What do you think of the script for film 2: Mindset

RE: What do you think of the script for film 2: Mindset

Arlo Guthrie — Fri, 25 Oct 2024 10:06:59 GMT

A reminder for everyone ... if you like the films I'm making and think they could help, even in some small way, to foster a better understanding by pet owners, then for god's sake, and excuse my french, but 'share' and 'like' the shit out of them on as many platforms as possible.

You're not just sharing with your friends, who may themselves be pet owners and not know the flack you get from people about vet bills, but you're also influencing the algorithm and pushing the films up the charts so they will be seen by more people you dont know.

So far, I estimate the first one has had 100,000 views. Let's get the second one up there alongside it!

You may like to follow any of these channels if you don't already.

Here are the links:

RE: What do you think of the script for film 2: Mindset

Judith Joyce — Fri, 25 Oct 2024 08:25:46 GMT

[quote userid="3585" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245779#245779"]I know this is how you feel, but can you show me where it is explicitly stated, and by whom.[/quote]

I think that sums it up. In the old days I certainly felt that we were brought up by RCVS to use our clinical judgement and ethical discretion using the Guide rather than following a Code slavishly. Perhaps not fit for purpose these days but is that a good thing? Crossing threads again to the consulting times question, I don't think its as easy to do that in a busy consulting session as it was with so much more to discuss

RE: What do you think of the script for film 2: Mindset

Arlo Guthrie — Thu, 24 Oct 2024 17:46:23 GMT

Well, here you go folks, here is film 2. It is not yet publicly listed, so there is still time to shout me down.

Nothing is ever going to please everyone, but I hope its evident how much thought has gone into this, and how I have tried to take into account your comments, esp Evelyn Barbour-Hill Alastair Welch Michael Woodhouse Clare Tapsfield-Wright Rob Loxley Judith Joyce and Glen McIntosh (and if your thoughts are not reflected in this film, I am taking them all into account and it may just be that they are for one of the next ones).

Anyway, deep breath, here it is:

www.youtube.com/.../hvWxKOlI2_I

RE: What do you think of the script for film 2: Mindset

Evelyn Barbour-Hill — Tue, 22 Oct 2024 23:18:27 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245792#245792"]

Evelyn Barbour-Hill said:
I haven't the faintest idea and don't really care. It's a professional obligation whether it's written down or not.

What are you saying is a professional obligation? To discuss reasonable treatment options, or all treatment options.

I think the point being made here is the Code defines it as ‘reasonable’ but there is a difficulty in applying that woolly definition.

[/quote]

I think Clare's nailed it.

RE: What do you think of the script for film 2: Mindset

Arlo Guthrie — Tue, 22 Oct 2024 22:32:57 GMT

Clare Tapsfield-Wright - I didnt for one second think anything is cut and dried, or black and white, or simple, or straightforward! Of course you’re going to be a bit more reticent about options for an old dog than a young one. I think the point here is really discussing the degree of obligation to discuss every option.

RE: What do you think of the script for film 2: Mindset

Clare Tapsfield-Wright — Tue, 22 Oct 2024 21:59:17 GMT

I think it comes under informed consent but also it would be extremely unprofessional not to give a client the information . How would you feel if a doctor decided not to tell you about possible chemo or radiotherapy for prostatic cancer? Sometimes it falls under the choice of what I can offer you in first opinion practice and saying that a referral centre may have more options ands giving you that choice to go. The code is deliberately “ woolly” because vets are professionals and use their clinical judgement. It’s not as cut and dried as you might think Arlo. I might actively propose a treatment for a young dog with good quality of life for several years when I might be less proactive about suggesting it for a 14 year old dog with limited quality time left . This is where vets become advocates for our patients and where the skill of consultation comes in. I might not start discussing brain surgery on an old dog with a tumour but I think I would be wrong if I didn’t mention amputation being an option for a six year old dog with a bone tumour and limited funds. It’s just not as simple as you might think and in my opinion it’s part of the art of being a good vet, listening to the owner , being on their side and on their animals side and working together. It can never be a tick box exercise and is why I hate protocols and stuff , every client is different and empathy, communication and pragmatism are undervalued skills

RE: What do you think of the script for film 2: Mindset

Arlo Guthrie — Tue, 22 Oct 2024 20:49:56 GMT

[quote userid="2131" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245787#245787"]I haven't the faintest idea and don't really care. It's a professional obligation whether it's written down or not.[/quote]

What are you saying is a professional obligation? To discuss reasonable treatment options, or all treatment options.

I think the point being made here is the Code defines it as ‘reasonable’ but there is a difficulty in applying that woolly definition.

RE: What do you think of the script for film 2: Mindset

Evelyn Barbour-Hill — Tue, 22 Oct 2024 17:17:14 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245785#245785"]I wonder when that piece was added to the CoPC, because I think I remember it being a more recent thing, and if so it may partially account for a growing factor in price inflation. [/quote]

I haven't the faintest idea and don't really care. It's a professional obligation whether it's written down or not.

