --> 00:21:05.275
Steve Dale: This is generalizing almost based on guesswork, and did you know, Dr.

00:21:05.275 --> 00:21:11.075
Steve Dale: Primm, some of these third-party providers, some of them actually have a veterinary professional.

00:21:11.075 --> 00:21:22.155
Steve Dale: You're talking to a professional, often a veterinarian, who might even be out of the country, and they don't offer that information, at least not voluntarily.

00:21:22.155 --> 00:21:31.755
Steve Dale: So what happens if there needs to be recourse, and how well is that person following up or proficient at medicine in the United States?

00:21:32.835 --> 00:21:33.615
Dr. Kathryn Primmm: I agree.

00:21:33.615 --> 00:21:38.675
Dr. Gail Golab: I was going to follow up just really quickly on that example that we used about the wound in the cat.

00:21:38.675 --> 00:21:43.655
Dr. Gail Golab: And so a lot of those skin sores can look really, really similar, as you know, Dr.

00:21:43.655 --> 00:21:44.575
Dr. Gail Golab: Primm.

00:21:44.575 --> 00:21:47.335
Dr. Gail Golab: And there can be a variety of causes for those, right?

00:21:47.335 --> 00:21:55.415
Dr. Gail Golab: Anything from a bacterial infection to a parasite issue, even to cancer, to a fungal infection.

00:21:55.415 --> 00:22:00.875
Dr. Gail Golab: And there's often no way for you to know that, just by looking at a picture of that particular wound.

00:22:01.515 --> 00:22:11.495
Dr. Gail Golab: And so by having that in-person visit, you have the opportunity to figure out whether or not that is a fungal infection or a bacterial infection or something else.

00:22:11.495 --> 00:22:14.375
Dr. Gail Golab: And you can do that relatively quickly, right?

00:22:14.375 --> 00:22:25.635
Dr. Gail Golab: And so that in-person visit is a way to make sure that you get to the issue that you need to treat very quickly, that you're accurate in making that diagnosis, and that you're using the right medication.

00:22:25.635 --> 00:22:37.615
Dr. Gail Golab: And one of the things that we've been concerned about, and this ties in to our problem with some of the direct-to-consumer telemedicine companies that are focused on prescribing, is antimicrobial resistance.

00:22:37.615 --> 00:22:44.415
Dr. Gail Golab: And veterinary medicine, we're working really hard to make sure that we are being good stewards of how we use antibiotics.

00:22:44.415 --> 00:22:57.155
Dr. Gail Golab: And so making sure that we get that right the first time is important not only for your pet, but it's also important to protect our use of antibiotics and make sure that those are effective not only for animals, but also for people.

00:22:57.755 --> 00:23:02.095
Dr. Gail Golab: So we want to make sure that we get that diagnosis and the treatment plan right from the beginning.

00:23:02.095 --> 00:23:06.495
Dr. Gail Golab: And then we can use telemedicine after that to follow up on that treatment plan.

00:23:06.495 --> 00:23:13.455
Dr. Kathryn Primmm: That is an excellent, excellent point because I feel like as a veterinarian, I do more than just look.

00:23:13.455 --> 00:23:23.955
Dr. Kathryn Primmm: And many times when I see a wound, for example, maybe there's sedation involved and clipping and cleaning and obtaining samples for culture and diagnostic things.

00:23:24.075 --> 00:23:28.055
Dr. Kathryn Primmm: So telehealth and telemedicine are just not a substitute for that.

00:23:28.055 --> 00:23:32.715
Dr. Kathryn Primmm: And I wanted to make sure that my listeners today heard that from both the experts.

00:23:32.715 --> 00:23:34.855
Dr. Kathryn Primmm: So I think it's a hybrid.

00:23:34.855 --> 00:23:37.515
Dr. Kathryn Primmm: It's a tool that helps us do better.

00:23:37.515 --> 00:23:38.855
Dr. Kathryn Primmm: Would you agree, Steve?

00:23:38.855 --> 00:23:40.835
Steve Dale: Absolutely, it's a tool.

00:23:40.835 --> 00:23:47.615
Steve Dale: And it's a wonderful tool for all of these things that all of us have mentioned in this conversation.

00:23:47.615 --> 00:23:51.195
Steve Dale: And there are other examples, other ways in which we can use telehealth.

00:23:51.195 --> 00:23:52.395
Steve Dale: It's terrific.

00:23:52.675 --> 00:23:55.755
Steve Dale: In fact, let me, can I share a little secret with you, Dr.

00:23:55.755 --> 00:23:56.275
Steve Dale: Primm?

00:23:56.275 --> 00:23:57.275
Dr. Kathryn Primmm: Of course, you can.

00:23:57.275 --> 00:24:06.575
Steve Dale: The American Veterinary Medical Association has been talking about, writing about, supporting telehealth even before the pandemic, as it turns out.

00:24:06.575 --> 00:24:21.055
Steve Dale: So yes, telehealth is a great idea, but there are parameters in which is best to follow for the profession, but arguably more importantly, for the pets that are served and for the clients.

00:24:21.195 --> 00:24:34.815
Steve Dale: Because if, for example, I go on one of these telehealth providers, these third party direct to consumer providers, and I'm given whatever it is I'm told to do, but it doesn't work out.

00:24:34.815 --> 00:24:38.975
Steve Dale: I'm going to end up in your office anyway, and it's going to cost me even more money, right?

00:24:38.975 --> 00:24:41.975
Steve Dale: So it doesn't necessarily save money.

