Imagine a graduate of veterinary medical school who has recently accepted an associate position at the clinic of her dreams. She feels her career is finally beginning and is excited to be in the trenches with her patients. The next patient’s medical record is waiting on her desk and the associate looks it over with a few differentials of what the presenting problem could be. Finally, all that hard work and studying in veterinary school will pay off! She eagerly walks into the appointment room and is abruptly told by the owners that they know what is going on with their pet because they came across something similar on Google. This frustrating occurrence is becoming all too common and can impact the profitability and perception of veterinary medical care.

Veterinarians can take comfort in the fact that their field is not the only one affected by online competition. Today’s patients are also less likely to take what a physician tells them at face value, and often come to appointments armed with a self-diagnosis backed up by information they obtain from WebMD and Google. According to the Pew Internet & American Life Project (Fox & Duggan 2013), “Thirty-five percent of U.S. adults say that at one time or another they have gone online specifically to try to figure out what medical condition they or someone else might have…looking more broadly at the online landscape, 72% of internet users say they looked online for health information of one kind or another within the past year.”

In my opinion, Dr. Google (http://www.google.com) and veterinary medicine are in a very similar situation as Netflix is to the business of movie theatres. Increasingly, movie theatres are offering discounted deals during the week or for matinees in order to compete with the convenience and relatively low cost of Netflix. People are delivered the media, but miss out on “the experience.” Other similar examples of products and services evolving include e-books versus books, texts versus phone calls, and emails versus written letters.

Here is the bottom line. Veterinarians are feeling economically pressured to keep up with online resources while clients are missing out on the experience of developing the veterinarian-client-patient relationship and of receiving veterinary expertise when they refer to the Internet for medical advice.

Who is Dr. Google? How is He Causing Harm?

Everyone knows that you can find just about anything on the Internet, and medical advice is no exception. Many pet owners don’t realize the numerous risks associated with using Dr. Google, though, which is essentially a search bar with the ability to return links to websites containing just about any information possible. The most obvious risk a person takes when consulting the Internet for veterinary medical advice is gathering misinformation. Clients have access to unlimited information, such as reviews of products that have no evidence of their safety or efficacy and can potentially cause harm. Another major way in which Dr. Google can cause harm is that it can enable long-term problems since clients may find information that causes them to delay making an appointment with their veterinarians and getting a proper diagnosis and timely treatment. An additional risk is that Dr. Google simplifies veterinary medicine and potentially provides the client a false sense of security that they know how to interpret the information correctly.

Dr. Google can cause harm in other ways, such as damaging communication between clients and veterinarians. Based on the information they find, clients may mistrust their veterinarians. For example, they may read something online that conflicts with a veterinarian’s account and may trust Google more than the person in front of them. Clients may also fail to see the value of a clinic appointment in relation to the cost. This, in turn, can promote clients to “play doctor” at home with their pets.

According to the main findings from a human medicine-focused study called “The Influence of Base Rate and Case Information on Health Risk Perceptions: A Unified Model of Self-Positivity and Self-Negativity” in the Journal of Consumer Research, it is proposed that using the Internet to self-diagnose can be unwise because people tend to focus on symptoms rather than the risk of having the illness. This may also be true for how humans perceive their pets’ illnesses. The authors of this study, Dengfeng Yan and Jaideep Sengupta, write in the introduction: “In today’s wired world, self-diagnosis via Internet search is very common. Such symptom-matching exercises may lead consumers to overestimate the likelihood of getting a serious disease because they focus on their symptoms while ignoring the very low likelihood that their symptoms are related to any serious illness” (Twist 2013). If we were to extrapolate to the veterinary setting, this would mean that a visit to the veterinarian can help determine if the animal’s clinical signs are likely with a certain diagnosis because of the veterinarian’s ability to see the overall picture and minimize bias.

Yet another study suggests that one reason that veterinarians struggle to get clients and patients through their door is the Internet. The “Executive summary of the Bayer veterinary care usage study” of 2011 states that, “In the online survey, 39% of pet owners agreed with the statement that they look online first if a pet is sick or injured and 15% agreed with the statement that because of the Internet, they rely less on their veterinarian” (Volk et al. 2011). The most alarming part of their findings is the impact it has had on clients’ behavior related to when they seek medical help for their pets. After consulting Dr. Google, some clients may wait to see if the clinical signs resolve in a day or so before taking their pet to the veterinarian. Sometimes this can work in their favor. However, in other cases, the pet’s condition has worsened by the time they are seen, thus requiring more extensive and costly treatments. To read more, access the “Executive summary of the Bayer veterinary care usage study” at http://avmajournals.avma.org/doi/pdf/10.2460/javma.238.10.1275.

