Telehealth is a topic we’ve touched on in both of our previous chats about the changing landscape of veterinary care. While it might sound straightforward, as most of us are familiar with telehealth in the context of human medicine by now, there are always some myths to bust. And who better to bust them than Felix&Fido founder Dr. Shlomo Freiman?
In the latest installment of Dr. Freiman’s interview series with journalist and pet parent Tobias Coughlin-Bogue, Dr. Freiman holds forth on the basics of telehealth, how to do it right, and how it can help pet parents and vets work together to ensure the best possible pet care.
I think everybody has a basic idea of what telehealth is, but what do you define it as in the context of veterinary medicine?
I think telehealth is the umbrella term for really any remote communication that takes place between a pet parent and the provider on the veterinary side. Because obviously the pet doesn’t communicate, they don’t use computers, but it’s essentially the same idea as telehealth in human medicine.
So really any contact you have that is not you in an exam room or you doing a home visit?
Exactly, and it’s not limited to calls, texts, or emails. It can also be data transfer. So, for example, let’s say that you have some sort of some cardio harness that takes vitals from your pet. That data can be transmitted remotely to your provider. We can also get photos and even in some cases, like when we are able to have a veterinary nurse visit a patient, test results.
Why is the adoption of telehealth so low in veterinary medicine as a whole?
Well first off, adoption is way higher among newer companies and startup companies. It’s not the only reason, but it’s definitely one that I think explains a lot of why more traditional veterinary practices are so hesitant to adopt telehealth: Most people don’t realize that most vets and probably their vet get compensated on commission.
Now, if I told you the person that’s selling you a car is working on a commission, you wouldn’t be shocked. But what about car service advisors? These people do in fact work on commission, so their bias becomes finding a problem and finding a solution that is going to increase the overall invoice. I’m not saying vets are not honest, but it’s a big problem if they’re only going to get compensated when you are going to come into the office and transact. It’s very much oriented around creating transactions rather than building a relationship, and I think it’s kind of a dirty secret that most clients don’t know about.
This also harkens back to the membership conversation, right? In terms of changing the revenue model.
Absolutely. Being a hospital owner for decades, I totally understand this whole pay structure, but we need to move away from it. At Felix&Fido, we are moving away from that, but it is still a big roadblock. Membership is a major thing for us because if you’re a member then we can stop worrying about compensation and look at how to provide you and your pet with the best care in the most efficient way and most effective way.
Is that why it seems like most of your membership plans automatically include telehealth?
Not most, all of them. It’s baked in to everything we do.
What are some of the advantages in care that you can deliver via telehealth?
So the emphasis here is on your vet team, which is very different from having a veterinary telehealth company – somebody online somewhere in the universe – providing you with advice remotely about your pet without having access to their medical record. Your vet team has the benefit of doing physical exams on your pet, which means that they know you, your pet and your pet’s record. It’s super important to have context. Unlike a generic veterinary telehealth service, I can look at old blood work, I know your pet, and I know what is normal for your pet. I have a reference point. Lots of reference points, actually.
You’ve likely seen them in person one or two times before you ever get a call.
Yeah, exactly. The other thing is that I want people to understand about the way that telehealth is delivered is that it’s very important how the visit is conducted. It shouldn’t be just, okay, you went online, you paid X amount of money and now somebody’s going to give you advice for 15 minutes, 20 minutes, ten minutes, five minutes, whatever it is. Then boom, you’re done.
When you contact your vet team, you’re just starting the process. They’re assessing. They’re now staying engaged. They may engage over the next day or maybe over the next four days remotely to make sure that things are going where they want them to go. I don’t see telehealth in the veterinary context as, “Here’s 20 minutes, tell me what the problem is with your pet and I’m going to solve the problem.”
Sometimes, yes, but for a lot of cases it’s more about staying engaged and working on it together and keeping track of where things are going. We may have to escalate, we may have to do things differently, but maybe the first couple of steps that we take are going to work. What we won’t do is take your money, take 20 minutes of your time, and tell you to come in at the end regardless of what’s going on with your pet. There’s definitely going to be cases where the patient has to come in. There’s no question about it. But it’s not every case. And even if it’s only 25 percent to 30 percent of the time, well, that’s 25, 30 percent of the time that we can save people time and money and stress.
