Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Jill Butterworth — Sun, 09 Apr 2017 22:33:45 GMT

I think we are heading that way. I was speaking to a group of young vets at the weekend, who I have no reason to think were atypical, and between them, they all seemed to be suffering stress, overwork and disillusionment from practices who are considering them expendable, and treating their nurses with far more consideration, because they expect to retain them in the long term.

Things really have changed, it IS more stressful than we qualified 20 odd years ago, for all of the reasons we have been discussing. Apart from voting with their feet and supporting the buoyant locum recruitment industry, I think eventually they may end up going the way of junior doctors and revive the idea of a veterinary union. If an all out strike happens, the profession may get what it deserves.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Richard Carter — Thu, 06 Apr 2017 18:28:49 GMT

so how much of the frustration / disillusion is finding you get all the training /cpd then you either cannot do it (not got correct equipment/ experience) or not going to do it (finances/ fear of previous litigation/ RCVS/ local rules)?

I do think the 'more rules, less independence, less innovation,' encouraged by RCVS/ VMD/ H&S/ government in general has definitely whittled away at our professional standing and usefulness to the public.

Are we heading towards the NHS model which is characterised by anyone worth their salt heading for the exit? Are we creating the type of profession where the only person who will thrive is the one who wants to be in a corporate type environment with rules and fixed, narrow parameters, not having to take any responsibility because the thinking has been done by someone else and there is a 'procedure' laid down for everything? (including how to load a washing machine!!)

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

George Cooper — Mon, 03 Apr 2017 23:02:10 GMT

It is nearly bedtime in the hills, and i feel an observation coming on.......or two.

I am pleased that there has been some response to my naive and disjointed meandering thought processes, despite, as I had predicted, the thread getting a tad diverted along the way. What is really SO disappointing, and yet, at the same time entirely predictable, is the deafening silence from RCVS, or the current candidates, and EVEN the re-canidates, one of whom was a chair of a committee that bulldozed through some of the stuff i referred to (overtly). And since Chris the Tuff (who boasts of his appointment with a veterinary surgeon in the wilds of the Welsh Borders - filling the gap, as it happened, of my departure) is seeking re-election, from a practice base, I would really welcome some response from him either as Pres, or as a practitioner... ... ... And i may comment further depending upon his response..........

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

David Mills — Mon, 03 Apr 2017 22:49:32 GMT

[quote user="J G Wray"]

[quote user="Robin Grimmer"]I think the changes in the profession are largely due to the rise of the corporates. Where once a town may have had two veterinary practices there are now half a dozen all competing, many now open all day Saturday and Sundays and bank holidays. All of which gives more choice and power to the consumer. Many practices now employ marketing gurus to make sure the whole practice team is doing the right things to attract and keep clients. [/quote]

As an owner of an independent practice, I can confirm that we have a marketing manager, who will be accompanying me to BSAVA to speak to suppliers about mutual marketing opportunities

http://www.gpvets.co.uk/about-us/meet-the-team/management-team.shtml

No idea what the Corporates are up to.

[/quote]

You been on a diet JGW?

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Beats — Mon, 03 Apr 2017 19:46:29 GMT

[quote user="George Cooper"]Do, DO, let me know.[/quote]

I think I roughly understand your perspective, I just don't necessarily share it. (you're right, I did groan )

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

J G Wray — Mon, 03 Apr 2017 16:01:07 GMT

[quote user="Bob Russell"]But how many of them make money? How many are paying wages at an equivalent rate to even a decade ago?[/quote]

We are and we are paying our staff better than ever.

[quote user="Bob Russell"]My view is the profession is steadily in freefall![/quote]

Speak for yourself my son.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

J G Wray — Mon, 03 Apr 2017 15:58:35 GMT

As an owner of an independent practice, I can confirm that we have a marketing manager, who will be accompanying me to BSAVA to speak to suppliers about mutual marketing opportunities

http://www.gpvets.co.uk/about-us/meet-the-team/management-team.shtml

No idea what the Corporates are up to.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Bob Russell — Mon, 03 Apr 2017 15:51:17 GMT

[quote user="Robin Grimmer"]

Getting back to the OP, I think the changes in the profession are largely due to the rise of the corporates. Where once a town may have had two veterinary practices there are now half a dozen all competing, many now open all day Saturday and Sundays and bank holidays. All of which gives more choice and power to the consumer. Many practices now employ marketing gurus to make sure the whole practice team is doing the right things to attract and keep clients.

