[Film] Why pragmatic veterinary care may often be the best option

RE: Film Club: Why pragmatic veterinary care may often be the best option

Cinzia Gandini — Sat, 11 Oct 2025 17:24:05 GMT

[quote userid="4181" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/247841#247841"]expensive solution'[/quote]

Just to clarify, I wasn’t suggesting that the owner’s choices should be restricted for better care. What I meant was that if an owner can’t afford the full cost, the focus should be on finding a more affordable solution or possibly offering reduced or no-cost options when necessary.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Rob Loxley — Sat, 11 Oct 2025 14:05:09 GMT

[quote userid="4103" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/247830#247830"]something that may only be truly possible in an independently owned practice[/quote]

I don't think this is necessarily a conclusion. In many corporate practices, local leaders do still retain some pricing flexibility where needed; in many 'independent' practices the vets on the frontline (often junior) still have to follow set protocols and can't make such financial decisions without referral upwards.
The practice may be 'independent' but are the employed vets?

[quote userid="4103" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/247830#247830"]It's about maintaining the same standard of care for all patients[/quote]

I prefer thinking about contextualised care, where we will differentiate the care given for a different pets in different situations with different owners. If a client pays money for insurance or has plenty of it to spend another way, why should they not be able to choose to have the 'expensive solution'/MRI scan/specialist referral/TPLO etc?

RE: Film Club: Why pragmatic veterinary care may often be the best option

Cinzia Gandini — Thu, 09 Oct 2025 12:45:50 GMT

To me, pragmatic veterinary care means providing straightforward, effective treatment rather than defaulting to expensive solutions—and offering reduced fees, or even waiving costs entirely, for those who can't afford them. It's about maintaining the same standard of care for all patients, something that may only be truly possible in an independently owned practice

RE: Film Club: Why pragmatic veterinary care may often be the best option

Evelyn Barbour-Hill — Sun, 21 Sep 2025 22:59:46 GMT

[quote userid="3169" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246430#246430"]Whoever did those skin sutures on the ex fix dog wants striking off - far far far too tight. [/quote]

And much too complicated.

The vast majority of surgical incisions (in small animals) require nothing more than simple interrupted skin sutures. Which, incidentally, will cause only the faintest of scarring.

That's just my opinion, of course.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Clive Ansell — Fri, 31 Jan 2025 17:23:01 GMT

[quote userid="16672" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246461#246461"]Just want to make all of us feel old and point out that Apoquel has been widely used now for 11 years. We've seen a generation of dogs treated with it, so I'd imagine we'd know the long term effects by now[/quote]

I didn't realise it had been that long, how time goes by when you're having fun. I concede that one would have expected any adverse effects to have shown themselves by no. It is a good drug, and usually my first choice for allergic or assumed allergic dermatitis. About 75% of cases I see, owners will decline it based on costs, so it's a pot of preds, off you go, suck it and see. In most of these cases investigation will be declined too, so usually a case of assumed allergic skin disease after ectoparasites are excluded and any secondary bacterial or Malassezia are treated. These treatments are often declined too, with a 1 - 2 week course of antibiotics being >£100 and Malaseb shampoo at arround £66 a bottle, although I often offer Hibiscrub/Chlorhexidine as a second or alternative choice.

I still often reach for preds first line if I want a short term anti pruritic; bad ear, hot spot etc. Many colleagues will use Apoquel though, and there does almost seem to be an anti-pred movement developing.

[quote userid="16672" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246461#246461"]But as the old adage does, "better pred than dead". There's still a place for them. Sadly, I had clients in GP who couldn't afford Apoquel, trialled pred and said they "couldn't tolerate the side effects" (PUPD). Eventually elected to euthanise anyway.[/quote]

Yep, been there too, but I have had many skin cases where preds have worked for years without any major issues.

Again, it is all about having an open and honest discussion around options and associated costs.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Martin Hamilton — Fri, 31 Jan 2025 16:09:58 GMT

[quote userid="5012" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246442#246442"]The likes of Apoquel and Cytopoint are fairly new on the block, so who knows yet whether long term side effects will become apparent. [/quote]

Just want to make all of us feel old and point out that Apoquel has been widely used now for 11 years. We've seen a generation of dogs treated with it, so I'd imagine we'd know the long term effects by now.....certainly no where near as significant as pred!

