BBC investigation into pressure on vets to meet targets

RE: BBC investigation into pressure on vets to meet targets

Judith Joyce — Wed, 07 May 2025 11:57:26 GMT

I agree with everybody a bit but I can categorically say that not every single dermatologist recommends cytology in all ear cases, especially in the first presentation of a first opinion case. Referral/second opinion. cases are different and it has to be said often partly caused by mismanagement

A useful tool when used appropriately but in a first presentation frequently not necessary or even advisable. Visual examination and client history goes a lot further. There was a discussion on it a few weeks back in another thread.

There is no such thing as a routine ear case. If taking cytology samples is a sign of thinking about the case its a good thing but its quite a nerdy activity to take and process samples, then read and report them with enthusiasm in a timely fashion where they will benefit the case ( apologies to dermatologists)

Much more important is to consider why bugs might be there, and consider that the external ear is just a rolled up piece of skin designed to cause 10 times as much trouble as flat skin when it gets inflamed and becomes an ideal home for opportunistic secondary bacteria and Malassezia.

I wonder how often foreign bodies and ear mites get missed because someone is fretting about whether they are looking at cocci or rods or whether Malassiezia really do look like Perrier bottles. It does reliably add £25-£40 to a bill and stress out a clinician who can't find the time to do a proper job of looking at and reporting their cytology.

The alternative to cytology is not necessarily lobbing a bottle of Canaural at the ear.

RE: BBC investigation into pressure on vets to meet targets

Malcolm Ness — Wed, 07 May 2025 09:52:20 GMT

Having worked closely with dermatologists in the management of early stage and late stage ear disease over several decades, my experience indicates that it is simply untrue to suggest that cytology is recommended by every single dermatologist in every case. Notwithstanding that, it makes little sense to reach for the anti-biotic-laden polypharmacy when in the overwhelming majority of cases in adult dogs, the key pathology is related to atopy and a significant clinical feature is accumulation/impaired drainage of ear-muck, so I concur with Anthony and Michael that ear-cleaner and corticosteroid make more sense as a pragmatic/contextuaised first choice after a thorough and reasonably well-informed clinical evaluation.

Finding yeasts and a collection of bacteria down an ear deemed bad enough to warrant veterinary attention is unsurprising and not, I would suggest, diagnostically useful information. As my son was won't to remark as a nine-year-old, "No shit Sherlock"

RE: BBC investigation into pressure on vets to meet targets

Clive Ansell — Wed, 07 May 2025 08:00:10 GMT

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247145#247145"]Ear cytology is just good practice; every single dermatologist recommends it. It's not about making money - number of times I've checked what I thought was a manky ear and just needed a cleanee (cheaper than canaural, including cytology fee as the bottle lasts longer).[/quote]

Not sure it is indicated for every case, but can't do harm I suppose.

My last locum with an IVC practice, I just didn't have the time to do it. 9 hours of consults fully booked back to back. Esay enough to take the swabs in consult, but no allocated time or available staff to do microscopy or to telephone the client later.

I wonder how well the cytology results correlate with first impression of the ear? how often do we dispense medicated drops anyway? how often does it change what we would have done without the swabs? Many cases of mild OE I often just dispense a cleaner.

RE: BBC investigation into pressure on vets to meet targets

Clive Ansell — Wed, 07 May 2025 07:53:21 GMT

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247146#247146"]As recent as a decade ago bitch spays were getting a jab of betamox LA at the time of the surgery - to do that now would seem bizarre.[/quote]

I qualified 29 years ago in 1996. We were taught not to give abx's to routine neutering surgeries and I never have.

(In my first job, nurses gave the obligatory Amox LA shot when I wasn't looking because boss man told them too, but thats a story for another day)

RE: BBC investigation into pressure on vets to meet targets

Clive Ansell — Wed, 07 May 2025 07:49:29 GMT

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247146#247146"]It can be broken down further with peri/post op antibiotics for dentals, orthopaedics and soft tissue surgery but I don't have the exact figures on me right now. I know our ortho periop antibiotic use is still high because of the dogma of 'an implant is being put in do it must need antibiotics to prevent complications'. It's one I'd like to focus on going forward but that will be a long haul project and trying to change people's views on it important.[/quote]

Do have figures or percentages for the unlicensed use of intravenous antibiotics such as Augmentin or Zinacef, for surgical procedures and dental work?

