How do YOU practise veterinary medicine?

RE: How do YOU practise veterinary medicine?

Judith Joyce — Tue, 12 Nov 2024 09:25:20 GMT

yes, frais I've skewed your data too

RE: How do YOU practise veterinary medicine?

Evelyn Barbour-Hill — Mon, 11 Nov 2024 19:37:14 GMT

[quote userid="7269" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245977#245977"] I’d just like to point out (very tongue in cheek) that length of being a vet the maximum is 20-40 years. As a veritable dinosaur nowadays, but still working clinically for now (not much longer though ) I’ve been working for 41 years…[/quote]

Hmm.

52 years, me.

RE: How do YOU practise veterinary medicine?

Arlo Guthrie — Mon, 11 Nov 2024 13:11:08 GMT

[quote userid="3169" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245979#245979"](good work and I have completed it)[/quote]

Thank you Michael Woodhouse. And Joyce Whitehead and vso96. Much appreciated.

[quote userid="4294" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245966#245966"]

I've filled it in, then come to this thread, now I'm worried that I've done it wrong.

I put that I would choose the best choice over the cheapest as I think that's obvious. Euthanasia would generally be cheapest and I'd never go straight for that for e.g. broken leg or a KCCS with a mildly symptomatic murmur.

[/quote]

Don't worry! I think a few people have struggled with the fact that a couple of the questions seem binary, when of course every situation is different and complex. But as David said, we're after more of an instinctive, best fit, general answer. Ie not thinking too hard about specific situations, but rather more generally whether you prioritise the best solution for the animal or the cheapest/cheaper solution.

[quote userid="3169" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245979#245979"]Can I suggest you start a new thread, this post is kind of lost in here? Might get more responses?[/quote]

I have run it in the news, and we are sharing on social media in various places, and I will be sending an email in due course, and maybe a film ...

Meantime, we've had a great response to this, very strong numbers so far. 1000 is in reach.

RE: How do YOU practise veterinary medicine?

Michael Woodhouse — Sat, 09 Nov 2024 22:30:13 GMT

[quote userid="2100" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245963#245963"]

Finally, after taking into account feedback from here (thank you all), and with the help of David Mills, who turned my germ of an idea into a proper piece of research which has now (again thanks to him) been reviewed and approved by the RCVS Ethics Panel, we proudly present:

Factors influencing the clinical advice given by vets to clients

PLEASE can you do this survey. Apart from anything else, you will hopefully have seen some of my films designed to promote greater understanding of the issues by the public, and this data will give greater strength to some of the arguments I make.

[/quote]

Can I suggest you start a new thread, this post is kind of lost in here? Might get more responses?

(good work and I have completed it)

RE: How do YOU practise veterinary medicine?

Joyce Whitehead — Sat, 09 Nov 2024 22:09:33 GMT

I’ve completed the survey. I’d just like to point out (very tongue in cheek) that length of being a vet the maximum is 20-40 years. As a veritable dinosaur nowadays, but still working clinically for now (not much longer though ) I’ve been working for 41 years…

RE: How do YOU practise veterinary medicine?

David Mills — Fri, 08 Nov 2024 19:49:10 GMT

Yes indeedy.

The survey is a best answer approach - i.e. what would you normally do. It's impossible to catch every single nuance of clinical encounters that's why we decided to go for a general approach, with vagueness and asset to quick completion.

But don't let perfection be the enemy of the good.

We want as many responses as possible to put some figures to these important topics. That's all. There's no judgement!

And yes we may pursue the more in-depth stuff in the future, but that is a whole different ball game in terms of time, work and analysis - and if you like this is a pilot of that to make sure it would be worth it.

RE: How do YOU practise veterinary medicine?

vs0u — Fri, 08 Nov 2024 15:31:43 GMT

I've filled it in, then come to this thread, now I'm worried that I've done it wrong.

However my idea of what's best for these two cases would be quite different in terms of relative cost

For the heart case I'd have no issue sticking it on vetmedin with some regular monitoring and respond as appropriate - lots of vets would want to do scans etc but I probably wouldn't do that first off. It would be a case by case basis but assuming it's a cash strapped client as most of mine are, I might mention the option of further diagnostics but I'd be quite happy with a pragmatic approach that protects QOL. (If I were thinking about doing work up I would consider the temperament of the dog and the owner's ability to bring it in just as much as the cost).

