How much is a dog life worth?

RE: How much is a dog life worth?

George Cooper — Fri, 12 Feb 2016 18:09:10 GMT

I know of at least three practices where there is, indeed a differential pricing structure for the Boss with two " Certs" to his name, for the middle tier colleague with one, and the youngest colleague with nothing (yet). The standard fee is for the most recent grad and there are two "experience surcharges" for the other two. Clients are given the choice.

Brave decision, especially to market it up front, but it does appear to be effective.

RE: How much is a dog life worth?

Bob Russell — Fri, 12 Feb 2016 14:27:52 GMT

Can I suggest dino-mod-vet for those older and experienced but up to date?

RE: How much is a dog life worth?

Nhombokisheni — Fri, 12 Feb 2016 13:59:22 GMT

[quote user="Nicola M"]

I don't have a problem with the terms dino-vet and mod-vet. I do, however, think that the generalisation stated above-that younger members seem to need the results of a multitude of tests before they can commit to a course of action-is unfair and is a regular occurrence on these threads. It does lead to a 'them' vs 'us' feel to things sometimes.......just my opinion though!

[/quote]

Agreed. Every case is unique......it's history, geographical location, season, client type etc all feed into how you handle it. While the "experienced" vets feed of years of pattern recognition to narrow down (with high levels of success) their ddxs, the less experienced tend to use the DAMNIT or similar approach to derive ddxs (which leads to more rule-outs)........this is the nature of the profession........there is no one stencil fits all.

However, it is also very true that even the "experienced" will expand beyond pattern recognition if history, or PE dictates. Most importantly "experienced" is really a result of practicing in one area (geographical/speciality) for a long time........take them out of that area and they will have as long a list of ddxs as anyone out to do a thorough job.........just try and present a dermatology case to a professor of orthopaedic surgery who has not seen a clinical case in donkey years!!!!!

On this forum we have experts in different areas.....a small animal vet well naturally struggle with some large animal stuff which, to people like Michael, is run of the mill. Referral centres will confirm that some of the cases they get are "mind boggling" and should not have been referred, because the referring vet missed something very "obvious to them".

I never forget my internal med prof who always said "diseases do not read books, neither can or patients talk".......the question of how much you do rests on case presentation (signalment, hx, PE, clinical picture).......and before any judgement, I think it's only fair to give benefit of the doubt.

(Maybe a tangent) but one issue that I have had to grapple with is, how much should a vet....if at all......charge a client for his/her lack of experience. When you are on a learning curve, you obviously will do more than what an experienced vet does......the knowledge you gain is yours for life (in other words you benefit more than the client/patient.....you proceed to become a specialist and earn even more because of those trials and errors of your formative years). Some of the tests are to assure yourself.

Should we charge for everything......even when you are fumbling in the dark, or just wanting to make sure? Is it enough to charge just because you told the client and they agreed for you to exhaust your arsenal of tests available? How do you guys factor in this in your pricing?????

Finally, in a practice with multiple vets of experience ranging from zero to forty years......are clients charged to reflect this.........also some locums "are best left unclassified".....know what I mean.....Should clients still pay the same no matter the quality of service??

RE: How much is a dog life worth?

Braden Collins — Fri, 12 Feb 2016 12:42:15 GMT

I think a pet is worth what a person will spend. I think we need to offer what we consider best practice, with an estimate of costs, then work from there.

When I see vets offer/advise a level of treatment, then when they find out the pet is insured and offer additional work, I think they have balked away from offering the best treatment because the were worried about discussing the price.

I always remind my staff that some people pride themselves on giving their pet the best possible treatment, and to not offer it is doing them a disservice.

If someone is willing to spend 4000 on their pet, and that is a fair price for the job, I'd happily take their money and everyone can walk away happy.

On Tuesday I had a car crash into me while riding my bike. I smashed 2 teeth and the estimated dental bill is $3000. some people will say that's ridiculous of 2 teeth, but for me I'm happy to pay that. I perceive it as fair value and will pay it happily rather than talk with a lisp and have a terrible smile. For someone else that may be daylight robbery. But if the dentist advised me to take a cheaper path then found out later something more expensive could have saved my smile (but wasn't offered) I would be very annoyed.

I think sometimes as vets we try to save the client money when they really want the best treatment. This robs the patient of the best treatment and the clinic of profit (which may be a dirty word but is very important).

RE: How much is a dog life worth?

