What do you think about this vet price comparison website?

RE: What do you think about this vet price comparison website?

Evelyn Barbour-Hill — Fri, 09 Feb 2024 20:08:18 GMT

[quote userid="5012" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243670#243670"]a practice local to me, 2.2 miles away is listed as 21st at 5.16 miles away,[/quote]

Perhaps the price comparison site people are using Google Maps, which often gets things wrong, to calculate these distances. Just a thought.

RE: What do you think about this vet price comparison website?

Clive Ansell — Thu, 08 Feb 2024 14:25:53 GMT

[quote userid="10397" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243666#243666"]I find it really difficult to see how this directory is helpful to the veterinary profession.[/quote]

It isn't.

It is inaccurate and there is insufficient information to reach an informed choice.

A search based on my postal code of the first 10 practices;

one is an office complex for a local CVS owned group, not a working practice
2 of the 10 are now closed down and no longer trading
only 1 of the 10 shows any prices
a practice local to me, 2.2 miles away is listed as 21st at 5.16 miles away, when it should be 5th or 6th on the list

RE: What do you think about this vet price comparison website?

ell — Thu, 08 Feb 2024 11:18:40 GMT

I agree with Anthony. Vet practices don't hide their costs. I find it really difficult to see how this directory is helpful to the veterinary profession.

Our practice did get a call from them asking about our prices etc. However I decided to abstain from supplying this information at which point the operative phoning basically indicated that us declining would be noted on our details on the directory. I told them that they should not note that I declined.

There must be a greater incentive than helping owners find local practices for this directory to be set up. Why should practices not giving certain information then be made to look as if they are being unhelpful or awkward. At the end of the day it's just another online list of practices same as plumbers, etc

RE: What do you think about this vet price comparison website?

Evelyn Barbour-Hill — Mon, 05 Feb 2024 15:27:00 GMT

Right from when Magill invented endotracheal intubation, the purpose of the cuff is to make as near as can be achieved a gas seal around the tube, so that the gas inhaled by the patient is whatever you are providing down the tube, undiluted and uncomplicated by room air.

Of course it provides an additional line of defence against aspiration of foreign material, but it's a pretty feeble line of defence. Otherwise, you would keep the cuff inflated when extubating and you would never employ masking rather than intubation (no, I know veterinary surgeons rarely maintain with a mask, but it's common in human surgery).

The defence against aspiration is a throat pack. No procedure involving putting anything into the mouth – instruments, fluids, whatever – should be done without a throat pack (on a string).. Unless that's totally impossible – searching for a pharyngeal stick injury perhaps. Ready use should be made of suction where fluids are involved.

And, of course, on completion of the procedure the oral cavity should be searched, and suction used if necessary, before removing the throat pack and very importantly after removing it.

Regurgitation is a worry, but there are ways to minimise the risk of it occurring, and if regurgitated fluid is not observed before, it will definitely be identifiable on the throat pack when that is removed.

RE: What do you think about this vet price comparison website?

Anthony Dennison — Mon, 05 Feb 2024 11:57:13 GMT

[quote userid="5277" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243385#243385"] David, whilst I agree that price is a single metric - it is a metric and its one that owners could find out if they rang the practice and asked. Do we really want to hide it online just in case clients see it and can't understand that service levels may vary between practices? Not all pet owners want the cheapest vet by any means, many just want the vet with the highest standards of facilities, equipment and team qualifications. Thats hard to find out too and we've been working on making that clearer for years, with our reviews etc so whilst I am in 100% agreement with you its not perfect, its a start.[/quote]

Vet practices don't hide their costs. If someone calls up to ask how much something is, they get told. But as part of that conversation they can also find out what is included in that price and have a human conversation.

I realise what you are trying to do is make it easier for people to find a local practice, but all they will see is the £££ rating and not why this is. No matter how hard you try to explain that to people using the website, people will look at that with not context and nothing else.

RE: What do you think about this vet price comparison website?

David Mills — Mon, 05 Feb 2024 08:13:24 GMT

It's (yet) another opinion spouted by specialists with no basis in reality that quickly becomes dogma. File with steroids are the devil's drug, everything ever needs a TPLO, lap spays are better, most fracture decision making, Dom kills animals, I've antibiotics for surgical prophylaxis, don't premed c sections, triple clamp bitch spays, transfix the uterine stump etc etc etc ad nauseum

If the seal is airtight it may prevent gunk going into the trachea. But you don't extubate with the cuff inflated. Most don't suction before extubating. So you deflate the cuff then extubate. And the gunk wherever it is isn't removed with the et tube. The cuff is inflated to make it airtight in case you need MV. but the cuff is circular and the trachea isn't. So you don't ever really get an airtight seal.

RE: What do you think about this vet price comparison website?