For the broken leg, if it's a young large breed dog I'd probably want to refer it for some very expensive surgery rather than euthanase or chop its leg off.

So it's very case dependent.

I didn't see the particular talk with Sue Paterson but perhaps she was talking about one field or clinical scenario where cheap would be ok - because it's fine for that particular clinical problem - I don't think cheap can be clinically best for everything. I'd be thinking about being cost-effective rather than "minimum cost" or "gold standard".

Also I don't think it's appropriate to offer clients a list of options with prices attached - generally I would offer them what I think is best and discuss that to find the best way depending on their circumstances.

The discussion groups or interviews mentioned by David might be a better way to draw out the nuances - really interesting topic!

RE: How do YOU practise veterinary medicine?

Arlo Guthrie — Fri, 08 Nov 2024 09:06:27 GMT

Factors influencing the clinical advice given by vets to clients

Beyond that, this is one of those surveys which should produce useful actionable data.

And if not that, do it for the one of the three Amazon vouchers that are up for grabs!

And do, please, email it to colleagues and ask them to do it too.

Obviously the bigger the response, the more likely we will be to tease out factors like age, years in practice etc.

RE: How do YOU practise veterinary medicine?

David Mills — Fri, 09 Aug 2024 19:09:15 GMT

I do think people are overthinking this a little. No survey will have answers that exactly match every scenario and some of the objections are reminiscent of why practices don't publish prices! Just select the answer that most closely matches your response.

No survey will be perfect but it has the power with volume of responses to give an indication of what people may do. So I would encourage to see it as ""best match" rather than exactly what you would do.

We could then develop this by interviewing 20-30 willing people, say with clinical case scenarios, and from there develop some themes as to how people make decisions and communicate options. This has not really been done as yet but could be enlightening especially across different levels of experience and qualification.

Why do this? Well vets as we are all aware are under fire for being expensive etc etc but seeing how much goes on in terms of mental reasoning and what value people are getting cancelled help with the counter argument.

RE: How do YOU practise veterinary medicine?

Lucy Fleming — Fri, 09 Aug 2024 16:15:42 GMT

Interesting one, because I think the answer is so often "it depends" even among more experienced vets. It depends on how strongly you suspect the diagnosis, or whether it could be a number of other conditions (with more or less equal certainty). It depends on the relationship/ trust you have in the owner - to understand that you aren't certain of the diagnosis, to follow instructions and come back if things aren't right, not to turn around and throw you under the bus with the next vet they see. It depends on the possible adverse effects of the medication if you are wrong (or even if you are right) - for example, I've been happy to recommend clients that can't afford testing for suspected hyperthyroidism start y/d food, but not yet been confident to start thiamazole treatment without confirming. But treatment trials for OA pain, for suspected CHF, for suspected allergic or even auto-immune skin conditions, sure...

RE: How do YOU practise veterinary medicine?

Miriam Lodewyks — Sun, 28 Jul 2024 20:58:45 GMT

It would be really interesting creating a poll that is split into experience levels, and asks how comfortable a vet would be to treat condition x without diagnostics to prove the diagnosis.
Obviously less experienced vets are likely to lean towards “proving” the diagnosis first, but at what point do vets typically trust themselves enough to just go straight to treatment?
AND… I’d be curious to know whether vets in independent practice differ from those in corporate practice (where protocols are perhaps a little more common?)

RE: How do YOU practise veterinary medicine?

Alistair Graham-Evans — Wed, 24 Jul 2024 14:49:51 GMT

This is so complicated!

Sometimes the cheapest is best ( but not for all owners).

Sometimes cheaper is best for owner but not animal.

Sometimes cheapest is hazardous if your intuition is wrong.

With a case like suspect Cushing’s syndrome and empirical treatment is dangerous you have to consider the overall cost for the lifetime of the animal before starting!

Sometimes euthanasia is a more appropriate option.

Sometimes eg repeat ear infections, then repetitive cheap treatments end up more expensive than diagnostic tests or surgery. Repeat splints or casts may end up more expensive than one surgical procedure.

Sorry to be negative but I can’t see how you can reduce all this into a binary question.

However I think we can all recognise the minority of cases where there has been excessive tests and treatment with total loss of pragmatism leading to overcharging. Hopefully not widespread but dare I say more common in emergency centres.

I am in Australia and can treat many cases cheaper and sometimes more effectively without the cascade.

