Vets - Scientists or Carers first?

RE: Vets - Scientists or Carers first?

Martin Atkinson — Thu, 18 Jan 2018 15:30:27 GMT

[quote user="Richard Carter"]so yes quite prepared to believe a nurse on a ward would not recognise a hypo if it was happening in front of them.[/quote]I'm not saying that such things don't happen, I'm sure they do, but that we need to take such accounts with a large pinch of salt if they are by hearsay, in a news article - where the truth is rarely allowed to get in the way of a good story, or told by someone with a grudge or limited medical knowledge

RE: Vets - Scientists or Carers first?

Bibs — Thu, 18 Jan 2018 15:03:12 GMT

We could also list a lot of veterinary horror stories that we've heard of I'm sure. I don't think in general people who are good at their job follow protocol blindly to the point of disaster. Not in general. A differential list helps to jog your memory if you have access to it but it doesn't mean it's going to give you the diagnosis.

Going back to the OP I think it's easier to teach science than change someone's nature to being empathetic but I don't know if that is always what we want.

We need some science types, introverted thinker types, some people orientated types, business types, outgoing types. They all should have an interest in the career but we can't select for just one type. As far as male vs female I had not thought about that at all. I was thinking only about personality type. In GP land probably being outgoing, making a fuss of people and pets and being interested in business will help. Not all clients want that though. My mum's favourite vet is one that is quiet and thoughtful. Other clients want sugar blown up their bottom all the time and for you to be rolling around on the floor with their "fur babies". I'm not one of them but I have other skills to give.

RE: Vets - Scientists or Carers first?

Richard Carter — Wed, 17 Jan 2018 13:30:11 GMT

I have witnessed an RTA of a child where the police unfortunately kept everyone away as the ambulance was on the way and then found he had stopped breathing and died and similar where geriatric ladies who have fallen in a 'care' home are left on the floor for 4-5 hours waiting for an ambulence as no-one qualified to help them back into bed and no-one (including family) was allowed to help her to her feet so yes quite prepared to believe a nurse on a ward would not recognise a hypo if it was happening in front of them.

A good friend of mine who had had a bit too much to drink, had taken a few too many nsaids to help recover but who also was on warfarin died of brain haemorrhage and the medics diagnosed 'leukaemia' (on a single blood sample)

RE: Vets - Scientists or Carers first?

Martin Atkinson — Wed, 17 Jan 2018 10:01:13 GMT

[quote user="Evelyn Barbour-Hill"] She was known to be diabetic but was in hospital for something else. The spouse of a diabetic is familiar with a "hypo" and what to do about it. He recognised it, found a nurse and asked for the appropriate thing to be done but nothing was done. He ran to the hospital shop and got some sweets and ran back; when he got back, nobody was busy measuring blood glucose or doing anything else for that matter. The nurse told him "your wife is diabetic, Mr. Jones, diabetics mustn't have sugar" and tried to prevent him from saving his wife's life.[/quote]So you know these people personally and have an accurate record of the verbal exchange or is it hearsay or even worse a story from the Daily Wail? A pinch of salt is more appropriate here than a boiled sweet I'd say!!

RE: Vets - Scientists or Carers first?

J G Wray — Tue, 16 Jan 2018 17:54:41 GMT

[quote user="Elizabeth Billimore"]

I think we need a range of types of people in the profession as a whole.

[/quote]

So, given the profession is no longer male, pale and stale, but pale, female and errrrrr, something else how would you make it more, how I hate this cliché, diverse?

RE: Vets - Scientists or Carers first?

Bibs — Tue, 16 Jan 2018 17:24:58 GMT

I think we need a range of types of people in the profession as a whole.

RE: Vets - Scientists or Carers first?

Evelyn Barbour-Hill — Tue, 16 Jan 2018 14:31:02 GMT

[quote user="Martin Atkinson"][quote user="Evelyn Barbour-Hill"]It reminds me of the true story about the nurse who tried to stop a man, visiting his wife in hospital, from giving his diabetic wife sugar when she was clearly having a "hypo" in her hospital bed, with "your wife is diabetic, Mr. Jones, diabetics mustn't have sugar!"[/quote]So this man had tested his wife's glucose and was medically qualified to know she was going hypoglycaemic? In an emergency at home to take a chance maybe but I think the nurse was quite right to tell him to stop until the glucose was measured which would have taken all of a minute![/quote]

No. She was known to be diabetic but was in hospital for something else. The spouse of a diabetic is familiar with a "hypo" and what to do about it. He recognised it, found a nurse and asked for the appropriate thing to be done but nothing was done. He ran to the hospital shop and got some sweets and ran back; when he got back, nobody was busy measuring blood glucose or doing anything else for that matter. The nurse told him "your wife is diabetic, Mr. Jones, diabetics mustn't have sugar" and tried to prevent him from saving his wife's life.

RE: Vets - Scientists or Carers first?

