Vets 'helping pet owners prolong animal agony'

RE: Vets 'helping pet owners prolong animal agony'

Anthony Dennison — Fri, 08 Oct 2021 12:12:31 GMT

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233270#233270"]One of my favourites if ' I see your dog for 15 minutes, you live with them all the time, you know them far better than I do'[/quote]

I say that at least once a day! Another stock phrase I use, often when euthanasia is decided due to cost grounds is 'even if you said here's a million pounds, fix my animal, we'd still be having exactly the same conversation'.

There is a trend to over investigate things sometimes, it is a combination of owner and vet driven in my opinion. Sometimes it is just an inexperience issue - recently qualified vet isn't sure what it could be but wants to consider worst case option in case it is that. We have a lot more googling owners, and owners wanting to be self referred.

One case of a severe prostatic tumour that had spread right through the bladder where the owner didn't want to believe there was nothing could be done. Next day we got a phone call from Fitzpatrick Referrals to send us a copy of the CT. We hadn't sent a referral request ourselves.

RE: Vets 'helping pet owners prolong animal agony'

helen herinckx — Mon, 04 Oct 2021 15:08:52 GMT

I was once berated by an owner for advising euthanasia for end stage renal disease - she had heard that dialysis was available at RVC and I had failed to mention it ( despite it only being suitable for ARF)

RE: Vets 'helping pet owners prolong animal agony'

Neil Wheadon — Wed, 29 Sep 2021 11:11:10 GMT

[quote userid="7811" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233269#233269"]Totally agree Sarah! I get the mickey taken out of me by younger staff for wanting to euthanise everything (I really don't!).[/quote]

It works the other way as well

I had a client last week, thank me profusely because I gave one of the options for her 14 year old dog as euthanasia. She stated quite firmly that the other (younger - sorry) vet wanted to treat, treat, treat, regardless. I have many stock phrases. One of my favourites if ' I see your dog for 15 minutes, you live with them all the time, you know them far better than I do'

Neil

RE: Vets 'helping pet owners prolong animal agony'

Julie Innes — Wed, 29 Sep 2021 11:05:57 GMT

Totally agree Sarah! I get the mickey taken out of me by younger staff for wanting to euthanise everything (I really don't!).

I think it's telling that we are inundated with cards, flowers and chocolates from animals we euthanase, and most complaints come from the things we either fixed or tried very hard to fix!

And no, I'm not just swayed by the chocolate!

RE: Vets 'helping pet owners prolong animal agony'

Sarah McGurk — Tue, 28 Sep 2021 13:01:01 GMT

After a few years in practice (and a stint responding to complaints from an emergency chain) I reached the conclusion that advising clients to euthanase quite promptly when it became obvious that the outcome was likely to be poor rarely resulted in client dissatisfaction (so long as you explained the reasoning clearly) whereas the majority of complaints and unhappiness resulted from clients who felt they hadn’t euthanased early enough and felt guilty at the suffering their animal had been through (even when the ultimate decision had been theirs to make).

I realise that progress can sometimes be driven by innovation, but I was always very torn on the odd occasions when I watched Supervet. No doubt he was very skilled, but on an individual basis, and given the number of perfectly healthy unwanted animals in the world, there were cases where I definitely wondered whether what he was doing was really ethical from an animal welfare standpoint.

Having worked in both city and rural practices, I also observed that in the rural practices, where the tendency was towards understanding that sometimes the kindest thing is to let the animal go, there was less owner-led/caused suffering, in general.

Then again, when I worked in an emergency clinic, I did earn myself the nickname “Mrs Shipman”!

RE: Vets 'helping pet owners prolong animal agony'

Arlo Guthrie — Tue, 28 Sep 2021 12:31:37 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233243#233243"]Basic/palliative/refused treatment is ultimately down to them.[/quote]

Yes, sure, but the WAY the advice is given can profoundly affect the decision-making process. I've been given advice which (inadvertently or otherwise) made me feel guilty for not taking option a).