But as the old adage does, "better pred than dead". There's still a place for them. Sadly, I had clients in GP who couldn't afford Apoquel, trialled pred and said they "couldn't tolerate the side effects" (PUPD). Eventually elected to euthanise anyway.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Clive Ansell — Fri, 31 Jan 2025 09:59:37 GMT

[quote userid="3169" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246453#246453"]Maybe we do need that investigation, after all.[/quote]

Without a doubt.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Clive Ansell — Fri, 31 Jan 2025 09:59:03 GMT

[quote userid="4181" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246454#246454"]But companies in general can't continually push up prices or they see reduced sales and/or customer retention at a point - see shoppers off to the German discounters or pet owners off to the online pharmacies or shopping around other vets.[/quote]

They do and they are. Many clients will sourse meds online, but many can't or don't and face being shafted.

Email from microsoft this morning, they are raising the cost off Office365 family from £80 to £105 a year, 31%. They do it because they can and want to make as much money as possible, and nobody can do FA about it really.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Clive Ansell — Fri, 31 Jan 2025 09:55:58 GMT

[quote userid="4181" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246454#246454"]£194 retail for 100 tablets from a range of online pharmacies, plus your exam/prescription fee every 6 months; but still £20 for 250x pred 5mg! Bring on the generics - but experience says they'll just be priced at £180 for 100... ...that's definitely a bit of the market that's broken IMO.[/quote]

Quick internet search and 60 x 16Mg Apoquel is £138, which would last a month in my case above. add a prescription fee of c£32, which in some cases is charged every moth because a practice will only supply a month at a time, £170 a month for meds. About half of the £350 or so in house, but still a heck of a lot of money to some and a heck of a lot more than c£20 for a pot of preds.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Clive Ansell — Fri, 31 Jan 2025 09:51:45 GMT

[quote userid="13891" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246456#246456"]

Clive Ansell said:
offering a clinically lower standard,

Sorry Clive, I think I've taken Aldo's quote out of your post.

[/quote]

Yes, not my words.

I think it is a different or alternative approach, rather than a lower standard.

[quote userid="13891" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246456#246456"]Gold standard' to me smacks of using protocols rather than case by case thinking in the wrong hands.[/quote]

Agree, and is more about maximising revenue in many cases.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Judith Joyce — Fri, 31 Jan 2025 09:42:12 GMT

[quote userid="5012" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246449#246449"]offering a clinically lower standard,[/quote]

Sorry Clive, I think I've taken Aldo's quote out of your post. Someone is playing devil's advocate here, I guess. It's not a lower standard, it's the original approach to a case, except its the one that we used before all the tests were available, and the one that is still applied by many successfully.

Takes experience (I've seen forty of these before and learned from the experience)

Clinical expertise and nous (I can feel something in this abdomen, need to discuss this with the client)

Mutual trust - (I've seen hundreds of these before and this happened; the client lives with the pet and knows their own circumstances so they know a lot about the problem)

It's pragmatic but just as good and it delivers affordable veterinary care to a lot more pets.

'Gold standard' to me smacks of using protocols rather than case by case thinking in the wrong hands.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Judith Joyce — Fri, 31 Jan 2025 09:12:28 GMT

Agree, it is maximising profit not price. and s.172 of CA 2006 gives a reporting duty for ESG or CSR or whatever to big companies - small but it's a start in compromising that profit at all costs stance. Companies know they have to be seen to behave a bit responsibly now (consumer pressure as well as law) so they go in for greenwashing etc - doesn't help the situation much, will it ever?

RE: Film Club: Why pragmatic veterinary care may often be the best option

Rob Loxley — Fri, 31 Jan 2025 08:32:05 GMT

[quote userid="3169" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246453#246453"]

Clive Ansell said:
Apoquel would be around £350 a month,

Cost price plus VAT for 60XApoquel 16mg is about £120........

Maybe we do need that investigation, after all.

[/quote]

£194 retail for 100 tablets from a range of online pharmacies, plus your exam/prescription fee every 6 months; but still £20 for 250x pred 5mg! Bring on the generics - but experience says they'll just be priced at £180 for 100... ...that's definitely a bit of the market that's broken IMO.

I'm with Clive that we can offer a range of treatment options and price points within general veterinary practice without needing to set up Arlo's Budget Vets

[quote userid="5012" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246448#246448"]In the case of corporate owned businesses, they are legal obliged to maximise return for investors, which is enshrined in company law.[/quote]

But companies in general can't continually push up prices or they see reduced sales and/or customer retention at a point - see shoppers off to the German discounters or pet owners off to the online pharmacies or shopping around other vets.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Michael Woodhouse — Thu, 30 Jan 2025 23:06:07 GMT

[quote userid="5012" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246442#246442"]Apoquel would be around £350 a month,[/quote]

Cost price plus VAT for 60XApoquel 16mg is about £120........