RE: BBC investigation into pressure on vets to meet targets

Francisco Gomez — Wed, 07 May 2025 05:39:35 GMT

[quote userid="9239" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247159#247159"]it brings nothing to the conversation[/quote]

Well...That's your opinion...

RE: BBC investigation into pressure on vets to meet targets

Dinu Catilina — Tue, 06 May 2025 23:21:46 GMT

[quote userid="3607" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247154#247154"]Without being judgmental of any of the views expressed here, I would caution against assuming that just because a multiplicity of views can be identified, all are inevitably valid.[/quote]

I know, it brings nothing to the conversation. My apologies.

RE: BBC investigation into pressure on vets to meet targets

Beats — Tue, 06 May 2025 21:13:57 GMT

Yes making sense. My clarification only aimed at the point that some vets will avoid using eg canaural as they feel this is not good stewardship of the antimicrobials within, while others will feel this is not a significant public health concern looking at the big picture and an unnecessary and largely pointless thing to be actively avoiding the simple use of something for no perceptible gain.

This is largely a point of opinion which can be argued based on inference etc but is not going to be answered by looking at outcomes from treating dogs ears.

All the other parts of decision making would be suitable to scientific assessment directly looking at outcomes of treated ears. This includes choice of initial treatment and factors considered when make Ng that choice which could include cytology or no cytology in all or a chosen subset of cases. It is the first point however, not suitable to answer by observing dog ears, which I suspect divides vets on their choice of initial ear treatment most.

I would define cytology as taking time rather than cost. The pricing is what you make it. The amount of time will depend on your setup and what you do and could range from om maybe 2 minutes to 7 minutes. Pricing can be based on perceived value as well as time taken and can be considered included in a higher consult fee or priced separately as an add on item etc. Let's say I feel that ear conditions are chronic or recurrent in many cases and wish to reduce the risk of the dog becoming ear shy I may choose to spend 7 minutes befriending the dog and educating the owner on training to encourage future treatment to f ears, billing this as a separate item would be considered odd at best.

Time taken and method of pricing are two separate issues that can both be approached and considered differently, but ultimately less time taken on average leads to lower charging I suspect.

RE: BBC investigation into pressure on vets to meet targets

Arlo Guthrie — Tue, 06 May 2025 08:22:55 GMT

[quote userid="12930" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247153#247153"]Arlo the canaural works fine. [/quote]

Beats Yeah, I get that ;) The question in my mind is whether cytology+more targeted treatment is more effective, and if so, whether so much more effective (or less detrimental) that it justifies the increased costs (if they are) of cytology.

Am I making any sense?!

RE: BBC investigation into pressure on vets to meet targets

Ben Walker — Mon, 05 May 2025 15:45:21 GMT

[quote userid="12930" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247153#247153"]A separate question in my mind is whether there is any point to ear cytology in a case of otitis on first presentation as opposed to if refractory to treatment with eg a cleaner and some steroids.[/quote]

This is interesting. Do non-suppurative OE cases need antimicrobials at all? Cortotic’s data sheet and (open access) field trial suggests topical hydrocortisone was similarly effective to the polypharmacy topical control. If so, I‘d agree it’s hard to see the point of cytology and you get the benefit of almost eliminating topical AMs for that presentation.

Maybe this is an example of the idiotic opinions Malcolm has identified on the thread, but I’m coming round to David Mills’ view that targets can be a bit hamstrung by the lack of quality clinical frameworks.

RE: BBC investigation into pressure on vets to meet targets

Malcolm Ness — Mon, 05 May 2025 14:05:26 GMT

Without being judgmental of any of the views expressed here, I would caution against assuming that just because a multiplicity of views can be identified, all are inevitably valid.

