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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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Are vets more interested in the health of their patients or the money in their pockets?

I recently wrote a blog here titled "Debunking myths about “rip off" veterinary fees”, and since then, the subject of money has continued to be one of the banes of my life as a vet in practice. My aim in life is to do a job that I enjoy, and to be paid a reasonable salary: for most people, that just means that you go to work, do your stuff, and come home at the end of each day. For vets, it's different: every day, as part of our job, we need to ask people to give us money. Most of us would be delighted if this discomfitting task was taken away from us, but unfortunately, it's an unavoidable part of our job description. One recent case provided a good example of the type of daily dilemma that faces vets. An elderly terrier, Sam, had a small benign tumour on his flank. He was fourteen years of age, and his owner had been hoping that we might be able to leave the tumour alone: it'd be better to avoid a general anaesthetic unless it was absolutely necessary. When the tumour began to ooze blood, and Sam began to lick it a lot, we couldn't leave it any longer so he was booked in for surgery. When booking the operation, I mentioned to his owner that it would be wise to take the opportunity to clean up his teeth, which were caked in tartar. And I gave a detailed estimate of the expected costs. We took all the usual precautions to ensure Sam's safety. He had a detailed clinical examination and pre-anaesthetic blood tests to ensure that he had no underlying illnesses that could make an anaesthetic risky. An intravenous line was set up to give him continual fluids during the procedure and to give us instant access to a vein if any emergency treatment became necessary. And a vet nurse was designated to hold his paw and to monitor him for every second of his time under anaesthesia, from induction until he was sitting up at the end. Everything went well: the tumour shelled out quickly and easily, and a line of sutures closed the wound. I carried out a thorough descale and polish of his teeth, as planned. But it was then that the dilemma arose: beneath the tartar covering his teeth, it turned out that two of his molar teeth had large diseased areas. The gum margins had recessed, exposing large parts of the tooth roots. One of the teeth had serious infection, causing the tooth to be loose: it was easily removed. The other molar tooth was more complicated: one root was seriously diseased, but the other two roots were healthy. The tooth needed to be extracted, but it would be a tedious, time consuming surgical extraction, taking over half an hour, and requiring follow up x-rays to ensure that it had been done properly. This would involve an extra cost to the owner of well over £100. I had already given an estimate, and I didn't feel that I could go ahead with this without permission. While Sam was still anaesthetised, I asked a nurse to phone his owner to explain the situation. There was no answer on the home line, and the mobile number wasn't working. What should I do now? If I went ahead, I'd be carrying out unauthorised work on someone's pet. If there were any unexpected complications, the owner could hold me liable. And as for the extra cost? Could the owner justifiably refuse to pay? The safest legal approach would be to make a note of what needed to be done, and then to inform Sam's owner that he needed a follow up anaesthetic in a few weeks, during which we'd tackle his dental issues. But I knew that it would be far safer for Sam to have the entire procedure completed during this first anaesthetic, and I knew that his owner would be unlikely to agree to pay for a second anaesthetic on top of this first one. So Sam's dental issues would probably not be treated, and he would suffer as a consequence. I made an "on the hoof" decision to go ahead with the dental procedure. It took even longer than I had anticipated, and I had to take a series of x-rays rather than just one. By the end, I was happy that Sam had been given the best treatment, but I was nervous about the owner's response. Would she think that I had done this just as a way of extracting more money from her? What if she genuinely couldn't afford more than the estimate that I had given her? I felt so uncomfortable about the situation that I gave a significant discount on the extra work that I had done. Effectively, I ended up working my lunch hour for nothing because I felt so awkward about it. But what else could I have done? In the interest of the dog, I could not have left painful, diseased teeth untreated. What would pet owners feel if the vet presented them with a situation like this? Should you pay the full amount of justifiable extra work if it is unauthorised?  Do you trust your vet? Or do you feel that we are working more for our own interests than for the benefit of your pet?  
