Kelvin Mckenzie, Daily Moan today

Re: Richard Littlejohn, Daily Moan today

plantagenet — Tue, 24 Jan 2012 08:38:05 GMT

[quote user="Anthony Todd"]

[quote user="Virginia Campbell"]I did 4 booster vaccine consults today.[/quote]

As Frank Carson used to say "It's the way I tell 'em"

Another, seeing those 4 boosters could well piss the owners right off and storm out mouthing "rip-off merchant"

The art [ NOT THE SCIENCE!!!!!] of successful veterinary practice personified.... all you young lot, go and get a job with Virginia, listen and learn!

[/quote]

Well said!

Re: Richard Littlejohn, Daily Moan today

Gillian Mostyn — Mon, 23 Jan 2012 23:28:34 GMT

As I have said umpteen times both on this forum and to my staff, it isn't about cost. It is about value for money.

Re: Richard Littlejohn, Daily Moan today

Anthony Todd — Mon, 23 Jan 2012 23:24:43 GMT

[quote user="Virginia Campbell"]I did 4 booster vaccine consults today.[/quote]

As Frank Carson used to say "It's the way I tell 'em"

Another, seeing those 4 boosters could well piss the owners right off and storm out mouthing "rip-off merchant"

The art [ NOT THE SCIENCE!!!!!] of successful veterinary practice personified.... all you young lot, go and get a job with Virginia, listen and learn!

Re: Richard Littlejohn, Daily Moan today

Niall Taylor — Mon, 23 Jan 2012 20:58:27 GMT

[quote user="Virginia Campbell"] Interesting thread... etc...[/quote]

Possibly the most perfect post I've ever encountered on vetsurg.org

Niall

Re: Richard Littlejohn, Daily Moan today

Virginia Campbell — Mon, 23 Jan 2012 20:34:19 GMT

Interesting thread.

I did 4 booster vaccine consults today.

1. Middle aged dog looking good no current problems. Discovered that O is going for cataract surgery soon so supplied her with some Surolan to give to the people who will be looking after the dog while she's away, in case his ears flare up as they often do. Thus possibly saving them a weekend visit. Discussed feeding, etc. O went away happy

2. elderly cat has lost 0.7kg since last vax...O had not noticed. hr 200, murmur, palpable thyroid. O elected not to test/treat, but happy to have some idea of the likely future, able to plan instructions to cattery/cat sitter in case cat gets saddle thrombus whilst they're away. Went away happy

3. 1yo schnauzer, healthy. The heart murmur we heard when he was younger was not heard today. Complimented them on his perfect BCS, explained that fat schnauzers prone to pancreatitis etc. Discussed Os concerns about dog's fear of car travel, Os went away pleased to have some suggestions to try.

4. was actually a repeat script check, but I found a fair sized mammary mass that the O had not noticed. O went away glad that mass has been found.

Well...I think these owners were happy. Maybe they didn't mean it when they thanked me for my time and were secretly raging thinking that I was ripping them off and trying to foist unnecessary stuff on them. In most cases there is something the owners want to discuss or be reassured about, or that I want to discuss (weight and teeth usually...mostly in a preventative role. If I do my job well enough here I will do the practice out of quite a bit of cash for frequent dentals/insulin/etc)

As far as the "Your GP/nurse practitioner wouldn't do a full clinical exam" question...different scenario. Number 2 would've noticed themselves having a racing heart and losing 1/4 bodyweight. Number 4 darn sure would've noticed that mammary mass if it was on herself. How many clients don't notice whacking resoprtive lesions; or think that their BCS 4/5 dog is a perfect weight? Most of 'em. I'd feel a bit crap banging a vaccine in, ignoring the issues and only addressing them when the animal presented not eating/ with a horrible pancreatitis etc.

With the crazy fractious cats or wildly snapping dogs...I grab 'n' jab. Tell O and put on record "physical exam not possible". Discuss any at-home issues if necessary. I don't feel bad about charging full price for the vax. It's danger money.

There is usually something to discuss. If they care enough to get it vaccinated they usually do care about the other things and want to talk about them. Unlike in some American states, there are no mandatory vaccines here...nobody is holding a gun to their head. Ok I admit, the young, healthy slim lab with great teeth that is bounding all over the consult room gets a shorter exam than the examples mentioned above. They get charged the same price. I reckon it all comes out in the wash. Our consult times are 15minutes, and they do not get charged more more for vax when said lab gets old, and it takes 20minutes+ to discuss its arthritis, weight, teeth, senility, etc. As a previous poster said, even if you are in and out of a vaccine consult in which there is literally nothing to discuss, the rest of that 15minutes is lost time unless you happen to have phonecalls to do.