[/quote]

But how many of them make money? How many are paying wages at an equivalent rate to even a decade ago?

I agree that there is a place for practices aiming for the cheaper end of the market. Is it right that they are claiming to be the same and do the same but for less when they don't?

My view is the profession is steadily in freefall!

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Robin Grimmer — Mon, 03 Apr 2017 15:19:55 GMT

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

George Cooper — Mon, 03 Apr 2017 15:14:35 GMT

[quote user="Beats"]

George, on the comment in your first post re it being all about value, I've heard this a lot and I just don't get it. This is true only of a profession for the middle classes. If you don't have £50-£100 then you simply can't spend it no matter how amazingly good value your vet makes their glitzy treatment sound. I live on a council estate in Belfast, and while I do see plenty of middle class clients, I see plenty without disposable incomes of £50-£100 also. I personally think that there has to be realistic provision of veterinary services for those without such disposable incomes. I have no problems with the RCVS adding layers of bureaucracy and therefore cost to the provision of veterinary services in "accredited" practices, but would like it very much if they left "basic" practices alone to cut corners on bureaucracy and provide an affordable service to the bulk of the population.

[/quote]

hi Beats - I'll try to elaborate on my take on this, simplistically as ever as my opinion. Wherever you choose to live and whomsoever your neighbours might be, remembering too that I can call the "poverty" excuse by reminding you that The Valleys in S Wales are classified as containing some of the most deprived areas in the current UK, to anybody the sum if £50 is exactly that - fifty pounds. That much is fact, and it is the only yardstick by which any client has to make a judgement call on a bill from a veterinary surgeon, or the cost of a rollickin' night out filled with fags and booze. Where your council estate dwellers from Belfast or my clients mortified by deprivation differ is in how they view that hard fact of the cost - that fifty quid spent on Fido's ingrown toenail might have been earmarked for Friday's frolics......do we ever enquire of our grumbling clientele how many fags they puff on or how many pints they sink? Some of our great hard-ups will see their fab Fridays as exceptional "value for money" as measured by their enjoyment of weaving home laughing as they go, choosing to ignore the thick head the next day. The £50 spent on Fido's foot, however is a f*****g liberty, a rip off that only took 7 minutes and an injection. Still that £50, but deemed frightfup "value"!!

Our profession, young and old, cynical and combative, conciliatory and caring are, in my opinion, so often guilty of imagining what a client's wallet contains, and then devising ways to save them money. If, instead, we tried our utmost to "add value" (Beats, I can hear you groaning from here!) by making them feel really, that's REALLY, wanted (I.e. NOT an enemy), by making them feel special, by taliking to Fido directly, by smiling, and so on and on then their opinion of the value for money of seeing us will increase.

Despite the above being just a tad flippant, or direct, or contrary - I really do hope, Beats, that it has cleared some of your fogginess and given you an inkling of what I mean! Do, DO, let me know.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Bob Russell — Mon, 03 Apr 2017 13:20:54 GMT

If I feel a drug is required then I will use it whatever. Human drugs, with consent.

I would consider human cephalexin if I knew the client would be unable or unwilling to continue to pay for rilexin. It becomes a clinical matter at that point.

Human cephalexin sold as Ceporex and at Ceporex prices would be unacceptable.

I am pretty unimpressed with the client focussed attitude by the RCVS, a happy or compensated client is not the required end result of the profession. Thankfully RCVS intervention has not been an issue (yet) but I expect them to maintain clinical and welfare standards, bounce the very badly behaved from the profession and pretty much leave it at that.

I don't like the close involvement of the RCVS with the Practice Standards Scheme. Don't think it is their job!

if a practice believes they will get some benefits from PSS then by all means pay in but it has nothing to do with the RCVS in itself.

It depresses me that the high aspirations indicated by those standing for council always seem to disappear into the gloom once elected. I have no doubts that many try hard but nothing much gets communicated to me!

