PROFESSOR Ynte Schukken from
Cornell University College of
Veterinary Medicine defines
sustainability as “survive in the
long-term without interruption”, a
concept that can apply equally to
veterinary practices or clients.
At the recent international “Dairy
Sustainability” veterinary symposium
staged in Barcelona by Pfizer Animal
Health and attended by 250 vets from
20 countries, speakers and delegates
returned a number of times to factors
that would improve the sustainability of
veterinary practices.
Professor Volker
Kromker from the
University of
Hannover said that in
his mastitis
consultancy work, the
goal was to reach his
farmers’ goals. “We
need to understand
human behaviour and motivation, and
think more like our farmer clients,” he
said.
On a similar note, Professor
Pamela Ruegg from the University of
Wisconsin proposed “a new paradigm
for vets as educators and persuaders
rather than scientists or technicians”.
However, she also reported
“disappointing uptake” by US vets of
training courses in communication and
consulting skills that she had staged
for the profession.
Salutary findings
Prof. Ruegg also outlined some
salutary findings from a seven-year
600-vet programme in Wisconsin
involving farmer-led teams of
appropriate experts to help them
tackle specific problems. At the outset,
she said, the expectation was that vets
would take an initiator or group
leadership role, but the reality was
mostly the opposite.
“We found that most vets wanted
to be the technical adviser to a group
rather than a leader,” she said. “It’s
also the case that rural vets in the USA
are already busy with the hands-on
work that many or most of them
prefer.”
A similar observation emerged
during the symposium at a
sustainability seminar involving UK
vets. “Most practices have plenty of
work,” said one participant who asked
not to be named.
“Finding new clients or generating
more work from existing ones can
easily pose its own sustainability
problems in balancing workload with
the practice’s capacity.”
Among the UK discussion group,
Pfizer Animal Health facilitator Niall Jaggan noted the view that some non-
veterinary advice providers to farmers,
such as Kite Consulting or Kingshay,
were better at demonstrating their
value to clients than the average
veterinary practice.
“However, while some practices or
vets still take a predominantly task-
orientated approach, an increasing
number are now looking at the big
picture with their clients and pursuing
the kind of holistic goal-orientated
approach advocated by Professor Kromker,” he said.
A consensus he did identify was that
practices needed to get
better at positioning
veterinary services as
an investment in
improvement rather
than an unavoidable
expense. From the
Westpoint Veterinary Group, Jon Mouncey
said, “We have to show worth.”
Some, but not all, of the UK
group supported a hypothesis that
farm work would follow the lead of
small animal vets in the use of para-
professionals as part of small multi-
disciplinary teams. From Synergy Farm
Health, Ed Powell-Jackson said his
practice now employed five cattle foot
trimmers, for example. Others
maintained that they and their clients
alike preferred a multi-skilled vet who
could handle most procedures
themselves.
Whichever model practices follow,
symposium speaker Dr Theo Lam
from the Dutch Udder Health Centre
identified a commonplace area for
improvement. “We have lots of
knowledge on the shelf,” he said, “but
it’s no good there and we must get it
into routine use in the milking
parlour.”
He described a research project in
which 17 consultations between “top
flight” Dutch vets and their clients
were recorded and analysed. Only
three contained a formal “statement of purpose” opening to the consultation,
and in only three others did the vet ask
the client about his or her needs.
Just one encounter involved any
follow-up to the previous consultation
and only two included summaries of
the encounter at its closure. None of
the 17 consultations contained a
“listen-summarise-clarify” component.
“To survive and thrive as a
veterinary practitioner, it will be
essential to become proficient in
advisory and consulting skills,” said Dr
Lam. With this in mind, he said that a
symposium on communication,
persuasion and behavioural change was
being staged in The Netherlands next
year.
Mastitis remains…
“Despite years and years of applying
science-based management, mastitis
remains,” said Professor Ruegg, who
opened the udder health session at the
symposium.
Challenging
delegates to find new
ways to help clients
defeat an old problem,
she suggested that, in
view of abundant
scientific knowledge,
“failure to control
mastitis is down to
poor communication,
poor on-farm
management and weak
or absent commitment
to change – all normal
human behavioural things.