I would not like to get into charging different prices for boosters depending on time. Imagine how that would go if they're booked in a a cheap quick vax with their young dog and open their mouths in the consult room. "Actually, he's been growling at the kids" "Stop!!! Right, resume, the meter is ticking" "Sometimes he's lame on that left hind" "Do you want to pay for me to discuss cruciate disease or do you want to sod off now?"

I don't think that charging different prices is wrong, I just think that it would be very difficult to implement in practice and lead to a lot more time spent wrangling over cost, and possibly the opposite of what was intended...ie more clients leaving thinking that vets are a ripoff.

Re: Richard Littlejohn, Daily Moan today

Colin Thomson — Thu, 19 Jan 2012 23:39:50 GMT

[quote user="David Mills"]Misinterpretation. Its an idea, something that would be interesting to implement and see what happens: offer both within the same practice ad let the client decide. [/quote]

In some ways I wholeheartedly agree with the thrust of your argument. There is IMO a huge pent up demand for low cost veterinary services. If someone could find a good reliable business model (and there's evidence around that some are beginning to do just that) I think they would do very well. I think its a far bigger growth area than the high input/high output model that has served SA practice so well over the 10 years up to about 3 years ago. But the business models that would work best for the low end of the market are severely restricted by our obligations imposed by the RCVS. We can't have clinics with nurses just vaccinating dogs, we can't have neutering clinics that shut up shop and go home at 5 o'clock. (BTW I'm not suggesting we should be allowed to do those things, its just that there were no restrictions, that's what we'd end up with, I think). So the low end of the market is always going to be limited, although I believe there is a huge pent up demand.

And if we did offer no frills "just the vaccine" vaccinations I think it would be a huge hit with many people. But if we offered it along with our current offering I think it would just lead to confusion and frustration. How does a client know what's included in the different offerings. How do they know if that's what they want? Those that only want whatever's cheapest would know, and those who "want whatever's best for their pet" would know, but what about those in the middle? Where do you have the conversation about the level of service you're going to provide - on the telephone when they're making the appointment? In the consult when they've arrived? It would be a nightmare, IMO. Its bad enough now, when someone brings a dog in for a nurse consult for nail clipping (say) and they then want vet to look at the dog's runny eye. Charge a vet consult for looking at it and all h*** break loose, because it cost more than they wanted to pay.

So yes it might be popular. But I think for many practices it wouldn't be wise. Maybe the market can stand two levels of service, but I don't think they'll often be offered in the one practice.

[quote user="David Mills"]What I protest against is that people think a consultation is essential [/quote]

I still think an examination is desirable, and advisable, and in the best interests of the animal. But, I'd probably even agree that a consultation isn't always essential. Its just you can't tell when it isn't until after you've examined the animal.

Colin

Re: Richard Littlejohn, Daily Moan today

Colin Thomson — Thu, 19 Jan 2012 22:42:27 GMT

[quote user="David Mills"]You cannot seriously be extrapolating from one person's experiences (of whom we know nothing of his practice's socioeconomic or otherwise standing) to the whole of our clientele? We've already seen that Mr Thomson can make unsubstantiated interpretations from data presented to him and re-present it as known fact (see other threads of specialisation where consultation documents become RCVS policy documents, and this thread).[/quote]

Its the cut and thrust of an internet forum debate, not a learned scientific journal. You should apply the same standards to your own posting as you seem to expect from others.

Re: Richard Littlejohn, Daily Moan today

Hanna Bennett — Thu, 19 Jan 2012 22:30:10 GMT

[quote user="David Mills"]Misinterpretation. Its an idea, something that would be interesting to implement and see what happens: offer both within the same practice ad let the client decide.[/quote]

But surely that is what happens when there are two practices in close vicinity to each other where one practice offers cheap and cheerful and another offers full price + consultation vaccine - people choose the option that suits them best - as stated before we have cheap and cheerful nearby, but still vaccinate an awful lot of pets. This suggests to me that these people have taken the decision that cheap does not always = value (i know i am suspicious of anything that is significantly cheaper than the same item from anywhere else)

Re: Richard Littlejohn, Daily Moan today

David Mills — Thu, 19 Jan 2012 22:02:30 GMT

[quote user="robloxley"]

[/quote]

Misinterpretation. Its an idea, something that would be interesting to implement and see what happens: offer both within the same practice ad let the client decide. What I protest against is that people think a consultation is essential - indeed some have said, bizarrely, its unethical not to - for a vaccination when we're so lax in other areas, notable farm animals, unhandeable animals etc. I'm sure people do add extra value, and there will always be a place for those consultation-vaccination people especially those on long-term meds or with worries they're leaving off til vaccination time.

