sick of it

RE: sick of it

J G Wray — Sat, 24 Mar 2018 08:03:21 GMT

[quote user="Neil Wheadon"]the profession should be taking a note of this.[/quote]

Note taken.

So what next - more of the jeremiad or solutions?

It takes a higher order of thinking to solve issues than that which created them, but if you enjoy continuing to stay in the moment then carry on, but recognise what you are doing, expecting others to come up with more than tea and sympathy.

Vet Futures is not the answer because it is flawed in any number of ways but specifically two. It does not address commercial realities and it does not address general practice.

Societal change, cultural change takes a long time, personal change takes less. Which is more pragmatic?

RE: sick of it

Neil Wheadon — Fri, 23 Mar 2018 23:45:02 GMT

[quote user="J G Wray"]Ref this thread. Anyone "sick of it" yet?[/quote]

Not yet, because having very recently worked with a recent graduate in his/her last week in General Practice and leaving because they too were 'sick of it' for pretty much the same reasons....... as you would say 'feedback is a gift' and the profession should be taking a note of this.

Neil

RE: sick of it

J G Wray — Fri, 23 Mar 2018 17:59:53 GMT

Ref this thread. Anyone "sick of it" yet?

RE: sick of it

Anthony Dennison — Fri, 23 Mar 2018 12:35:57 GMT

[quote user="Anthony Todd"]

[quote user="Julie Innes"]I've decided this is the only option I will give you[/quote]

Rather I'd say "this is the best option, but it is the most expensive" otherwise the client won't know what's best...... and, as I said, work back from that.

[/quote]

I personally wouldn't want to work in that way. Anthony, you come across as the kind of vet that would say 'this is your option (singular). Take it or leave it'.

Where is the drive to try new things? Where is the willingness to push yourself? Sounds very stuck-in-a-rut-ish.

RE: sick of it

Anthony Todd — Thu, 22 Mar 2018 17:48:00 GMT

[quote user="Gillian Mostyn"]

Julie ... Give up. Those of is in practice know exactly what you mean.

[/quote]

Yes, hadn't realised that. Golly do you really get dogs that bite you?

We used to get clients to give the pills just before they went to work, soon as they got home and last thing.

Gosh things are so hard now; we had it so easy, but we were lucky, we only had to see about 8 clients [an hour] after the usual 4 C/Ss and a B/S and a couple of dentals.

The nurse used to hold them if the phone wasn't ringing

I'm joking on the square, Gillian, just to wind you up.

RE: sick of it

Julie Innes — Thu, 22 Mar 2018 17:38:28 GMT

[quote user="Gillian Mostyn"]

Julie ... Give up. Those of is in practice know exactly what you mean.

[/quote]

Gillian , so you have the Ah-Buts in your practice too?

"Here is the best option"

" ah but..... "

"Ok, this is another option"

"Ah but...."

I did once smile eventually and say "bye then!"

" What? Aren't you going to do anything for my cat?! "

"Ah, but....."

RE: sick of it

Gillian Mostyn — Thu, 22 Mar 2018 17:29:27 GMT

Julie ... Give up. Those of is in practice know exactly what you mean.

RE: sick of it

Anthony Todd — Thu, 22 Mar 2018 17:27:21 GMT

[quote user="Julie Innes"]"their situation" : eg[/quote] sure, sure But that comes after you've advised the best treatment not before!

Er, not many options to insulin,but the others needn't deny best treatment.

I had a cat that nobody could pill!

You didn't mention "money"....??

Every discussion or diagnosis on the forum seems to include money, usually sanitised by calling it "insurance", as a sort of diagnostic test and certainly something to do with treatment!

RE: sick of it

Julie Innes — Thu, 22 Mar 2018 17:18:27 GMT

Anthony, "their situation" : eg. Work shifts mean can't give insulin at regular times. Dog is aggressive, can't shampoo. Cat is an unpillable psycho. Not home during the day to give tid meds. Granny has dog 3 days a week, can't get ear drops in. Cat goes out and gets fed at three different houses, obesity control is a waste of time. Dog will not eat anything other than chicken from M and S, diet trial will not be complied with. Etc etc.

RE: sick of it

Julie Innes — Thu, 22 Mar 2018 17:13:11 GMT

George, I assure you I do "deal with it" (and I'm actually quite good at it, if I say so myself ) but practice HAS changed, as Society has changed. Not only do I need my superior, professional knowledge, but now I need to make the client believe in it.

I will always have animal welfare as my first concern. But you can't MAKE a client do something they don't want to do.

Please don't get me wrong, I have lots of nice clients, and more patience in RL than it may appear on here! But it is undeniable that our job, along with most public-facing roles, has changed.

