Help Is (Sometimes) Only a Phone Call Away!

Your horse is experiencing a colic episode.  He seemed fine this morning, but he’s pawing in his stall and refusing his evening hay. He doesn’t seem all that distressed, his heart rate is 40, and you can hear gut sounds when you listen with your stethoscope—but you’ve owned horses long enough to know that something isn’t right. Your friend gave you a tube of flunixin but you don’t know how much to give. Time to call the vet!

Illustration by June Brigman

What Next?

Scenario #1: You’re an experienced horse person and you do all of your own routine vaccinations. Your horse has always been healthy—until today! The last time you called a veterinarian was four years ago when your horse had his teeth done. You call that vet’s emergency number, and when they call you back you tell them you think your horse’s symptoms are mild. You just need to know how much medication you should give. The answer? “I can’t give you that advice without examining your horse.”

Scenario #2: You have owned horses forever, but still make sure you see your veterinarian at least once a year for routine vaccinations and a general exam. Your vet last saw your horse three months ago. You call to report on your horse’s symptoms, and your vet agrees—it sounds like a mild colic episode. They advise you to give a small dose of flunixin, keep a close eye on your horse, and check back in 45 minutes unless his signs get worse.

So…

What’s the difference? Was the first vet just a jerk? Absolutely not! You might be surprised to learn that veterinarians have strict rules when it comes to over-the-phone advice—and having a valid veterinary-client-patient-relationship (VCPR) before prescribing any form of medication is one of them. In fact, if that first veterinarian had answered your question, they could lose their license—especially if something went wrong! Although it’s true we’ve used telehealth for years in equine practice, it became much more prevalent during the COVID-19 pandemic, and factors including the widespread shortage of equine veterinarians mean it’s here to stay.

The rules surrounding telehealth are rapidly evolving, and it helps to understand that those rules are there to protect you, your horse, and your veterinarian. In this article I’m going to clarify the terminology and different categories of telehealth that are most relevant to equine practice. You’ll learn about the rules, and why they exist. The next time you need help, you’ll know what you can expect from your vet and when. 

Tele-What???

The terminology surrounding telehealth can be quite confusing. In fact, you can add “tele” to the beginning of almost any medical service (telehealth, telemedicine, teletriage, teleadvice) and it means something different. Let’s start by defining the most important terms you should understand when it comes to your horse’s health, and learning about the rules that apply to each category of telehealth. 

Telehealth

Telehealth is the over-arching term that’s used to refer to any electronic method of accessing health care. It’s often confused with telemedicine, but in reality telemedicine is a very specific subcategory of telehealth.

Telemedicine

Telemedicine involves information specific to a certain patient and can include both making a diagnosis and prescribing medication. When you call your veterinarian because your horse is exhibiting colic symptoms and they recommend administering a dose of flunixin, it falls under the umbrella of telemedicine. When you send your vet a picture of a wound they sutured for instructions at a bandage change, this would also be considered telemedicine.

How Does it Work?

In order to provide telemedicine services, your veterinarian must have a valid veterinary-patient-client-relationship (VCPR) in place. Most commonly, that means that they must have completed an in-person physical examination on your horse within the past year. Although the requirements for a valid VCPR vary from state-to-state. For example, in California it’s required that your veterinarian perform an in-person examination for every diagnosis (i.e., they have to see your horse in-person for his colic symptoms before recommending medications), while in other states the rules simply state that a physical examination must be performed in a timely fashion.

Some states do allow a VCPR to be established electronically, although that’s discouraged by the American Veterinary Medical Association (AVMA). Finally, there is also a federal requirement for a VCPR that will override a state if your vet wants to prescribe any extra-label medication, which includes the use of a human-labeled medication in a horse (think “sulfa” antibiotics). The federal requirement for a VCPR does demand an in-person examination be performed. In addition to having a valid VCPR, telemedicine also requires that your vet be licensed to practice in the state where your horse is located. As well as the state where they are when you call.

What does all of that mean?  If your vet says no when you request antibiotics for a horse they haven’t seen in years, they’re simply adhering to the rules. And if they don’t, their veterinary license could be at risk. 

Your horse shows signs of colic, so you decided to call your vet to see what you should do. But there are strict rules on what kind of advice your vet can give you over the phone, which is why it’s important to have a veterinary-client- patient-relationship. Photo by Shawn Hamilton CLiX/stock.adobe.com

Teletriage

Teletriage refers to the situations when you call your veterinarian with a problem, and they help you assess your horse’s condition to determine whether you should see the vet immediately or wait it out. This is common in equine practice—it’s what happens every time you call your veterinarian’s pager to determine whether a laceration needs suturing, or a colic needs a visit. The goal of teletriage is to help you make safe decisions about your horse when faced with an urgent situation. It can’t include making a diagnosis or giving treatment advice. 