Just remember how this thread started - it wasn't an article in a paper talking about how vets add value, take time etc, but how 'rip off' vets are. To people who think all's well with the vet PR out there on this: complacency. Other threads have highlighted the line 'you must be rich if you're a vet'. We are seen as an expensive profession, same as plumbers, electricians etc etc. All's I'm saying is that transparency and increasing understanding of the fees charged is only going to help. If the public knew about the vaccine mark up they'd be horrified, no matter the bleating on here about how we should be respected ad nauseum; it's a facet of the poor PR, and a particular bugbear of mine.

[quote user="robloxley"]

Otherwise why would people not just choose to go to the cheap and cheerful vaccination only clinic (see Colin's reply)?

[/quote]

You cannot seriously be extrapolating from one person's experiences (of whom we know nothing of his practice's socioeconomic or otherwise standing) to the whole of our clientele? We've already seen that Mr Thomson can make unsubstantiated interpretations from data presented to him and re-present it as known fact (see other threads of specialisation where consultation documents become RCVS policy documents, and this thread).

Re: Richard Littlejohn, Daily Moan today

Rob Loxley — Thu, 19 Jan 2012 17:27:33 GMT

[quote user="David Mills"]My point still remains.[/quote]

And fine, I see what you are saying and that there are indeed plenty of clinics operating a 'cheap and cheerful' vaccination service.

What grates is your insistence that everyone else should be doing that; that those offering a 'fuller' (for want of a better word) consultation are necessarily fleecing the client; that clients don't value the time and care we might be taking; that we can't add extra value. Otherwise why would people not just choose to go to the cheap and cheerful vaccination only clinic (see Colin's reply)?

Re: Richard Littlejohn, Daily Moan today

David Mills — Thu, 19 Jan 2012 17:01:33 GMT

[quote user="Hannah Wynne Richards"]

I would say that introducing farm animals into the debate was muddying the waters

[/quote]

They are animals too, last time I checked, and our vaccination of them is bounded by the same GtPC that was touted before.

Have you ever TB tested Ms Richards? How did you tell all the animals were healthy enough? Or did you clinically examine them all? What about the fractious cat?

Health checks are perfectly possible - ask client any worries, no, well lets just check vitals (nurse), all fine, great, vaccinate.

My point still remains. Vaccination allied to clinical examination isn't necessary and is marketing. For those doubters, why not try offering two services for 6 months and see what happens?

Re: Richard Littlejohn, Daily Moan today

James Laidlaw — Thu, 19 Jan 2012 15:54:19 GMT

Surely if you don't feel like charging for your time, or providing the service that some others might do for a booster then you can charge less. If you do a complete physical exam and take the time to talk to owners and find out if they are having any problems or have any questions then you feel as though you are giving them value for their money and they will likely feel the same.

If you just jab an animal and send it out because you're busy or don't actually get enough time, then yeah - I guess it may feel like it's not value for money and I've definitely worked in both environments.

I definitely think there can be value for an annual health check - it just depends what service you're able or prepared to provide.

James

Re: Richard Littlejohn, Daily Moan today

Hannah Wynne Richards — Thu, 19 Jan 2012 12:03:41 GMT

I think those of us who come from a small business background are more comfortable with the idea of profit as opposed to salary-but I'm only able to offer very low rates to small charities because I charge properly to normal owners-a £30booster is approx 60p/week-and how many owners don't waste that much?Anyway it's really a £25 booster -the rest is tax

Wynne

Re: Richard Littlejohn, Daily Moan today

Mark Hedberg — Thu, 19 Jan 2012 11:39:07 GMT

[quote user="Hannah Wynne Richards"]

I've come tothe conclusion David,that for one reason or another you dislike profit, and can't see that it's profit generated by the private sector that keeps the country going-and veterinary profits are certainly far from excessive

Wynne

[/quote]

In fairness, the money side of things has never been the easiest topic in the world. Some practitioners feel genuinely unhappy that their clinical freedom is, or can be, constrained by financial issues. I know I hate it when that happens...but if I had a pound for every vet who hated putting something to sleep because the owner couldn't pay - I think I'd be able to offer free care to everyone, forever! :p

Re: Richard Littlejohn, Daily Moan today

Hannah Wynne Richards — Thu, 19 Jan 2012 10:39:31 GMT

David How does one carry out a full health check without a clinical examination ? Please please tell me With over 30 years experience I still don't know

As for farm animal vaccines on the GSL list:

a) we are none of us responsible for DEFRA/VMD decisions

b) they won't have a veterinary surgeons signature on a vaccination certificate (oh, dear is it a certificate debate again )