RE: Vets 'helping pet owners prolong animal agony'

Bob Russell — Tue, 28 Sep 2021 12:23:30 GMT

The older my pets are, the less 'heroic' will be the treatments. I regularly talk to owners about the benefits and welfare issues about the options available.

Part of my job is to guide them to make a good decision. This may be referral or more tests here but where I feel the patient is likely to gain little then I try to be honest. I don't weigh their wallets, I try not to be too judgemental but the welfare of patient and owner is paramount.

Basic/palliative/refused treatment is ultimately down to them.

RE: Vets 'helping pet owners prolong animal agony'

Neil Wheadon — Sun, 26 Sep 2021 23:49:50 GMT

3 replies in the Sunday Times letters today

One I found interesting as it follows a pattern I see in an awful lot of owners. They will do it once and once only. Many many clients tell me that X or Y went through procedures that they felt in hind site neither benefitted their pet or added to their quality of life. Faced with a second pet needing anything other than palliative treatment or basic treatment , anything else is politely declined.

Neil

RE: Vets 'helping pet owners prolong animal agony'

Anthony Todd — Thu, 23 Sep 2021 01:35:27 GMT

[quote userid="2131" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233136#233136"]all sensible things that all pets should be offered and advised to be done.[/quote]

For sure, which is why we measured them...

[quote userid="2131" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233136#233136"]You can only microchip a pet once.[/quote]

Yup, and the number varied enormously between branches, some virtually nil!

Dentals again, great variation even if they were done badly, by some standards, but better than nothing at all!

Ceporex man was spoken to, and as I've explained before it made no difference to his take-home.

Worming was annual usually at booster time, again some vets did, some vets forgot or didn't.

I wonder when, or if, the corporates will start this sort of analysis, or is it/will it be purely on turnover and sales ie money??

RE: Vets 'helping pet owners prolong animal agony'

Evelyn Barbour-Hill — Wed, 22 Sep 2021 18:47:26 GMT

[quote userid="5904" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233106#233106"]Dentals, microchipping, worming etc. all sensible things that all pets should be offered and advised to be done.[/quote]

We don't have a raised eyebrow thingy any more.

You can only microchip a pet once.

Worming, true we used to think the more the better, but we know now that's quite wrong.

As for "dentals"... it would depend what you mean by "dentals". One thing's for sure, a lot of pets are still getting un-necessary, pointless or thoroughly bad dental attention.

[quote userid="5904" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233106#233106"]We didn't use anything financial 'cos we found one of the vets giving every dental 2 weeks of Ceporex!!![/quote]

Did you tell him to stop it or did you continue to rake in the cash?

RE: Vets 'helping pet owners prolong animal agony'

Julian Earl — Wed, 22 Sep 2021 18:20:39 GMT

[quote userid="12930" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233080#233080"]f you think open heart surgery is a sensible option to be discussing with an owner re their pet then do so. If you don't, then don't. Discussing it with an owner if you don't think it is a sensible option and then complaining that it wasn't a sensible option makes little sense.[/quote]

Spot on! I have agrreed with this comment in articular. Nobody wants to disctss a totally irrelevant ndnon-sensible option! Why would they? Yo make decision for the client up to a point by advising what is best for the animal, always and are, if like me, veryinfluenced by what you would dofor your own pet? Simple in principle? The question from a client "Whatoyuld you do is very pertinent, always!. Thanks for reading,,,!

TTFN.

RE: Vets 'helping pet owners prolong animal agony'

Bob Russell — Wed, 22 Sep 2021 08:43:41 GMT

We don't have targets beyond the need to pay our wages and all the various tax demands!

Beyond that we just do the best we can for our patients and their owners. None of our patients are (to the best of my knowledge) left in agony at all, let alone that being extended.

Edit: I wholeheartedly agree with the aims stated on the ethics first website but would be far more comfortable knowing who is behind it. The 'about' is very vague.

