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Is that “veterinary nurse” really a veterinary nurse?

Language and terminology is important. Our society recognises this fact, and in some walks of life, you cannot call yourself by certain terms unless you are appropriately qualified. The medical field is the area where so-called “protected titles” are most prevalent: there's a long list from “music therapist” to “dietician” to “clinical scientist” to “physiotherapist” and “paramedic”. If you read the list, you'll be surprised, and I suspect that you'll be reassured too: it's good to know that when you go to see a “hearing aid dispenser”, under law they must be properly trained and qualified. There are serious penalties for people who try to set themselves up as one of these practitioners when they are not entitled to do so: anyone using one of these titles must be registered with the Health and Care Professions Council, or they may be subject to prosecution and a fine of up to £5,000. Interestingly, not all professional titles are protected. The words “doctor” and “nurse” have been in general use for hundreds of years to describe a variety of people, and so they are not specifically protected. The title “doctor” is used far more broadly than just for medical doctors, with a number of professions (including dentists and now vets) using it as a courtesy title, as well as people who hold academic doctorates, such as PhDs. Similarly, the title “nurse” is not protected: as well as medical nurses, it's used by nursery nurses in nursery schools, and sometimes by veterinary nurses. The fact that the terms “doctor” and “nurse” are not protected can lead to issues where the public can be mislead by individuals who use the terms to their advantage (such as a person who is an academic doctor trying to pass themselves off as a medical doctor). For this reason, the terms “doctor of medicine” and “registered nurse” are protected titles, but for the public, arguably this is not sufficient to avoid confusion. There are some professions that would like to have protected titles, but for various reasons, this is not possible. Anybody can call themselves an “engineer”, a “scientist” or a “surveyor” because these terms are said to be in such widespread use. These professions have had to add prefixes to their titles to try to minimise confusion, such as “incorporated engineers”, “biomedical scientists” or “chartered surveyors”. Only properly qualified and registered vets are allowed to call themselves “veterinary surgeons”, but there is a major anomaly in the veterinary world: anybody, even without training or qualification, is allowed to call themselves “veterinary nurse”. The veterinary nursing profession has so far had to use the protected title “registered veterinary nurse” to be used exclusively by properly trained and qualified nurses, but there's a strong argument that this is not enough. Most readers, I'm sure, would agree that if they were dealing with someone calling themselves a “veterinary nurse”, they would assume that the person was qualified. Unless something changes, it's very likely that unscrupulous individuals will use this confusion to their advantage, misleading people into believing that they are qualified. What has to change? Clearly, the term “veterinary nurse” needs to be made a protected title. The Royal College of Veterinary Surgeons, the British Veterinary Association and the British Veterinary Nursing Association all believe that this is necessary. They are asking Parliament to change the law to protect the title “veterinary nurse”, and they need as much help as possible to achieve this. Please sign the official petition to register your support. The aim is to get 100,000 signatories which will trigger the issue will be considered for a formal parliamentary debate. The petition is currently at 20,594 signatures and the petition closes on 14th February 2016 so time is running out. The engineering profession tried a similar tactic to protect the word “engineer” last year, but the attempt failed after their petition only reached 6176 signatures. It makes clear sense that the term “veterinary nurse” should be trusted as the recognised name for a skilled, trained and qualified profession. If you agree, please sign this petition now, and ask as many as possible of your friends and contacts to do the same. Please follow this link to the petition. The RCVS has also produced a short animation stating the reasons behind the petition:  watch this by clicking here. Animals are the ones who will benefit from "veterinary nurse" being protected: so if you care, take action now.
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Why would an experienced vet go back to college? Here’s why…

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The university course leading to a degree in veterinary medicine and surgery is by necessity a hard-working, information-packed five years. The focus has traditionally been on accumulating facts, with the presumption that other aspects of being a vet can be learned later, when life in practice has commenced. As a result, there has sometimes been a perception (which may or may not be true) that new graduates can be over-academic, with a tendency to be impractical.

An innovative response to this criticism has been established at many vet schools, with a concept known as the “Practitioner-in-Residence” . An experienced veterinary surgeon leaves their own practice for a period of ten weeks, to spend time at the Veterinary College, teaching students about “real life”. A few years ago, I was lucky enough to fill this role at my own local vet college.

My teaching duties had various aspects. Every morning, I consulted as a normal vet, seeing “real life” cases with on-looking students. However the pace was different to my usual busy lifestyle in private practice. Instead of examining fifteen patients in a morning, I might see only one or two, with every aspect of the case scrutinised in fastidious detail. Students were involved as much as possible, asking questions and taking part in discussions.