RE: BBC investigation into pressure on vets to meet targets

Beats — Mon, 05 May 2025 12:19:00 GMT

Arlo the canaural works fine. The dispute is whether putting drops containing a systemic antimicrobial into a dog's ear is a) detrimental and b) sufficiently detrimental to make an effort to do something different

A separate question in my mind is whether there is any point to ear cytology in a case of otitis on first presentation as opposed to if refractory to treatment with eg a cleaner and some steroids.

RE: BBC investigation into pressure on vets to meet targets

Arlo Guthrie — Mon, 05 May 2025 10:28:22 GMT

Anthony Dennison Thank you SO much for sharing your very interesting and illuminating perspective! I think it goes to show that there's always two sides.

[quote userid="3169" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247140#247140"]Have you done any work looking it overall costs of treatment to the client? I remain sceptical about the need for routine ear cytology, but then I'm a fan of 10 min consults and don't really enjoy microscope work. I'm pretty sure that a consult + a bottle of Canuaral is going to work out cheaper than consult + cytology + specific treatment and consume more time and resources. I agree more needs to be done in recurrent cases, but in 9/10 the consult and canaural would have cured the dog. The new grad likes the guidance as they don't have to think as hard, the business likes it as they can show the additional cytology revenue, ATV goes up and everyone feeling warm inside with their gold standard badges, but does Arlo Guthrie like his vet bill that's now £100+ and not £55? Does the dog care?[/quote]

I think this is an interesting, very important point. Right or wrong, my impression is that vets have always been primarily focused on what is clinically best, without as much thought about the cost. My question is ... how much does cost-to-client factor into company targets or what a practice may decide is its position on the best way to treat condition x.

This seems like a good case in point.

Above my pay grade, but accepting that there may be reasons other than cost or efficacy for a given approach (ie it may be more expensive to do tests to identify whether an antibiotic is needed, but reduce the amount of antibiotics used), is there any data to support this:

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247145#247145"]

Ear cytology is just good practice; every single dermatologist recommends it. It's not about making money - number of times I've checked what I thought was a manky ear and just needed a cleanee (cheaper than canaural, including cytology fee as the bottle lasts longer).

Or just needs a steroid only topical treatment, which then will last the whole summer as its given less often. Client isn't coming in every few weeks with ear issues, saves money.

Just chucking Canaural at a sore ear is lazy and pretty outdated.

[/quote]

What I mean is that your observation about manky ear just needing cleanee or steriod could (easily) - and with absolutely no disrespect intended, be confirmation bias.

Would it be difficult to routinely test a thesis in practice before turning it into targets or agreed treatment recommendations? In this case, two groups of patients, one using canaural, the other cytology, after 3 months, which approach a) worked better and b) cost the client less. And if the answer to b) differed from a) was the improvement in efficacy worth it?

I guess everyone is too busy for that, but really, practice management software should allow practices to test a clinical / cost thesis. I don't know if any of them can do that.

RE: BBC investigation into pressure on vets to meet targets

Beats — Mon, 05 May 2025 07:11:49 GMT

i dont like the idea of routine canaural use

https://pubmed.ncbi.nlm.nih.gov/16392088/

that sais i dont think that means cytolog in every ear (or otoscopy either, but thats a separate argument

RE: BBC investigation into pressure on vets to meet targets

Michael Woodhouse — Sun, 04 May 2025 23:48:36 GMT

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247145#247145"]Just chucking Canaural at a sore ear is lazy and pretty outdated. [/quote]

I strongly disagree. We are back to pragmatic medicine, the combination is likely to be curative and we are actually using tiny amount of antibiotic that are not systemically absorbed. I'm not even saying it is my 1st choice product, BUT I have minimal desire to do cytology, it doesn't fit with my workflow and I'm unconvinced this is doing any real harm and a lot of good.

For referred cases, I imagine essential and it is something I'd use in recurrent cases (virtually never culture, for obvious reasons). A dermatologist asked you a question on your target, that you seem to have glossed over..... If you believe it is essential, why are you not doing it in 100% of cases?

