[Film] What is pragmatic vet med anyway?

RE: Film Club: What is pragmatic vet med anyway?

Judith Joyce — Wed, 15 Jan 2025 10:52:09 GMT

Geez, this language thing is complicated! I had used fixed as in current objective theories (guess maybe that's not fixed as they change with time and research? ) where your fixed is more fixed? You're probably right as I don't think fixed is a fudge word.

Agree about your second point, as soon as you open your mouth there is room for misinterpretation, is it a losing battle to try to minimise it?

RE: Film Club: What is pragmatic vet med anyway?

Arlo Guthrie — Tue, 14 Jan 2025 18:28:08 GMT

[quote userid="13891" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246362#246362"]and the explanation said using 'evidence based medicine' I think EBM sticks more to fixed theories than a lot of treatments available[/quote]

Well, I'd say that the point of EBM is that it evolves as new E emerges, so not something I see as fixed.

[quote userid="13891" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246362#246362"]Opinionated pet owners may hijack selected content to choose to think their wacky ideas are being endorsed[/quote]

I think that is a hazard of modern life which you can apply to almost anything!!

RE: Film Club: What is pragmatic vet med anyway?

Judith Joyce — Tue, 14 Jan 2025 10:52:51 GMT

Good film! Like the Blue Cross definition and the meaning is clear but a contradiction between the dictionary definition and the explanation struck me. The dictionary definition said not sticking to 'fixed theories' and the explanation said using 'evidence based medicine' I think EBM sticks more to fixed theories than a lot of treatments available, I am just concerned that pet owners might choose to interpret it as using UNevidenced based medicine to cut costs instead of optimal treatment, despite what it says later. Opinionated pet owners may hijack selected content to choose to think their wacky ideas are being endorsed rather than theory is being applied pragmatically. Can't do much about that I guess. Oops, forgot to like and share and stuff

RE: Film Club: What is pragmatic vet med anyway?

Judith Joyce — Mon, 13 Jan 2025 09:16:12 GMT

[quote userid="2131" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246349#246349"]It's a mealy-mouthed euphemism for cheap[/quote]

Agreed it's subjective and open to perception but not sure it's mealy mouthed. Agree 'affordable' has been hijacked and abused (don't get me started on affordable housing in our village) but it works here if you can ignore the negative connotations, or perhaps we need a better word. Cheap is a great word when we're talking about commoditised items like vaccinations, drugs, dog food, etc, I'm not sure we are talking about 'cheap' - we are talking about matching clients and their pets to the right options for them (which could easily end up quite expensive) and we have ended up with even more subjective, hard to define terms such as contextual and pragmatic - are they less mealy mouthed?

While we are on hijacked terms - where did 'gold standard' come from and how has it come to mean maximising profit from diagnostics if that's what it means?)

RE: Film Club: What is pragmatic vet med anyway?

Evelyn Barbour-Hill — Mon, 13 Jan 2025 00:10:12 GMT

[quote userid="13891" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246328#246328"]

Arlo Guthrie said:
without using words like 'affordable'.

Whats wrong with 'affordable' ?

[/quote]

It's a mealy-mouthed euphemism for cheap. There's nothing wrong with "cheap" so why not use the word? It drives me mad when councils and quangos and do-gooders rabbit on about "affordable housing". Everything is affordable to someone.

RE: Film Club: What is pragmatic vet med anyway?

Alasdair Hotston Moore — Sat, 11 Jan 2025 09:50:04 GMT

[quote userid="7232" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246327#246327"]Ultimately the decision does rest with the client, but we cannot overlook our role and responsibility in the process. [/quote]

Absolutely but without us including costsing in decision making, clients cannot give informed consent

RE: Film Club: What is pragmatic vet med anyway?

Arlo Guthrie — Fri, 10 Jan 2025 11:33:52 GMT

[quote userid="13891" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246328#246328"]Whats wrong with 'affordable' ? [/quote]

Nothing at all, Judith Joyce!