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Debunking myths about “rip off veterinary fees”

"Rip-off veterinary fees" were the subject of a recent poll on a vets-only website. In answer to the question "How often does your practice receive complaints about the prices it charges?", the results were:
  • All the time - 16%
  • Fairly often - 53%
  • Hardly ever - 30%
  • Never - 1%
So around 69% of vet clinics get regular complaints about their fees, and given that many people may feel irritated about fees without vocalising their concern to the vet, the true level of discontent is likely to be even higher. This is clearly an aspect of veterinary care that pet owners feel strongly about. I always find this a difficult topic to discuss: as a vet, I can't help feeling defensive, and it's all too easy to write a self-justifying commentary. Sceptical readers may then brush off any of my explanations: "well, he would say that, wouldn't he?". The challenge is that only vets know about the detailed financial background to running a veterinary practice; we're the only ones in a position to be able to explain why vets seem to charge so much. So please bear with me while I do my best to address some of the main myths about veterinary fees. 1. "Veterinary fees are so expensive that they must be a rip off" The reason why vets' fees are so costly is that vets' costs are high. For every £10 you give the vet, around £7.50 to £8 goes towards the running costs of the vet clinic, with the remaining £2 to £2.50 going to the vet. For a pie-chart that shows the breakdown of costs in a typical vet clinic, see here. Outgoings include drugs, utilities, building costs, staff wages, office supplies, continuing education, and, of course, VAT. Like any business people, vets try to keep these costs to a minimum, but they do need to be covered, and vet clinics only have one income source: pet owners. Human medical costs are perhaps the nearest equivalent to veterinary costs, but free medical care in the NHS means that the public in the UK have no appreciation of what's involved. As an example, a bitch spay may seem pricey at £300, while the standard cost of a human hysterectomy is around £5000 when done by a private human surgeon. Such comparisons make veterinary fees seem like ridiculously good value. 2. "Vets are loaded: you never see a poor vet" Look at the facts. The most recent survey of vets' earnings in the UK is carried out by the Society of Practising Veterinary Surgeons showed that the median salary of vets who have been qualified for a year is £32000. This rises to £41232 after five years of experience in practice, but it doesn't shift much higher than this subsequently. The median salary of a vet qualified between 10 and 20 years is between £45000 and £52000. The hourly rate for vets ranges from £15 for new graduates to around £25 for vets with many years experience. So vets are paid well enough, but nobody could call them "loaded". When you compare these rates of pay with other professions, it's clear that if a young person is motivated primarily by earning money, the veterinary profession is the wrong one to choose. 3. "Vets clean up with pet insurance. The first question they ask is: do you have your pet insured?" Why do people presume that vets ask this question with pound signs in their eyes? Yes, we do often ask the question, but people misunderstand the reason for it. If a pet is not insured, the owner will have to cover the costs themselves, and rather than shocking owners afterwards, vets prefer to give a detailed estimate, perhaps with different options, in advance. When a pet is insured, there's no need to go over such detail beforehand with the owner: the focus can immediately be to attend to the animal, in the knowledge that appropriate costs will be covered without the owner having to worry about them. 4. "When a pet has a serious injury or accident, if you can't afford to pay for it, vets often suggest that the animal should be put down. A genuine animal loving vet would never do that. If vets cared about animals, they'd do it for free" The problem here is that there is no such thing as "zero cost" treatment. Given that vets receive 20 to 25% of the fees charged, simple arithmetic shows that 75 - 80% of vets' fees are needed to cover the non-vet costs of treating an animal. If a vet gave you a 10 - 12.5% discount, they are effectively taking a 50% reduction in their take-home pay. If you are given a 20 - 25% reduction, the vet is doing it for free. And if the vet does the work at no charge, then he or she is actually giving you money for the benefit of treating your pet. Much as vets may feel a desire to do this from time to time, they do need to earn a salary so that they can pay for their own living costs. Vets operate in an open market: competition means that people are free to shop around to choose the best value vet in their area. If you feel that vets' fees are still "too expensive", ask yourself what corners you would like your vet to cut. Do you want less time with your vet? Do you want him to pay his nurses less? Do you want him to use cheaper surgical and medical products? Would you like him to move to a part of town where property is cheaper? Do you want him to decorate his clinic less often? Should he undertake less continuing education so that he isn't as up to date with treatments? Please don't just assume that vets are "ripping you off": if money was our main motivation in life, we'd all have left our profession many years ago.