Maybe we do need that investigation, after all.

[quote userid="3607" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246444#246444"] in the hierarchy of things for which some would have you struck off, lies the offence of being unable to distinguish between a cat and a dog??[/quote]

Touché! Still one of my biggest bug bears (and I do use Ford Interlocking quite frequently, usually in cows)

RE: Film Club: Why pragmatic veterinary care may often be the best option

Judith Joyce — Thu, 30 Jan 2025 21:05:46 GMT

[quote userid="2100" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option"]I'm not sure of the price difference between steroids and the more modern treatments[/quote]

Approximately pennies for pounds

RE: Film Club: Why pragmatic veterinary care may often be the best option

Clive Ansell — Thu, 30 Jan 2025 17:23:18 GMT

[quote userid="2100" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246445#246445"]

There's been this assumption by the profession that owners want to spend whatever is needed on their dog, and I think it is a false one, masked to a large degree by the presence of insurance (and the lengths some people will go to in a time of crisis)

But now that the costs of insurance are rising, and owners are starting to feel the impact of the profession's endless striving for the 'highest standards' and its investment in the latest diagnostic and testing equipment, they are starting to kick back.

I might be in a minority of one, but I think the profession as a whole needs to rethink its whole consumer proposition and start offering a clinically lower standard, one that is more proportionate to the species being treated, with reduced costs but a greater margin.

[/quote]

This is what I have always done , and still do.

I advice what I consider to be best clinical practice, which is not synonymous with the most expensive. I will usually discuss and offer alternatives if a client can't or won't follow my advice for whatever reason. I tend to adopt a fairly conservative approach, where I will treat first and if no better then reassess along with tests and investigations as needed in a stepwise approach.

The key to this is to discuss options and let the client make an informed decision.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Clive Ansell — Thu, 30 Jan 2025 17:15:37 GMT

[quote userid="2100" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246445#246445"]

Clive Ansell said:
There is of course a fundamental difference between a charity such as the Blue Cross, where they have limited and finite resources so have to keep costs per case down as much as they reasonably can; and private, particularly corporate, practice where they there to make as much money as possible.

But there shouldn't be.

[/quote]

There always will be, of course.

One has limited funds to try and help as many patients as possible, the other is a business that has to generate income to be able to surive and exist and/or generate as much loot as possible. In the case of corporate owned businesses, they are legal obliged to maximise return for investors, which is enshrined in company law.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Clive Ansell — Thu, 30 Jan 2025 17:09:38 GMT

[quote userid="2100" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246445#246445"]The thing is, it's a vast amount of money to spend on a dog full stop. Regardless of whether you're on the minimum wage or not.[/quote]

I agree, to me it is/would be.

But, money and its value is relative.

To someone of limited means, they likely as not will not be able to find or afford £350 a month whether they want to or not. A client once very eloquently put it as storming out of the building "I'm not spending 80 quid on a bag of f****** dog food when I can't feed the kids properly!"

Others may be well able to afford it and choose not too, because they perceive it as too much or a lot of money.

Others may be fine with it, can afford it, and it works for them. After all folk spend far more on alcohol, cigarettes, buying a car.

Others may be insured.

I always seek to discuss the different options and give owners an honest choice.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Arlo Guthrie — Thu, 30 Jan 2025 16:55:40 GMT

[quote userid="3607" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246444#246444"]Interested to hear where, in the hierarchy of things for which some would have you struck off, lies the offence of being unable to distinguish between a cat and a dog??[/quote]

RE: Film Club: Why pragmatic veterinary care may often be the best option

Arlo Guthrie — Thu, 30 Jan 2025 16:53:10 GMT

[quote userid="5012" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246442#246442"] One case I am currently dealing with is a 60+Kg XL Bully with assumed allergic skin disease, Apoquel would be around £350 a month, which is vast amount of money to someone on minimum wage that can barely feed their kids. [/quote]

The thing is, it's a vast amount of money to spend on a dog full stop. Regardless of whether you're on the minimum wage or not.

[quote userid="5012" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246443#246443"]There is of course a fundamental difference between a charity such as the Blue Cross, where they have limited and finite resources so have to keep costs per case down as much as they reasonably can; and private, particularly corporate, practice where they there to make as much money as possible. [/quote]

But there shouldn't be.

