The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Julian Earl — Tue, 02 Nov 2021 20:56:16 GMT

Thank you Joyce. Ihad not thought of that. After all Jack Russells are not really a pedigreei the true sense are they? But your explanation does fit, thanks! Best Wishes... :)

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Joyce Whitehead — Tue, 02 Nov 2021 18:35:59 GMT

Well we don’t see many atopic pure poodles, but then we see very few pure poodles. However tons of cockerpoos, cavapoos, labradoodles etc, and so many of them are atopic, I think it is the combo of genes that is the issue, as both breeds are susceptible. I guess it also partly depends on local populations?

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Julian Earl — Tue, 02 Nov 2021 16:39:32 GMT

[quote userid="7269" url="~/001/nonclinical/f/life-in-practice-discussions/30013/the-5-minute-consult-any-comments-regarding-why-we-should-be-doing-these-rather-than-15-minutes-in-here-please/233504#233504"]I agree Julie, so many atopic dogs now, predominantly poodle crosses…. Although we are also better at spotting them than when I was a new grad many years ago. And the cho[/quote]

I thought that Poodleswerethe standout breed for NOT being susceptible to atopy? Inlike, \terriers, Labradors, Retrievers andothers I have forgotten?

Thanks.

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Julian Earl — Tue, 02 Nov 2021 16:36:19 GMT

[quote userid="4367" url="~/001/nonclinical/f/life-in-practice-discussions/30013/the-5-minute-consult-any-comments-regarding-why-we-should-be-doing-these-rather-than-15-minutes-in-here-please/233498#233498"]5 min, max 30.[/quote]

Hello Ian, How are you doing nowadays?

I think we are focusing too much on a fixed consultation time for anything, even a booster consult' E.g. for an older cat I would always palpate and ask about the thyroids regardless of whether clinical signs were reported beforehand. . One takes the time required to be thorough and then if thorough, then this = more accurate surely? If the owners see you being thorough they will be happy and accept your diagnosis and advice will they not? It is good for the pet, good for job satisfaction, good for business if we are being honest about all this, and one can sleep easier at night finding these unexpected problems!

The objective is to maximise the welfare of our patients so anything to enhance that is justifiable! I defy anyone to disagree with that!!

Thank you. J.Earl...

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Alistair Graham-Evans — Sun, 10 Oct 2021 21:17:03 GMT

Our young vets struggle with time management with skin cases. I advise deal with start of treatment for ears and skin infection and give atopy information handout and re-book in a week for serious atopy chat.

I prepared comprehensive cruciate, hip and patella handouts with lots of pretty pictures but it’s obvious that very few owners read or understand them unfortunately.
I think people remember less than 10% of information delivered during a consultation. They look less confused when I finish with “Don’t worry-we’ll improve things” Then the last thing they remember is something optimistic!

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Joyce Whitehead — Fri, 08 Oct 2021 16:46:59 GMT

I would agree Iain, our appointments are 15 minutes and that is usually ok as we have some shorter thungs booked in that can let you catch up, but there is definitely a benefit for some things to rebook in a week and have a decent conversation.

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Iain Richards — Fri, 08 Oct 2021 15:15:43 GMT

There is probably a lot of wisdom in rescheduling the appointment for a longer one rather than cramming it into 10 mintues.

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Joyce Whitehead — Fri, 08 Oct 2021 13:32:10 GMT

I agree Julie, so many atopic dogs now, predominantly poodle crosses…. Although we are also better at spotting them than when I was a new grad many years ago. And the choice of treatments is so much bigger, and warrants a longish chat. I still find them the most frustrating to get through to owners that this is a life long condition that we will control not cure. I often compare it to asthma in people which helps some folk.

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Julie Innes — Fri, 08 Oct 2021 12:42:43 GMT

Agree with Beats re the health of dogs. Where years ago I would see mostly cuts/ sprains/ gastroenteritis, now we are seeing sooo many skin conditions that require a full discussion about food allergies vs atopy etc etc. Dogs with crap joints and such a plethora of options for treating osteoarthritis. Brachy breeds requiring (but rarely affording) BOAS surgery.

I feel sure the steep rise in breeding designer "breeds" and frenchies is giving us a huge increase in workload! Sadly the owner rarely blames the breeder, it must be our fault....

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Iain Richards — Fri, 08 Oct 2021 12:27:57 GMT

Ian, 15 min, max 30.

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Bob Russell — Thu, 07 Oct 2021 12:03:03 GMT

I cannot easily get access to the paper (need to find my BVA log in details!) but owners are likely to be satisfied with any length that is appropriate for their concerns.

Removal of a tick and a little advice may take 5 minutes and be acceptable but generally we find owners present pets with multiple problems. Careful direction can keep clients happy without them feeling short changed!

