This year, the regional CPD event VetsNorth took place at the Manchester Metropolitan University Business School on 12 and 13 June 2019. The conference had dedicated streams for veterinary medicine, surgery and nursing, and at the end of day one, ran a Q&A panel session for delegates in all areas of practice.
Facilitated by Jon King, Centre Manager for the World Veterinary Science Centre at the University of Aberystwyth, the expert panel comprised Wendy Nevins, President of the BVNA; Jon Hall, Senior Lecturer in small animal surgery at the University of Edinburgh; and David Williams, Director of Studies in Veterinary Medicine and Pathology at the University of Cambridge.
The problem with the gold standard
The first question posed to the panel was “Do we always need to be following the gold standard?”
Simply put, David said, it is “somebody’s gold standard”; the best option will vary depending on the circumstances. At the vet school, they teach what the best thing to do is, but in situations limited by money, or some other factor, there are still things that can be done. He used the example of a blocked cat, for which there would be a typical operating procedure that would be considered “gold standard” – bloods, electrolytes, X-rays, etc. We could try other things to treat the blockage, “but are you able to do anything other than what’s considered best?” he asked. “The guidelines should say that there are several different routes.
”What actually is the gold standard? Wendy asked. Are we talking about the gold standard for the practice, the profession or the pet? Because these will not necessarily be the same.
Jon agreed, raising the question of “just because we can do it, should we?” “Just because it can be done, doesn’t mean it is gold standard,” he said. “When we talk to students, we’re clear that we want to work a case up thoroughly and tick every box: ‘this is one way of doing it; these are the safe corners we can cut; these are the risks we might introduce by doing that,’ and we target it to the patient.”
Some things considered gold standard might also be for the sake of the clinician, as means to ensure that you as the clinician aren’t going to get into trouble, he said. “You have to use your veterinary acumen and your social conscience together.”
New graduates may leave vet school and get frustrated that we can’t always do what they consider the “gold standard” and it needs to be drummed in that this often isn’t just for the pet. We typically think the reason we can’t do something using a “gold standard” method is money but there are many other potential factors in an owner’s life that may alter what is the best treatment option for a pet.
A look at accountability
The next question asked how we ensure non-veterinary practice owners are held responsible for clinical mismanagement – for example, for enforcing short consult times or refusing to pay for the right equipment.
“Corporatisation allows non-veterinary owners and business management and input. If you argue it’s the same pot of money from the pet-owning public, it’s now held in a lot of levels in middle management and higher management; it’s going to get absorbed into that and taken away from veterinary surgeons,” Jon said. “And that means that the business owners don’t have the same investment in animal welfare and health; they are going to look at the financial bottom line.” On the other hand, vets can be soft, he said, highlighting that if they are left to their own devices when it comes to charging cases, things can go badly wrong for the business.
It’s easy to blame corporates and non-vet owned practices, Wendy said, “but I think we all need to make sure that we’re aware of our own value in practice”. If vets don’t charge as much as they should, it can have a significant negative impact on the practice. Consistent charging and valuing the time of vets and nurses is important and will help a business to be successful.
Bob Partridge, veterinary dentistry specialist, noted from the audience that the Royal College does require clinics that are non-veterinary-surgeon owned to have a clinical director. It’s not right to demonise corporate practices as being those with five-minute consults and no facilities, he said, noting that there are vet-owned practices that have limited facilities and do a poor job.
Thinking green
Finally, the conversation turned to a totally different area of practice with the question “How do you increase the environmentally friendly aspect of veterinary practice?” “Surgery is a horribly unenvironmental thing and I don’t know how you get away from that,” Jon said. But it is undoubtedly something we would all like to improve in practice.
Wendy advocated the role of vet nurses as champions of greener practice initiatives. There is lots of interest in the topic on vet nurse chat groups on social media, and this is a good place to go for more information and advice, she said. If we make more conscious decisions to buy products that are better for the environment, then we can improve, she said, adding that often, it can reduce costs for the practice too.
Contributions from the audience included turning down lanyards at events and plastic freebies from stands at exhibitions, washing out the urine pots for diabetic patients and giving them back to them and looking for other alternatives to single-use plastics, such as the VetPen for giving insulin. If more environmentally friendly choices are reflected in our buying decisions, we may collectively be able to make an impact and encourage pharmaceutical companies to look for alternative solutions too.
