Panorama reviewed

RE: Panorama reviewed

Arlo Guthrie — Wed, 04 Aug 2010 14:24:09 GMT

Hi Ann

I'm not presuming anything of the kind! :)

All I AM saying is that unlike many other purchases, veterinary care invariably comes with a strong emotional pressure to buy. Either out of a sense of duty to the pet, or as a result of a recommendation from an authoritative figure (i.e. the vet), or a bit of both.

As veterinary costs escalate, so I think it is increasingly important for vets not to increase the pressure on the owner. i.e. to inform, rather than recommend.

Having said that, I disagree with you when you say that 'we have to offer the best' (I read you to mean always).

And the pet owner on benefits, with no insurance? Is it sensible even to advise them of the existence of 'Bionic vet', for example?

Surely not without probing a little first to check that they have some unknown benefactor who would cover costs they blatantly can't afford.

Otherwise all you do is lumber them with the guilt of not being able to help their animal.

Incidentally, my 'just a cat or dog' remark was devil's advocate.

I agree absolutely that for many, their most important companion in life is their animal.

RE: Panorama reviewed

Ann Jagoe — Wed, 04 Aug 2010 11:41:36 GMT

Arlo I think you are falling into the old trap of presuming owners can't/won't pay for advanced treatment/tests, we have to offer the best and let the owners decide what they can afford and what they feel is best for their animal , they are not our pets and only the owner can decide the importance of a pet in their life. Like it or not although they are "just a cat or a dog" pets can be the most important companion some clients have in their lives and you shouldn't make decisions on their behalf as to what is justifiable when treating them.

When presented with a young male cat with haematuria surely the practitioner who dispenses antibiotics and "a bag of food"is the poorer clinician as he/she has obviously recognised that it is most likely urolithiasis by providing the food, but choosing to give antibiotics which are not actually indicated, no mention made of any followup or warning that the condition could ultimately be life threatening either.

As regards the case against Kfir Segev I am not sure what the other complaints against him were, but from what I can see their main complaint on the programme was the cost of the tests ie MRI and the fact the owner had had himself had an MRI scan which cost £600 instead of the £2200 quoted and the fact that the dog had secondaries in the chest( which Kfir missed on the xray). Specialist oncology is now more readily available in veterinary medicine and it is not wrong to refer animals for this, if owners are aware that of the costs and that remission is not always possible and may be months rather than years. The costs of veterinary MRI will be higher as GA is required, often more than one area of the body will need to be scanned and if numerous different sequences are used GA times are longer. A nurse, a vet and a specialist radiographer need to be present and a specialist needs to read the films this automatically raises costs. If the MRI is on site at the practice there are very high costs involved in purchasing the equipment, maintaining it and staffing it, if it is provided by an external provider the practice has to pay their fees, so we are not comparing like with like. To be honest in this case Kfir should really have ordered CT to assess the chest before ordering MRI for the other area (shoulder ?).

RE: Panorama reviewed

Edward Jones — Mon, 26 Jul 2010 13:50:01 GMT

A comment on your part about the insurance claim. If it is shown that fraud took place, then the RCVS would probably come down on it harder than almost anything else on the program.

As an MRCVS, signing something you shouldn't is generally an express route to being struck off.

Not that I necessarily think fraud has taken place in this instance. The owner would have had to pay three the excess fees, so would have been less well off in the short term.

RE: Panorama reviewed

Arlo Guthrie — Mon, 26 Jul 2010 09:31:07 GMT

Thank you so much Jane, Martin, Julian and sailboat. It's nerve-wracking waiting to see what people think of one's efforts, and I'm relieved!

Ailsa, I didn't mean to say that vets don't give owners the options. I guess many do (I also guess that the change from dictating to the owner, to advising them is one of the big changes of the last 20 years).

But it is a very, very grey area, largely down to semantics. While one owner will leave the practice considering themselves 'informed', another might (under the very same circumstances) think they have been 'advised', and yet another will feel they have been 'instructed'.