Ben Walker — Sun, 04 Feb 2024 22:52:53 GMT

[quote userid="2131" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243642#243642"]The purpose of the cuff is not to prevent aspiration.[/quote]

Can you elaborate? I took inspiration from the BSAVA manual of canine and feline anaesthesia and analgesia (second edition, pp 41-43). Regurgitation and aspiration risks are specifically mentioned as important considerations relating to cuffs. What have I misunderstood?

RE: What do you think about this vet price comparison website?

Beats — Sun, 04 Feb 2024 21:06:52 GMT

[quote userid="10320" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243639#243639"]Tru-Cuff[/quote]

was interested. website says single-use - I assume can use repeatedly, but what is your feeling on accuracy over time with repeated use? or are they so cheap it really is used single use?

also look like used in humans? Does the green zone match well for a cat also?

RE: What do you think about this vet price comparison website?

Evelyn Barbour-Hill — Sun, 04 Feb 2024 20:16:58 GMT

[quote userid="25265" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243640#243640"]Is there a high likelihood of needing to use mechanical ventilation, or of aspiration? Could we reduce the aspiration risk any other way? Even if we can’t exactly quantify the risks, we can get a feel for it.[/quote]

The purpose of the cuff is not to prevent aspiration.

RE: What do you think about this vet price comparison website?

Ben Walker — Sun, 04 Feb 2024 11:58:15 GMT

[quote userid="10320" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243639#243639"]I don't know if there's specific studies out there, but I tend to think of weighing up the pros/ cons and expected risks of each[/quote]

Same here. I can’t think of any studies off the top of my head, but from first principles we can still make reasonable decisions.

Cuffed vs uncuffed oversimplifies it. Do you use the red rubber high pressure, low volume ET tubes, or the PVC low pressure, high volume ET tubes? The latter ought to be safer as the pressure on the mucosa is less likely to exceed perfusion pressure.

Is there a high likelihood of needing to use mechanical ventilation, or of aspiration? Could we reduce the aspiration risk any other way? Even if we can’t exactly quantify the risks, we can get a feel for it.

RE: What do you think about this vet price comparison website?

Lucy Fleming — Sun, 04 Feb 2024 11:41:26 GMT

I don't know if there's specific studies out there, but I tend to think of weighing up the pros/ cons and expected risks of each. I prefer uncuffed for most procedures - if nothing else I find I can usually get a significantly larger uncuffed tube into a cat - but I do use cuffed for dental procedures as I feel the risk of aspiration is going to be higher. I don't do a lot of GI surgeries in cats, but would probably cuff if I thought there was a regurgitation risk.

We recently got some of the Tru-Cuff syringes for inflating the cuffs which I believe have some evidence for being more accurate than "listening for a leak"

RE: What do you think about this vet price comparison website?

Clive Ansell — Sat, 03 Feb 2024 10:11:25 GMT

[quote userid="25265" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243470#243470"]

Michael Woodhouse said:
David Brodbelt found intubation in cats associated with greater risk of mortality.

Dave did, but not in that paper. That’s the cohort study where they looked at sedation vs anaesthetic rather than ET status (sedation defined as chemical restraint insufficient to allow for intubation were it to have been attempted).

However, he embedded a case control study within the cohort that found some evidence that intubation of anaesthetised cats was associated with higher odds of mortality in minor procedures, but protective in more invasive procedures.

[/quote]

Is there any evidence around the safety of cuffed vs uncuffed ET tubes in cats? I tend to use uncuffed, of if a cuffed one do not inflate it, and will use a throat pack or a swab for oral or dental procedures.

RE: What do you think about this vet price comparison website?

Ben Walker — Mon, 22 Jan 2024 10:48:05 GMT

[quote userid="3169" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243465#243465"]David Brodbelt found intubation in cats associated with greater risk of mortality.[/quote]

Free text link:

https://doi.org/10.1093/bja/aem229

RE: What do you think about this vet price comparison website?

Lucy Fleming — Mon, 22 Jan 2024 10:02:38 GMT

I was going to mention this - there's bound to be some confounding factors in that non-intubated procedures are likely to skew towards the minor, in relatively fit and healthy patients, but the risks of laryngospasm and tracheal damage associated with intubation in cats (especially if care isn't taken) are not insignificant... I don't routinely intubate my cat castrates, and at this point have no particular plans to start doing so.

RE: What do you think about this vet price comparison website?

Michael Woodhouse — Mon, 22 Jan 2024 01:09:09 GMT

[quote userid="6386" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243430#243430"]I was thinking the same- implies that it is better to intubate them- but is it? [/quote]

David Brodbelt found intubation in cats associated with greater risk of mortality. We intubate few cats. If I was castrating my own cat, then no tube would be going in.

https://pubmed.ncbi.nlm.nih.gov/18466167/

RE: What do you think about this vet price comparison website?