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

ian bates — Thu, 07 Oct 2021 10:18:14 GMT

Iain - I can't see the length of consultations they used. I would have guessed if they compared 15 mins to 25mins then clients might not be too bothered. But if the comparison was 5 min to 15 mins they might well feel short changed??

I await to be proved wrong......!

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Iain Richards — Thu, 07 Oct 2021 09:47:53 GMT

There has been some work on cosult length. It seems vets like it, but clients are not that bothered:

A comparison between the long-form and single-question satisfaction instruments demonstrated significant correlation for both vet and client tools (ρ=0.609, P<0.005 and ρ=0.483, P<0.005, respectively). The average client satisfaction with the consultation was high; however, vet satisfaction levels were significantly lower (U=1073, P<0.005). Increased consult length was associated with increased vet satisfaction (ρ=0.332, P=0.007) but not increased client satisfaction

Measuring satisfaction in the small animal consultation and its relationship to consult length

Louise Corah, Liz Mossop, Rachel Dean, Kate Cobb,

First published: 06 August 2020

https://doi.org/10.1136/vr.105910

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Rob Davis — Tue, 05 Oct 2021 17:36:38 GMT

[quote userid="6550" url="~/001/nonclinical/f/life-in-practice-discussions/30013/the-5-minute-consult-any-comments-regarding-why-we-should-be-doing-these-rather-than-15-minutes-in-here-please/233449#233449"]I would sort of beg to differ. The 'average' dog or cat is probably in better health for longer but a problem dog is likely to be more distorted, badly bred and short nosed.[/quote]

Agreed, but we see a far higher proportion of the latter than a few years ago.

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Bob Russell — Tue, 05 Oct 2021 17:28:27 GMT

I would sort of beg to differ. The 'average' dog or cat is probably in better health for longer but a problem dog is likely to be more distorted, badly bred and short nosed.

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Arlo Guthrie — Tue, 05 Oct 2021 15:48:28 GMT

[quote userid="12930" url="~/001/nonclinical/f/life-in-practice-discussions/30013/the-5-minute-consult-any-comments-regarding-why-we-should-be-doing-these-rather-than-15-minutes-in-here-please/233443#233443"]The health of dogs appears to have deteriorated in the last decade.[/quote]

Beats Really? Can you elaborate. Are there studies which show this?

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Beats — Tue, 05 Oct 2021 12:45:12 GMT

Less healthy dogs.

The health of dogs appears to have deteriorated in the last decade.

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Julian Earl — Mon, 04 Oct 2021 13:46:29 GMT

Tanks Evelyn... That all gave me a big ironic smile!! I absolutely agree that ian abcess is straihghtforward but not necessarily quick if done "properly!" And I use that word with care and thought! The mostcommon compliment was to be told that I was thorough! Without being torough for a so-called simple cat-bite absces, sooner or later you'il miss, the foreignbody in there, the deeper spreading celulitis and the mulitple puncture wounds on the body somewhere! Not sure about closing the edges of these though? Best left open for further drainage, surely? 48-49 years ago, I was working at our local vets atweekends being the lowly dogsbody for cleaning the exam. table, the kennels and holdng the cat whilst it's abscess was stabbed Ithink that they all received a dose of Mylipen at that time, but no NSAIDS were available for subcut-use in these poor moggies! Evn PBZ was not readily-available then IIRC? And intravenous -only only as well... Ketofen was a fantastic nrew product when it arrived, sbcutaneous, non-apinful and apparently very effective! [andI presume that it still is I?]..., Or Rimadyl s/c? Metacam? Etc., etc?

Cheers Evelyn, an excellent summary! Stay safe and well!

After all this, I stand by my preferred choice of treatment:lance, drain and flush, plus NSAID for pain as well! SORTED!!

Thanks!

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Evelyn Barbour-Hill — Mon, 04 Oct 2021 12:26:10 GMT

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30013/the-5-minute-consult-any-comments-regarding-why-we-should-be-doing-these-rather-than-15-minutes-in-here-please/233399#233399"] Owners will frequently save everything up for a booster consultation[/quote]

And quite right too. It's the annual health check.

[quote userid="10320" url="~/001/nonclinical/f/life-in-practice-discussions/30013/the-5-minute-consult-any-comments-regarding-why-we-should-be-doing-these-rather-than-15-minutes-in-here-please/233418#233418"]In my opinion, the majority of owners have absolutely NO IDEA that they might have an allotted time slot with a definitive finishing point - they expect the problem to be fully dealt with, and either fixed or a plan formulated, by the end of the appointment, no matter how long it takes.[/quote]

Exactly.

I don't understand, with these 5 or 10 minute appointments, what's supposed to happen when time's up. "OK, Mrs. Aythornthwaite, you've had four and a half minutes and it takes me 30 seconds to write up notes, off you go and pay at the desk... Next!"

