Blog

  • The Doctor debate

    Yes or no?
    Yes or no? Image ©iStock.com/benstevens

    One of the big discussion topics within the veterinary profession at the moment is the RCVS consultation on UK-qualified vets adopting the courtesy title of “Doctor”, or “Dr”.

    Given that the consultation closed on February 16, I may seem a bit late to add my two pennies’ worth, but I didn’t really know how I felt on the matter and wanted to assess the justifications before assuming a position on one side of the fence or the other.

    Reasons for and against

    There are valid arguments for both sides – and while those against the use of “Doctor” invariably shout louder with their opinions, there is an undeniable majority (at least across the veterinary student body) in favour of the change. In fact, a poll on the Association of Veterinary Students’ (AVS) Facebook page found 97% of respondents were in favour of adopting the title.

    The suggestion is that use of the title would bring vets parity with doctors and dentists in the UK, and also with veterinarians in the US, Australia, New Zealand and parts of Europe. It has also been suggested the change would see an increased respect for vets and help highlight the level of training required (which is of similar length and breadth of doctors and dentists).

    Those against the idea argue that human surgeons do not style themselves "Doctor" (due to a historical quirk that differentiates them from physicians) and so, as veterinary surgeons, we already are on a level playing field with our human counterparts. However, as those less surgically minded are quick to point out, vets are not just surgeons; we are GPs, radiographers, anaesthetists, midwives etc, and so our skill set expands beyond those constrained by this historical quirk. Additionally, in the US, vets are termed "veterinarians" rather than "veterinary surgeons", which makes this historical quirk inapplicable if the argument is simply down to semantics. Instead of achieving parity and clarity, some claim it would actually cause more confusion as vets are neither medical doctors or PhD holders (unless they have indeed spent another few gruelling years at university), although the relevance of this in a clinical situation is questionable – are clients or farmers really going to be too fussed about whether you have a PhD if you’re calling yourself "Doctor"? They’re probably more interested in whether or not you can heal their dog or calve a cow. To this end, giving vets the option to use the title may cause further confusion as not all veterinary professionals will necessarily take it up. So should we have this option, or should we stick firmly to an "all or nothing" approach to ultimately achieve true coherence and unity?

    A matter of trust

    I feel the reasoning with regards to increasing respect for vets and highlighting their level of training is weak – most people outwith the veterinary field actually think we undergo more training than we do (how many times have you been asked if you train for seven years?), and I don't believe respect comes from having a couple of extra letters before your name. Respect must be earned through demonstration of skill and – perhaps more relevantly – client trust. It is this aspect of trust I believe to be the most important justification against the use of the title, and perhaps the one that might just tip the balance for me to fall into the "against" crowd. [caption id="attachment_4659" align="alignright" width="300"]Rather than trying to force this respect, would we not be better off preserving the relationship and earning respect through trust? Image ©iStock.com/JackF Rather than trying to force respect, would we not be better off preserving the relationship and earning respect through trust? Image ©iStock.com/JackF[/caption] It is said the client-vet relationship is often far better than the patient-doctor relationship, with vets often getting to know their regular clients as well as the animals they bring in. Many clients see their vets as friends and so trust their judgement and take heed of their advice (how many times do you hear the question "what would you do if this were your dog?” ?). Rather than developing trust towards a friend, adopting the title "Doctor" may actually form a barrier (however unintentionally), causing an immediate distance between professional and customer due to subtleties such as the client feeling less inclined to be on first name terms with the vet. This would be the cost of the "respect" the title holds. Rather than trying to force this respect, would we not be better off preserving the relationship and earning respect through trust? My gut reaction to the suggestion was yes, of course I’d call myself "Doctor" given the choice – but I began to think a bit more carefully when the strong opposing statements had a substantial backbone to them. And then, on a very personal level, I remembered that I am "blessed" with a unisex name and, as such, always sign emails with a definitive MISS in front of it. For an entirely un-veterinary related reason, I might consider keeping the Miss/Ms just to avoid turning up at an interview to a confused look before the employer realises their mistaken assumption (yes, this happens more times than you would think). Alternatively, in an increasingly female-dominated profession where males may still be considered (however wrongly) to be superior, those two letters in front of my name may cause sufficient confusion to gain an interview I may otherwise have been denied based on gender... but that’s an entirely different debate.