Kate Richardson — Thu, 18 Jan 2024 14:44:42 GMT

[quote userid="2131" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243397#243397"]

Susie Samuel said:
whether practices intubate cats for castrates on their website yet that would be important for any vet choosing a practice for their own pet

Why?

[/quote]

I was thinking the same- implies that it is better to intubate them- but is it?

RE: What do you think about this vet price comparison website?

Carl Gorman — Wed, 17 Jan 2024 17:46:04 GMT

Respectfully Susie, you really shouldn’t be trying to publish these ‘facts’ when your system seems to have so many bugs. Blaming upload errors isn’t an excuse when you are affecting a clinics reputation and feeding client dissatisfaction at a time when maintaining reputation is more and more challenging. The profession does need more transparency and we (associations) will continue to work on how this is best achieved.

RE: What do you think about this vet price comparison website?

Arlo Guthrie — Wed, 17 Jan 2024 17:10:11 GMT

Update - have written a news story here: https://www.vetsurgeon.org/b/veterinary-news/posts/new-vet-clinic-price-comparison-service

RE: What do you think about this vet price comparison website?

hilary warner — Tue, 16 Jan 2024 23:03:06 GMT

The practice I am in and those I know are closest do not appear on the search at all. How do the check value and how do they judge reviews. Could be useful but are they comparing apples and pears?

RE: What do you think about this vet price comparison website?

Dinu Catilina — Mon, 15 Jan 2024 22:23:26 GMT

[quote userid="9035" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243401#243401"]It places practices with loss leaders in a more favourable light.[/quote]

Exactly my thought. If this particular enterprise takes off then it will not be long until someone will learn how to play the system and arrange their pricing structure to appear more appealing to the public but overall being a worse deal.

I do believe that in theory this is a good idea but it is virtually impossible to compare practices on price. Some practices have vacs for life while others charge per year the equivalent of vaccs for life. Some practices have double or triple the price of a cruciate surgery even though their spays are half price than their competitors. How can you objectively weight these prices against each other?

And it's not sour grapes, we are pretty reasonable priced compared to our corporate competitors but why would anyone get involved in yet another race to the bottom?

RE: What do you think about this vet price comparison website?

Glenn Hodgson — Mon, 15 Jan 2024 20:29:15 GMT

Hi.

I like openness of pricing, but I am also not a fan of this.

It places practices with loss leaders in a more favourable light.

It's all fine to have a low consultation fee on a website.... However, the £££ signs do not take account for £25 injection fees and 509% mark ups on acute meds.

We should focus more in value then price. And encourage clients to do the same?

RE: What do you think about this vet price comparison website?

Susie Samuel — Mon, 15 Jan 2024 15:31:50 GMT

Im not sure Arlo lol - here is the guidance they have issued www.gov.uk/.../funerals-market-study

RE: What do you think about this vet price comparison website?

Arlo Guthrie — Mon, 15 Jan 2024 14:58:36 GMT

[quote userid="5277" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243396#243396"]Thank you for your thoughtful reply.[/quote]

My pleasure, trying to be constructive!

[quote userid="5277" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243394#243394"]The CMA is about to publish its findings, if you look at what the recommendations were to the funeral directors who were similarly investigated it was all around publishing prices.[/quote]

That's really interesting to hear. I can't wait to see what the CMA makes of the veterinary profession. It is (of course) rather different to the funerary profession, in that there isn't much room for a variation in the advice given by a funeral director. I mean it's basically a box or a barbeque!

RE: What do you think about this vet price comparison website?

Evelyn Barbour-Hill — Mon, 15 Jan 2024 13:38:40 GMT

[quote userid="5277" url="~/f/non-clinical-questions/30873/what-do-you-think-about-this-vet-price-comparison-website/243383#243383"]whether practices intubate cats for castrates on their website yet that would be important for any vet choosing a practice for their own pet[/quote]

Why?

RE: What do you think about this vet price comparison website?

Susie Samuel — Mon, 15 Jan 2024 11:04:19 GMT

Hi Arlo

Thank you for your thoughtful reply.

I don't think though that we are fuelling a price war by publishing prices. We regularly speak to vets who tell us they deliberately price them selves high because of the type of work that interests them and the type of clients they want. In my experience there is a huge cohort of owners would like choose their vet on quality of care, experience, seeing the same vet vs the cost. Hiding prices does not seem sensible, and I don't think anyone actually thinks we should do that. We are just making them easier to access. See my comments to Miriam below on the lovely lady from Highfield vets who has unsurprisingly had a drop in call volume from publishing hers.

I love the suggestions for overall pricing that takes into account the approach to diagnostics, treatment etc, these are all things we would love to do in the future but as you say very expensive for the moment.

Susie