Martin Atkinson — Tue, 16 Jan 2018 09:21:18 GMT

[quote user="Julie Innes"]For example, my dad has a heart attack, despite being an otherwise fit guy. He gets stents, ACE inhibitors, beta blockers and simvastatins. That is the standard treatment.[/quote]The issue here is the term 'heart attack'. Normally this means myocardial infarct due to coronary artery disease - is short the vessel clogged up with cholesterol so its not unreasonable to advise statins until proven otherwise. Inappropriate in my case where my 'heart attacks' are bouts of extra systoles due to AF.

[quote user="Evelyn Barbour-Hill"]It reminds me of the true story about the nurse who tried to stop a man, visiting his wife in hospital, from giving his diabetic wife sugar when she was clearly having a "hypo" in her hospital bed, with "your wife is diabetic, Mr. Jones, diabetics mustn't have sugar!"[/quote]So this man had tested his wife's glucose and was medically qualified to know she was going hypoglycaemic? In an emergency at home to take a chance maybe but I think the nurse was quite right to tell him to stop until the glucose was measured which would have taken all of a minute!

RE: Vets - Scientists or Carers first?

Julie Innes — Tue, 16 Jan 2018 08:48:55 GMT

[quote user="bevs2251"]This is referred to as "pattern recognition", a process slightly frowned upon in the vet world these days when we are now supposed to go down a "problem solving" list. A proper clinical examination, such as actually checking your father's heart rate initially, as we do with just about all animals that walk thru the door, rather than putting straight onto drugs, would have detected his normal BPM. Then again, back to the old refrain of when do medico GPs ever routinely stick a stethoscope on their patients' chests ? SOPS and ChatBots can't do that ![/quote]

Yes, very frustrating! Even after long discussions with the doctors they would not agree to my dad stopping these two drugs (he did anyway) and made it clear that it would be his own fault if he had another heart attack . To cover themselves, they had to prescribe these drugs as standard practice, even if common sense dictated otherwise. Good use of NHS funds...

RE: Vets - Scientists or Carers first?

bevs2251 — Tue, 16 Jan 2018 02:54:30 GMT

[quote user="Julie Innes"]

You have had a heart attack, so you need to take beta blockers. Similarly the simvastatins- his cholesterol has never been high, in any check (and he has had several) But he has had a heart attack, therefore must need his cholesterol lowering.

[/quote]

[quote user="Evelyn Barbour-Hill"]Um, no, that's not pattern recognition, which is a respectable diagnostic process (and in this case if done properly would have included auscultation) and doesn't prescribe treatment.[/quote]

Well, yes, not "pattern recognition" of the diagnosis per se, but the treatments doled out were all the standard "pattern recognition" treatments for heart attack without taking into account the BPM was now normal so beta blockers were not required (and in fact lowered the BP too much), and cholesterol was normal but still prescribed statins unnessarily because "you have had a heart attack".

RE: Vets - Scientists or Carers first?

Evelyn Barbour-Hill — Tue, 16 Jan 2018 02:25:24 GMT

[quote user="bevs2251"]This is referred to as "pattern recognition", a process slightly frowned upon in the vet world these days when we are now supposed to go down a "problem solving" list. [/quote]

Um, no, that's not pattern recognition, which is a respectable diagnostic process (and in this case if done properly would have included auscultation) and doesn't prescribe treatment.

It reminds me of the true story about the nurse who tried to stop a man, visiting his wife in hospital, from giving his diabetic wife sugar when she was clearly having a "hypo" in her hospital bed, with "your wife is diabetic, Mr. Jones, diabetics mustn't have sugar!"

RE: Vets - Scientists or Carers first?

bevs2251 — Tue, 16 Jan 2018 01:28:01 GMT

[quote user="Julie Innes"]

Trouble is, my dad's normal heart rate (and even during and after the heart attack) is around 60bpm. Beta blockers reduced it to 30-40bpm, which meant he fell over every time he tried to stand up. He asked the doctors why he was on the beta blockers. Answer: "to slow your heart rate". He asks what they would like his heart rate to be. They answer around 70bpm. He explains his is going well below that, can he stop taking the beta blockers. No. You have had a heart attack, so you need to take beta blockers. Similarly the simvastatins- his cholesterol has never been high, in any check (and he has had several) But he has had a heart attack, therefore must need his cholesterol lowering.

One size really doesn't fit all, and rigid SOPs aren't always best for the patient.

[/quote]

This is referred to as "pattern recognition", a process slightly frowned upon in the vet world these days when we are now supposed to go down a "problem solving" list. A proper clinical examination, such as actually checking your father's heart rate initially, as we do with just about all animals that walk thru the door, rather than putting straight onto drugs, would have detected his normal BPM. Then again, back to the old refrain of when do medico GPs ever routinely stick a stethoscope on their patients' chests ? SOPS and ChatBots can't do that !