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247146#247146"] some vets still send clinically well post-op pyo surgeries home with sometimes up to a week's worth of antibiotics. Why? [/quote]

Not a clean surgery, there will be some abdominal contamination and you have a sick debilitated animal. Perfectly justified use. Same with clean/contaminated surgery.

Don't use them in clean ortho surgery, but a lot of patients getting implants have trauma and broken skin, so would use a course.

Never in mouths post extraction, maybe for a few days relief if I see a dental abscess on a Friday evening and it's going to be next week before can remove the tooth.

I have seen quite a number of animals caused harm by younger vets NOT giving antibiotics when indicated. We need to be responsible in use, but a sick pyo recovering is not a place to cut back, in my opinion (their white cells are in the bucket on the floor). Campylobacter diarrhoea in puppies is another great and specific example where I've seen chronic animals back to normal after 5 days of erythromycin. Wouldn't give an uncomplicated dog with diarrhoea any antibiotics.

[quote userid="12930" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247144#247144"] I have always assumed and in my locality at least amoxicillin resistance in cats just isn't a problem[/quote]

Agree, I will almost always use 2 injections of long acting amoxycillin in cats, to great effect. I avoid oral medication in cats wherever possible, for compliance as much as anything.

[as an aside I've never used Convenia as a qualified vet, don't think I've touched a fluroquinolone or 3/4 gen cephalosporin this year and I'm working full time in mixed practice].

RE: BBC investigation into pressure on vets to meet targets

Ben Walker — Sun, 04 May 2025 23:23:24 GMT

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247146#247146"]The percentage of every single animal that comes into our practice for anything, that is then dispensed antibiotics.[/quote]

Thanks Anthony. That’s really interesting. Are topical antibiotics included in the figure? I could still interpret it two ways from your description though:

- X% of animals who had at least one interaction with the practice were prescribed at least one AM prescription

- Y% of interactions with the practice included a prescription

Or, at a push:

- Z prescriptions per 100 animals who had at least one interaction with the practice

Please forgive the curiosity. Your rates are extraordinarily low, so I’m trying to understand how your rate might compare to others I’ve seen. It sounds like part of it is a focussed effort to achieve this as a team.

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247146#247146"]Antibiotic usage is down across the board. [/quote]

That’s great. Cat data can get buried unless you interrogate by species, but if you’re seeing an overall reduction for cats you’re probably achieving what you are aiming for. Our overall figures didn’t decrease at all for cats, though cefovecin use went down by a quarter.

RE: BBC investigation into pressure on vets to meet targets

Martin Hamilton — Sun, 04 May 2025 23:22:44 GMT

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247146#247146"]peri/post op antibiotics for dentals[/quote]

I'll just chime in with the fact this should be near-zero. I only use abx in cats with FeLV/FIV, animals that are immunocompromised (incl. on pred, cyclosporine, diabetic), or if they have aortic stenosis. Not indicated otherwise - we are a dental referral and don't even stock them, rather we order in for patients that require them. A little off topic, but couldn't help chiming in.

RE: BBC investigation into pressure on vets to meet targets

Ben Walker — Sun, 04 May 2025 23:03:21 GMT

[quote userid="12930" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247144#247144"]Ben I don't understand the suggestion that most of the time convenia is given to cats they don't need an antibiotic. Also I don't think clav is good for cats. Tastes bitter I have always assumed and in my locality at least amoxicillin resistance in cats just isn't a problem[/quote]

I agree. Amoxicillin and clindamycin are often solid options for cats and would be my preferred alternatives for most cases needing an AM. But we found (and published) the clav upswing nonetheless.

My opinion on not needing an antibiotic is just that the main reasons it is given could often be managed differently. FLUTD is often not bacterial, managing pruritis and using topical approaches can resolve pyoderma, and abscesses can be flushed. I’m not saying no case needs an antimicrobial, but that Convenia can be used as a bit of a crutch.

Convenia is licensed for skin infections, abscesses, and E. coli UTIs, so I’m also not arguing that vets are doing anything wrong in their prescribing. The team at Langford published on cefovecin prescribing in FOP using SAVSNET data 8 years ago. Most prescriptions were within the license, but they point out these other approaches. I think their findings are probably still relevant.