00:24:41.975 --> 00:24:49.615
Steve Dale: If you go to these third party or direct to consumer providers, it can and often does cost clients more money.

00:24:50.115 --> 00:24:51.335
Steve Dale: It gets confusing.

00:24:51.335 --> 00:24:57.875
Steve Dale: And by the way, in some cases, the pet really does need to be seen in person.

00:24:57.875 --> 00:25:01.155
Steve Dale: And meanwhile, it hasn't been seen in person.

00:25:01.155 --> 00:25:05.315
Steve Dale: So there are all kinds of reasons in which that is not a good idea.

00:25:05.315 --> 00:25:13.395
Steve Dale: Now, going to your veterinarian, doing telehealth that way under the supervision of your veterinary professional.

00:25:13.395 --> 00:25:16.135
Steve Dale: And by the way, sometimes that can be a technician.

00:25:17.015 --> 00:25:18.435
Steve Dale: And we have, what is it?

00:25:18.435 --> 00:25:21.275
Steve Dale: National Technician Week, not too far from now.

00:25:21.275 --> 00:25:22.875
Steve Dale: It's around the corner.

00:25:22.875 --> 00:25:27.935
Steve Dale: So yes, absolutely, that can work wonderfully.

00:25:27.935 --> 00:25:37.615
Dr. Kathryn Primmm: So I think that this is kind of an exciting time for all of us in veterinary medicine, because we're just using every tool that we have to take the best care of pets.

00:25:37.615 --> 00:25:37.875
Dr. Kathryn Primmm: Dr.

00:25:37.875 --> 00:25:42.335
Dr. Kathryn Primmm: Golab, is there any final thought that you would want to add for my listeners?

00:25:42.335 --> 00:25:42.955
Dr. Gail Golab: Actually, Dr.

00:25:42.955 --> 00:25:44.395
Dr. Gail Golab: Prem, I think that's a perfect lead.

00:25:44.535 --> 00:25:54.435
Dr. Gail Golab: And this is really all about making sure that you and your pet are both served well by your veterinarian and that animal health is taken care of.

00:25:54.435 --> 00:25:56.935
Dr. Gail Golab: And we want to make sure that we do it in the right way.

00:25:56.935 --> 00:25:58.195
Dr. Gail Golab: So you're absolutely right.

00:25:58.195 --> 00:26:02.615
Dr. Gail Golab: We want to use every possible technologic tool that is available to us.

00:26:02.615 --> 00:26:15.035
Dr. Gail Golab: But using those in the right way and at the right time is what is the best approach to making sure that your pet stays healthy and that you continue to be comfortable with the services you're receiving from your veterinarian.

00:26:15.035 --> 00:26:31.055
Dr. Kathryn Primmm: And anybody that listens to my show a lot knows that I believe in a relationship with your own veterinarian that knows you and that knows your cat and can, you know, just pick up on those extra clues that maybe you have trouble medicating or whatever.

00:26:31.055 --> 00:26:34.615
Dr. Kathryn Primmm: The relationship is very important to me and that's kind of my soapbox.

00:26:34.615 --> 00:26:40.735
Dr. Kathryn Primmm: And so I think my closing thought would be telemedicine certainly has a place, but you need a relationship first.

00:26:40.735 --> 00:26:41.735
Dr. Kathryn Primmm: Would you agree, Steve?

00:26:42.175 --> 00:26:42.875
Steve Dale: Oh, yeah.

00:26:42.875 --> 00:26:45.255
Steve Dale: Yes, that's that's what we're saying.

00:26:45.255 --> 00:26:46.435
Steve Dale: It has a great place.

00:26:46.435 --> 00:26:55.035
Steve Dale: I think it can absolutely be terrific as an adjunct to whatever it is that I've seen you for as follow up.

00:26:55.055 --> 00:26:57.975
Steve Dale: Once you know me and once you know my cat.

00:26:57.975 --> 00:26:59.435
Dr. Kathryn Primmm: Well, that's perfect.

00:26:59.435 --> 00:27:03.555
Dr. Kathryn Primmm: So thank you both for being here today and sharing your expertise.

00:27:03.555 --> 00:27:08.455
Dr. Kathryn Primmm: And to my listeners, remember, your pet's well-being is the priority.

00:27:08.455 --> 00:27:16.955
Dr. Kathryn Primmm: Whether it's in person or it's virtually, you need to talk with your own veterinarian about the tools that are available.

00:27:16.955 --> 00:27:25.795
Dr. Kathryn Primmm: And thank you both for taking the time out to meet with me today and discuss this important, important technological advance, I think.

00:27:25.795 --> 00:27:27.295
Dr. Kathryn Primmm: So thanks for joining me.

00:27:27.295 --> 00:27:28.315
Dr. Gail Golab: Thank you so much, Dr.

00:27:28.315 --> 00:27:28.835
Dr. Gail Golab: Primm.

00:27:28.835 --> 00:27:29.555
Dr. Kathryn Primmm: Okay.

00:27:29.555 --> 00:27:35.055
Dr. Kathryn Primmm: So thank you to my amazing producer, Mark Winter, who makes the show happen.

00:27:35.055 --> 00:27:40.135
Dr. Kathryn Primmm: Thank you all my listeners for tuning in and we'll see you next time on Nine Lives with Dr.

00:27:40.135 --> 00:27:40.395
Dr. Kathryn Primmm: Kat.

00:27:40.815 --> 00:27:44.315
Dr. Kathryn Primmm: Go out and have a purrfect day.

00:27:44.315 --> 00:27:45.675
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00:27:47.675 --> 00:27:50.355
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