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Evelyn Barbour-Hill — Sun, 02 Apr 2017 23:58:03 GMT

[quote user="Beats"] She replied "is that allowed under the cascade by he RCVS"?[/quote]

The "cascade" is law, not a RCVS rule. There's an awful lot of confusion.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Beats — Sun, 02 Apr 2017 23:12:19 GMT

[quote user="Glen McIntosh"]Just get on a plane to just about anywhere else outside of the UK/Europe and you will find it working fine today. [/quote]

A plane ticket to most of Europe should suffice quite fine also.

Or indeed a boat ticket to Ireland if you're afraid of flying.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Glen McIntosh — Sun, 02 Apr 2017 23:08:18 GMT

[quote user="Beats"]time travel back 15 years - it worked fine.[/quote]

No need for a time machine.

Just get on a plane to just about anywhere else outside of the UK/Europe and you will find it working fine today.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Francisco Gomez — Sun, 02 Apr 2017 22:41:01 GMT

[quote user="Anthony Todd"]

+1 It must be almost unheard of for a vet willfully to give a drug off licence without being very sure it was indicated and safe to do so.

[/quote]

Im not arguing murder, Im arguing manslaughter.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Beats — Sun, 02 Apr 2017 22:38:18 GMT

[quote user="Francisco Gomez"]No. I mean if a doctor kills you from a unknown side effect by using a specific drug by the wrong route when there is a safer known and tested alternative, what's the chance of your family getting past the dictatorial 'profesional judgement'? I'm not trying to be awkward, I'm only trying to interpret the RCVS side (if there is one, there must be a reason they enforce this?)[/quote]

I'm not sure I understand. If there is a safer and more effective alternative why are you choosing to administer a drug by a knowingly wrong route? I genuinely can't think of an example of this?

If I've mis-read you (likely), and you're asking whether there is a logical problem with you offering a client, for example, a £1 minim's fluorescein rather than a £50 veterinary--licensed fluorescein as a matter of informed consent (even with a signed form if one must insist), then I can't personally see the problem from any angle.

There was a thread here the other day dsicussing what you use to treat (juvenile) demodicosis in a dog. Most replied Bravecto, as do I. A colleague asked me what I would use to treat juvenile demodicosis yesterday. I replied Bravecto. She replied "is that allowed under the cascade by he RCVS"? I replied "If you're not sure just don't treat it at all and see if it self-resolves ... oh, and treat it for fleas at the same time." Folks are confused. Everyone is following "cascade", but few agree what that actually means anyway.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Anthony Todd — Sun, 02 Apr 2017 22:26:19 GMT

[quote user="Evelyn Barbour-Hill"]On that particular point, I think you are wrong. In my opinion it would be perfectly feasible, and sensible, for the College (that's us) to declare that off-licence use of a drug, not in accordance with the "cascade", is not per se disgraceful conduct in a professional respect.[/quote]

+1 It must be almost unheard of for a vet willfully to give a drug off licence without being very sure it was indicated and safe to do so.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Francisco Gomez — Sun, 02 Apr 2017 22:21:03 GMT

[quote user="Beats"]

[quote user="Francisco Gomez"] But how would that work exactly?[/quote]

time travel back 15 years - it worked fine.

[quote user="Francisco Gomez"]Fom a client POV, would you think it fair that a practitioner was to be given carte blanche in how to use a medicine?[/quote]

If by "carte blanche" then you mean "professional judgement and scientific training", then yes.

[/quote]

No. I mean if a doctor kills you from a unknown side effect by using a specific drug by the wrong route when there is a safer known and tested alternative, what's the chance of your family getting past the dictatorial 'profesional judgement'? I'm not trying to be awkward, I'm only trying to interpret the RCVS side (if there is one, there must be a reason they enforce this?)

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

grumpyoldman — Sun, 02 Apr 2017 21:44:52 GMT

[quote user="Beats"]time travel back 15 years - it worked fine.[/quote]

This is unfortunately very true, I had lots of patients who lived for years on vetmedin frusemide prils of some kind and aldactone ,they all did very well for a long time , if they did not we looked further with echo radiology and ECGS if the client wanted to go that far . Now I find myself working them all up in case I miss a heart based tumour and get frowned upon if I just treat the clinical presentation. Some of this is defensive, and some is insurance driven, the clients themselves are often keen on getting their payback from the insurers before the dog /cat dies.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Beats — Sun, 02 Apr 2017 21:12:26 GMT

[quote user="Francisco Gomez"] But how would that work exactly?[/quote]

time travel back 15 years - it worked fine.