RE: BBC investigation into pressure on vets to meet targets

Anthony Dennison — Sun, 04 May 2025 21:47:58 GMT

[quote userid="25265" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247143#247143"]Are you checking you aren’t getting an upswing of amoxyclav prescriptions in cats?[/quote]

No, we're not. Antibiotic usage is down across the board.

[quote userid="25265" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247143#247143"]Secondly, what does antibiotic usage of 4.8% mean?[/quote]

The percentage of every single animal that comes into our practice for anything, that is then dispensed antibiotics.

It can be broken down further with peri/post op antibiotics for dentals, orthopaedics and soft tissue surgery but I don't have the exact figures on me right now. I know our ortho periop antibiotic use is still high because of the dogma of 'an implant is being put in do it must need antibiotics to prevent complications'. It's one I'd like to focus on going forward but that will be a long haul project and trying to change people's views on it important.

I use the data to see where we can improve clinically, not to earn more money. For example, some vets still send clinically well post-op pyo surgeries home with sometimes up to a week's worth of antibiotics. Why?

If contamination during an enterotomy/enterectomy is stopped with good packing/isolation of the site and the abdomen is flushed thoroughly, are antibiotics justified at all, even perioperatively?

As recent as a decade ago bitch spays were getting a jab of betamox LA at the time of the surgery - to do that now would seem bizarre.

Care frameworks and measuring of these KPIs collated from all IVC practices in the UK could help bring data to justify certain protocols, or disprove them, quicker than a single practice could, with a bigger sample size and more statistical weight behind it.

RE: BBC investigation into pressure on vets to meet targets

Anthony Dennison — Sun, 04 May 2025 21:34:47 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247140#247140"]

Anthony Dennison said:
we're stopping using Convenia altogether (66% reduction in it since the beginning of the year to only 2% of all antibiotics being Convenia, and will be 0 before the end of the year (we're not ordering any more in)

then you say

Anthony Dennison said:
If there is a clinical justification for something, then it can be done/dispensed.

Can't be both

(I am playing devil's advocate here, but I think you are a little brainwashed in the system)

[/quote]

The convenia choice was made locally by myself, our other clinical director and our senior vet. Convenia is a lazy choice of antibiotic and people were using it for all the wrong sorts of cases. There are palatable alternatives.

The clinical justification is a central IVC policy - need a specific drug not on the preferred list? If it can be justified, fine. Letting everyone order willy nilly leads to a cluttered dispensary and loads of money wasted on drugs being DOOPed when they go out of date.

Or just needs a steroid only topical treatment, which then will last the whole summer as its given less often. Client isn't coming in every few weeks with ear issues, saves money.

Just chucking Canaural at a sore ear is lazy and pretty outdated.

RE: BBC investigation into pressure on vets to meet targets

Beats — Sun, 04 May 2025 19:12:35 GMT

Ben I don't understand the suggestion that most of the time convenia is given to cats they don't need an antibiotic. Also I don't think clav is good for cats. Tastes bitter I have always assumed and in my locality at least amoxicillin resistance in cats just isn't a problem

RE: BBC investigation into pressure on vets to meet targets

Ben Walker — Sun, 04 May 2025 11:29:58 GMT

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247120#247120"]With these care frameworks and advice, we have reduced our antibiotic usage to 4.8%, we're stopping using Convenia altogether (66% reduction in it since the beginning of the year to only 2% of all antibiotics being Convenia, and will be 0 before the end of the year[/quote]

I want to be really clear before the rest of this post that I am generally pro-clinical targets and I believe Anthony and Kate when they say that IVC are putting these forward with good intentions.

The quoted paragraph leaps out to me as a good example of how some targets can be hard to link to positive net outcomes.

I completely understand why cefovecin is a popular product. But most of the time it is used in cats, an antimicrobial isn’t required at all. Targeting reductions therefore sounds sensible.

However, our most commonly prescribed alternative antimicrobial is amoxyclav. I’m no longer convinced that switching from cefovecin to amoxyclav is meaningfully beneficial.