RE: What do you think of the script for film 2: Mindset

Arlo Guthrie — Tue, 22 Oct 2024 08:39:08 GMT

[quote userid="3585" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245779#245779"]From RCVS Code of professional conduct supporting guidance:[/quote][quote userid="4181" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245780#245780"]Agree it's not to discuss EVERY option[/quote]

Yeah, I was going to say just that when you popped up Rob Loxley - but I think your second point is, er, the point. I think we are a nation of rule takers, and I think vets are especially good at following rules, for the understandable fear of losing your career.

So I think that it is quite reasonable for vets (esp new grads or less confident ones) to interpret 'reasonable' as 'everything'.

I wonder when that piece was added to the CoPC, because I think I remember it being a more recent thing, and if so it may partially account for a growing factor in price inflation.

RE: What do you think of the script for film 2: Mindset

Rob Loxley — Tue, 22 Oct 2024 07:04:23 GMT

[quote userid="3585" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245779#245779"]

From RCVS Code of professional conduct supporting guidance:

"11.2 Informed consent, which is an essential part of any contract, can only be given by a client who has had the opportunity to consider a range of reasonable treatment options (including euthanasia and the option to monitor the animals without further tests or treatment),..."

and

"11.24 Discussion should take place with the client, covering a range of reasonable treatment options and prognoses, and the likely charges (including ancillary or associated charges, such as those for medicines/anaesthetics and likely post-operative care) in each case so as to ensure that the client is in a position to give informed consent."

[/quote]

Agree it's not to discuss EVERY option, but it makes reasonable hard to define, especially if a relationship hasn't been built up with the client over time to better inform this. Eg. for MVD should I be discussing the ins and outs of valve replacement every time, or can I reasonably assume this isn't on the cards?

RE: What do you think of the script for film 2: Mindset

Glen McIntosh — Tue, 22 Oct 2024 05:33:19 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245776#245776"]

Clare Tapsfield-Wright said:
Vets are obliged to offer you all treatment options.

Clare Tapsfield-Wright and Evelyn Barbour-Hill - I know this is how you feel, but can you show me where it is explicitly stated, and by whom.

I wonder if it has not actually been stated, but inferred from RCVS actions or 'messaging' or opinion leaders saying, or something else.

[/quote]

From RCVS Code of professional conduct supporting guidance:

and

RE: What do you think of the script for film 2: Mindset

Arlo Guthrie — Mon, 21 Oct 2024 10:10:31 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245773#245773"]It's a 5 year course[/quote]

[quote userid="2490" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245775#245775"]You do state six years training ,[/quote]

my source was gov.uk: https://nationalcareers.service.gov.uk/job-profiles/vet#:~:text=Full%2Dtime%20veterinary%20degrees%20usually%20take%205%20to%206%20years.

I took the higher figure to make the point. But will use 5 years!

[quote userid="13891" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245774#245774"]Sense and strength of professional obligation hasn't changed in that we would always try our best for the clientI but I would say how it is expressed has. it used to be working long hours, always being there for the client with limited resources to fix a lot of things. It has morphed towards the other extreme of having lots more (expensive diagnostic and treatment modalities) and complying with better health and safety and employment conditions (also expensive as more vets are employees. [/quote]

That's a fascinating thought, and yes, makes sense.

[quote userid="2490" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245775#245775"]Vets are obliged to offer you all treatment options. [/quote]

Clare Tapsfield-Wright and Evelyn Barbour-Hill - I know this is how you feel, but can you show me where it is explicitly stated, and by whom.

I wonder if it has not actually been stated, but inferred from RCVS actions or 'messaging' or opinion leaders saying, or something else.

RE: What do you think of the script for film 2: Mindset

Clare Tapsfield-Wright — Mon, 21 Oct 2024 09:11:15 GMT

Hi Arlo

I like it and agree with other points made .
You do state six years training , are you including the post grad supervision year after graduation? It is five years at vet school not six

Vets are obliged to offer you all treatment options. I think this is indeed where the client struggles and infers emotional blackmail. Fear of being sued and owners misremembering after animals deteriorate combined with a desire to use their skills make this a difficult communication challenge.

RE: What do you think of the script for film 2: Mindset

Judith Joyce — Mon, 21 Oct 2024 09:03:12 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2-mindset/245772#245772"]My question about professional obligation is whether you think that feeling of professional obligation has increased and therefore contributed to price inflation (due to, for example, messaging from the College), or do you think it was ever thus?[/quote]

Sense and strength of professional obligation hasn't changed in that we would always try our best for the clientI but I would say how it is expressed has. it used to be working long hours, always being there for the client with limited resources to fix a lot of things. It has morphed towards the other extreme of having lots more (expensive diagnostic and treatment modalities) and complying with better health and safety and employment conditions (also expensive as more vets are employees.

