Time to consider how private veterinary practice is structure - Veterinary Practice
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Time to consider how private veterinary practice is structure

There has been much hand-wringing since that Panorama programme went out on TV and I believe that some of the individuals “featured” on the screen have been called to account by their employers.

This is right and proper; when someone is accused of wrongdoing they should account for their actions and a decision can then be made as to the appropriate course of action. However, the kind of threats to an individual’s safety that have reportedly occurred as a result of the screening have no place in resolving any of the issues raised.

Moving on now that the dust has settled, it is perhaps a good time to look at what was portrayed in a more balanced way and try and tease out what it really tells us about the profession.

So what were the main issues? Looking from the animal care perspective there were two things that I, and I suspect most of the viewing public, found disturbing. The first was the issue of the two unqualified nurses trying to insert an intravenous cannula into a dog’s front leg.

Two-fold problem

The problem here was two-fold. Firstly, why were inadequately trained personnel asked to carry out the procedure in the first place? And, why was the supervision and/or the instructions given so inadequate that those persons concerned did not know when it was time to desist and ask for more qualified assistance?

In my experience, even in the busiest practices, there is always time for a vet or qualified veterinary nurse to intervene in such circumstances and indeed it is their duty to do so. I think it is very hard to come up with any defence to what appeared to occur.

The second issue was that of the inappropriate handling of the semianaesthetised cat and the Shar Pei dog, the former I believe by a vet and the latter by a qualified veterinary nurse. Both instances appeared ugly and unprofessional but if one assumes that they were the worst cases of animal treatment in all the months of undercover filming that took place, then I think that the profession can take some comfort from that fact.

It implies that there could have been hour after hour of film showing vets and nurses behaving in a very caring manner if the intention had been to make a balanced programme – which it clearly was not.

Rewarding – but frustrating…

Working in veterinary practice can be very rewarding but it can also be frustrating. Animals don’t always cooperate fully with what we want to do to them and I have to say there have been times when vicious cats and dogs have genuinely scared me.

I would also add that there are a handful of occasions when I’ve not been particularly proud of the actions I’ve thought it necessary to take in order to get the job done.

Looking back I don’t think that I would have wanted an undercover camera filming me and then putting it on show without giving me the opportunity to put what happened into some sort of context.

I am not condoning, excusing, or defending such action, merely trying to offer a rational explanation of how it can come about. When we get bitten or scratched we can get angry. If an animal pulls its leg away before all the anaesthetic has been injected, it can look messy and incompetent and we might say inappropriate things.

Of course, good sedation and competent restraint can help minimise such instances but those of us who have worked in small animal practice for any length of time will have experienced events that we would rather forget. Our reaction to such events is the key issue here and it is up to each and every one
of us to do our utmost to act in a calm, measured, respectful and, dare I say, professional manner.

But let us not forget that we are all human and although the animals concerned in the aforementioned cases experienced a degree of physical and/or mental pain, there was no suggestion that they had suffered any long-term effects.

Let’s turn now to the matter of recommending inappropriate procedures (e.g. a follow-up MRI scan at huge expense for a dog with secondary lung tumours already diagnosed on x-ray); and the apparently dishonest act of splitting up a client’s bill into several separate ailments in order to maximise a claim on pet insurance.

This appeared to me nothing more than profiteering and has no place in a profession where the mutual trust between client and vet is paramount. In such cases one can only squirm and say that the perpetrators deserve all that they get.

The problem, of course, is that pieces of kit like MRI scanners cost an absolute fortune and have to be used frequently in order to justify their existence.

Great temptation

The temptation to use them whenever possible (and not just when they are genuinely needed) must be very great – particularly in the current world of practice where there is still very little differentiation between most first and second opinion veterinary practices (high-powered referral practices excepted).

Everybody is clamouring to do anything and everything which means there is a lot of underused kit out there which somehow has to be paid for.

What is the answer? Certainly a strict disciplinary process which clamps down hard on any proven cases of fraudulent activity. That will punish the guilty and hopefully persuade those of somewhat “flaky” professional integrity to think again.

Much more though, we need to consider how private veterinary practice is structured and in many cases stop trying to be all things to all men and all animals, particularly in heavily populated urban and suburban areas.

Perhaps we need to start thinking whether it really is in the animals’ best interests for just about every vet to offer a complete medical and surgical service.

Why don’t some (more) instead start offering more of a primary care/minor surgical intervention scenario with referral on to the practice up the road for more major interventions?

That way those practices with expensive equipment will get a higher throughput of cases that really merit such interventions and there will be far less temptation to use them purely because they have to somehow be paid for.

We should not beat ourselves up as a profession because of this programme. Instead, let’s see it as an opportunity to reorganise the profession into something a little bit more fitting for the 21st century but which still retains its deserved reputation as one of the most caring and trustworthy professions in the world.

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