A few years ago we published the outcome of an in-practice intervention we did that showed exactly this switch. We’d convinced the team not to use cefovecin, but not on their actual approach to the case. At the time I saw it as a win. Now I’m not so sure. Are you checking you aren’t getting an upswing of amoxyclav prescriptions in cats?

Secondly, what does antibiotic usage of 4.8% mean? The way we measure can affect behaviour. Different groups use different measures of antimicrobial prescribing:

Percentage of interactions (eg. consults) with an associated antimicrobial prescription (can miss in-patient prescribing, used to miss repeat prescriptions, can be gamed by dispensing longer courses)

Prescriptions per 100 interactions (eg. consults) (we used this as it doesn’t miss any but can still be gamed by length)

Total amount of antimicrobial prescribed (used in farm, not helpful for us where patient size is so variable, can be gamed by using antimicrobials that need lower amounts of the active ingredient)

Days under antimicrobial (used by Vets at Home Vet Group, requires a small amount of math, and is probably the most robust measure)

An easy way for a clinic to boost a percentage measure would be to just start issuing four weeks of antimicrobial to every pyoderma case instead of reviewing more regularly. Nothing wrong with that. The licenses give that kind of course length and the RCVS has made it trickier to extend a course on the back of a phone call and a picture. But would anything actually be better for patient, client, public health, anything?

I approve of the targets (I actually approve of these specific targets), but activity-based targets (as opposed to outcome-based) are tricky devils and these AM targets cover a wide and complex clinical field. Are you also doing the auditing required to make sure they’re achieving their intended goal?

RE: BBC investigation into pressure on vets to meet targets

Judith Joyce — Sat, 03 May 2025 23:14:36 GMT

Is that a good thing? If so, from whose point of view. I don't think I'm being disingenuous but it ain't that simple.

RE: BBC investigation into pressure on vets to meet targets

Michael Woodhouse — Sat, 03 May 2025 22:40:24 GMT

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247120#247120"]we're stopping using Convenia altogether (66% reduction in it since the beginning of the year to only 2% of all antibiotics being Convenia, and will be 0 before the end of the year (we're not ordering any more in)[/quote]

then you say

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247124#247124"]If there is a clinical justification for something, then it can be done/dispensed.[/quote]

Can't be both

(I am playing devil's advocate here, but I think you are a little brainwashed in the system)

[quote userid="11308" url="~/f/non-clinical-questions/31171/bbc-investigation-into-pressure-on-vets-to-meet-targets/247120#247120"]Ear Cytology has gone up from 5% of cases to 25% of cases (still room for improvement there). IVC have introduced 'test then treat' fee codes with a reduced price for these (our in house cytology used to be £40 due to historical pricing, it's now £27.50),[/quote]

Have you done any work looking it overall costs of treatment to the client? I remain sceptical about the need for routine ear cytology, but then I'm a fan of 10 min consults and don't really enjoy microscope work. I'm pretty sure that a consult + a bottle of Canuaral is going to work out cheaper than consult + cytology + specific treatment and consume more time and resources. I agree more needs to be done in recurrent cases, but in 9/10 the consult and canaural would have cured the dog. The new grad likes the guidance as they don't have to think as hard, the business likes it as they can show the additional cytology revenue, ATV goes up and everyone feeling warm inside with their gold standard badges, but does Arlo Guthrie like his vet bill that's now £100+ and not £55? Does the dog care?

(then again, I'm not a fan of pre-op bloods, agreed to team requests to add them onto the consult form, usually actively advises against them. Say that on the US vet forums and they shudder in fear).

RE: BBC investigation into pressure on vets to meet targets

Kate Richardson — Sat, 03 May 2025 10:32:53 GMT

I'm lucky in being cat only and find checking BP easy. I have the Doppler in my room already and set up to use. I know you are supposed to allow time for them to acclimatise but in my environment and in my hands I can do it within the space of a 15minute consult- essentially if it's normal on the first reading I don't bother doing serial readings, if its normal its normal. Those that are a little high or borderline we will book back for a follow up, sometimes admitting them to allow them to chill a bit first. Follow ups are chargeable, but its a good thing to screen for if you can.