The thread about consultation length shows how appointment times have increased over the years (my experience is the same as the others - in my 40 odd years it has gone from open surgeries with crammed waiting rooms --> 5 mins --> 5mins with catch up gaps -->10 mins -- 15 mins --> double for new grads, euthanasias and other tricky ones and 20 min to 1 hour referral appointments. The increased length often to cater for improved communication (or more of it anyway) , discussing more complicated diagnostics and treatments and defensive practice.

Clients are hugely getting more for their money in a consult but do they all want it or need it. (Occasionally get asked to not exam the pet in a booster appointment (client doesn't want to know if there's a problem, hasn't got time etc)

Our clients do demonstrate increased expectations and certainly are more demanding but do they just want their pet fixed and we are confusing them with our diagnostics and science which is what interests us?

RE: What do you think of the script for film 2: Mindset

Michael Woodhouse — Mon, 21 Oct 2024 08:29:50 GMT

It's a 5 year course

I realise you are very tight for space but is there space to acknowledge that more vets have specialised in particular areas meaning there are more complex surgeries, expensive drugs and diagnostic techniques available that we didn't have in the past.

Other than PTS, virtually no treatment is 100% effective and I wonder if that sets an unrealistic expectation?

RE: What do you think of the script for film 2

Arlo Guthrie — Mon, 21 Oct 2024 08:12:30 GMT

[quote userid="2131" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2/245770#245770"]Veterinary surgeons are obliged professionally to offer the best. That's not because "the owners almost always say..." It's because we have to. On the other hand, the best is not always the most expensive.[/quote]

Interesting, thank you Evelyn. My point about owners saying they want the best was informed by what vets are always saying to me, along the lines of what Mark was saying in this post: https://www.vetsurgeon.org/f/non-clinical-questions/31062/why-have-vet-bills-gone-up-so-much/245736#245736

But yes, of course, it's driven by professional obligation too (or maybe even primarily).

My question about professional obligation is whether you think that feeling of professional obligation has increased and therefore contributed to price inflation (due to, for example, messaging from the College), or do you think it was ever thus?

[quote userid="2131" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2/245770#245770"]Entirely as a matter of English style, I'd avoid that horribly over-employed cliche.[/quote]

LOL - you are absolutely right. Thank you! I will.

I think I am now going to share the script for another film, because it is more obviously and directly related to price inflation, which is the march of science, and perhaps I will film that one next.

RE: What do you think of the script for film 2

Evelyn Barbour-Hill — Mon, 21 Oct 2024 01:05:19 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2"]Secondly, because owners almost always say they want the best, vets feel obliged to offer it.[/quote]

Not quite right.

Veterinary surgeons are obliged professionally to offer the best. That's not because "the owners almost always say..." It's because we have to. On the other hand, the best is not always the most expensive.

[quote userid="2100" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2"]do not be afraid or ashamed to ask your vet for a cheaper treatment plan.[/quote]

Yes, absolutely, needs saying again and again.

[quote userid="2100" url="~/f/non-clinical-questions/31065/what-do-you-think-of-the-script-for-film-2"]Lets face it[/quote]

Entirely as a matter of English style, I'd avoid that horribly over-employed cliche.

(Sorry, I can't seem to get an acute accent on an e )

RE: What do you think of the script for film 2

Arlo Guthrie — Sun, 20 Oct 2024 19:18:23 GMT

Alastair Welch Thanks, yeah, you’re right. Desire to do the best is not itself a reason for inflation, but its an underlying factor that massively exacerbates inflation caused by the march of science. Ie if vets wanted to do the best when there was only one tincture which cost a shilling and another that cost 2 and 6 pence, it didnt make much odds. Now, with a vast array of new diagnostics etc, it does.

Thats my point, anyway. Plus its an opportunity to highlight that the thing going through the vets mind is not ‘how much can I get out of this owner’, but what is the best for the animal.

RE: What do you think of the script for film 2

Alastair Welch — Sun, 20 Oct 2024 19:06:23 GMT

The above may (or may not) be true but I’m not sure it has much to do with vet fee inflation. Are you suggesting that previous generations of VS didn’t have the animals best interest at heart? I don’t think VS desire to do the best for their patients is very different than 30 years ago.

What has changed is that the difference (in £ and technologically terms) between what is considered ‘the best’ and what is considered acceptable/on the sub-standard side is now enormous.

https://www.theguardian.com/world/2024/oct/10/brown-bear-in-kent-recovering-well-after-uk-first-brain-surgery

£20k!

The above being said I would still contend that the biggest change is the transition from a long- hours vocation to a regular job with the attendant increment in staff costs. Fees were low off the back of VS working long hours and then doing some extra OOH as part of the deal. Stand alone OOH demonstrates the real cost of healthcare. Unless and until you can convince the profession to turn the clock back I can’t see things changing much.