RE: How do YOU practise veterinary medicine?

Arlo Guthrie — Tue, 23 Jul 2024 06:19:59 GMT

[quote userid="11308" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245122#245122"]When you then get your results, the way you have worded your questions you could use your data to make a statement that you can 'back up with vet's opinions' when actually it wasn't quite truly the vets opinions.[/quote]

Anthony Dennison Sorry, missed your post earlier - but no, I am very well aware of the limitations of giving the choices I did, and how it would absolutely NOT allow one to make firm statements to the effect of: 'vets think x' only, perhaps, that 'given a choice between x&y, vets picked y'

But as I said earlier, the survey is very much beta at this moment and the final version will be better. Plus, behind the scenes I was talking to someone about some qualitative research to support it,

[quote userid="13891" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245137#245137"]Might it not be so complex that you'd need something like a focus group or interviews to collect all the rich qualitative data. Would make your analysis job pretty big too. [/quote]

Well I guess one way round it might be to take a very specific diagnostic situation?

RE: How do YOU practise veterinary medicine?

Judith Joyce — Mon, 22 Jul 2024 21:12:20 GMT

Definitely fascinating, especially reasoning behind diagnostic decisions making. Might it not be so complex that you'd need something like a focus group or interviews to collect all the rich qualitative data. Would make your analysis job pretty big too.

RE: How do YOU practise veterinary medicine?

Mark Rowland — Mon, 22 Jul 2024 20:53:43 GMT

What Champagne (they are not all the same!)

RE: How do YOU practise veterinary medicine?

Arlo Guthrie — Mon, 22 Jul 2024 16:07:24 GMT

Hi Miriam,

[quote userid="11901" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245128#245128"]I think this is an interesting survey, and it’s made me look into my professional “soul” a little, which is probably the whole point. [/quote]

Thanks so much. I saw there'd been another reply and almost didn't read it as I'm currently on holiday and thought it might be some more criticism ... anyway, nice to hear you found it thought provoking - which was/is the intent.

[quote userid="11901" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245128#245128"]I believe it’s OK at times to go straight to the cheapest solution. [/quote]

I think Sue Patterson is right, it is always OK!

[quote userid="13891" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245130#245130"]It's a really interesting survey[/quote]

Thanks!

[quote userid="13891" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245130#245130"]but the questions were a bit leading[/quote]

Certainly not meant to be, and I am going gf to update them with feedback from here.

[quote userid="13891" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245130#245130"]led me to make generalisations[/quote]

That was intentional. For example, to ascertain whether if, when pushed into a corner, your priority is the best that can be done for the animal in front of you, or the cheapest solution to the problem.

[quote userid="13891" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245130#245130"]

One question was so binary I couldn't give a truthful answer, the one about empirical treatment vs definitive diagnostics. I expect most of us fall between the two and there isn't a third option. I think my third option would be discuss with owner and diagnostic test until client and I have enough data to make an informed decision for the best way forward.

[/quote]

OK, thank you, we need a third option. The point of the question was really just to get a very general sense of how comfortable GPs are in commencing treatment without incurring the costs of diagnostic tests.

Of course I appreciate that a drug is expensive, a diagnostic test could actually save money by confirming the need for it.

I wonder how I could ask a question which gives a steer on whether vets have become more reliant on diagnostic test, and any different between experience levels (which I think would be fascinating).

RE: How do YOU practise veterinary medicine?

Judith Joyce — Mon, 22 Jul 2024 09:29:10 GMT

Hi Arlo,

It's a really interesting survey but very difficult to answer and I tried to skip a couple of questions, although it wouldn't let me. It was thought provoking but the questions were a bit leading and led me to make generalisations. Think the biggest insurmountable issue was that I have never faced those situations before without a client and patient in front of me to discuss it on an case by case basis. One question was so binary I couldn't give a truthful answer, the one about empirical treatment vs definitive diagnostics. I expect most of us fall between the two and there isn't a third option. I think my third option would be discuss with owner and diagnostic test until client and I have enough data to make an informed decision for the best way forward.

I'm guessing the point was to remain vet centric though and it's certainly that.

I couldn't see a box for over 40 years qualified

RE: How do YOU practise veterinary medicine?