[quote userid="13891" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246328#246328"]Perhaps if we were all more comfortable talking about cost, it would help. Affordable means something to everyone, whether it's turning the heating off, struggling to pay the school fees, or maybe not going on holiday to pay the vets bill. Avoiding direct cost words has led to fudge words like pragmatic and contextual [/quote]

Completely agree.

[quote userid="13891" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246328#246328"]Also, I don't think pragmatism isn't all about cost. [/quote]

Agreed, though it leans more toward costs.

Still, there's the danger of beating around the bush. I think what we all need to be talking about here, very clearly, is ...

MONEY!

[quote userid="13891" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246328#246328"]Despite haggling about the words, yes, taking the profession and the regulator do need to be more pragmatic. But in defence of the owner vets we are/were. I think most of us (?all) applied discounts and had pro bono schemes (ad hoc or otherwise) Younger graduates often aren't free to do that, so its perhaps the industry rather than the profession that needs to change. We relied a lot more on history and clinical examination, along with knowledge of our clients and patients, and less on diagnostic tests.[/quote]

Not just discounts / pro bono. A senior vet I was talking to the other day made the point that the problem isnt black and white. It's not that vets were all doing contextual or pragmatic care and now they are not. It's a spectrum, and pragmatism / contextualism have been eroded by a greater reliance on diagnostic tests, fear of complaint, regulation etc.

[quote userid="13891" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246328#246328"]As an aside, not relating to Blue Cross but I have had charity employed vets be very judgemental with me (and airing their issue with clients) about daring to charge to fix pets [/quote]

How horrible. I suppose its just a different mindset, still I would have found it difficult not to be bloody furious if that happened to me (not that it would, of course!)

RE: Film Club: What is pragmatic vet med anyway?

Judith Joyce — Thu, 09 Jan 2025 13:27:49 GMT

[quote userid="2100" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway"]without using words like 'affordable'.[/quote]

Whats wrong with 'affordable' ? Perhaps if we were all more comfortable talking about cost, it would help. Affordable means something to everyone, whether it's turning the heating off, struggling to pay the school fees, or maybe not going on holiday to pay the vets bill. Avoiding direct cost words has led to fudge words like pragmatic and contextual

Also, I don't think pragmatism isn't all about cost. Unnecessary treatments are about animal and human welfare as well. Take the old and very sick patient. Should you always do heroics to prolong life regardless of the quality of that life.

Despite haggling about the words, yes, taking the profession and the regulator do need to be more pragmatic. But in defence of the owner vets we are/were. I think most of us (?all) applied discounts and had pro bono schemes (ad hoc or otherwise) Younger graduates often aren't free to do that, so its perhaps the industry rather than the profession that needs to change. We relied a lot more on history and clinical examination, along with knowledge of our clients and patients, and less on diagnostic tests.

As an aside, not relating to Blue Cross but I have had charity employed vets be very judgemental with me (and airing their issue with clients) about daring to charge to fix pets - that's not pragmatic.

RE: Film Club: What is pragmatic vet med anyway?

Mark Holmes — Thu, 09 Jan 2025 12:28:40 GMT

So I have a particular philosophy on this,

It's a pretty basic concept of economics that people have agency when it comes to how they spend their money. Sometimes you may struggle to understand their choices however a person has the freedom and ability to choose how they achieve the maximum utility from a sum of money.

That is to say - "For me - does my £500 provide me with greater utility (benefit) if I spend it on food, clothing, shoes for the children, holidays or cigarettes or any other essentials. On the basis that the same £500 cannot be spent twice and most people have finite resources".

I mention cigarettes mainly to highlight the point that their decisions may not make sense to you. However you cannot possibly understand the relative weights they place on things.

Most people can make this choice and have sufficient understanding of the relative benefits to make a choice which (whilst you may not agree with that choice) is theirs to make.

The problem is people don't have sufficient knowledge and experience to be able to compare the relative benefit of Veterinary services against the other demands on their budget.

That isn't me being paternalistic, judgemental or an intellectual snob. Simply put "How can a client compare the relative benefit of radiographs in an old stiff dog who is probably always going to receive meloxicam regardless of the image against Christmas presents for the children. How do they compare the relative benefit of an ultrasound in a dog with reasonably predictable pathology against heating the house?"

