What does 'independent practice' really mean to a consumer, anyway?

RE: What does 'independent practice' really mean to a consumer, anyway?

Anthony Dennison — Thu, 27 Sep 2018 18:25:20 GMT

[quote user="Anthony Todd"]

Primary central nervous system lymphoma can be histologically diagnosed after previous corticosteroid use: A pilot study to determine whether corticosteroids prevent the diagnosis of primary central nervous system lymphoma.

from

https://doi.org/10.1002/ana.21366

Cited by: 41

Nor does it sound as if all people agree with you all the time??

But I take your point, and I screamed "biopsy" for a recent mouth case on here.

[/quote]

Sorry Tony - very specific form of lymphoma, and a human study. Don't think it's particularly applicable in this argument.

RE: What does 'independent practice' really mean to a consumer, anyway?

Kate Richardson — Wed, 26 Sep 2018 14:14:49 GMT

To be fair to Anthony Todd he was provoked on this occasion

RE: What does 'independent practice' really mean to a consumer, anyway?

Lucy Fleming — Wed, 26 Sep 2018 13:04:24 GMT

[quote user="Rob Davis"]

[quote user="Anthony Todd"]

How do you get to Carnegie Hall?

Practise baby, practise!

Surgery, like piano playing, is largely a manual exercise so the more you do, the better you should get.

[/quote]

But also like playing the piano, it helps enormously to have an experienced mentor constantly ironing out your flaws and helping you to improve. It is easy to keep practising the same mistakes over and over again unless there is somebody to point them out to you....

[/quote]

That's part of the issue that we have (certainly as far as orthopaedics is concerned) is suitable, fairly straightforward cases in sufficient numbers to develop and maintain skills. Most of our fracture cases seem to smashed to bl**dy smithereens!

RE: What does 'independent practice' really mean to a consumer, anyway?

Anthony Todd — Wed, 26 Sep 2018 10:49:05 GMT

[quote user="Wren"]

Dear Lord. Does everything have to descend to an argument over bl**dy steroids?

[/quote]

Sorry, I will not rise again, so they'll be resigned to dinosaureal disgrace, more's the pity!

RE: What does 'independent practice' really mean to a consumer, anyway?

Wren — Wed, 26 Sep 2018 09:34:37 GMT

Dear Lord. Does everything have to descend to an argument over bl**dy steroids?

RE: What does 'independent practice' really mean to a consumer, anyway?

Robin Grimmer — Tue, 25 Sep 2018 22:01:16 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]Care to explain why you disagree? Anthony Todd[/quote]

Sure, this is the sort of throwaway line which exaggerates the diminution of the value of "steroids" and implies that they, of all the groups of drugs used in vet. practice, are specifically used inappropriately.

I would have been fine if I had "thrown full bloods at it".............

I wish there was an additional "justify please" button, when those sort of statements are made.

[/quote]

Not denying that steroids are an essential drug when use appropriately, but if steroids have been given to an animal prior to referral, it pretty much knackers any chance of getting a diagnosis - especially if it's got cancer. Just ask any internal medicine specialist..

[/quote]

Your response is apposite, if exaggerated, as I did refer a case to the RVC, years ago. on the owner's insistence, and it had had steroids [strange pododermatitis] to which it was responding. As the 'roids had bounced the ALT/ALP. [I think], they diagnosed a "hepatitis" from which both liver and feet recovered.

Primary central nervous system lymphoma can be histologically diagnosed after previous corticosteroid use: A pilot study to determine whether corticosteroids prevent the diagnosis of primary central nervous system lymphoma.

from

https://doi.org/10.1002/ana.21366

Cited by: 41

Nor does it sound as if all people agree with you all the time??

But I take your point, and I screamed "biopsy" for a recent mouth case on here.

[/quote]

https://www.dogcancerblog.com/blog/common-cancer-mistake-starting-your-dog-with-lymphoma-on-prednisone-too-soon/

RE: What does 'independent practice' really mean to a consumer, anyway?

Anthony Todd — Tue, 25 Sep 2018 21:41:55 GMT

[quote user="Robin Grimmer"]

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]Care to explain why you disagree? Anthony Todd[/quote]

I would have been fine if I had "thrown full bloods at it".............

I wish there was an additional "justify please" button, when those sort of statements are made.

[/quote]

Primary central nervous system lymphoma can be histologically diagnosed after previous corticosteroid use: A pilot study to determine whether corticosteroids prevent the diagnosis of primary central nervous system lymphoma.

from

https://doi.org/10.1002/ana.21366

Cited by: 41

Nor does it sound as if all people agree with you all the time??

