Telemedicine in Aquatic Veterinary Health

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Otherwise called, “why can’t you diagnose and treat my fish over the phone, email, social media, etc?” I mean, if people over the internet can utilize telemedicine, why can’t veterinarians? Sorry to say, but being a state licensed veterinarian requires all patients have a valid VCPR, which is mandated by state veterinary practice laws. These laws may vary slightly by state, but for an example, here is what is laid out by the state of California (yes, I copied this from their site):

2032.1. Veterinarian-Client-Patient Relationship.

(a) It is unprofessional conduct for a veterinarian to administer, prescribe, dispense or furnish a drug, medicine, appliance, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture or bodily injury or disease of an animal without having first established a veterinarian-client-patient relationship with the animal patient or patients and the client, except where the patient is a wild animal or the owner is unknown.
(b) A veterinarian-client-patient relationship shall be established by the following:
(1) The client has authorized the veterinarian to assume responsibility for making medical judgments regarding the health of the animal, including the need for medical treatment,
(2) The veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s). This means that the veterinarian is personally acquainted with the care of the animal(s) by virtue of an examination of the animal or by medically appropriate and timely visits to the premises where the animals are kept, and
(3) The veterinarian has assumed responsibility for making medical judgments regarding the health of the animal and has communicated with the client a course of treatment appropriate to the circumstance.
(c) A drug shall not be prescribed for a duration inconsistent with the medical condition of the animal(s) or type of drug prescribed. The veterinarian shall not prescribe a drug for a duration longer than one year from the date the veterinarian examined the animal(s) and prescribed the drug.
(d) As used herein, “drug” shall mean any controlled substance, as defined by Section 4021 of Business and Professions code, and any dangerous drug, as defined by Section 4022 of Business and Professions code.”

The most important part is the “personal acquaintance” part you may have glossed over. In order for me or any other veterinarian to render services to a client, we have to meet you and your fish in person. Telemedicine is only valid if you already have a VCPR, and these are another set of regulations that vary by state. VCPR’s will be recognized for a certain time period and then need another in person assessment. For California, this is 1 year. If I have seen your fish within the year, know of their history and you call me describing a similar disease state that was previously treated or known, I can prescribe you medications without seeing them in person. That is what a VCPR boils down to.

The problem comes when you can get “free” help online, why would you pay good money for a vet? We’ll consider a common example: a koi pond owner is noting their fish are displaying flashing behavior, noting they are itchy, and everyone and their mother tells them to treat with a common OTC product called ProForm-C. Will this fix the issue? Maybe, but what is missing from this cause and effect that you are most likely oversimplifying. Living animals, especially aquatic ones, are never that cut and dried approach. Why would veterinarians struggle for years in school if it was that easy?

Limits of Telemedicine

What you get from a veterinarian approach is a multi-level assessment. In this situation, I want to know how the parasites got there in the first place. Did you add a new fish without quarantine? Yes, then that’s a likely source of infection. No? Well then, where did it come from? Is this actually a parasite? (To be honest, some fish will do it when nothing is wrong.) Is this something that has happened before? Do you add prophylactic medications every month for no other reason than breeding super-resistant strains? Is that medication even effective against the parasite in question?

In the toilet that is a fish pond or tank, there are many lurking threats. If you haven’t done your maintenance regularly, your water quality may be off. This will cause your fish to have poor immune function and a lurking parasite can take advantage. How many online “miracle cures” mention their water parameters? A few yes, maybe around 1%. This is critical information that needs more than a casual thought.

And then how to we prevent the infection from coming back? Since you can’t sterilize a fish, that parasite could be a problem in the future. How do we make sure your fish will be healthy? Could you benefit from a better quarantine protocol, improving your maintenance regimen, hiring additional help or simply switching fish foods? All of these recommendations can come from your veterinarian, for any species, if you just ask! Why waste your time doing countless hours of research when your veterinarian has done it for you? (And if anyone mentions that we get paid by “Big Pharma” to push their products, you’d think we’d drive fancier cars or not carry so much education debt.)

We recommend yearly checkups for our fish patients on a yearly basis to maintain our valuable VCPR. If you email, text or contact us on social media, we have automatic replies set up to tell you to call us. We are useless to you otherwise. I know it’s a pain to dial all those numbers, so we’ve made a helpful appointment request to get us to call you! I know I don’t make the rules, but they’re there for a reason. Don’t ask us to break them. My veterinary license and the lives of all the patients I treat is not worth it.

When to Use Telemedicine

Telemedicine is great technology when used properly. For clients with an established VCPR, telemedicine allows us to do assessments without logging the road miles. Technology is expanding everyday to allow us to do more for our patients than ever before. We are able to give general guidelines over our telehealth consultations, but please don’t expect a diagnosis and treatment plan.

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