Miriam Lodewyks — Sun, 21 Jul 2024 10:30:46 GMT

Well Arlo, I think this is an interesting survey, and it’s made me look into my professional “soul” a little, which is probably the whole point.
Having done some work in “third-world” countries where some treatment is deemed better than none, and where you really have to resign yourself to doing the best you can with what’s available, I believe it’s OK at times to go straight to the cheapest solution.
And I’m surprised how often clients are so grateful for the simplest solution without their pet being “messed about”.
What IS important though is that we explain the consequences of taking “short cuts” (increased chance of misdiagnosis, inappropriate treatment etc) but I think that as long as owners are properly informed to make a choice, then that’s ok.

Then again: I’ve been a vet long enough to trust my clinical intuition now, and not beat myself up if things don’t go entirely as expected.

RE: How do YOU practise veterinary medicine?

Anthony Dennison — Fri, 19 Jul 2024 15:11:45 GMT

[quote userid="2100" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245093#245093"]I'm sorry, I genuinely do not understand why simple questions reflect badly on a survey (any more than over-complicated ones might), or what relevance they have to Helping Each Other. [/quote]

I don't want to sound overly negative Arlo, because I highly doubt that this is what you are trying to do with your survey, but if the questions aren't quite worded correctly or the answers don't exactly fit, people will either go with the closest option or not do it at all.

When you then get your results, the way you have worded your questions you could use your data to make a statement that you can 'back up with vet's opinions' when actually it wasn't quite truly the vets opinions.

Lies, damn lies, and statistics etc.

RE: How do YOU practise veterinary medicine?

Arlo Guthrie — Thu, 18 Jul 2024 16:31:40 GMT

[quote userid="10320" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245118#245118"]Also the complex nature of trying to word questions for a survey![/quote]

No kidding!

RE: How do YOU practise veterinary medicine?

Lucy Fleming — Thu, 18 Jul 2024 08:43:43 GMT

Also the complex nature of trying to word questions for a survey!

RE: How do YOU practise veterinary medicine?

Alistair Graham-Evans — Wed, 17 Jul 2024 17:20:34 GMT

I think this shows the complex nature of consultations when we try and achieve the best outcome for the patient and owner while having the welfare of the animal as the primary consideration.

Maybe impossible to prepare a binary question?

Unless - do you consider cost when recommending treatment?

RE: How do YOU practise veterinary medicine?

Arlo Guthrie — Tue, 16 Jul 2024 08:49:48 GMT

Andrew Kent Oh god - hadn't thought of that.

Maybe if I just remove the first part of that sentence:

a) Yes, I am focussed on providing my clients with the cheapest solution to their problem

b) No, I first recommend the solution that I believe is best for the animal in front of me.

It doesn't go against the code to say that you go with the cheapest solution to the problem, because solving the problem cheaply is also for the animal's welfare, if you see what I mean.

RE: How do YOU practise veterinary medicine?

Andrew Kent — Tue, 16 Jul 2024 08:04:25 GMT

I think the wording is improved and certainly agree with the removal of clinically best.

I worry now that including welfare means you lead people to have to select the second option - would people really want to suggest welfare is not their primary concern? (which maybe goes against RCVS declaration?) - you would have to make it anonymous!

Andy

RE: How do YOU practise veterinary medicine?

Arlo Guthrie — Mon, 15 Jul 2024 18:36:52 GMT

Thanks so much, Lucy, very helpful ...

[quote userid="10320" url="~/f/non-clinical-questions/30992/how-do-you-practise-veterinary-medicine/245108#245108"]The first is, as others have mentioned, the way it is worded does suggest that the "best" is most expensive and the cheapest is not the best...particularly the way it was originally worded:[/quote]

Anyway, how about this

When you give your treatment recommendations to your clients, do you normally start by recommending the cheapest solution to the problem first, then offering additional options, explaining their costs and benefits as you go?

a) Yes.

b) No.

Maybe I SHOULD just leave it at that. Let's not bring in 'best', or create a conflict between "clinically best' and 'cheapest'.

But somehow it sounds bald, so perhaps:

a) Yes, I am focussed on providing my clients with the cheapest solution to their problem

b) No, I am primarily led by the welfare of the patient and I first recommend the solution that I believe is best for the animal in front of me.

Andrew Kent, Lucy Fleming, Rob Loxley

It's getting to the heart of Sue Patterson's point, it's got two clear answers, I've removed all the contentious, subjective words.

And I don't think sounds judgemental, as if there is a right or wrong answer, because surely both answers are right!

Have I cracked it?!