RE: sick of it

Anthony Todd — Thu, 22 Mar 2018 17:03:43 GMT

[quote user="Julie Innes"]If they ASK me "what would you do?" I tell them what I would advise given their situation. obviously I need to understand their situation to be able to do that.[/quote]

Why, and how, in almost any case, is "their situation" going to influence your advice regarding a condition in their animal unless, and only unless, you are going to offer treatment costing more or less.

Otherwise you just offer, and/or do the best, surely and "adjust" that if, say, they "can't give tablets" etc.

I think that's just what dinovets did, I did.

I'd love to hear clients' take on this discussion.....

Or hear a recording of a consult and see where the question and answer session starts.

Reading the regs now about informed consent, it has to be the vet, not the client.

RE: sick of it

George Cooper — Thu, 22 Mar 2018 17:03:16 GMT

Julie, Julie!

DEAL with it. Use YOUR superior, professional knowledge and assessment of each and every case and - PLEASE - remember that YOU are the animal's advocate - to do what is RIGHT.

RE: sick of it

Julie Innes — Thu, 22 Mar 2018 16:51:28 GMT

It is driven by clients because they ASK about what we can do, and have often already googled and want to explore the options in some depth.

If they ASK me "what would you do?" I tell them what I would advise given their situation. obviously I need to understand their situation to be able to do that.

It is driven by clients who increasingly want a first rate service. I see a lot of second opinions nowadays, as clients are not always prepared to accept what their usual vet told them.

It is driven by clients who have become suspicious of vets trying to needlessly part them from their money- they want a detailed explanation of where their money went.

It is driven by a society where accidents are unacceptable and must be someone's fault. Driven by a society which needs the words "CONTAINS NUTS" on a bag of nuts. Driven by a society which demands compensation for misselling of things they were not clever enough to understand that they didn't need. Driven by a society that needs a bewildering number of brands of baked beans.

"Society" demands to have choices and to be informed about those choices. and someone to blame when they make the wrong choices

RE: sick of it

Anthony Todd — Thu, 22 Mar 2018 16:41:28 GMT

[quote user="George Cooper"]WE are in the driving seat in terms of our advice in each case.[/quote]

As in estate planning advice!

Get swept away by jargon and options!!

RE: sick of it

George Cooper — Thu, 22 Mar 2018 16:33:06 GMT

[quote user="Julie Innes"]

[quote user="Anthony Todd"]Again, I hope to see some sort of client survey just to see how clients view the flood of options and choices[/quote]

To be fair, Anthony, I think most of the change has been driven by the clients. It was far far easier for vets when the client complied without a murmur, and accepted that sometimes things went wrong! A large percentage of clients come to me having first consulted Doctor Google, and I then have to explain why I don't think that their cat is hypOthyroid or that I don't think their 18 mth old dog who is suddenly lame after rough and tumble with another dog has an osteosarcoma. But I do have to explain my thinking, which I wouldn't have to do previously. I don't mind that, I like that people care enough, but it is a slightly different way of working.

Given the expense of some of the available treatments today it would be unthinkable not to give people options

eg. hyperthyroidism in cat- radiotherapy (£2000, but overall possibly cheaper in the long run, dependant on age of cat) vs tablet therapy vs thyronorm liquid vs thyroidectomy vs. iodine-free food vs topical treatment

Lots of options there! Ask me which one I would pick and I would say it depends on the cat and its nature/ age/ lifestyle and its owner (finances/ lifestyle) Too many factors there for me just to say "I've decided this is the only option I will give you" Given that the owners will no doubt nowadays find out about all those other options, you'd better be ready to give a very good reason why they weren't offered, especially if the cat doesn't do well with the option you unilaterally decided upon.

[/quote]

Can you explain HOW this is "DRIVEN" by clients?

WE are in the driving seat in terms of our advice in each case.

RE: sick of it

Julie Innes — Wed, 21 Mar 2018 18:49:40 GMT

But what IS best, Anthony??

I'd need to discuss it at length with the owner to find out what is best in this particular case. Is radiotherapy "best" because it is more expensive? Some people do not feel happy with the idea of their cat being locked away with them unable to see it for the weeks of radiation therapy. And I have had 1 client where it didn't work...thousands of ££ later we were back to the other options (another discussion about the possible limitations of the therapy). Indoor cat, owners useless at giving or not prepared to give tablets? Food might be a possibility. Outdoor cat, tableting not possible- maybe thyroidectomy (another discussion about the risks/ possible complications).

I do not give the client a menu of choices. There are options. I discuss with the client to find out what is the best fit option for them and their cat

(my own cantankerous 19 year old psycho cat? He went onto thyronorm! We don't blood test him, because he only takes as much of it as he gets in his food, and no one wants to lose a limb or send him into heart failure pilling him! maybe not "Best" but best for him and us. Best for every cat??)