Not sure if I can explain what I mean very well, but I'll give it a shot.

I said a few years ago that if I had the money, I'd consider setting up a chain called 'we'll give it our best shot". I'm starting to wish I had!

RE: Film Club: Why pragmatic veterinary care may often be the best option

Malcolm Ness — Thu, 30 Jan 2025 16:42:27 GMT

[quote userid="3169" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246436#246436"]It's half in jest, but they are shocking and should be used as an example of how NOT to close a wound. Someone who is capable of putting on an ex fix needs a strong talking to, and I find that disappointing and concerning. Causing unnecessary suffering is an offence under the Animal Welfare Act......[/quote]

Sutures perhaps a little tighter than I would choose (but then I would have used a continuous - Ford interlocking - pattern. The use of continuous suture patterns is considered by some to be a striking-off offence). Interested to hear where, in the hierarchy of things for which some would have you struck off, lies the offence of being unable to distinguish between a cat and a dog??

RE: Film Club: Why pragmatic veterinary care may often be the best option

Clive Ansell — Thu, 30 Jan 2025 14:33:07 GMT

It depends on the client and their perception of worth or value

There is of course a fundamental difference between a charity such as the Blue Cross, where they have limited and finite resources so have to keep costs per case down as much as they reasonably can; and private, particularly corporate, practice where they there to make as much money as possible.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Clive Ansell — Thu, 30 Jan 2025 14:28:03 GMT

[quote userid="2100" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246437#246437"]Is owning a dog a privilege to the degree that it is morally wrong to use steroids not cytopoint?[/quote]

No, of course not.

The drugs Michael mentions, Apoquel and Cytopoint, are without doubt very effective for treating allergic skin disease, but they are very expensive and in many cases I come across they are unaffordable to the owner, particularly large breed dogs. One case I am currently dealing with is a 60+Kg XL Bully with assumed allergic skin disease, Apoquel would be around £350 a month, which is vast amount of money to someone on minimum wage that can barely feed their kids.

To me corticosteroids are the next, or second, go to choice. They are cheap and cheerful, effective, but do come with side effects. I would not say inferior, but very much a second or last choice. Have the discussion with the client and they choose. I have mananged many skin cases on corticosteroids for years,with careful dosing and the lowest possible dose. I don't know why so many are so against them. I have even seen cases where euthanasia has been advised over and above trying corticosteroids.

I have also come across skin cases where Apoquel or Cytopoint are not working well, and they need either permanent or occasional corticosteroid tops ups in addition.

The likes of Apoquel and Cytopoint are fairly new on the block, so who knows yet whether long term side effects will become apparent.

RE: Film Club: Why pragmatic veterinary care may often be the best option

Arlo Guthrie — Wed, 29 Jan 2025 16:42:59 GMT

[quote userid="3169" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246436#246436"]I agree, but steroid in these cases are not an equivalent but a far inferior solution.[/quote]

I don't know how bad the side effects of steroids are, and therefore how inferior, but surely the point is that they are not a far inferior solution if they are all the owner can afford or wants to spend.

[quote userid="3169" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246436#246436"] Remember, owning a dog is a privilege and not a right.....[/quote]

But that's you imposing your values.

I may happen to agree with you, but the difficulty with that line of argument is where you draw the line. Is owning a dog a privilege to the degree that it is morally wrong to use steroids not cytopoint? If it is, then is it morally wrong not to send it for cancer treatment in a linear accelerator at £5K a pop?

RE: Film Club: Why pragmatic veterinary care may often be the best option

Michael Woodhouse — Wed, 29 Jan 2025 15:41:50 GMT

[quote userid="2100" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246431#246431"]striking off for a too-tight suture? Steady on.[/quote]

It's half in jest, but they are shocking and should be used as an example of how NOT to close a wound. Someone who is capable of putting on an ex fix needs a strong talking to, and I find that disappointing and concerning. Causing unnecessary suffering is an offence under the Animal Welfare Act......

[quote userid="2100" url="~/f/vetsurgeon-film-club/31124/film-club-why-pragmatic-veterinary-care-may-often-be-the-best-option/246431#246431"]I don’t know about how often or for how long cytopoint is given, but £100 a month or more is a LOT of money for some people. [/quote]

I agree, but steroid in these cases are not an equivalent but a far inferior solution. Not that long ago it was about all we had, these new drugs are excellent. Remember, owning a dog is a privilege and not a right.....