But I take your point, and I screamed "biopsy" for a recent mouth case on here.

RE: What does 'independent practice' really mean to a consumer, anyway?

Robin Grimmer — Tue, 25 Sep 2018 19:04:07 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]Care to explain why you disagree? Anthony Todd[/quote]

I would have been fine if I had "thrown full bloods at it".............

I wish there was an additional "justify please" button, when those sort of statements are made.

[/quote]

RE: What does 'independent practice' really mean to a consumer, anyway?

Anthony Todd — Tue, 25 Sep 2018 18:54:55 GMT

[quote user="Robin Grimmer"]Care to explain why you disagree? Anthony Todd[/quote]

I would have been fine if I had "thrown full bloods at it".............

I wish there was an additional "justify please" button, when those sort of statements are made.

RE: What does 'independent practice' really mean to a consumer, anyway?

Robin Grimmer — Tue, 25 Sep 2018 18:22:59 GMT

[quote user="Robin Grimmer"]

It ain't all about surgery though, is it? Those complex medical cases are often good ones for referral, unless some dinovet has thrown steroids at it.

[/quote]

Care to explain why you disagree? Anthony Todd

RE: What does 'independent practice' really mean to a consumer, anyway?

Robin Grimmer — Tue, 25 Sep 2018 16:53:47 GMT

It ain't all about surgery though, is it? Those complex medical cases are often good ones for referral, unless some dinovet has thrown steroids at it.

RE: What does 'independent practice' really mean to a consumer, anyway?

Rob Davis — Tue, 25 Sep 2018 16:21:22 GMT

[quote user="Anthony Todd"]

How do you get to Carnegie Hall?

Practise baby, practise!

Surgery, like piano playing, is largely a manual exercise so the more you do, the better you should get.

[/quote]

RE: What does 'independent practice' really mean to a consumer, anyway?

Anthony Todd — Tue, 25 Sep 2018 15:23:31 GMT

How do you get to Carnegie Hall?

Practise baby, practise!

Surgery, like piano playing, is largely a manual exercise so the more you do, the better you should get.

RE: What does 'independent practice' really mean to a consumer, anyway?

grumpyoldman — Tue, 25 Sep 2018 15:10:21 GMT

[quote user="robloxley"]If we can do it good enough, but still refer them out, then the general practice skill base will only decline?[/quote]

That is inevitable with the hub and spoke system employed by the corporates . Its that system that many clients are trying to escape.

I once upset a group of my wives friends who were residents on a skiing holiday , one of them said "there was no I in team ", my response was "but there was a George Best" , and as part of the response to the old residents are better because they have worked with a guru I commented "polishing Wayne Rooneys boots for 3 years does not make you Wayne Rooney it just means he has forgotten how to clean his own boots".

We only refer awkward obnoxious people we don't trust or feel comfortable with.

RE: What does 'independent practice' really mean to a consumer, anyway?

Rob Loxley — Tue, 25 Sep 2018 08:18:29 GMT

[quote user="Gillian Mostyn"]

[quote user="robloxley"]I'm sure a medicine specialist or orthopod or specialist soft tissue surgeon might do a better job than a GP vet of many things, but the GP vet can still do a good enough job?[/quote]

Good enough, absolutely. But it goes without saying that somebody doing a TPLO, abdominal ultrasound or TECA, after years of specialist training, and on a daily or weekly basis, will be better at it than me!

[/quote]

If we can do it good enough, but still refer them out, then the general practice skill base will only decline?

RE: What does 'independent practice' really mean to a consumer, anyway?

Gillian Mostyn — Tue, 25 Sep 2018 07:39:17 GMT

But I'm pretty nifty at pilling a cat!

RE: What does 'independent practice' really mean to a consumer, anyway?

Rob Loxley — Mon, 24 Sep 2018 22:54:25 GMT

[quote user="Gillian Mostyn"]We should, certainly, be offering referral if someone else is likely to do a better job.[/quote]

I'm sure a medicine specialist or orthopod or specialist soft tissue surgeon might do a better job than a GP vet of many things, but the GP vet can still do a good enough job?

RE: What does 'independent practice' really mean to a consumer, anyway?

Michael Woodhouse — Mon, 24 Sep 2018 20:43:04 GMT

[quote user="Robin Grimmer"]I've come across this too where vets won't even do basic orthopaedics like a cruciate or pin a cat's femur. So they all end up getting referred for a much greater cost.[/quote]

I really don't understand this, I have a kittens femur to pin tomorrow. It's technically quite straightforward and satisfying work. Squeeze it in before farm calls.