Julian Earl — Fri, 12 Feb 2016 12:23:06 GMT

George: A good thoughtful reply. As long as the terms are not used in a derogatory manner, rather than an understanding of differing abilities and knowledge, I think the terms are acceptable. Personally, I would only be offended if I was described as being rubbish/stupid/ignorant due to my experiences and knowledge. as being worthless?

RE: How much is a dog life worth?

Nicola Cole — Thu, 11 Feb 2016 22:31:39 GMT

[quote user="George Cooper"]

[/quote]

RE: How much is a dog life worth?

Julian Earl — Wed, 10 Feb 2016 21:39:15 GMT

Hello Rob,I am unsure towhat you refer as unacceptable,;use in perjorative sense? If

so then, no an insulting tone is never acceptable , but as I have pointed out, I used the term for myself first. I see it as a short-hand for older/ experienced but perhaps not up to date in all respects? Likewise I see Mod-vet as a cimpimentary: young-ish/ well-educated with latest information/progressive and still learning as we all are.

Or did you mean unacceptable that a moderator missed the meaning of the useas insult? I did not miss it but do not see it as necessarily insulting. Context and wording iscritical there. I certainly do not see it as insulting for anyone to suggest hat there might be a different/better way of doing something. If it is my CDP has been insulting me for years. Does this answer your question?

By the way why the apparent fuss about HTH? Does it ever mean otherthan Hope this helps? News tome if it has another meaning! Hypertrophic help???

RE: How much is a dog life worth?

Rob Loxley — Wed, 10 Feb 2016 20:03:44 GMT

[quote user="Julian Earl"]

Rob: Maybe Julian is missing that these labels are often used on these forums in a pejorative way?

Indeed I was

[/quote]

Therefore in your capacity as clinical moderator, do you think that is acceptable?

RE: How much is a dog life worth?

Julian Earl — Wed, 10 Feb 2016 17:52:24 GMT

Maybe Julian is missing that these labels are often used on these forums in a pejorative way?

Rob: Maybe Julian is missing that these labels are often used on these forums in a pejorative way?

Indeed I was, I don' treally consider them insulting, and I did use the term for myself up there so I hope that was not taken badly by anyone. It is just a short-hand description for my outmoded thought processes perhaps. The reverse is that Ithought modvet complimentary; young/ up-to-date/ progressive and aware of state of the art? Isn't that acceptable?

RE: How much is a dog life worth?

Virginia Campbell — Wed, 10 Feb 2016 16:25:53 GMT

[quote user="George Cooper"]4 weeks post season, vag discharge, vomiting, pu/pd, and swollen, colour not good[/quote]

James Herriot referred one of these - the pathetic, craven, refer-everything overspecialised modvet- to a small animal surgeon. Though he and Granville Bennett did go on the lash after so that's OK. Proper Olden Times. Like a Hovis ad it were.

RE: How much is a dog life worth?

Rob Loxley — Wed, 10 Feb 2016 13:49:55 GMT

[quote user="Joyce Whitehead"]And can we please stop the use of "Dino" versus "mod" vet?[/quote]

[quote user="Julian Earl"]Mod-vets are welcome as are dino-vets with their older views and as long as all views are argued reasonably, with understanding of A.N.Other's point of view there should be no problem. Lack of consideration of different opinions is frequently a cause ofproblems IME. I cannot see anything derogatory or unprofessional in the posts so far[/quote]

Maybe Julian is missing that these labels are often used on these forums in a pejorative way?

RE: How much is a dog life worth?

Bob Russell — Wed, 10 Feb 2016 13:38:57 GMT

Fluids are a good idea and I have always used them! Thio was routine before Rapinovet came along. It worked, was pretty much as successful and to the best of my knowledge did not result in additional cases of kidney failure beyond the effects of toxins from the pyo.

Colleagues did not always administer fluids and seem to have had a similar success rate.

Lack of fluid therapy may well be seen as negligent (certainly I would struggle to support it) but thio worked very well and safely IMO.

We were all guilty of inadequate pain relief in those days. I used to use Fortral in them there days!

RE: How much is a dog life worth?

Julian Earl — Wed, 10 Feb 2016 13:01:02 GMT

Bob: Sorry I think fluids are critical, as is using an anaesthetic regime which protects kidney function as much as possible. Yes thousands were treated successfully with thiopentone , but they probably suffered agonies post-op, and many died of kidney failure some six months later.

Wynne

I agree, fluids make a huge amount of difference to how bright and well dogs seem after surgery, but once upon a time it was rare and subcutaneous was the most likely if any were used IME.