  • Check for rising coronavirus titres in suspected cases of FIP

    Coronavirus (3D rendered illustration)
    Coronavirus (3D rendered illustration) ©iStock.com/xrender

    We had a very sad case lately of a little kitten that developed the classic signs of wet feline infectious peritonitis (FIP), had a very high titre to feline enteric coronavirus (FeCoV), responded poorly to treatment and went on to develop neurological signs with the inevitable outcome.

    This horrible result was made all the worse as he had a little brother…

    As his new owners were thinking about getting another kitten, we thought it worth checking titres on our apparently healthy brother. The first titre was low and indicated exposure, but a second was sky high – so we’re really hoping he is one of the 90% that bats this off without developing the mutated form of the virus.

    As a result we have suggested his owners delay introducing a new cat for the time being.

  • Faecal screens for squitty kitties

    Cat sat on toilet
    “I knew that vindaloo was a mistake!” – image ©iStock.com/adamdowdee282

    We do a lot of work for the local branch of the RSPCA and come across all kinds of squitty kittens with varying degrees of diarrhoea, which (on occasion) respond poorly to symptomatic therapy.

    We have found it worthwhile to do the full faecal screen, which includes a whole range of PCR diagnostic tests.

    This enables us to diagnose a range of infectious agents – feline parvovirus, Tritrichomonas foetus and feline coronavirus to name just three.

    At least then we can explain why our kitty is not responding to treatment!

  • It’s worthwhile tapping the abdomen

    Quiet, lethargic, not eating very much and just generally a bit slow? It’s worthwhile tapping the abdomen.

    I saw a golden retriever presenting in just this way, just as surgery was about to close on Christmas Eve. On examination she was a bit pale but not particularly tachycardic, although her abdomen felt distended.

    A quick needle tap sadly revealed the presence of free blood. However haematology showed a significant reticulocytosis consistent with the bleed occurring 2-3 days previously (the owner did point out that, in fact, she had started to perk up that morning).

    Our next step will be some imaging to see what the spleen looks like and whether we can consider surgery – hopefully with a favourable outcome. Fingers crossed.

    Dr Lisa Powell from the University of Minnesota’s College of Veterinary Medicine describes how to perform an abdominocentesis (peritoneal tap) – the procedure used to obtain free abdominal fluid.

  • Represent, support, engage!

    AVS committee at annual ball
    The AVS committee poses for an official photograph at the association’s annual ball.

    The AVS (Association of Veterinary Students) Congress marks one year since my involvement with the association began.

    Last year, in Nottingham, I stood up at the AGM and gave a hustings speech. Before long, I found myself elected the editor of JAVS (the Journal of the Association of Veterinary Students), which is sent out to students in all of the nine veterinary schools. More importantly, this meant I had joined the AVS committee, which has allowed me to gain an insight to the workings of veterinary education and the profession as a whole.

    The first full AVS meeting I attended at BVA headquarters in London was a bit overwhelming, but I soon realised how much capacity AVS has to reach out to students and implement changes in order to maximise the veterinary student experience.

    Since then, in addition to the annual congress and the infamous AVS sports weekend, the committee has accomplished many things, with just a few outlined below.

    The policy sub-committee announced the AVS Workforce Policy, which outlines the concerns over the impact of rising numbers of veterinary schools for the future of the profession. This has been viewed more than 2,000 times on the website and, ultimately, impacted on a national policy.

    The marketing sub-committee has been extremely successful this year too, especially with the new website and push on the committee’s part with social media, which has encouraged members to engage with AVS more than ever before.

    AVS equine rescue practical
    The equine rescue practical from AVS Congress 2015, held in Glasgow.

    A direct example of this is the RCVS consultation on the use of the courtesy title of “Dr” – while members of the BVA MSG (members services group) committee were indifferent or against the proposal, the AVS junior vice president, who was present at the meeting, was able to respond with evidence of the student opinion.

    AVS posted about the consultation on the website, Facebook and Twitter. The initial post was seen by more than 22,000 people, 1,719 of which followed the link to the RCVS website. AVS then carried out a quick poll, in which 290 people voted, and 281 of these were pro using the title. Hence, there was an overwhelmingly positive reaction to the consultation and the use of social media has widened the ability for AVS to engage with their members and accurately represent the veterinary student body.