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A vet visits a Delhi slum: day two – educating young people about animal welfare

[caption id="attachment_3744" align="aligncenter" width="717"]So-called "street dogs" often have a care-giver keeping an eye out for them So-called "street dogs" often have a care-giver keeping an eye out for them[/caption] After an overnight flight from London, I was delighted to be welcomed to Delhi this morning by a remarkable lady who works on the coal face of the street dogs/rabies issue. Bondana Dutta (or Bondi, as everyone calls her) is the founder of a small but rapidly growing NGO charity called Alliance of Animals and People (AAP). Bondana resigned as a regional director for CRY ( one of the major Childrens Rights NGO's) to pursue her work with AAP, and she has brought many skills and strengths to her new role. She believes that the way to improve animal welfare in the slums of Delhi is to start with the children: if she can convince young people of the importance of valuing animals, the rest will follow naturally. The children will pester their parents to do more for animals, and in due course, they will mature into a new generation of adults who are strongly pro-animal. [caption id="attachment_3743" align="aligncenter" width="614"]I found myself in front of an audience of children, talking about animal welfare I found myself in front of an audience of children, talking about animal welfare[/caption] As an introduction to the educational projects she's created, I travelled with Bondi to one of her projects, in a slum in South-West Delhi. The cross-city drive to the slum gave me a taste of the lunacy of Indian traffic: half a dozen lanes of a mad mix of vehicles (from cattle-drawn carts to tuktuks to cars to trucks) barging against each other to get ahead, beeping horns instead of using indicators, yet somehow, all keeping going and reaching their destinations. We pulled up outside the slum, and walked in through narrow laneways past people sitting outside their homes in small groups. The weather in Delhi at this time of year is pleasant: 20°C with crisp clear sunshine rather than the humid 30°C plus of mid-summer. For people and animals alike, it's a comfortable climate to be outdoors. [caption id="attachment_3745" align="aligncenter" width="717"]We walked a few hundred yards from where we'd parked the car We walked a few hundred yards from where we'd parked the car[/caption] After walking a few hundred yards, we came to a fenced off courtyard in the middle of an open area: around fifty children were waiting for us there. This was Bondi's community: children aged between five and fifteen who have signed up for regular classes in animal welfare. An AAP worker, a former teacher, was giving a class when we arrived. She acted as an interpreter (the children speak Hindu, with just a smattering of English) to allow me to talk to the children. [caption id="attachment_3742" align="aligncenter" width="717"]The children gathered in the courtyard, as if in an outdoor classroom The children gathered in the courtyard, as if in an outdoor classroom[/caption] I asked a few questions and learned a lot: most of the children cared for street dogs which they view as their “family dogs”. They feed them a mixed diet of scraps, and they make sure that they are vaccinated against rabies and where possible sterilised. I asked about what should be done if a person was bitten by a dog: the children knew all about washing a wound thoroughly then seeking post-exposure rabies vaccination. [caption id="attachment_3741" align="aligncenter" width="614"]A hamster, kept as a pet, was an unexpected critter to find in the middle of  the slum A hamster, kept as a pet, was an unexpected critter to find in the middle of the slum[/caption] I then asked the children if they kept any other animals as pets – cats are popular (but they aren't as visible as street dogs here), some children kept pet fish, and one girl disappeared for a few minutes, astonishing me when she returned cuddling her pet hamster, Pooni. I stayed for half an hour talking the the children, and the end, they sang a song to me about the importance of looking after animals well. I came away feeling full of hope and optimism: in the three years that she's been visiting this slum, Bondi has created a population of young people who care passionately about animals, and in the process, they are taking the necessary steps to ensure that they – and their pets - are protected against rabies. The AAP model is only being used on a small scale at the moment – Bondi would like to have more full time employees to visit more slums running classes like this, but funds are scarce. Bondi has great vision, and with the right support, her dream of all Indian children being taught about the importance of caring for animals will come true. [caption id="attachment_3740" align="aligncenter" width="614"]This slum-dwelling goat was dressed to cope with the cool February evenings This slum-dwelling goat was dressed to cope with the cool February evenings[/caption]
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