Gold Standard

Re: Gold Standard

Gina Dungworth — Wed, 12 Jun 2013 14:55:49 GMT

Actually, I think that could be a Gold Standard for charity work. Not just vet charities (I was writing up an interview with someone in a completely different part of the charity sector earlier).

Do the best, within resources, and make sure everyone understands that resources are limited.

Re: Gold Standard

Tim Browning — Wed, 12 Jun 2013 14:52:40 GMT

Working at a busy charity clinic where resources are largely allocated by the vets and not the clients choice with the depth of their pockets, we have had to develop a philosophy of pragmatism.

This is defined as -

'Pragmatic case management is the treatment of disease by medicine or surgery using the necessary, but minimum, resources of time and money consistent with good animal welfare whilst ensuring a realistic client understanding and buy-in to the process.'

This approach leads to vets, working as a team, to do useful work without the dread of failing the 'Gold Standard' . I find many younger vets are in a perpetual state of paralysis, causing anxiety, when faced with making clinical decisions without a defensive screen of tests in many routine cases. There is another way.

Re: Gold Standard

Gina Dungworth — Wed, 12 Jun 2013 14:36:49 GMT

Accepted by whom? Maybe we need to come up with a vetsurgeon.org Gold Standard for how to deal with clients and patients.

Re: Gold Standard

Anthony Todd — Wed, 12 Jun 2013 13:49:56 GMT

[quote user="Gina Dungworth"]sick dog = run tests'.[/quote]

But it is, ask my neighbour.

And it's now the accepted "gold standard".

Re: Gold Standard

Gina Dungworth — Wed, 12 Jun 2013 11:30:08 GMT

Agreed that you don't need to check for everything all the time. And I'm wasn't thinking of the cases where 99% (or even 90%) will get better with symptomatic treatment, but the ones where there's something suspicious, but a 60 or possibly even 70% chance that the animal will get better on symptomatic treatment. So, yes, possible petechiae on exam, or suspicions of anaemia.

Considering how much fighting I've had to do to get the NHS to believe me about anything, I think there are cases for and against running tests from the outset in practice, and 'Gold Standard' has to depend on the full details of a case, not just 'sick dog = run tests'.

Re: Gold Standard

Mark Holmes — Wed, 12 Jun 2013 09:51:21 GMT

Anthony, you have summed up my point exactly. We don't know in this case if this was the vet's normal course of action (either by inexperience or bad experience or target driven culture) or something had raised particular concerns - petechiae like spots for example. Gold Standard does sometimes seem to mean checking for everything immediately all the time - not something I subscribe to.

Re: Gold Standard

Anthony Todd — Wed, 12 Jun 2013 09:15:13 GMT

[quote user="Gina Dungworth"]

Taking shortcuts (like in the case of treating the most likely cause before carrying out diagnostics)

[/quote]

Yes, well, this sums up the modern approach to veterinary practice as opposed to back in the day and I'll give you an example this week.

Neighbour took her nice, well, dog to the local practice for diarrhoea with blood in it, dog not unwell but...

She was told that this needed £200 of tests 'cos it "could be indicative of a serious condition", which she had done; all normal of course.

Sure, "gold standard" or "cutting edge" or "state of the art" but necessary, or best for the animal or owner, I very much doubt it.

Back in the day 99.9% of cases like this would be better with water only and symptomatic treatment in a maximum of 48hours or have returned for further assessment, the other 1 in a thousand would have further exam with or without more tests if necessary after or before the 48hrs.

Which is the "gold standard or "cutting edge" or "state of the art"?

I know which I'd do ,and which is better for the animal to say nothing of the owner's pocket.

Re: Gold Standard

Thomas Johnson — Wed, 12 Jun 2013 08:50:27 GMT

[quote user="Michael Woodhouse"]

[quote user="Braden Collins"]I use the term gold standard to prepare the client for the very large price I am about to present them with for an estimate. It's a bit like saying "I'm afraid I've got some bad news" before you tell them their pet has died.[/quote]

"Mrs Miggins, I'm sorry to tell you that I think Fido is dead. The gold standard is that I do an ECG to confirm that at an extra £50..............."

[/quote]

Don't forget the lab test and cat scan

Re: Gold Standard

Michael Woodhouse — Tue, 11 Jun 2013 20:02:55 GMT

"Mrs Miggins, I'm sorry to tell you that I think Fido is dead. The gold standard is that I do an ECG to confirm that at an extra £50..............."

Re: Gold Standard

Gina Dungworth — Tue, 11 Jun 2013 09:28:19 GMT

I don't think Gold Standard has to exclusively refer to the most expensive process. Taking shortcuts (like in the case of treating the most likely cause before carrying out diagnostics) may often work out more expensive in the long run. Or Gold Standard can be a case of doing the best possible set of options, rather than doing all of them without thought as to which are really necessary.

Re: Gold Standard

Braden Collins — Tue, 11 Jun 2013 04:48:27 GMT

I use the term gold standard to prepare the client for the very large price I am about to present them with for an estimate. It's a bit like saying "I'm afraid I've got some bad news" before you tell them their pet has died.

Re: Gold Standard

Anthony Todd — Mon, 10 Jun 2013 19:16:14 GMT

Are you sure that the "gold standard" has nothing to do with the bill?