Other Internet Sources

Veterinarians should also be aware that Dr. Google is not their only competition. Online resources, such as Webvet (http://www.webvet.com) and PetMD (http://www.petmd.com) are only a few clicks away. These two resources are threatening veterinary business in other ways. While Dr. Google consists of a person typing in the Google search bar and receiving a list of generated results/links, PetMD has a search function that is a symptom checker. More specifically, clients can check the symptom(s) of their pet and are then given more tailored options of articles to read. Based on the article the pet owner selects, it generates information that includes a brief description, symptoms, causes, and a diagnosis. As a positive, PetMD is veterinarian authored and veterinarian approved. It also refers the pet owner to a veterinarian based on the diagnosis, which may encourage some people to actually seek veterinary medical care. Webvet has a search box where one can type in a symptom and the site generates various informational links. Their website states that all medical-related content has been approved by a veterinarian in order to ensure its timeliness and accuracy.

Business Model Evolution

One cannot ignore that Dr. Google has the advantage of providing clients with unlimited and immediate information at no cost. Since the beginning of veterinary medicine, scarcity marketing was the model upon which generations of doctors had successfully built their practices (Wong 2014). Until Dr. Google became a click away for many clients, health information had been scarce and veterinarians were the primary reference for animal-related health. Now veterinarians are fighting harder than ever to help the client understand that the information they provide is the most accurate and of value.

Veterinarians must remember that they have many tools with which the Internet cannot compete effectively. Veterinarians dedicate years of their lives in school, learning the expertise of veterinary medicine. Dr. Google does not have a degree or training in anything other than transporting searchers to various web pages and does not have the ability to assess the patient and make a proper diagnosis. Most importantly, Dr. Google cannot foster any form of a veterinarian-client-patient relationship. Dr. Google is not capable of comforting a client when delivering difficult news, offering an anxious dog a treat to put him/her at ease, or feeling for abnormalities on a physical exam. These are just a few examples of the skills that veterinarians should promote in order for clients to understand why their services have value.

Benefits Conferred by Dr. Google

Despite its disadvantages, Dr. Google also provides benefits to veterinarians. For instance, Dr. Google can help a client be a better educated consumer and, therefore, more understanding of the veterinarian’s recommendations. A better-educated client will optimize the time veterinarians spend with their clients because some of the basics, such as medical terminology and the reasoning behind testing, can be quickly covered without a lot of explanation. Furthermore, a client who is familiar with the terminology is easier to have a mutual dialogue with, which is preferable to a one-sided monologue given by the veterinarian. A dialogue will actually improve the veterinarian-client relationship because the clients will feel empowered and that they have input in their pets’ future. This gives veterinarians the ability to abandon the patriarchal tone that is common during appointments and increase client satisfaction and compliance. Veterinarians are encouraged to ask the clients questions about what issues led them to search a certain health topic and what information they have learned so far. When a client becomes educated on veterinary health in the appointment room, he/she will see greater value in the veterinary visit. Clients become educated and engaged collaborators as opposed to silent benevolent servants of the pet.

Dr. Google also has the ability to empower clients in other ways. Finding information online may validate their concerns and persuade them to bring their pet to the veterinarian even sooner. For example, a client may be embarrassed by an issue their pet has, such as extreme thunderstorm anxiety, and finding support online may encourage them to schedule an appointment with their veterinarian. Therefore, Dr. Google has the ability to influence a client to bring their pet in sooner as well as later. Finally, Dr. Google can also help educate the client about necessary diagnostics so clients are less inclined to have the “cost” govern their decision. Some clients will read about their pet’s condition and find comprehensive lists of tests that should be done according to the gold standard. The client comes to the appointment with an expectation that one or more tests will be necessary, thereby making it easier for the veterinarian to persuade the client that the tests are needed to properly assess the condition of their pet.

Competing with Dr. Google

When it comes to Dr. Google, the most common question veterinarians think of is how they can compete with Dr. Google. Veterinarians can use Google itself to increase their marketing potential. Owners have the option to create Google advertisements or have their website more easily accessed through search engine optimization techniques. Another way in which veterinarians can compete is by using their own websites and social media pages to provide trustworthy, vet-approved sources of information. These, in turn, can be used as a starting point for veterinary-client discussion.