BTW; no offence meant to anyone by the use of the term dinosaur, not least because I used it in reference to myself, and never taking bloods for diagnosing an open pyometra,

RE: How much is a dog life worth?

Bob Russell — Wed, 10 Feb 2016 09:58:22 GMT

[quote user="Hannah Wynne Richards"]

Sorry I think fluids are critical, as is using an anaesthetic regime which protects kidney function as much as possible. Yes thousands were treated successfully with thiopentone , but they probably suffered agonies post-op, and many died of kidney failure some six months later.

Wynne

[/quote]

Thiopentone did not appear to damage kidneys and I don't remember any pyo's that died of renal failure six months later. Fluids a good idea and thio not a good at pain relief but did work perfectly well.

RE: How much is a dog life worth?

Hannah Wynne Richards — Wed, 10 Feb 2016 08:42:36 GMT

Wynne

RE: How much is a dog life worth?

Julian Earl — Tue, 09 Feb 2016 22:25:28 GMT

Hello Joyce, Mod-vets are welcome as are dino-vets with their older views and as long as all views are argued reasonably, with understanding of A.N.Other's point of view there should be no problem. Lack of consideration of different opinions is frequently a cause ofproblems IME. I cannot see anything derogatory or unprofessional in the posts so far, only surprise, including my own in my post just up there^

I would not dispute bloods for this pyometra except possibly as a diagnostic tool, but not as a means of full clinical assessment, eg renal function. Joyce : are you aware that pyometras used to be successful treated and rapidly cured by thiopentone-only GA, no fluids and penicillin as routine antibiosis. Thosands of them in fact. That was the basis of my surprise and I concede fluids in particular make a huge difference to recovery and probably well-being but experience tells that are not necessarily critical. I accept many younger vets will probably not have witnessed these cases.

Moderation here? I don't think anyone needs reprimanding just a polite request to be considerate of how one's own experience is personal, not universal of course. Thanks in advance. Yep I will continue to watch.

RE: How much is a dog life worth?

Joyce Whitehead — Tue, 09 Feb 2016 20:22:18 GMT

And can we please stop the use of "Dino" versus "mod" vet? I'm happy to stand with anon in my own name, it gets really boring. I'm qualified 32 years, so I've been around a fair time. Yes, as a new grad in the early 80s I would get a pyo, whip out the uterus and stick it on antibiotics. No, I wouldn't always do that now. Generally, unless the owners are very cash strapped, I will scan preop, we have a scanner so it doesn't add a huge amount of time ( and a lot less than in the old days when we had to X-ray of we weren't totally sure if it was a pyo). I'd rather know before surgery if there is a peritonitis going on.

Yes I will often run bloods, as there is no point in putting a 13 year old with potential renal failure through surgery without the owner being aware the outlook is much worse. I will also always use iv fluids. And yes our recoveries are smoother, we lose fewer patients, and therefore I and the owners are happier. Yes we probably do charge more, but our care, and therefore our job satisfaction is much better. I wouldn't do a C and S but I think that's a rare and therefore not entirely useful example, as I doubt many practices would do that.

I think if I was a young vet I would be wary of posting on here for fear of being jumped on by certain people condemning me for being a mod vet. Julian Earl I would hope as clinical moderator this is something you could keep an eye on? This is not what the forum is for, surely, how in the olden days we were all amazing and needed no diagnostics? Sorry, rant over.

RE: How much is a dog life worth?

Gillian Mostyn — Tue, 09 Feb 2016 19:54:25 GMT

[quote user="Andrew Kent"]Can we not all try to see the best in our professional colleagues rather than look for any opportunity to be critical of them?[/quote]

I have noticed that the true 'experts' (whatever your personal criteria are for granting this title) seem to be the kindest people to their colleagues. It is a minority of 'GPs' who seem to look down from their lofty perches to cast judgement on their colleagues. Odd really.

RE: How much is a dog life worth?