The truth is - they cannot without our assistance. There is an imbalance of power (on our side) which is open to abuse if we are not very, very careful. We can dress things up, market, put fancy stickers on things and encourage spending on Veterinary Health Care. Other industries do it - use marketing to increase the relative benefits of a product, attract clients and encourage spending.

The fact is we deal with some very vulnerable people, people who could easily suffer disadvantage if we are not extremely clear and honest.

Ultimately the decision does rest with the client, but we cannot overlook our role and responsibility in the process.

Professionally spending people's money demands that we don't simply lead them in unwittingly.

RE: Film Club: What is pragmatic vet med anyway?

Arlo Guthrie — Thu, 09 Jan 2025 09:44:45 GMT

[quote userid="7232" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246323#246323"] They end up several hundred pounds in before realising they don't have the funds to actually treat the dog and they are left with a really expensive body.[/quote]

Something about that appeals to my black sense of humour, but actually, that is SUCH an important point and a powerful way of putting it. I hope you don't mind if I plagiarise. Let me know where to send the royalties!

RE: Film Club: What is pragmatic vet med anyway?

Alasdair Hotston Moore — Wed, 08 Jan 2025 21:35:27 GMT

[quote userid="7232" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246323#246323"]Often I seen clients led through the process one step at a time. They end up several hundred pounds in before realising they don't have the funds to actually treat the dog and they are left with a really expensive body.[/quote]

That’s a great way of putting the importance of the art of vet science across. I recognise exactly the scenario you describe

RE: Film Club: What is pragmatic vet med anyway?

Mark Holmes — Wed, 08 Jan 2025 21:10:06 GMT

I'm loving this thread already because I have been espousing realistic pragmatic treatment of patients my whole life rather than getting bogged down in the "What ifs".

For example - An 8 years old Labrador walks in - a but pale, tachycardic with a swollen abdomen. Now you can be almost certain it has haemoabdomen and this can be confirmed by blind abdominocentesis in seconds. Aspirating frank blood looks quite different to a heavy sanguinous ascites.

At that point you can reasonably predict that the costs of treating that issue are going to be in a surgical bracket. Or at least you can give the owner the heads up that they are likely to be in a surgical bracket. You know the likely problem but regardless precisely -you know it will be costly. If the client only has £500 or £1000 they will waste it, unless they understand from the outset that bloods etc are for information only and they are comfortable with that prospect.

You could lead the client through the problem a test at a time. £150 her and £200 there. Lets bleed, lets put them on fluids etc etc. Or you could give them the wider picture from the outset.

"Mrs Smith, Twiglet appears to have an abdomen full of blood. He is pale, he is showing signs of cardiovascular shock. These cases are very frequently due to a ruptured organ such as his liver or spleen and in such cases its often associated with neoplasia. We could do X tests to establish a firm diagnosis but regardless of the diagnosis actual treatment to the extent that we would expect to resolve the issue at least for a period of time, would be expected to be in the following range. You should understand that anything less than that is likely to be for information only and that information may only be relevant in a practical sense if we anticipate proceeding with treatment.

I'm more than happy to proceed with establishing the precise cause of Twiglet's problem if you wish . Occasionally something crops up which surprises me and I really like surprises - but you should know what to expect"

Often I seen clients led through the process one step at a time. They end up several hundred pounds in before realising they don't have the funds to actually treat the dog and they are left with a really expensive body.

RE: Film Club: What is pragmatic vet med anyway?

Arlo Guthrie — Wed, 08 Jan 2025 18:30:59 GMT

[quote userid="8663" url="~/f/vetsurgeon-film-club/31110/film-club-what-is-pragmatic-vet-med-anyway/246320#246320"]I enjoyed watching you and the Blue Cross team work on this, and it’s turned out really well[/quote]

Thanks Alasdair Hotston Moore - yeah it was fun making it and I hope it stimulates some interesting debate.

RE: Film Club: What is pragmatic vet med anyway?

Alasdair Hotston Moore — Wed, 08 Jan 2025 18:27:29 GMT

I enjoyed watching you and the Blue Cross team work on this, and it’s turned out really well