The fact of the matter is that veterinarians cannot stop clients from doing online research, but they can enhance their searching strategies. Veterinarians can utilize technology by helping guide clients to appropriate sites based on six recommendations composed in 2012 by Dr. Nancy Kay, a veterinarian who writes for DVM360. Her approach advises veterinarians to take the following paraphrased steps [more detail on these recommendations can be found at the following link: http://veterinarynews.dvm360.com/put-dr-google-work-your-veterinary-practice]:

1) Create a list of recommended websites that have already been approved by a veterinarian.

2) Advise clients to search on veterinary college websites because the quality of information is likely better. Clients can add “veterinary college” or “veterinary school” after the name of the disease or clinical sign they are researching.

3) If the patient has a breed-specific disease, encourage the client to visit the site hosted by that specific breed’s national organization.

4) Advise clients to avoid business-sponsored websites due to potentially biased information.

5) Teach clients to recognize anecdotal information for what it is.

6) Encourage clients to check out disease-specific online forums that have been pre-approved. Not only do they provide a wealth of educational information, but members can provide an excellent source of emotional support.

These six recommendations do not allow veterinarians to compete with Dr. Google in the classic sense, but they can be utilized to strengthen a trusting relationship between the client and veterinarian. The veterinarian benefits because the client will become educated correctly and will see that that the veterinarian cares about empowering their clients with accurate and easily accessible information.

According to Brandon Breshears (2014) from The Veterinary Marketing Podcast (click here for access), there are a few electronic ways in which to compete with Dr. Google. One way is to create a forum for one’s own practice in which clients are free to ask questions. Breshears said it best when he said, “Veterinarians are not beating Dr. Google, they are becoming Dr. Google.” This places the veterinarian in the position to become Dr. Google rather than having clients read random information found on websites from questionable sources. It is possible to create a forum in the form of a Google Hangout, which basically entails a webcam chat on a computer at a specific time of the day. We reached out to Beshears by Facebook message on May 22, 2015 in order to expand on some of our inquiries. He wrote the following message: “If local vet practices don’t cement bonds and become the resource for pet owners, someone else will.” This is definitely something for all veterinarians to think about. The industry is being fragmented by big box pharmacies, non-profits and the Internet, and veterinarians need to find creative ways to adapt with the times and get their clients more engaged with their practices.

It is understandable that some may hesitate embracing this idea due to the types of Google Hangout questions that cannot be answered without seeing the pet in person. It is recommended to always err on the side of caution and apologize for not being able to give advice over the Internet if the issue is too complex or specific to answer without a physical examination. There are times when a client needs to come to the veterinary practice, and this can be one way in which to make that clear to the client. Practices would also need to consider whether they want this open to anyone or only established clients. This online tool, which embraces Google rather than running away from it, can be an accessible marketing opportunity for veterinary services that provides detailed information and strengthens client relationships. Furthermore, recording the Google hangout can serve as protection in case your explanation was misinterpreted. The veterinary industry needs to engage in today’s technology to reach clients on a different level and actively foster those relationships.

As a caution, here is a case in which a veterinarian was said to cross the line when it came to dispensing advice online. Dr. Ronald Hines, a veterinarian in Texas, had been consulting with pet owners via his website (http://www.2ndchance.info), mostly free of charge, for more than a decade when the Texas State Board of Veterinary Medical Examiners suspended his license in March 2013 (Fiala 2014). Regulators said Dr. Hines’ services were illegal because he was not establishing veterinary-client-patient relationships with patients before offering any type of medical advice or treatment. This is the key point in how Dr. Google differs from telemedicine. The First Amendment protects Dr. Google; the information that is available is considered as a form of freedom of speech and is not specific to any pet. Dr. Hines’ telemedicine involved him offering medical opinions and/or treatment options, thus the practice of medicine without physically examining the animal. According to Raphael Moore, general counsel for the Veterinary Information Network (VIN), “The issue is not whether telemedicine can be used for ongoing treatment. The issue is whether telemedicine can be used to establish a relationship when that is being outlawed in more and more states” (Deneen 2015). Telemedicine is also a hot button topic in human medicine and the debate will continue. Nevertheless, the Supreme Court’s ruling will influence what it means to have an established veterinarian-patient-client relationship in an increasingly electronic veterinary medical world.