RE: Panorama reviewed

Vikki Halliday LLB — Sun, 25 Jul 2010 23:40:40 GMT

Perhaps two words would sort out the interesting issue of spiralling costs which you have quite rightly raised Arlo, Informed consent.

We can no longer assume that what we decide to do for an animal is the best thing, without offering the options to the owner.

RE: Panorama reviewed

bob lehner — Sun, 25 Jul 2010 19:32:28 GMT

On the question of whether the'trainee' nurses should have be performing these duties I think that Sandy Trees was absolutely correct.

The RCVS website has a section 'Advice on Schedule 3' which spells it out pretty clearly.

The term 'trainee' nurse is not a recognised description - nurses are either 'students', who are enrolled on a recognised nursing course, or Qualified/RVNs. Anyone else is no more than a lay-assistant and has no legal right to perform Schedule 3 duties.

RE: Panorama reviewed

Ailsa Rutherford — Sat, 24 Jul 2010 21:19:20 GMT

Surely on the point of giving options to the clients with the pros and cons is always part of our duty. People come to us for advice, but they also come to us with constraints, be that financial, or "not wanting anything invasive" or simply wanting a "quick fix" I think as long as you explain the benefits of doing the tests/procedures you recommend and the risks of not doing them (ie if your working diagnosis from history and clinical exam alone is incorrect) then it is up to the client to decide. The client who walked out after being presented with an estimate he did not like was in the wrong to walk out without paying his consultation fee and that should be followed up. One of my favourite phrases is "I advise .... because ......., but there's always a plan A, B & C"; this gives clients the opportunity to decide, whilst not feeling bulldozered into doing something they don't want to or feeling guilty. Surely this is what most other people do too? That way nobody can accuse you of "over-diagnosing" or just "guessing" Since they have had the informed decision.

RE: Panorama reviewed

Adi Nell — Sat, 24 Jul 2010 18:44:52 GMT

I'm very grateful for the support we've received from across the profession. It was very heartening to see the lack of schadenfreude from our colleagues. What was broadcast was appalling and we're going to get it sorted as quickly as we can. Many thanks to all for your understanding, and rest assured that we will be taking any steps needed to set things right.

Best regards,

Adi

RE: Panorama reviewed

Tim Cheyne — Sat, 24 Jul 2010 16:00:51 GMT

Not having had to deal with SA insurance (LA insurance seems much more straightforward) I wonder what pressure is put upon the consulting vet to throw a battery of tests at the pet at the initial consultation 'just in case'. If an 'oldie'like me and (clearly) some other posters on this forum relies initially on his/her clinical examination, experience and acumen, and the case goes pear-shaped,will the insurance still pay? I have heard (purely anecdotal)stories of insurance claims being refused because "the vet didn't......" Does this remote pressure from the insurance companies (and their advisers)really exist, and should it be allowed to do so?

Tim.

RE: Panorama reviewed

Robert Jenkins — Sat, 24 Jul 2010 15:48:18 GMT

Nice one Arlo a very level, thoughtful and accurate response.

RE: Panorama reviewed

Julian Earl — Sat, 24 Jul 2010 10:43:23 GMT

Excellent Arlo. I think the matter of over-diagnosis/treatment is an issue that the profession - or more specifically the colleges - need to address, and you have neatly placed that in your review. As a whole, you have summarised the programme very eloquently .

RE: Panorama reviewed

Martin Jones — Sat, 24 Jul 2010 10:39:50 GMT

Good on, Arlo. I think you've hit the wider issues on the head. I would have liked to have seen a rider at the end of the show, 'No animals were ACTUALLY harmed during the making of this show' which would have been reasonably the truth, but not so great as a spectacle.

RE: Panorama reviewed

jd2008 — Sat, 24 Jul 2010 09:51:21 GMT

Well written Arlo. Measured, sensible and sensitive. Thank you. One small correction if I may: Panorama did not focus heavily on Medivet, then focussed exclusively on Medivet. Regardless of Medivet's crimes - real or perceived - I believe there is something inherently very wrong about that.