“Whether it’s farm failure or vet
failure, they have the same causes,” she
said.
One of the main challenges she
identified was for vets to become re-
involved in the battle against mastitis,
because in many respects the tactics
deployed were in the hands of the
herd owner and farm staff, with little
day-to-day involvement of the vet.
In addition to this, Pfizer vet Matt
Williams said that some or indeed
many dairy farmers have become
conditioned over time that a certain
frequency of clinical mastitis cases is
inevitable.
“Once a norm gets established like
this in someone’s mind, it can create
an expectation that it cannot be
changed and an acceptance that ‘it
happens’, which both act as significant
barriers to change,” he said.
To break out of this rut of
acceptance, Mr Williams believes vets
need a game-changing gambit with
which to establish a new mastitis
dimension in client relationships. One
such gambit is the ultra-comprehensive
Dairyco Mastitis Control Plan that is currently in use by 168 vets on 375
farms. A somewhat simpler one
suggested by Bruce Haggerty from
Miller and Partners in Lockerbie was a
review by the practice of each client’s lactating cow tube use.
While working in
New Zealand, he
witnessed “annual
script consultations”
with clients, in which
the practice would
review with each
owner or manager
their herd’s medicine
use and identify any
concerns arising, such
as above average use of
lactating cow intra-
mammary antibiotic
tubes.
He said the
consultation gave vets an opportunity to agree with clients a programme of
action together with a maximum
number of tubes that could be issued
to the farm in a defined time period,
which if reached would trigger a
further consultation.
“The dispensing staff at the
practice were very good at keeping
track of this,” he said. “At the very
least, this process gave you an excuse
to point out where tube use was well
above the norm. If we can’t flag this
up to clients, we shouldn’t expect them
to be able to identify it for themselves,
because they don’t have the benefit of
seeing the norm across a number of
herds.”
Another aspect of the problem for
vets to overcome is that only about
2% of farmers have a goal for mastitis
control, according Dr Lam. He
regarded it as very simple for vets to
tackle this.
“Just ask them about it,” he said.
“Do a review with them, ask what they
want to achieve, help them identify
and understand a few key performance
indicators that can be used to track
progress and measure success.”
An approach
adapted for the UK,
according to Matt
Williams, is to analyse
practice dispensing
records and identify
clients whose lactating
cow tube use suggests
high incidence of
clinical mastitis. He
suggests that these
clients can then be approached by their
regular vet with a simple proposition
that, “We’ve noticed your tube use is a
bit on the high side and we’d like to
help you reduce it. Are you OK if we
have a chat about this?”
For many vets, he said, the opening
gambit can be the most difficult part
of getting re-involved in tackling
mastitis. But if nothing changes, he
said that Prof Ruegg may be able to
begin her presentation to the 2020
symposium by saying: “Despite
everything we considered at this event
10 years ago, and everything we know
about this disease, mastitis remains.”
Parasites
“Parasites and their control is an area
of opportunity for vets, which
currently many don’t give enough
attention to.” That was the view of vet
and parasitologist Professor Mike
Taylor from the Food and Environment Research
Agency (FERA).
He told the
symposium that it was
the matter of
sustainability of
control, in particular
slowing or halting the
development of
anthelmintic-resistant
parasites, that required veterinary intervention.
“We need to help and encourage farmers to understand the different
wormer groups and how to employ
them effectively,” he said.
“World-wide, it is true that we
haven’t seen much evidence yet of
wormer-resistance in cattle compared
with sheep, but we cannot be
complacent. The veterinary profession
has a responsibility both to promote
responsible use in general and to
prescribe the use of new POM-V
wormer groups only where their use is
justified as a component of sustainable
parasite control.”
The symposium was chosen as the
launch pad for the new Control Of
Worms Sustainably (COWS) initiative,
developed by Prof. Taylor with
sponsorship from Eblex, Dairyco and
RUMA, whose websites offer the
COWS technical manual for vets and
advisers as a downloadable file.