I would say that introducing farm animals into the debate was muddying the waters

Wynne

Re: Richard Littlejohn, Daily Moan today

Colin Thomson — Thu, 19 Jan 2012 07:04:07 GMT

[quote user="David Mills"]Fine. All's I'm saying is that it doesn't have to be lumped in with something essential like a vaccination without giving the client choice. Call it what it is and let the client decide. Problem is I imagine the ego might take a bit of a punishing if the nurses consults were booked out and yours weren't. [/quote]

For us, if a client really wants the sort of "vaccination only" service you describe, they can go 4 miles down the road to the vaccination clinic. Some of them certainly do. Its cheaper than getting their animals vaccinated with us. But the most surprising thing about the pattern of our business over the last 2 years, when recession or near recession has surrounded us has been that our annual vaccination and primary course numbers have held up. To me that means that many of our clients value vaccinating their animals with us. And we don't offer an optional level of service. If they want a vaccination, their animal will have a physical examination with a vet, and if necessary, and the client isn't rushing for the door, if there are dental, weight, parasite or other problems they'll have a chat with a nurse afterwards as well. We see it as a valuable way of extending our preventative offering to the client, helping bonding clients to the practice, as well as increasing revenue from the sale of additional services and drugs.

So why don't we offer just vaccination only? Its all to do with client expectation, building brand, client bonding, differentiation in the marketplace, the difficulty of market segmentation in professional service industries, the tangible qualities of service, customer service focus and internal consistency as well as enhancing sales and the value of our service to the client. Its a fundamental building block of our business. Ego has very little to do with it.

Colin

Re: Richard Littlejohn, Daily Moan today

Colin Thomson — Wed, 18 Jan 2012 22:10:09 GMT

[quote user="David Mills"]It was an expression of frustration, justified in my opinion by the wilfully tangental nature of Mr Thomson's crass attempts at point scoring that have since, by his own lack of any sort of defence, been exposed as being as valid as an interpretation that the facts means that 96% of the clients believe in aliens[/quote]

They were my opinions. They don't necessarily need any sort of defence. Possibly 96% of clients do believe in aliens. You were harping on about data - that hasn't stopped you lambasting us with your opinions.

Colin

Re: Richard Littlejohn, Daily Moan today

David Mills — Wed, 18 Jan 2012 21:56:22 GMT

[quote user="Hannah Wynne Richards"]

David Read the Gto PC It's UNETHICAL to vaccinate an animal without a full health check-that's why nurses are banned from doing so As others have pointed out, it can be dangerous to vaccinate an unhealthy animal-and I would like to know DCs reaction if an adverse reaction was suffered by one of the animals given a cheap no examination vaccine

[/quote]

This is a deliberate muddying of the waters.

Giving vaccinations does not, in any part of the GtPC, require a clinical examination. The exact wording is "carry out a full health check". This is the same as a TB test where one is supposed to ascertain, without recourse to a clinical exam, an animal's fitness to be a reliable test subject. There is no requirement for this to be done by a veterinary surgeon, plain and simply because vaccination is decidedly not an act of veterinary surgery. No one's saying here that the animal shouldn't be checked, but a) that doesn't mean a vet; b) it doesn't mean a full clinical exam.

What about the fractious cat that's impossible to examine but just possible to inject? On your ethics horse, Ms Richards, that would entail sedation in order to exam fully. Is that what you do?

Or what of the old cats, the diabetics with only 'fair' control, the cats with CKD - I agree with not vaccinating acutely ill animals but are cats with CKD going to raise a robust response to a vaccine? And yet I bet everyone on here has vaccinated one if not today then in the last week (I'm not saying this is necessarily wrong - but it is pretty hypocritical).

Re: Richard Littlejohn, Daily Moan today

David Mills — Wed, 18 Jan 2012 21:46:13 GMT

[quote user="Colin Thomson"]

You admit that 4% had something wrong with them

[/quote]

No, not 'admit' - there was no pressure or subjugation or threats or extraction of information by questioning. I simply offered it as a data set, unbidden, far more valuable than the unverifiable 'I've seen lots' which is the stock evidence for a plurality of vets, as a response to a previous poster.

[quote user="Colin Thomson"]

(a low figure IMO - I've seen figures that around 40% of pets have dental disease).

[/quote]

I'd be happy to look over these figures if you point me towards them. Also note that our data set was of a limited age range, which is my point about 'routine' boosters of young, healthy animals.

[quote user="Colin Thomson"]

Do you accept that for at least some of your 4% some treatment was necessary or advisable?

[/quote]

Not always. The vast majority were monitor only. A heart murmur, for instance, is hardly treatable.