RE: Vets 'helping pet owners prolong animal agony'

Arlo Guthrie — Tue, 21 Sep 2021 18:05:21 GMT

[quote userid="8361" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233104#233104"]

Arlo Guthrie said:
something rather more subtle, more marginal??

Such as?

[/quote]

I don't know. I try and put myself in a vets shoes and think it might be possible that if I were under some sort of pressure to meet targets, or be Employee of the Month, or whatever, and I had a patient where you could make a case for further treatment, or not, and it was a bit in the balance, I might be swayed, subconsciously perhaps, on the side of recommending treatment.

As I said, I am not talking about anything to the degree of the headline of this thread.But I would be surprised if things were often that clear cut.

RE: Vets 'helping pet owners prolong animal agony'

Anthony Todd — Tue, 21 Sep 2021 17:12:39 GMT

Vets 'helping pet owners prolong animal agony'

No, I can't remember my having seen any evidence of this, but this was "pre-corporate and our parameters were not ever based on turnover.

I've had it, as described before when a cat with a massive abdo tumour went through the whole protocol : op biopsy histology etc. then PTS and I was accused of "not caring"......

RE: Vets 'helping pet owners prolong animal agony'

Sarah Wheadon — Tue, 21 Sep 2021 16:50:40 GMT

But I'm questioning for examples relating to the title of the thread, not worming, chipping etc which as you say are all sensible, and therefore based on common sense.

RE: Vets 'helping pet owners prolong animal agony'

Anthony Todd — Tue, 21 Sep 2021 16:23:31 GMT

[quote userid="8361" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233104#233104"]Such as?[/quote]

We used to do this simply to highlight and stimulate good practice, based simply on 100 contacts [ie including "chats" during a routine booster]

The results were staggering between competent. experienced vets!

Dentals, microchipping, worming etc. all sensible things that all pets should be offered and advised to be done.

I can produce the data, but trust me, staggering!!

PS We didn't use anything financial 'cos we found one of the vets giving every dental 2 weeks of Ceporex!!!

RE: Vets 'helping pet owners prolong animal agony'

Sarah Wheadon — Tue, 21 Sep 2021 16:04:26 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233102#233102"]something rather more subtle, more marginal??[/quote]

Such as?

RE: Vets 'helping pet owners prolong animal agony'

Arlo Guthrie — Tue, 21 Sep 2021 15:22:18 GMT

[quote userid="8361" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233097#233097"]

Anthony Todd said:
SO the vet may be driven, in these non-vet-owner times by "parameters" rather than common sense or sympathy!

Sorry, but this is the sort of insulting comment that I expect to read on one of the 'vet bashing' forums.

[/quote]

Sarah Wheadon The problem with the written word is that it does tend to present arguments in black and white.

I don't find myself rushing to Anthony Todd's defence very often, but I think he has a point ... in the sense that I've certainly heard of employee vets having to hit targets (or parameters). I'm sure that primarily relates to things like flea treatment sales, but it's not unthinkable that it could also have a bearing on the advice given in other areas. Not in the sense of anything as cynical as 'let's keep this animal going for a couple more consultations', but perhaps something rather more subtle, more marginal??

RE: Vets 'helping pet owners prolong animal agony'

Sarah Wheadon — Tue, 21 Sep 2021 13:48:27 GMT

[quote userid="5904" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233079#233079"]SO the vet may be driven, in these non-vet-owner times by "parameters" rather than common sense or sympathy![/quote]

Sorry, but this is the sort of insulting comment that I expect to read on one of the 'vet bashing' forums.

My only consideration in treating patients, and I am sure that of my colleagues is the best outcome possible for that individual. In some cases, that is euthanasia. The art of veterinary medicine is being able to adapt treatments according to an owner's wishes, always ensuring that the welfare of the animal is prioritised.

RE: Vets 'helping pet owners prolong animal agony'

Bob Russell — Tue, 21 Sep 2021 10:30:14 GMT

Pushing boundaries is sometimes a good thing. It is how the profession moves forwards.