Economic Impact of Dr. Google

There is some light at the end of the tunnel. Dr. Google may not be affecting veterinary business as much as people think. According to the Pew Internet & American Life Project, “53% of online diagnosers talked with a clinician about what they found online” (Fox & Duggan 2013). Perhaps the economic impact of Dr. Google has been slightly exaggerated. Some practices seem to be busier than ever even in this economic climate. If anything, Dr. Google may be pushing veterinarians to be at the top of their game, and is that really the worst thing? The pressure of Dr. Google may encourage veterinarians to do a wellness exam of their practice. They may be inspired to think of new ways in which to improve service, client education, compliance, return rate, and their position in the community.

Also, it is worth considering if the questions that clients pose to Dr. Google are even topics that would bring a client in the door to discuss with a veterinarian. According to Google, the top 10 most searched questions for dogs are as follows: 1. Why do dogs eat grass?; 2. Do dogs dream?; 3. Why do dogs howl?; 4. Why do dogs have whiskers?; 5. Why do dogs chase their tails?; 6. How do you clean dogs’ ears?; 7. Why are dogs’ noses wet?; 8. How do you stop dogs from digging?; 9. How do you introduce dogs to…(babies, cats, etc.)?; and 10) Why do dogs bury bones? (Scheidegger 2015). Veterinarians may be losing out on some income when clients Google these questions, but it is possible that the amount has been exaggerated. The fact of the matter, though, is that no studies have been conducted that support how much gross income veterinarians lose when clients reference online sources. It is possible that Dr. Google may be disproportionately blamed for lost revenue.

Conclusion

Although Dr. Google may not be as big of a threat as imagined, web usage is certainly a factor that is affecting veterinary practices’ income in some capacity. Online resources are here to stay, so it is best to be proactive in trying to compete with their presence. Veterinarians have learned to compete with Internet pharmacies and there is no reason why this hurdle should be any different. Veterinary medicine is an evolving field and it is imperative for veterinarians to be innovative in order to compete and Dr. Google is not the only enemy. If Dr. Google is changing the game of veterinary medicine, so can veterinarians. Challenge accepted.

References

Breshears, B. (2014, Sep. 8). How To Beat Dr. Google. The Veterinary Marketing Podcast. Podcast retrieved from https://itunes.apple.com/us/podcast/veterinary-marketing-podcast/id901095884?mt=2

Deneen, S. (2015, May 14). Telemedicine to Supreme Court? VIN News Service. Retrieved June 5, 2015, from http://news.vin.com/VINNews.aspx?articleId=36773&callshare=1

Fiala, J. (2014, March 21). Appeals court asked to decide free speech element of veterinary case. VIN News Service. Retrieved June 5, 2015, from http://news.vin.com/VINNews.aspx?articleId=31312

Fox, S. & Duggan, M. (2013). Health Online 2013. Pew Internet & American Life Project. Retrieved June 5, 2015, from http://www.pewinternet.org/files/old-media//Files/Reports/PIP_HealthOnline.pdf

John Volk, et. al. “Special Report: Executive Summary of the Bayer Veterinary Care Usage Study,” Journal of the American Veterinary Medical Association 238:10 (May 15, 2011): 1275-1282.

Kay, N. (2012, May 1). Put Dr. Google to work for your veterinary practice. Retrieved May 27, 2015, from http://veterinarynews.dvm360.com/put-dr-google-work-your-veterinary-practice

Paddock, C. (2012, July 23). “Dr Google And The Unwise Practice Of Self-Diagnosis.” Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/248145.php

Scheidegger, J. (2015, February 5). Veterinarians know clients Google, but what are they asking? Retrieved June 2, 2015, from http://veterinarynews.dvm360.com/veterinarians-know-clients-google-what-are-they-asking?rel=canonical

Twist, M. [Journals]: Online self-diagnosis: Am I having a heart attack or is it just the hiccups? Retrieved June 2, 2015, from http://www.press.uchicago.edu/pressReleases/2012/July/JCR_1207_SelfDiagnose.html [Original Source: Dengfeng Yan and Jaideep Sengupta. “The Influence of Base Rate and Case Information on Health Risk Perceptions: A Unified Model of Self-Positivity and Self-Negativity.” Journal of Consumer Research: February 2013, 931-946]

Wong, R. (2015, May 14). International Perspective: Is Dr. Google Good or Bad For Your Practice? Retrieved May 27, 2015, from http://www.doctorpulse.co/?p=4361