RE: What does 'independent practice' really mean to a consumer, anyway?

Anthony Dennison — Mon, 24 Sep 2018 18:12:50 GMT

[quote user="Gillian Mostyn"]

[quote user="Anthony Dennison"]I'd prefer a dirty chippy at 3am with some proper chips (not fries) and curry sauce to a McDonalds. [/quote]

Where's I'd go for clean before everything.

[/quote]

Sorry, when I say 'dirty chippy', I don't mean a place with a low food rating, more the decor of the place compared to the bright lights and shiny machines of McDonalds. Chippy Lane in Cardiff on a Saturday night after an international is a wonder to behold!

Have you ever eaten at This n That on Soap Street in Manchester Gillian Mostyn? That's the kind of thing I mean - amazing food comes first, appearance second.

RE: What does 'independent practice' really mean to a consumer, anyway?

Wren — Mon, 24 Sep 2018 14:33:36 GMT

[quote user="George Cooper"]

Post Script :- anyone recall the fiasco that was “tendering” for OVS work? We had as a practice coped with White Meat Inspection, Red Meat Inspection, Ante Mortem Inspection, Meat Products Inspections, Lorry Consignments (which always,ALWAYS, seemed to be loaded and off in the wee sma’ Oors necessitating a round trip of about 16 miles, for a fairly cursory glance at an artic full of cardboard boxes stacked to the gunwale prior to clasping on the seal and signing and stamping the paperwork ...). Having done all that we were pretty damn sick of all of it and when tendering came along, did everything possible to thwart the process, including errors on forms filled for the tendering, followed by missing the last post, then when some gremlin blew the process out of kilter requiring that we repeat it all, a number of times.........each time we submitted something an additional tenner per hour was put on the bid, ending up at a farcical £200 per hour or thereabouts.

You can predict how sick we felt when it was accepted!

[/quote]

No chance of that up in our parts. We bust a gut to keep the OVS work for our local small abattoir/butcher's shop. However every single contract for miles around was awarded to the same big corporate (ironic, given the title of the thread) who promptly sub-contracted the work back to us, for a couple of quid an hour less than we'd previously been getting, as they had no interest in a tiny family butcher's in the back end of nowhere which only needed an inspector 2 days a week. Total fiasco.

RE: What does 'independent practice' really mean to a consumer, anyway?

George Cooper — Mon, 24 Sep 2018 13:54:34 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Dinu Catilina"]Same for McDonalds. Better than a dirty chippy shop but is it the best we can get?[/quote]

A McDonalds sells McDonalds muck.

[/quote]

Claim to fame, if a little bit dubious.........When MacDonalds decided to introduce Chicken MacNuggets into the nation’s diet, and psyche, I probably examined, consigned and certified every single one of them for the first year or two, usually at about three in the morning for the consignment into Europe.

You can predict how sick we felt when it was accepted!

RE: What does 'independent practice' really mean to a consumer, anyway?

Gillian Mostyn — Mon, 24 Sep 2018 13:49:29 GMT

[quote user="Anthony Dennison"]I'd prefer a dirty chippy at 3am with some proper chips (not fries) and curry sauce to a McDonalds. [/quote]

Where's I'd go for clean before everything.

RE: What does 'independent practice' really mean to a consumer, anyway?

Anthony Dennison — Mon, 24 Sep 2018 13:16:34 GMT

[quote user="Dinu Catilina"]Same for McDonalds. Better than a dirty chippy shop but is it the best we can get?[/quote]

I'd prefer a dirty chippy at 3am with some proper chips (not fries) and curry sauce to a McDonalds.

RE: What does 'independent practice' really mean to a consumer, anyway?

Anthony Todd — Mon, 24 Sep 2018 09:43:01 GMT

[quote user="Robin Grimmer"]

I've come across this too where vets won't even do basic orthopaedics like a cruciate or pin a cat's femur. So they all end up getting referred for a much greater cost.

[/quote]

We had this too with inter-vet clashes and cases were referred elsewhere when we had vets very competent in orthopaedics, for example.

RE: What does 'independent practice' really mean to a consumer, anyway?

Robin Grimmer — Mon, 24 Sep 2018 08:56:53 GMT

I've come across this too where vets won't even do basic orthopaedics like a cruciate or pin a cat's femur. So they all end up getting referred for a much greater cost.