    Another example is BVA’s stun before slaughter campaign, which AVS was involved in the initiation of when the reality of non-stun slaughter came into the public eye last March (following the ban of slaughter without stunning in Denmark).

    The stun before slaughter e-petition gained an immense amount of support, and has just passed the 100,000 signatures mark – the target required in order for the subject to be considered for parliamentary debate. AVS has been supporting and promoting the e-petition online and, as a result, many of those signatures have come from veterinary students.

    Our MSG (members services group) sub-committee has produced a preclinical EMS guide for first year students, which advises many things including what to expect on different types of placement and how to find placements. Having been produced and written by students, it is hoped that the guide will be relatable and useful to help support freshers embarking on EMS for the first time.

    AWF (Animal Welfare Foundation), the BVA’s charity, has been hosting talks and debates in each of the universities throughout the year, allowing students to engage with hot animal welfare topics.

    AVS tagline: represent, support, engageStudent welfare is also integral to the role of the welfare sub-committee. Just discussing different methods of promoting student welfare and support allows the AVS representatives to share ideas and take those back to their respective schools. As a result, Glasgow has followed in the footsteps of Liverpool and recently set up its own network of peer supporters within the vet school, who have had intensive training to allow them to be proficient in their roles.

    In one year, we have achieved so much, and yet there is so much potential for long term aims too, such as the production of an AVS app, consultations on EMS provision and involvement in the Vet Futures project run jointly by the BVA and RCVS.

    The AVS marketing sub-committee came up with a “tagline” for AVS: represent, support, engage – and after reviewing all we have done over the last year, you can see this accurately and concisely sums up what AVS stands for.

    Since I stood up and shakily gave my plea to become an editor, not only have I made great friends across all of the vet schools, but I have also felt part of a community that has the ability to really stand up and make a difference for our students; and I have not regretted it for one second.

  • Sterile pyogranulomatous cysts are worth bearing in mind

    Interdigital cyst
    An interdigital cyst in the paw of an English bull terrier – image by Nottingham Vet School (CC BY-NC-SA 2.0) via Flickr.

    I recently saw a very large, and very friendly bull mastiff that presented with what appeared to be typical interdigital cysts. These had been chronically recurrent and previous histopathology indicated a pyogranulomatous reaction.

    However his lesions responded poorly to three weeks’ of cephalexin antibiotic therapy and, in fact, he developed several lesions on his other feet.

    Cytology revealed mild bacterial colonisation, and it occurred to me this might be an immune-mediated reaction (his blood work and TSH/T4 were all within normal limits) – and, hey presto, we got a rapid clinical response to steroids.

    In spite of being under control he has also developed an acute erythematous otitis externa, so I think a food trial is my next line. Watch this space…

  • Ticarcillin as a treatment for Pseudomonas otitis

    Pseudomonas aeruginosa otitis externa
    Greenish purulent discharge accompanied by crusting, erythema and punctuate ulcerations in a crossbreed affected by Pseudomonas aeruginosa otitis externa, secondary to an adverse drug eruption. Image source: Veterinary Times 45.01 (Jan 6, 2014) – “Otitis: a diagnostic approach” by Filippo De Bellis.

    I suspect we have all come across that tricky Pseudomonas otitis case that just seem to refuse to completely respond to antibiotic therapy in spite of extensive investigation for underlying causes.

    I had just one such case recently that, in spite of culture and sensitivity, blood work, skin biopsy, extensive flushing, lack of response to licensed products (and so on), just refused to respond.

    A quick look through one of my trusty text books* suggested Ticarcillin.

    Ticarcillin potentiated with calvulanic acid (Timentin) is an extended spectrum penicillin that often has good activity against Pseudomonas. The 100mg/ml antibiotic solution can be applied directly to the ear canal as a drop.

    The case I’m treating has responded really well.

    * Reference: Hill, P.B. (2002) Small Animal Dermatology: a practical guide to the diagnosis and management of skin diseases in dogs and cats. Butterworth-Heinemann. London.

  • What makes a good vet?