[quote user="Francisco Gomez"]Fom a client POV, would you think it fair that a practitioner was to be given carte blanche in how to use a medicine?[/quote]

If by "carte blanche" then you mean "professional judgement and scientific training", then yes.

If your answer is no, then surely one must start to legistlate to stop vets being given "carte blanche" in how to do surgery and diagnostics also by logical extension. Heck, a medicine is only as good as a diagnosis - what do you mean you prescribed a heart medicine without doing echocardiography, radiographs, ECG and an NT-proBNP (all using specific dog-licensed equipment of course).

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Iain Richards — Sun, 02 Apr 2017 21:11:35 GMT

Evening George. Good to see the old noggin is still working!

JW's pithy summary is about right.

Cascade - Michael the power to change the VMR is already there irrespective of Brexit. We just need the will (eg ensuring SPC don't say "do not use" when they mena "not tested").

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Beats — Sun, 02 Apr 2017 21:06:08 GMT

Michael, there are plenty of technical illegalities that the RCVS does not pronounce judgement on. While they are never going to tell me its just fine for me to take my dog for a walk on the other side of the Irish border without a rabies vaccine and pet passport, or say I can't take my dead rat home to bury in my garden because since that injection of euthatal it has become "clinical waste" and I do not have a license to transport it, I don't expect them to publish advice saying that I shouldn't do these things based on these technicalities. If the environment agency wish to prosecute me that's fine, but I don't expect the RCVS - the representative body of my profession ensuring I have the competence and integrity to be trusted by the public to look out for the welfare of their animals - to make it their business to. Ditto rational prescribing (in NON-food animals where no-one is eating their dog and at risk of consuming medicines residues) of medicines in the interests of animal welfare.

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Michael Woodhouse — Sun, 02 Apr 2017 21:04:18 GMT

[quote user="Francisco Gomez"]would you think it fair that a practitioner was to be given carte blanche in how to use a medicine?[/quote]

I don't care. My view is one of 2 things needs to happen:

1. Abandon the cascade entirely. Drug companies have 10 years with a new product and then a free for all. Human generics freely available and usable with the prescriber taking responsibility for adverse reactions.

2. Strict enforcement of cascade as it stands.

My great frustration is trying to do things by the book whilst other practices flout the law and do as they want. I then get shit from farmers because I won't give them cat pills for their lambs.....

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Francisco Gomez — Sun, 02 Apr 2017 20:49:41 GMT

[quote user="Michael Woodhouse"]

[quote user="Evelyn Barbour-Hill"]In my opinion it would be perfectly feasible, and sensible, for the College (that's us) to declare that off-licence use of a drug, not in accordance with the "cascade", is not per se disgraceful conduct in a professional respect.[/quote]

Unless I am mistaken the veterinary medicine rules we have are law. There is no way any regulator could encourage its members to break the law. If we want the cascade dealt with then it's when we draft the veterinary medicines regulations (GB) that we have our chance.

[/quote]

I agree it might be seen (by us) like a step in the right direction. But how would that work exactly? Fom a client POV, would you think it fair that a practitioner was to be given carte blanche in how to use a medicine?

RE: Consumerism; Expectation; RCVS; EBVM; 'Informed Consent'; Because we can... ... ...; Fear; Apathy.

Evelyn Barbour-Hill — Sun, 02 Apr 2017 19:45:45 GMT

[quote user="Michael Woodhouse"]Unless I am mistaken the veterinary medicine rules we have are law. There is no way any regulator could encourage its members to break the law. If we want the cascade dealt with then it's when we draft the veterinary medicines regulations (GB) that we have our chance. Maybe a positive to come from Brexit?[/quote]

It's not suggesting the College is encouraging its Members to break the law. Just that breaking the law in that small particular way is not, per se, disgraceful conduct in a professional respect. Thus putting both good medicine and animal welfare above the letter of the law.

Yes indeed, this could be one of the many good things to come from leaving the EU. There may of course be considerable resistance by civil servants.