I have experienced patients that have been through the mill. Treated at primary practice then referred then referred on again. Some bills in the tens of thousands. This does not impress me one bit.

I work with owners and will often recommend limited treatment or euthanasia where I believe the patient welfare is compromised. I am known to be fairly straight talking. It may be a benefit of age that people listen!!

I struggle with the welfare issues suffered by some breeds especially the short nosed breeds. There are plenty of vets willing to specialise in the disaster cases and plenty of non-vets to ensure they are still breeding.

Heart surgery sits fairly comfortably with me if it results in improved patient welfare and the owner has the money to deal with it. A lot of heart disease in humans is considered surgical and 'curable' whereas we think of them as medical and incurable. It will always be an option for a fraction of patients.

RE: Vets 'helping pet owners prolong animal agony'

Arlo Guthrie — Mon, 20 Sep 2021 17:53:51 GMT

[quote userid="12930" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233081#233081"]I have no doubt I could make the care of your dog exceptionally complicated if I tried, however as you have experienced this is not a common problem when attending a vets.[/quote]

What I meant is that my dog has not needed open heart surgery. I HAVE certainly experienced veterinary over diagnosis / treatment.

RE: Vets 'helping pet owners prolong animal agony'

Anthony Todd — Mon, 20 Sep 2021 17:53:23 GMT

But much commoner than it used to be, which is part of my points! and probably/possibly part of this:

Vets 'helping pet owners prolong animal agony'

RE: Vets 'helping pet owners prolong animal agony'

Anthony Todd — Mon, 20 Sep 2021 17:51:11 GMT

I think it's easy if you only think of the "wellbeing" in the future life of the patient and the time frame and the odds.

What really is the point of giving owners all the options when they don't understand most/some/none of the options or the explanation and really just want

what's best for their beloved pet?

Try recording the final thing the owner says ie decision time, and I'll be surprised if ANY owner does NOT say "What do you recommend" or "what would you do" !

eg An old vet friend has just had his much loved 8yo lurcher put down, 8yo, with a large tumour of the humerus, very sad, but the right decision

RE: Vets 'helping pet owners prolong animal agony'

Beats — Mon, 20 Sep 2021 17:27:50 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29997/vets-helping-pet-owners-prolong-animal-agony/233073#233073"]my dog has not yet needed anything complicated.[/quote]

You can make anything as complicated as you wish.

I have no doubt I could make the care of your dog exceptionally complicated if I tried, however as you have experienced this is not a common problem when attending a vets.

RE: Vets 'helping pet owners prolong animal agony'

Beats — Mon, 20 Sep 2021 17:25:05 GMT

OK, I get the point that the increase in treatment options can have the effect of removing the option that many the owner of an elderly pet would like to have: having their pet euthanased knowing that everything possible had been done! This may seem like a paradox, that the increase in options now available removes, for all but the wealthy, the option of knowing you had done everything possible for your beloved companion.

This is an interesting philosophical point, however, in practical terms I don't note a problem. There are no vets I personally know of practising in a manner that I would consider questionable. Many (most! - ask 2 vets, get 3 opinions and all that) will have different opinions to me on an individual case, but I consider that healthy.

If you think open heart surgery is a sensible option to be discussing with an owner re their pet then do so. If you don't, then don't. Discussing it with an owner if you don't think it is a sensible option and then complaining that it wasn't a sensible option makes little sense.

It is mad to think you could discuss all options with an individual owner regarding their pet. Nobody does this. You discuss the options you think are sensible, probably limiting that to 3 maximum (symptomatic treatment/basic investigation versus extensive investigation/treatment versus euthanasia), you gauge the owner's response as you talk and then lead them to what you consider is best for them/their-pet. If you don't think an option for extensive investigation/treatment is sensible, then either don't mention it or mention it to dismiss it.

I have discussed open heart surgery with just one owner in my career (an in-law). I thought the dog was a good candidate, and it was not wholly ridiculous to discuss the pros and cons of it.