I absolutely do not understand why this is always cited as something quick and easy. Straightforward, sure, but not quick. Every abscess in my opinion requires admitting for a GA or deep sedation, and as a minimum incision, drainage and exploration. Sometimes flushing though that's not as important as some say, in my opinion. Sometimes excision of necrotic skin, sometimes drawing up skin edges with sutures. A dose of NSAID but rarely any antibiotic administration.

Granted, I wouldn't attempt to do all that in a consultation appointment. The cat would be admitted. But the initial greeting, getting the cat out of the box, the examination, the explanation to the client, the admittance consent form signing, the reassurances, that's all going to take ten minutes.

At this point somebody is probably going to say how they used to just hold the cat by the scruff over the sink, slash it with a scalpel blade and give it a dollop of Propen. Yes, I've done that, and done it on home visits too, but that was 48-49 years ago. Things are done better now.

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Jill Butterworth — Mon, 04 Oct 2021 11:59:44 GMT

I saw practice with an old vet who would do 5 min consultations on open surgery nights. To achieve this, his non verbal communication was to literally shoo clients out with the record card. Gradually people stopped coming to his nights because they wanted a better service from the younger vets. It was only achievable when every single animal got some version or other of antibiotics and steroids.

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Lucy Fleming — Mon, 04 Oct 2021 11:45:25 GMT

So, there can be a few reasons why 5 minute consults are challenging:

"Good" reasons:

- improvements in available treatments - there may be more we can do for our patients than previously, which can improve the QOL and life expectancy in many cases. However, this means more to discuss with owners, in order to determine what further tx/ investigation (or not!) may be the best option for pet and owner.

- better recognition of chronic painful conditions - especially things like arthritis or periodontal disease - or the benefits of early detection of disease (eg CKD, hypertension, hyperthyroidism etc in older cats). However, owner reognition of these problems can be poor, and the chances of persuading them to follow up, trial analgesia etc with only 5 minutes to complete exam, chat and clinical notes is fairly slim.

"Bad" reasons:

- defensive medicine - vets feeling that they need to ensure all options (including referral) have been discussed and documented, and extensive notes needing to be completed in order to "cover their backs" for possible complaints (I would say that comprehensive notes are a good thing, within reason, but does add time to consult.)

- less "trust" from owners, more owner education (misinformation?): for better or worse, many owners are more informed about their pet's health than previously. That can often be a really positive thing, but the days of just telling them "here, take this medication" or "book them in for a dental" without needing at least some further discussion or explanation are pretty much gone.

- vet "overtreatment"??? perhaps we have become less willing to treat simple things symptomatically initially, and instead strive for a definitive diagnosis all the time. I don't necessarily think that should be seen as a bad thing (after all more accurate diagnosis should mean better treatment), but it shouldn't come at all costs, and it perhaps doesn't always need to be launched into at the initial consultation (pressure to do this can come from the vet side OR the owner side)

In my opinion, the majority of owners have absolutely NO IDEA that they might have an allotted time slot with a definitive finishing point - they expect the problem to be fully dealt with, and either fixed or a plan formulated, by the end of the appointment, no matter how long it takes. That I don't think has changed over time! Just that it can be more challenging achieving that in a very short period of time (experience helps, but I consider myself a pretty experienced GP after 14 years in mixed practice and I feel that 5 minute consults wouldn't serve vet or animal welfare very well!)

Edited to add, as Neil mentioned above, booster appointments often come with a laundry list of additional things to talk about (or do, like EAGs and trimming nails) that the owners have saved up for the last 6-12 months!

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Neil Wheadon — Sun, 03 Oct 2021 18:12:17 GMT

Very few things can get away with 5 minutes these days

Boosters - Can you squeeze the anal glands, oh... by the way can we discuss his skin. Owners will frequently save everything up for a booster consultation

Cat Bite Abscess - The last seen in this family had an air gun pellet in it, so required a work up. Even then a client is paying £35-£48 for a consult. It is neither cricket or a particularily good idea to drag the cat out of the basket (either let the cat come out or dismantle the box) wipe it with a piece of cotton wool and inject it with the other hand before pushing it back in again and writing CBA in the notes. Folks want a bit of value for their buck, either real or percieved.

Neil

RE: The 5 minute consult, any comments regarding why we should be doing these rather than 15 minutes in here please

Martin Hamilton — Sun, 03 Oct 2021 18:06:09 GMT

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30013/the-5-minute-consult-any-comments-regarding-why-we-should-be-doing-these-rather-than-15-minutes-in-here-please"]Do you think most clients really need/understand/want to pay for 15 minutes[/quote]

I'm aware this was from Anthony, but as you created the tangent it's under your name, sorry Neil!

The short answer to this is yes. Anthony clearly hasn't worked with urban small animal clients in the last 5 years.

The client will likely have already googled the symptoms and be asking why we don't suspect it's some uncommon neoplasm, or on the flip side will be arguing that they just want a shot of antibiotics and steroids because that's what the partner was doing for the last 30 years.