Which would be the most expensive "gold standard", "best practice" or "best thing for the animal"?

Examples please.

Re: Gold Standard

Morag Kerr — Mon, 10 Jun 2013 16:06:50 GMT

I suppose "reference method" doesn't have quite the same ring to it....

(See what I did there?)

Re: Gold Standard

Martin Atkinson — Mon, 10 Jun 2013 15:50:08 GMT

[quote user="Morag Kerr"]Of course the new test may turn out to be even better than the previous gold standard, which makes for some interesting arguments.[/quote] Platinum presumably, then Palladium then.....

Re: Gold Standard

Morag Kerr — Mon, 10 Jun 2013 12:53:20 GMT

Gold standard, as I've always encountered it, is the most accurate test in existence, against which any test being evaluated should be compared.

Of course the new test may turn out to be even better than the previous gold standard, which makes for some interesting arguments.

Re: Gold Standard

Gina Dungworth — Mon, 10 Jun 2013 09:44:54 GMT

[quote user="bob lehner"]

I would guess in current usage 'Gold standard' in most peoples' minds would relate to Olympic Gold Medals - i.e. 'The Best'.

All these o.t.t. terms 'Gold Standard', 'State of the Art', 'Cutting edge', when used in practice Yellow Pages ads etc. leave me cold - I've come across some pretty mediocre practices which use such terminology...!

Would be refreshing to find one describing itself accurately - 'We are a pretty average practice in reality - probably Bronze Standard at best, if the truth be known'.

[/quote]

Personally, I'm unsure about anyone using the term (or any of the alternatives) as an absolute to describe themselves or their services. I see Gold Standard as an ideal based on what would be done in a perfect world, i.e. a standard to aspire to.

So, to define 'Gold Standard' for any one aspect of veterinary practice, we need to gather opinions of what is the best answer to a series of questions and then aspire to meet as many of those as possible.

Say I want a car that will get me up to the stables in any weather. The Gold Standard would be one that moves forward reliably, stops reliably, carries everything I need to take with me, uses next to no petrol and looks really flashy. In aspiring to have a Gold Standard car in those circumstances, I'm going to want one that fits the first three or four and cross my fingers whether it will also match the fifth. Other people might favour looking flashy over not using petrol, of course ;-)

Re: Gold Standard

bob lehner — Sat, 08 Jun 2013 09:19:48 GMT

[quote user="Mark Holmes"]This is a term that bugs me. Would somebody like to define it because as far as I can see its a load of subjective nonsense. THE Gold Standard was a system of currency exchange which was abandoned in 1931 and whilst there is some debate on its merits it has generally been considered that abandoning it was a good thing. The term has more recently been adopted as some indicator or quality[/quote]

I would guess in current usage 'Gold standard' in most peoples' minds would relate to Olympic Gold Medals - i.e. 'The Best'.

Would be refreshing to find one describing itself accurately - 'We are a pretty average practice in reality - probably Bronze Standard at best, if the truth be known'.

Re: Gold Standard

Mark Holmes — Sat, 08 Jun 2013 00:07:21 GMT

Oh and Martin I just noticed your signature lurking under THAT photo. Snigger - it's appropriateness is a perspective thing.

Re: Gold Standard

Bob Russell — Fri, 07 Jun 2013 17:20:14 GMT

I have tried to introduce some more err... interesting staff uniforms but nearly got my face slapped!

Re: Gold Standard

Martin Atkinson — Fri, 07 Jun 2013 16:45:47 GMT

[quote user="Mark Holmes"]Martin, Use THAT photo next time you are posting a job advert I would even consider applying myself!

[/quote] OK but be aware there is no sexual discrimination in my practice so you'll have to wear the same uniform and unless you've got legs like Roger Taylor (cf Queen 'I want to break free' video) it may not be a good image.

Re: Gold Standard

Mark Hedberg — Fri, 07 Jun 2013 16:34:50 GMT

[quote user="Mark Holmes"]Martin, Use THAT photo next time you are posting a job advert I would even consider applying myself!

[/quote]

Why, do you look good in a pink skirt?

Re: Gold Standard

Mark Holmes — Fri, 07 Jun 2013 16:14:54 GMT

Martin, Use THAT photo next time you are posting a job advert I would even consider applying myself!

Re: Gold Standard

Martin Atkinson — Fri, 07 Jun 2013 15:53:00 GMT

[quote user="Julian Earl"]Isn't everyone's practice staffed by hunks and babes? [/quote] Mine is! Sorry girls no picture of the hunk.

Re: Gold Standard

Julian Earl — Fri, 07 Jun 2013 11:15:25 GMT

[quote user="Stephen Courtney"]

I don't think there is a specific definition - that's my point! It's just marketing guff. doesn't mean a thing, but perhaps in the generic client's imagination it means lovely shiny equipment and staff like the cast of Baywatch cuddling puppies and kittens.

I agree with your dislike of the term.

[/quote]

Stephen: I didn't know that you'd visited my practice! Isn't everyone's practice staffed by hunks and babes? Maybe it's just here then?!

Re: Gold Standard

Martin Atkinson — Fri, 07 Jun 2013 10:38:54 GMT

Five stars for that Bob.