A colleague of mine recently took her dog to the vet, after a long illness. At the vets, the nursing staff came to her in the car park, and took him away. The next she heard was the vet giving her a phone call, as she sat in her car, and told her he thought it was time to put her dog to sleep. He was as supportive as he could be. But it wasn’t exactly the way to receive bad news that any of us would choose for our pets. And while my colleague was allowed into the practice for euthanasia, it seems that some practices aren’t even allowing that. It’s something that a lot of pet owners are finding very distressing at the moment. While pubs, and most shops, and even some beauty parlours are open, why are some vets still not allowing people inside?
This was the general advice back during the first full lockdown, and it made sense. However, while some vets are now doing face-to-face consults again, many it seems are not. So why not? Well, there are four parts to the answer.
Knowledge of Risk
As vets, we have a better understanding of disease transmission than most people. We know how important distancing is, and how easily diseases spread between unprotected individuals. We also know how limited our knowledge of this disease still is, and so are inclined to take the “precautionary principle” to minimise all risk.
This, by the way, is an occupational hazard of our profession – we tend to be personality types who want to keep control. In these stressful and worrying times, this is one way of staying in control.
There’s also the issue with Personal Protective Equipment. While yes we do have access to full medical-grade PPE, and know how to use it, should we really be using this equipment? After all, there’s a high chance that it will be needed by our medical colleagues in hospitals or care homes. Or should we be carefully minimising its use to preserve supplies for the NHS?
Duty of Care
As a result of the knowledge of risk, veterinary employers are very aware of the risks to their staff. They have a duty to protect their employees, and if there is a way of doing so, they will try to minimise the risks to their staff and colleagues. This is all very laudable – after all, we’ve seen the anxiety amongst teachers and other workers at being put into more risky situations. So, it makes sense from a company point of view to minimise the stress and anxiety as well as physical risk to your staff.
After all, in most cases the owner doesn’t NEED to be with the dog or cat or rabbit – much as they would like to. Ultimately, the vet needs to be able to talk to the owner to get a history, but this can be done over the phone. Otherwise, any contact between vet and owner is strictly speaking optional. So why increase the risk if you don’t have to?
Need for Speed
There’s also the efficiency argument. Many vets practices still have HUGE backlogs of “non-urgent” but still essential consultations that built up over lockdown. If the client stays outside, the patient can often be treated faster. This is especially true if only one member of the team needs to don protective equipment and come into contact with them. Less people having to change in and out of kit means a faster turnaround. This is good for the majority of clients, as the waiting lists get shorter, and it’s also good for the practice finances because more patients can be seen by the same number of staff,
Because they can?
It’s no secret that there are some (perhaps many?) vets who as a general rule much prefer the patient to the owner! After all, we went into this profession because we wanted to work with animals. For many or most of us, helping the owner is as important (certainly, it is for me). But I do know that some colleagues would much rather work with the patient directly without having to deal with the person on the other end of the lead. And the pandemic has given them the ideal opportunity to move to this style of working.
How are animal owners responding?
It seems to be very variable. Some clients are very supportive – they’d much rather quick appointments, especially for routine work.
However, many have found it very difficult. And I think it’s telling that many vets are reporting the numbers of complaints and the amount of abuse they’re facing is growing rapidly.
But is it right?
This is a really hard call to make. The vets who aren’t allowing people in would argue that they’re protecting themselves AND their clients from a serious and potentially fatal disease.
However, those practices who are doing face-to-face consults again say that they’re trying to support client and staff mental health and wellbeing. Certainly it seems undeniable that mental health has, collectively, taken a huge knock over the last 6 months. And of course, a lot of the abuse that vets are currently getting is overspill from frustrated, scared and angry people.
However, I’m worried that the excessive focus on physical safety is damaging our profession. From the outside, we look uncaring and uncharitable. We look like we have no compassion for the people – like my colleague – who are losing a beloved pet. This just stokes up anger – which doesn’t help anyone. It’s causing unnecessary suffering to our clients, many of whom are in a fragile mental state or already distressed anyway.
It especially doesn’t help us – believe it or not, vets really hate it when we get complaints or unhappy clients. We generally want to get on with people, and the deluge of complaints – some justified, some definitely not – is a disaster for our mental health, as much as our clients’.
When is a need a need?
Many vets would argue that owners don’t “need” to be seen. After all, they can give news (good or bad) by telephone. They can even put an animal to sleep while the owner waits outside, and that keeps everyone safe. Why risk it?
But is that right? What about the owner’s psychological needs – how are they being met? What about all the non-verbal elements of human communication – the components that are so important for expressing empathy and understanding each other’s feelings?
I’d argue that for many of our clients, in emotionally stressful situations, a face-to-face conversation can be a need, not just a desire. And until we address this problem, we’re going to struggle with both our clients’ and our own mental health.
What do the professional bodies say about it?
Interestingly, Daniella dos Santos (the President of the British Veterinary Association) has called on practices to reassess “kerbside vetting” and try to reopen if possible. Of course, in some practice situations it just won’t be safe. And of course, some areas are much higher risk than others, with more active circulation of coronavirus in some parts of the country. So this should of course be on a case by case basis. But it’s very clear that the BVA is concerned about the mental health impacts on both our colleagues and our clients.
What’s the way forward?
I really don’t know. Yes, there are very good reasons for both minimising contact and for conducting face-to-face. However, personally I’m really worried that we’re throwing the baby away with the bath water. While none of us want anyone else to get or die from Covid, the long-term impacts on people’s mental health – on both sides of the consulting room table – are potentially disastrous. After all, vets already have one of the highest suicide rates in the UK per head of population… And our clients come to us in times of great distress anyway.
Perhaps the best way forward would be a “staggered” return to some face to face. By all means keep owners outside for routine and uncomplicated matters; or if you’re in an area with a very high virus caseload. That would be the responsible thing to do. But for the high stress cases and the distraught owners, use a little bit more PPE and a little bit more compassion and see them in the practice if there’s any way that you can do so safely.