    Supervet
    Vets aren’t superheroes… or are they?
    Original image ©iStock.com/VasjaKoman

    As a student on placement, I’m often in awe of the vets I’m working with. The ability to take a history, examine an animal, run through differentials and come up with a diagnosis or action plan within 10 minutes – all while listening to an owner commenting on the weather or traffic – seems superhuman.

    This may seem an exaggeration (after all, vets aren’t superheroes), but when considered like that, it is pretty impressive.

    While seemingly intangible at the moment, I know the ability to do this with such ease comes with practice – and clearly some presentations are far more complex than that.

    However, while I find this impressive, others have a different opinion…

    A family friend recently commented on their own vets, claiming they would avoid seeing the partners if possible because – in their opinion – they see an animal for five minutes and see it as a money making exercise, whereas the younger vets spend a bit more time with the clients.

    Obviously I can’t comment on the vet/client rapport, which may have a huge influence on this opinion, but I can’t help but think that a younger, newly qualified vet would spend more time during consultations purely due to experience, or lack thereof.

    It has become evident recently that the profession has an image problem and we must try to change that for the better. But what do the public consider as a “good vet”? Apparently the opinion differs depending which side of the table you’re on.

    This is just one example, but in general, do clients want the vet to spend more time with their animal? They probably do – but, at the same time, they don’t want to be kept waiting and they want to be able to get an appointment. There has to be a balance between the three.

    As for cost, I’ve seen some vets charge meticulously, whereas others would try and keep prices as low as possible to please customers. In the clients’ eyes, the cheaper the better. But a vet practice has to function. It’s no good offering neutering for £10 because the practice would be bankrupt within a week.

    House
    “The most highly qualified and experienced surgeon in the practice might not be the best at client communication,” claims Jordan.

    Surgical skills and experience are perhaps something that the client will never fully appreciate. For a start, the vet seen in the consultation room may not be the same one who performed the operation, particularly if it’s something fairly routine. Also, the most highly qualified and experienced surgeon in the practice might not be the best at client communication.

    A vet can have such a diverse set of skills and knowledge that it is difficult to pinpoint which of these defines a “good vet”. Many vets have certain areas of expertise and will be better than others in certain situations, but not all.

    The key to time and money is striking the balance between what the client desires and what is realistic.

    Communication, however, doesn’t need to be compromised and can be the difference that alters the client’s opinion. For example, the manner in which an examination is conducted and the attitude of the vet during a 10-minute consult could leave the client feeling rushed, whereas a different vet with a different approach could leave the client with a far more positive impression.

    Client opinion is important, but at the end of the day, the welfare of the animal in front of you is your priority, whether or not the client values you highly.

    While the profession as a whole should take heed of what clients want, the customer is not necessarily always right, and at the end of the day, it is the welfare of the animal in front of you that should be paramount.

  • Check out pad wounds thoroughly

    A veterinary nurse treats a paw wound on a large dog.
    A veterinary nurse treats a paw wound on a large dog. Image ©iStock/Mypurgatoryyears

    Last Saturday I had a “walk in” – a very cute spaniel that was limping slightly and had a cut pad. The owner thought she might have trodden on something.

    A good palpation didn’t seem to suggest the presence of any foreign body and the dog was very stoical. My previous experiences suggest any foreign material produces a lot of pain that is exacerbated by palpation – sometimes with dramatic effect!

    However, the insistence of the owner made me look closer and I could just see a glint of a firm object deeply embedded in the pad. A pair of rat toothed forceps later and I extracted a 5mm slither of glass from the pad.

    The result was a happy dog and owner, but oh – I could so easily have sent that poor dog away!

  • The power of reflective listening

    The power of reflective listening

    Image ©iStockPhoto/Slava Gutsko
    Image ©iStockPhoto/Slava Gutsko

    Vets are always taught, quite rightly, the power of effective history taking. The value of it is undeniable, particularly in certain disciplines, such as dermatology.

    However, over the years I’ve learned to clarify with owners exactly what they are saying. For example, I’ve found “he’s not eating” means quite different things to different people.

    The “so what I understand from what you are saying is that he hasn’t touched his food for a week?” question can sometimes produce an “oh no, it’s just he hasn’t eaten his Boneo/prawns/mixer (delete as appropriate) for the past few days”, or “she’s eating human food, but not her own food” is another common reply. So it’s always worthwhile just clarifying with owners what they mean – you might be surprised by the reply.