Andrew Kent — Tue, 09 Feb 2016 19:48:49 GMT

[quote user="Gillian Mostyn"]

[quote user="George Cooper"]As an Example. 5 yo farm collie, 4 weeks post season, vag discharge, vomiting, pu/pd, and swollen, colour not good - presented to lovely, useful, client friendly very 'modern' VS....... Dog had bact/sens swab, scanned abdo, bloods, X-rays, all prior to any thought of surgery. Farm client landed w bill of over £800, and when we had scraped him off the ceiling... ... ... ..[/quote]

I find posts like this really unhelpful, and very disrespectful to your colleagues. You were not in that consultation. You didn't see the dog that day (sounds pretty bloody ill though to me) so cannot possibly judge the need, or not, for the diagnostics it had. But, for example,: swab: not expensive and is generally considered good practice. Scan: if the uterus had already ruptured, or if co-morbidities, then prognosis altered dramatically. Bloods: well, yes. So although I can't say I would have carried our all, or any, of those things, they were all completely appropriate. And in my experience, farm clients are happy to pay for the care of their dogs as they are far more valuable to them, both in monetary and emotional terms, than the 'average' pet.

But maybe I'm just getting bored with the threads on here where there is a lot of 'colleague bashing' going on.

[/quote]

Clearly your example is far fetched and I wouldnt try to defend the approach in any way but, I also dislike the use of these kind of examples and don't find them useful. We all see frequently situations where a clients account of something is very different to that of one of our colleagues and so without seeing both sides of this it is inappropriate to criticise.

We can all recount anecdotes of when our approach was better than somebody elses, and I could provide you with numerous examples of times when some investigation before jumping in dramatically altered the clinical course for the better.

[quote user="George Cooper"]how the younger members seem to need the results of a panoply of tests before they can commit to a course of action[/quote]

I am not in favour of anonymous forum posts (or user names for that matter) but I do share some of the sentiment that its a shame these discussions always seem to go back to some kind of generational gap. I don't think this is generational at all.

The reality is that there are good vets and bad vets, and that people will all approach cases differently, but as I have said before the vast majority (with a tiny number of exceptions) are just trying to do the best they can in whatever situation they find themselves in and with whatever restrictions they have.

Can we not all try to see the best in our professional colleagues rather than look for any opportunity to be critical of them?

RE: How much is a dog life worth?

George Cooper — Tue, 09 Feb 2016 18:53:08 GMT

It was certainly neither "colleague bashing" nor even critical - and the initial response probably reveals more of the mind set of the writer, more elegantly than mine ever does about anything.

it was, quite simply, an example - and a simple one at that - of how the younger members seem to need the results of a panoply of tests before they can commit to a course of action. A dino vet would most likely have gone straight to a diagnosis, had the dog on the table and the womb whipped out within half an hour. The dependence of "third party" aids and assistance instead of using eyes, ears and fingertips is part of where a disservice is done to the patient and the client - as ever, in my opinion.

Nor was it "insurance loading" (and how dare you), not target-reaching, as I believe both to be anathema to 'proper' ethical practice, just as I do "because-we-can-ness" which has become endemic.

RE: How much is a dog life worth?

grumpyoldman — Tue, 09 Feb 2016 17:28:24 GMT

I do not think its colleague bashing to admit that there is often some degree of insurance loading as well as pocket radiography when there are also financial performance targets involved from above. We all remember Panorama 2009 ?.

RE: How much is a dog life worth?

Julian Earl — Tue, 09 Feb 2016 17:11:38 GMT

Seriously, I now feel like a dinosaur: who really does bacteriology and sensitivity on a pyometra? Surely they've been doing fine with hysterectomy and perioperative broad-spectrum-penicillins for the last forty years? Gilding in my opinion, rather unnecessary.

RE: How much is a dog life worth?

Bob Russell — Tue, 09 Feb 2016 12:47:04 GMT

Pets are often considered family members and owners will pay as much as they are able. Some will spend any amount needed even if it causes severe financial difficulty.

Those willing to spend minimal amounts either don't see vets or use budget practices and allow them to do as little as possible.

I am afraid I would not jump in to save my dogs because (judging by news reports) the dogs often survive where the owner does not!

RE: How much is a dog life worth?

Julian Earl — Tue, 09 Feb 2016 12:10:25 GMT

I think it is a very personal decision and not up to us. When people jump into the sea to save their dog ordo something in an equivalent situation, that shows how much their pet is worth. It is worth risking their life for. I had a a couple of dogs that I would have done anything for, so I cannot be critical of people wanting to spend a fortune . I wouldn't jump into the sea for someone else's dog because there is then no emotional bond. What price love? Surely that is the question for owners?

RE: How much is a dog life worth?

Gillian Mostyn — Tue, 09 Feb 2016 08:45:16 GMT

But maybe I'm just getting bored with the threads on here where there is a lot of 'colleague bashing' going on.