[quote user="Colin Thomson"]

Did you know which animals were in that category before you examined them?

[/quote]

How could I? Peculiar question.

[quote user="Colin Thomson"]

An annual physical examination is easily justifiable in my opinion. I see no reason not to charge for it.

[/quote]

Fine. All's I'm saying is that it doesn't have to be lumped in with something essential like a vaccination without giving the client choice. Call it what it is and let the client decide. Problem is I imagine the ego might take a bit of a punishing if the nurses consults were booked out and yours weren't.

Re: Richard Littlejohn, Daily Moan today

David Mills — Wed, 18 Jan 2012 21:36:08 GMT

[quote user="Arlo Guthrie"]

David, you seem to be making good points - why spoil them with the patronising remark at the end?

[/quote]

It was an expression of frustration, justified in my opinion by the wilfully tangental nature of Mr Thomson's crass attempts at point scoring that have since, by his own lack of any sort of defence, been exposed as being as valid as an interpretation that the facts means that 96% of the clients believe in aliens. Spoilt in your opinion, perhaps, but hey ho can't please 'em all.

Re: Richard Littlejohn, Daily Moan today

Anthony Todd — Wed, 18 Jan 2012 20:56:43 GMT

[quote user="Colin Thomson"]An annual physical examination is easily justifiable in my opinion. I see no reason not to charge for it.[/quote]

And just wait, all of you knockers of boosters, until we get another panleucopenia outbreak like we had in the late [?] seventies.

And with the over-vaccination scares and the questionable vaccine effectiveness, distemper is a possibility for the future too.

Re: Richard Littlejohn, Daily Moan today

Colin Thomson — Wed, 18 Jan 2012 19:56:07 GMT

[quote user="David Mills"]If you had paid attention to the statement closely I gave no indication of knowing the client satisfaction rating for the service provided, nor attempted, entirely unsupported by any data whatsoever, to give any indication what they thought. The data applies only to objective clinical findings in apparently normal animals presented for vaccination. Can I put my spoon away now?[/quote]

Well, as we have no data to hand regarding client satisfaction, only our conflicting opinions, let's consider the value of examining a pet's health once yearly. You admit that 4% had something wrong with them (a low figure IMO - I've seen figures that around 40% of pets have dental disease). Do you accept that for at least some of your 4% some treatment was necessary or advisable? Did you know which animals were in that category before you examined them?

An annual physical examination is easily justifiable in my opinion. I see no reason not to charge for it.

Colin

Re: Richard Littlejohn, Daily Moan today

Arlo Guthrie — Wed, 18 Jan 2012 19:32:57 GMT

David, you seem to be making good points - why spoil them with the patronising remark at the end?

Re: Richard Littlejohn, Daily Moan today

David Mills — Wed, 18 Jan 2012 19:27:03 GMT

[quote user="Colin Thomson"]

Lets reinterpret your data. 96% of owners left happy to know that there were no obvious medical problems detected on physical examination of their pet. Many felt the whole process was good value for money. Have you any data to suggest otherwise?

[/quote]

Nice try. Interpret the data how you like for your own ends, as long as you appreciate the difference between interpretation and factual data. I haven't any data to suggest otherwise but equally there isn't any data in support of of your interpretation unless you surveyed my clients in November 2010 without my knowledge. Did you? Have you any data to support your view?

If you had paid attention to the statement closely I gave no indication of knowing the client satisfaction rating for the service provided, nor attempted, entirely unsupported by any data whatsoever, to give any indication what they thought. The data applies only to objective clinical findings in apparently normal animals presented for vaccination. Can I put my spoon away now?

We can all play such a silly fantasy game of course. 96% of owners left thinking 'was that it for £30? A general check up to say everything was fine - I could have told him that - and a quick jab, bloody hell' and 4% thought 'bloody vets always trying to get you to pay for extra tablets this and dentals that, all I wanted was a quick vaccination'. Have you any data to suggest otherwise, Mr Thomson?

Ms Richards, does such strict adherence to the rules apply to farm animals I wonder? And what of sheep vaccines being sold in wholesalers on GSL? Hmmm.

Re: Richard Littlejohn, Daily Moan today

Hanna Bennett — Wed, 18 Jan 2012 14:10:28 GMT

Our vaccination reminders do not simply say 'come in for your vaccination' they say 'come in for your vaccination including a full clinical examination by the vet and a chance to discuss any concerns you may have regarding your pet'. Even in the odd case where we no longer vaccinate for clinical reasons (previous reaction to vaccination/ongoing immune mediated disease) I still recommend an annual health check without the vaccination as I believe it is very useful.