In the afternoons, I took part in tutorials with small groups of students. We discussed the cases seen each morning, and we debated the pros and cons of various investigations and treatments. A member of the university staff provides the viewpoint of the academic vet, and I was then asked about what I would do in practice. Sometimes there was no difference in approach, but at other times my approach would differ. “Real life” clients do not always want the standard academic route. Some tests may give information that is of interest to the vet, but that may not make a significant difference to the treatment of the animal. Such tests can be expensive, and pet owners often have a limited budget. My input to these tutorials aimed to help students understand more about how they would be expected to treat animals in the world of private veterinary practice when they qualified.

The tutorials also focussed on other aspects of life in veterinary practice. What should students look for in their first job? What sort of facilities and equipment should they expect to find? How do you tell the difference between boss who is a friendly, helpful mentor, and one who might be a hot-tempered intolerant slave driver? What sort of stresses will the young vet be under? How can they minimise them? Vets have one of the highest rates of suicide in modern society, and young vets need to be told about this. It can be difficult to live a balanced life, with focus on both work and leisure, but it’s important.

My life as a “practitioner-in-residence” was very different to my normal routine. I spent lunchtimes in the university library reading the latest veterinary journals. I attended early-morning seminars held by visiting experts. I took part in departmental meetings with the academic team. It was like having a taste of an entirely alternative life, and I thoroughly enjoyed it.

But I did miss aspects of my normal life. I missed the social chat with my clients. I missed those animals that I have learned to know as individual characters over the years and who have become my friends.

If there was one single message that I wanted to give to those students, it was this: “Veterinary practice is an enjoyable, sociable, stimulating, exciting job – get qualified, get out there, and enjoy it!”

 
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Old cat, young cat: a bittersweet episode in the life of a companion animal vet

Mrs Kennedy was an elderly widow, whose only companion was a small seventeen year old cat called Puss. Mrs Kennedy had phoned me because she thought that Puss had broken her leg after chasing another cat.

I wasn’t expecting anything too serious. Cats commonly hurt themselves while fighting with each other. An owner may think that the leg is broken, but in most cases the problem is a simple cat bite abscess, which can be easily treated. However, this time it was different. The owner was right.

Mrs Kennedy explained how a neighbouring cat had sneaked into the kitchen, and Puss had leapt up to chase it away. Immediately afterwards, she’d started limping, and since then she had barely moved from her bed.

When I touched Puss’s shoulder I could feel heat and swelling, and when I gently probed deeper, I could feel the rough ends of broken bone. I asked a few more questions, and it turned out that Puss had been drinking more than normal for a few months, and she had begun to be fussy about her food. She had also started to vomit occasionally. The pieces of the jigsaw began to fit together, and I explained it to Mrs Kennedy.

Puss is very elderly and at this stage in her life, her body is gradually failing her. Her main problem is that her kidneys have stopped working properly, which is why she has developed an increased thirst and a poor appetite. As a result of her kidney failure, her bones have become very fragile. Unfortunately, advanced kidney failure in a seventeen year old cat is not easily treated. And worse again, a broken bone in a cat like Puss cannot be fixed. At this stage, all of her bones will be as weak as egg shells. If she carried on, Puss would continue to suffer from further broken bones during normal activities.”

Mrs Kennedy sadly shook her head. “ So it’s time to say goodbye.” She knelt down beside her cat, and gave her a last, long hug. I gave the painless injection, and Puss quietly passed away, as her owner whispered into her ear.

Mrs Kennedy told me how Puss had originally been a wild stray cat. She had finally been tamed after months of coaxing her into the kitchen with food. She had been Mrs Kennedy’s closest friend, but she would never have another cat. She was elderly and she could not bear to think about what might happen if she died herself. I tried to tell her that somebody would look after her cat, and that this could be arranged in advance, but she just shook her head again. I felt very sad as I left her house.

Two weeks later, I received a call from someone who had a half-tame feral kitten in their garden. They were moving house, and they didn’t know what to do with it. An idea occurred to me. I collected the kitten, and drove on to Mrs Kennedy’s house. When she answered the door, I smiled and I said that I had something that might interest her.

Mrs Kennedy could not take her eyes off the kitten in the basket beside me. “He is just like Puss used to be –the poor frightened creature. Bring him inside”. She went to her kitchen cupboard and took out a tin of cat food. I stood back, as she spooned the food onto a plate, and opened the cat basket. The kitten licked the food hesitantly, and then began to eat heartily. As he ate, Mrs Kennedy chucked his cheek gently. He looked up at her, and to my surprise, he purred. A new friendship had begun.

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Vets are now doctors (in a strictly veterinary sense, that is….)

Did you know that your vet is now a doctor? The Royal College of Veterinary Surgeons  has just changed the rules. Vets are not obliged to call themselves "Doctor", but we now have the option to do so, if we wish. Traditionally, vets were called "Mr": the logic was that as "veterinary surgeons", we fell into the same (slightly superior) category of medical personnel as medical consultant surgeons, who were also "Mr". Dentists (dental surgeons) were also called "Mr" for the same reason. In the past thirty years, two factors have moved against this traditional nomenclature.