Routine post checks to reassess medication efficacy or necessity ??

RE: Vets - Scientists or Carers first?

J G Wray — Fri, 12 Jan 2018 15:19:51 GMT

[quote user="Neil Wheadon"]With the increase in AI and computers we may well be getting to a point where good practical vets can easily cope, simply because soon we will have a system where we plug in the observations and a list of potentials come out. If I'm right GP's are on this path already.[/quote]

I see things differently - see previous stuff about the "curation" of knowledge - that is where I would like to see our education heading

RE: Vets - Scientists or Carers first?

Julie Innes — Fri, 12 Jan 2018 14:46:47 GMT

How depressing. But you are right- there seems to be a lot of this in the NHS. For example, my dad has a heart attack, despite being an otherwise fit guy. He gets stents, ACE inhibitors, beta blockers and simvastatins. That is the standard treatment.

One size really doesn't fit all, and rigid SOPs aren't always best for the patient.

RE: Vets - Scientists or Carers first?

Neil Wheadon — Fri, 12 Jan 2018 09:18:14 GMT

[quote user="Richard Carter"]the base job of day to day practice is a manual practical skills job. Some thinking when the tried and tested 'recipes' or SOPS or whatever they are called these days don't work as planned but still lots of text or other references to consult when things getting more tricky so yes, there is definitely scope for a less 'educated' but more practical graduate level[/quote]

I have this from a retired DVM (Divisional Veterinary Manager) who worked for AHVLA

If you work for the government you are bound by the chapters. These are highly detailed notes that take you though any scenario. For example in TB if you have a slaughter house case you send a sample here, get the first case typed etc etc. They are written by 'experts' and passed down and are regularly updated.

They are basically a step by step guide. If you are A go to B, but don't even consider going to C.

Now here's the relevant bit. They are done like this so that anyone can step into the role and cope with the work. The stakeholder (farmer) get's a consistent message and everyone knows what is going on and it's logical.

With the increase in AI and computers we may well be getting to a point where good practical vets can easily cope, simply because soon we will have a system where we plug in the observations and a list of potentials come out. If I'm right GP's are on this path already.

Neil

RE: Vets - Scientists or Carers first?

Iain Richards — Thu, 11 Jan 2018 20:53:38 GMT

Dear Baffled of Basingstoke,

I'm baffled by your bafflement. However, knowing that you can't see a sentence without creating more meanings than the author intended, I don't know whether you are baffled, or your hinting at something else. My point was that perhaps we make too much of being caring and empathic and, in doing so, are swayed by nice anecdote, thus leaving any evidence base or logical decisions behind.

Iain

PS Lest new readers think I am unduly rude to the Ravenous Bugblatter Beast of Basingstoke, I've known him (by e-mail) for a long time and I like his posts and turn of phrase.

RE: Vets - Scientists or Carers first?

Richard Carter — Thu, 11 Jan 2018 19:18:56 GMT

the base job of day to day practice is a manual practical skills job. Some thinking when the tried and tested 'recipes' or SOPS or whatever they are called these days don't work as planned but still lots of text or other references to consult when things getting more tricky so yes, there is definitely scope for a less 'educated' but more practical graduate level - cannot even think when last I tried to mix some chemicals together to form an ester, thought about nuclear fission and how many electrons in an element or thought about the insertion points of some muscle group that hasn't been drawn in lots of detail in my Fossum or Piermattei, all things I knew by heart for the first few years of my undergraduate course. Would have been better served by being taught how to ride a horse.

RE: Vets - Scientists or Carers first?

J G Wray — Thu, 11 Jan 2018 17:40:26 GMT

[quote user="Iain Richards"]Well it was linked in my head. I've edited it.[/quote]

"it" - your head?

Still baffled

RE: Vets - Scientists or Carers first?

Iain Richards — Thu, 11 Jan 2018 13:29:12 GMT

Well it was linked in my head. I've edited it.

RE: Vets - Scientists or Carers first?

J G Wray — Thu, 11 Jan 2018 12:15:26 GMT

[quote user="Iain Richards"]The RCVS are currently looking at promoting being a vet in schools as applications are falling[/quote]

Point 1

[quote user="Iain Richards"]There's been the "Graduates are too academic" school of thought for as long as I've been in the trade, but I've never heard, "Too scientific"[/quote]

Point 2

[quote user="Iain Richards"]The Cert AVP, has elements of good science, but not enough, not least with its lean towards reflection. [/quote]

Point 3

[quote user="Iain Richards"] There has been so much in the last few years on customer care and seen to be caring or empathic, that I wonder if it's gone too far.[/quote]

Point 4

Why are these points linked?

[quote user="Iain Richards"]Which is easier - a scientist to learn to be empathic, or the empath to learn to become scientific? [/quote]

A question, which isn't linked to the points as far as I can see. My answer, a scientist can learn to be empathetic e.g. Robert Winston.