I think I’m really starting to understand the difference between Felix&Fido and a service that just connects you to some person in a call center. Maybe they have training, maybe they’re a veterinary technician or even the vet themselves, but they’re sitting there with their headset on for eight hours a day, whereas Felix&Fido is your pet’s actual vet. Just on the phone and on demand.
Absolutely.
It helps the client and helps everybody.
Yes, it saves time and money and prevents stress. As we talked about, there’s a huge shortage of veterinarians and providers, so it allows us to prioritize more, to see the patients that really need to be seen. We just walked by Jen, who works here, in the lobby. She was telling me recently that she was talking to her aunt and her aunt’s dog had a seizure. They thought they had to wait six weeks before anybody could see the dog. Why? Because they were expecting to bring the dog in to a clinic, of course. So if you provide people a solution where they don’t necessarily need to come in, well, then you are able to see pets that really need to be seen even if you don’t see them in the clinic.
It’s kind of like we talked about earlier, about peace of mind, right? Where a lot of times people are calling you because they just want some guidance. The lack of information is what scares them.
So what I have tried to do in my practice and what we’re trying to do on an even larger scale with Felix&Fido is to create a relationship where instead of you going to Dr. Google and freaking out, you have a source you can trust that can help you. Someone who really knows your pet and can help you assess them quickly and accurately. Like, this is something that you need to watch versus this is something that you need to take care of right away. Or if it is urgent, what needs to be treated in a clinic or what can be managed differently. There are so many options to deliver care these days and it’s about having the type of relationship that enables you to pick the right one, not about, “Oh well, we’ve got to bring them in every time.”
Kind of makes me think of the scenario I had with Catticus where he stopped eating as much and started just lying smack dab in the middle of the kitchen floor not moving for hours at a time. He’s a weird cat, he’s a little bit crazy, so I wasn’t immediately like, “Oh, he needs to see a vet.” I was definitely worried but I didn’t know what to do. After two or three days though, I was like, “Okay, this is really unusual.” I had to pack him in the car, which he hates, and we had an extremely miserable ride up to a walk-in clinic, where we found out it was a simple cat scratch abscess on his back. But I’m guessing you would have known exactly what was going on if you’d already seen him once or twice and I told you about his behavior and said, “Oh there’s a little bump on his back he won’t let me touch,” right?
Yeah, for sure. We could have used a variety of platforms to have this conversation, but we would probably have asked, “Okay, is it an outdoor or indoor cat? Can you take a temperature? Can you touch the sensitive spot at all? Can you see wetness?” And maybe at that point, it would have been that I’m going to prescribe antibiotics. Maybe if we caught the infection right when it was beginning, just prescribing antibiotics would have been all that he needed instead of having to have a procedure. Or if it was even earlier, I could have even just had you clean the wound really well.
You could have saved us both a lot of stress!
That’s the idea, absolutely. I want my clients not to hesitate even a second before they jump on their chat and start communicating with me about whatever problem they have. And maybe nine out of ten times it’s nothing. That’s fine, but it’s so easy to chat and find out.
Are there incidents where you’ve caught anything really dangerous via a telehealth visit?
Of course! When you have done veterinary telehealth for as long as I have you’re going to see a little bit of everything. There was one instance where I had a patient, James, call me worrying about his Norfolk Terrier, Issa, who had been coughing for a few days. Now, I get clients calling all the time panicked that their dog is having an asthma attack or something really serious when in reality it’s just a reverse sneeze. In those cases I can tell pretty quickly what it is on a video call and reassure them.
With Issa, however, it was the opposite. James thought it was just a kennel cough, but when I saw the dog via video James sent me, I noticed a few subtle things about the cough that made me concerned. I told James to bring Issa in same-day for an exam and chest x-rays, and when we examined him, it turned out that Issa was in the early stages of heart failure.The early diagnosis completely changed the course of treatment for him and led to a much better outcome, all because of one quick telehealth chat session. On the other hand, video calls probably saved all those people panicking about asthma attacks a lot of money too.
Like you said, telehealth can be a real win-win scenario.