The veterinary profession has been feminised.

In the 1960's, over 80% of veterinary graduates were male. The gender ratio moved to 50:50 in the 1980's, and it's now changed so that a high majority of new graduates are female, 57% of the total profession in practice are female. Why is this relevant to the "doctor" issue? Well, "Mr" may be a handy title for male vets, but there's a dilemma for females: there's an awkward choice between Miss ("young and single?"), Mrs ("married") or Ms ("feminist?"). The term "Dr" is gender neutral, which suits our politically correct era.

Most vets around the world are "doctors"

The second, and probably more significant, reason for change in terminology is to keep the UK within international norms. In nearly every other country in the world, vets are known as "Dr". So when British vets travel overseas, it causes mild consternation if they try to stick to the "Mr" title from home. And when foreign vets visit the UK, they naturally expect to be called "Dr", leading to some confusion for members of the public ("Are they better qualified than British vets?")

Vets, vet nurses and the public voted for vets to be doctors

The decision to change to "Dr" was democratic: the RCVS carried out a consultation process, receiving the opinions of over 11000 people, 74% from vets, vet students and veterinary nurse, and 26% from the public. Overall, 81% were in favour of vets becoming "doctors", 13% were against, and 6% did not mind either way. The RCVS has placed some stipulations about how vets use the term "Dr", to avoid the risk of misleading people about our qualifications. The two possible misapprehensions are first, that we have earned a doctorate (PhD), and second, that we are medical doctors. To avoid the risk of this happening, vets have to do one of two things. First, add the word "Veterinary Surgeon" as a post-script to our names ("Dr Pete Wedderburn, Veterinary Surgeon") or second, add our post-nominal letters our names ("Dr Pete Wedderburn MRCVS"). This is a clear way of defining that we are "vet doctors" rather than "doctorate doctors" or "doctor doctors". I'm sure it seems like trivial stuff to most members of the public, but to those folk who are concerned about these details, it's very important to get it right. And it is important, that when people consult a professional, whether online or in person, that they have a correct understanding of that individual's qualifications. I never thought I'd be a doctor, but all of a sudden, I've become one without even trying. A doctor, veterinary surgeon, or a doctor, MRCVS, that is, of course.  
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Euthanasia – one vets opinion.

People often tell me that they think putting pets to sleep must be the worst part of my job but in many ways, it is one of the easiest. Yes it is sad, letting a beloved animal go, but in the majority of cases we are doing it for very good reasons; releasing them from a life that has become more about pain and suffering than the joy it should be.

A couple of years ago it was time to put our family labrador to sleep.  Molly had reached the grand old age of 14 and had been struggling with arthritis for many years.  Although her mind was still willing, her body had let her down and no amount of drugs would help her to be able to walk again.

What was interesting was my mother’s attitude.  She is a GP and admitted that in her job death can be seen as a failure, rather than a release.  She agreed with my decision but it was a totally different mind set to the one she was used to.

When patients come towards the end of their lives, in many ways the decisions that doctors and vets take are very similar, it is just that vets have an extra option; euthanasia.

Obviously with animals we don’t, and shouldn’t, take things to the levels that human medicine can.  It often isn’t appropriate to put a pet through painful surgeries or medical treatments, especially if it will only result it a short period of extra life.  Also, although it can be tempting to think an immobile pet could be kept going with nursing care, it simply isn’t fair.  We can’t explain why their lives are so restricted, they find it distressing and complications including urine scaling and bed sores are common and very painful.

End of life care in people is very different and is an extremely sophisticated process, often involving several teams of people, and usually relies on attentive and intimate nursing care.  It allows us to give our dying a peaceful, pain free end, often at home, with their family with them.

However, there are many people who believe this can sometimes prolong the inevitable and increase suffering and that we should have the option for human euthanasia in the UK.  Certainly I have lost count of the number of clients who comment “I wish we could do this for people” when I put their pets to sleep.

The debate surrounding this issue is a passionate one with contentious opinions on both sides.  I can certainly understand why some people diagnosed with degenerative or terminal conditions wish to be able to have control over their death and the option to end their lives before their suffering becomes extreme.

At least in veterinary medicine we don’t have this issue.  Animals have no understanding of their illnesses or how they will progress.  It saves them from the mental distress of their decline or the fact they will die. These are the burdens their owners have to bear instead.

Despite this I feel extremely fortunate to have euthanasia as an option for my patients.  It is never a decision taken lightly, is always upsetting but I know it is a peaceful, pain free process which brings an end to suffering and distress.

However, if it did become available for my colleagues in the medical profession, I would not envy them. Not only would it be the polar opposite of everything they trained for but to take that decision for another human being, even if they were supportive of it, would be a responsibility that I would not wish on anyone.

Cat Henstridge BVSc MRCVS - Read more of her blogs at www.catthevet.com

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