Teletriage does not require a VCPR. But, if you are expecting the vet to give you medication or treatment advice—go no further. As soon as that happens, you’ve crossed over into telemedicine and all of the rules apply. The vet can only help you if a VCPR has been established. 

Teleadvice

Finally, teleadvice is the term applied to any non-specific advice given regarding medical care.  When your vet publishes a recommended vaccination and deworming schedule on their website that’s considered teleadvice. When you call your vet to ask whether they would recommend feeding a specific hay, that could also fall under the umbrella of teleadvice, as long as you aren’t asking whether that hay would be suitable for a horse in your barn that had been diagnosed with metabolic disease by another veterinarian. The minute you start asking questions about a specific horse, teleadvice becomes telemedicine. And again, all of the rules apply.

Making the Most of Telehealth

Telehealth offers a number of advantages. It makes it easier to access care, helps reduce costs, and can even minimize burdens on over-worked veterinarians. But when your horse experiences an injury or illness, your vet needs to have accurate information in order to assess what’s wrong (make a diagnosis), and suggest appropriate treatment. If information is missing or incorrect, your vet could easily suggest an incorrect treatment or prescribe the wrong medication—putting your horse at risk. 

Imagine this scenario. You find your horse exhibiting painful colic symptoms. You don’t have a regular vet, so you call the closest one you can find, hoping they’ll suggest you administer a medication that will control your horse’s pain. When the vet asks for your horse’s vital signs, you estimate his heartrate at around 40 beats-per-minute, and you think you can hear gut sounds. The vet suggests a small dose of flunixin and after you administer it, your horse feels much better. Relieved, you head to bed—only to find your horse dead in his stall the next morning. 

Think that can’t happen? Guess again. I’ve seen it myself. And in that scenario, chances are you misread the severity of your horse’s symptoms. And the vet (who’d never met you or your horse) misread your level of expertise. That’s why a VCPR is so important. 

How Is This Effective?

In order for telemedicine to be safe and effective, it’s essential that you establish and maintain a relationship with a veterinarian. If your vet knows you and knows your horse, it will be much easier for them to make an accurate assessment of your horse’s condition based on your description. They’ll also know if there are any pre-existing conditions that might make certain medications risky, and whether your horse’s behavior could mean some treatments are likely to be impossible.

Understand the Limitations

Now let’s consider another potential story for your colicky horse. You’ve used the vet you call, but it’s been years. They tell you they can’t give you medication advice because they don’t have a valid VCPR, and you get angry. In frustration, you slam down the phone and call every other veterinarian in town—only to get the same response. You don’t understand! All you want is a little bit of help. You finally agree to have one of the veterinarians come see your horse. When they do, you learn your horse’s condition is severe—and he needs surgery STAT. You head to the nearest referral hospital, your horse goes immediately into surgery. Your horse survives! 

In that scenario it’s clear why it was in your horse’s best interest for the vet to pay a visit. Think how much less stressful it would have been if you had understood the rules in the beginning! If you plan to take advantage of telemedicine, take the time to learn the regulations in your state. Discuss with your veterinarian ahead of time what it will take to maintain a valid VCPR. Then, make sure to comply with those requirements. If you fail to do so and a vet tells you that they need to see your horse before offering advice, understand that they are just following the rules that have been established to protect you.

One Last Thing…

Equine veterinary medicine is facing a workforce crisis. The number of veterinarians who choose to take care of horses after they graduate is getting smaller and smaller. Many of those who do choose the life of a horse vet drop out of the profession after just a few years.  This, combined with the fact that large numbers of existing equine practitioners are reaching retirement age, means it’s getting harder and harder to find a vet who will care for your horse. 

Telemedicine can help. As telehealth continues to evolve, there’s a good chance you can replace some of the visits from your vet that would have required a farm call with a fully remote appointment (once you’ve established that VCPR). This helps make it easier for you to get an appointment. It takes some of the stress off of overworked veterinarians and their staff. Equine vets are starting to offer remote care, complete with designated appointment times, using video conferencing platforms that provide a way to more fully evaluate your horse.

This Means…

What does all of this mean?  Don’t be surprised if you vet starts billing you for those remote appointments. You may not realize it, but your vet is required to treat every telemedicine interaction just like they would any other appointment. This includes maintaining a complete medical record. That translates into a significant investment of time and, in some cases, expensive resources such as software designed to manage telehealth appointments. The good news is even if you are required to pay for an appointment, chances are it will cost less than an in-person visit to your farm.  

There’s no question that remote access to medical care is going to become more and more prevalent as time unfolds. And by establishing a good relationship with your veterinarian and learning what rules apply, telehealth can be a safe and valuable addition to your horse’s health care plan. If managed properly telehealth means your vet saves time, you save money, and your horse has access to more timely care.

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