RE: sick of it

Anthony Todd — Wed, 21 Mar 2018 17:57:07 GMT

[quote user="Julie Innes"]I've decided this is the only option I will give you[/quote]

Rather I'd say "this is the best option, but it is the most expensive" otherwise the client won't know what's best...... and, as I said, work back from that.

This is a discussion I'm not going to win, I know, and I go back to Frank Carson and my dilemma with the plethora of Estate Planning....

The client just wants what's best rather than a menu from which they are expected to make choices.

RE: sick of it

Julie Innes — Wed, 21 Mar 2018 17:32:59 GMT

[quote user="Anthony Todd"]Again, I hope to see some sort of client survey just to see how clients view the flood of options and choices[/quote]

Given the expense of some of the available treatments today it would be unthinkable not to give people options

RE: sick of it

Anthony Todd — Wed, 21 Mar 2018 15:35:01 GMT

[quote user="Anthony Dennison"] Things have massively changed even since I graduated in 2012. [/quote]

So everyone keeps telling me but "change", particularly when decreed by regulation, isn't necessarily a good thing, yet seems to have been silently complied with without a murmur, let alone any discontent.

Again, I hope to see some sort of client survey just to see how clients view the flood of options and choices.

RE: sick of it

Anthony Dennison — Wed, 21 Mar 2018 13:09:46 GMT

[quote user="Anthony Todd"]It maybe that clients don't like the sales pitch[/quote]

It's not a sales pitch

[quote user="Anthony Todd"]in the same way that when your car has a hundred and something things ticked, on a form with your service invoice, obviously to justify the large bill.[/quote]

Not a transparent way of explaining all the charges? Or would you prefer just the lump sum and no explanation? Explaining costs isn't a justification, it's being transparent and open with fees.

[quote user="Anthony Todd"]I wonder whether the giving of all the options at every stage of the consult really is the best way?[/quote]

Yes. It is. Just because the way you think is right doesn't mean it's the right treatment choice for the situation, due to various confounding factors like client compliance, costings etc. For example, with Osurnia coming on to the market, I'm surprised at the number of clients that jump for that option and say they can never get the ear drops in anyway, despite never saying that at previous check ups.

[quote user="Anthony Todd"]This is what dinovets used to do.[/quote]

As I have repeated a few times, and other people have said in this thread, it's not the good old days anymore. How long have you been out of practice? Things have massively changed even since I graduated in 2012.

RE: sick of it

Bob Russell — Wed, 21 Mar 2018 09:28:59 GMT

I am sure we are more 'informed' but much of this is poor information.

MMR, medication bought on-line to treat a self-diagnosed problem. GP's available again on-line ready to send prescription medication to people they have never seen.

I am not sure that we were not better off when we relied on professionals to do what professionals have always done - advise!

I have to say I have much better access to a GP than I ever did before. Groups of practices in the Forest run a service called The Practice that allows access later in the day and weekends. Not too difficult to get an appointment at short notice which suggests it may be a minority that need this service.

RE: sick of it

Julie Innes — Wed, 21 Mar 2018 08:35:09 GMT

[quote user="Anthony Todd"]I don't think it has reached the NHS yet, judging by our local practice who only allows access to a doctor if you're really ill, otherwise the nurse "prescribes a course of antibiotics" if you think you need them.... cross my heart![/quote]

It will reach the NHS, and in some ways not before time! People are not prepared any more to just do what the doctor tells them- they don't have the same confidence, probably because we are far more informed than we used to be, and that is no bad thing!

To err is indeed human, but society seems to be less and less "divine". That's the big difference.

RE: sick of it

Julie Innes — Wed, 21 Mar 2018 08:25:41 GMT

My neighbour took 8 of us to school, in an estate car, with 3 of us in the boot!

I was called up to the school a couple of weeks ago because my son poked another boy with a pencil, and we had to address it as a "violent incident"

RE: sick of it

Evelyn Barbour-Hill — Tue, 20 Mar 2018 19:25:27 GMT

[quote user="Arlo Guthrie"]As I remember, I don't think my parents even slowed the car when they dropped me off [/quote]

I was walking to school by myself when I was six.

We didn't have a car anyway.

I'm not sure things have changed for the better.

RE: sick of it

Arlo Guthrie — Tue, 20 Mar 2018 18:38:55 GMT

[quote user="Julie Innes"]When I take my children to school, I see the huge difference in then and now: the level of involvement of parents, health and safety, signing of forms for every little thing, the school contacting me for every tiny bump and scrape. it is just the way society is now, for better or worse.[/quote]

As I remember, I don't think my parents even slowed the car when they dropped me off

It is extraordinary how things have changed. Overall (although certainly not entirely) I think for the better.