How do we care for pets ethically?

With Dr Christopher Neff, who didn't shy away from the hard questions about pet ownership. 

How do we look after pets ethically? It was a question I was asked by Dr Christopher Neff for the University of Sydney’s “Open for Discussion” series. 

It was a fascinating experience. Dr Neff, a lecturer in public policy, challenged me about whether its okay for people to keep pets at all. 

You can read a brief summary of the key points, and listen to the podcast here.

And here's another making-of shot!

Anne Fawcett being grilled by Dr Chris Neff.

Getting to zero in shelters, keeping pets cool, and an introduction to medical ethics

Better shelter management has improved the outlook for healthy kittens like these (happily rehomed). We can still do more.

The welfare of animals in shelters in Australia has improved by leaps and bounds since I graduated. The influx of animals, once overwhelming, is now being stemmed thanks to better shelter management, increased education of staff in animal welfare, behaviour and enrichment, an understanding and determination to be proactive about combating compassion fatigue and a groundswell of motivation to do something to prevent the destruction of healthy animals. There is still a way to go.

Getting to Zero is a model aimed at achieving ZERO killing of healthy or treatable cats and dogs – that more than 90 per cent of the intake of shelters. Every two years, G2Z hosts a conference, drawing on expertise from around the world.

This year I will be attending the Getting 2 Zero 2017conference. Save the date!

Meantime this has been an incredibly busy week. The current heatwave is playing havoc with companion animals. One of the most common things I’m seeing is late presentation of unwell animals, with owners reporting that they noticed their pet was a bit off colour, or perhaps less interested in food, but thought it was just the heat. It’s understandable – this heat is knocking everyone around, and causing behaviours like lethargy, panting, increased thirst and inappetence that are also seen with illness. But this is also problematic as it means that signs of illness are easily dismissed.

Undoubtedly its preaching to the converted, but please ensure pets have access to a cool environment and if you think they’re a bit off colour, best to get them checked out. More tips on keeping animals cool here. It looks like this hot weather is set to continue.

Finally, Dr Gwen Adshead, who treats people, gave a great lecture about medical ethics which raises some issues faced not only by doctors, but veterinarians. This article provides a beautiful summary of the key schools of thought in medical moral decision making. Read it here.

What do clients think of consent forms in veterinary practice?

Getting consent in veterinary practice can be tricky for a number of reasons. Cartoon by Aileen Devine, conceived by Anne Fawcett.

Have you ever signed a consent form? Do you read the fine print? Do you feel like you’re signing over your rights? What goes through the mind of veterinary clients when they sign a consent form? These are really important questions to ask, and UK veterinarians have done just that.

Martin Whiting and colleagues surveyed 470 clients from the Queen Mother Hospital for Animals about the consent process and the findings are surprising.

To backtrack slightly, informed consent in medicine is a concept that was developed to ensure that patients have autonomous choice, and to protect their interests. In veterinary medicine consent is never obtained from the patient (another can of worms that I’m working on a paper about at the moment), but 

from the owner/guardian or client.

It usually also includes agreement about expected costs.

When asked about signing consent forms, most clients recalled signing forms (records indicated that 100 per cent signed a consent form – this was an inclusion criteria for the study).

But the majority of these found the process disempowering – the opposite of what it’s meant to be.

More than half did not read the form – 60 per cent “trusted their veterinarian”.

Most (71 per cent) felt that the consent process explained the proposed procedure/procedures in a way they could understand, and 77 per cent felt they could understand potential risks. Yet 33 per cent felt frightened by the process.

Only 15 per cent felt in control of their choices. Half (51 per cent) did not feel in control, nor reassured (51 per cent) by the consenting process.

Almost half (45 per cent) believed that consenting removed their right to compensation for negligence, while 31 per cent felt the veterinarian could do something different from the agreed procedure anyway.  More than one third of clients did not realise that they could change their mind. And 7 per cent did not understand what the consent form meant.

These findings are interesting. It’s not known whether similar findings apply in a general practice setting – animals attending referral hospitals like the Queen Mother Hospital for Animals may be undergoing advanced, invasive or higher risk procedures. The authors indicate that they may undertake further studies to determine if this is the case.

What can be done?

The study found that it wasn’t about time – 96 per cent of clients were satisfied with the amount of time offered to consider a procedure before consenting.

But better communication may be helpful. For example, some people dismissed the form as a standard agreement and therefore didn’t read it, others were too worried to read the form (suggesting scope to address further concerns), and some just preferred to listen to the vet’s explanation. The study found that clients want to hear about a few treatment options, risks of procedures and treatment, prognosis and an estimate of fees. They want the opportunity to ask questions about the treatment, and they want to be talked through the aftercare.

From a client’s point of view, what might help the process? Asking for more time to consider a process if needed, getting a second opinion (not always possible in the case of emergencies but possible for some procedures), and telling the vet what you are most concerned about (is it the anaesthetic? Is it the procedure itself? Do you feel that there’s something else you would like the vet to look at before proceeding? Is it the recovery or post-operative care?). As a consumer of health care services (including veterinary services) myself, I want to know as much about potential risks and benefits that the vet can impart, and I seek out a clinician who seems to genuinely care.

As the authors suggest, perhaps we also need two different consent forms – one regarding a fee estimate, and another regarding procedures. By combining the two, some clients may feel that the consent form is simply an instrument that the hospital uses to ensure it gets paid, i.e. to protect its own interests. By signing two different forms, it may be clearer that consent to procedures is about ensuring informed consent and protecting the interests of the client/patient. Of course, additional forms increase administrative load and may not be favourably perceived by clients.

It would be really interesting to find out and compare vet’s perceptions of the consent process.

You can read the paper here. 

Reference

Whiting M, Alexander A, Habiba M & Volk HA (2017) Survey of veterinary clients’ perceptions of informed consent at a referral hospital. Veterinary Record January 7, doi 10.1136/vr104039

Where do your views on animal welfare and ethics sit?

Is it acceptable to hunt? Is it acceptable to hunt using other animals? A scene painted on tiles at the Cascais Town Hall.

Do you have a position on animal welfare and ethics? One tool designed to help you find out is the Animal Ethics Dilemma online learning tool, which is open to everyone.

You just need to set up an account by visiting here. Once this is done, you will be asked to answer twelve multiple choice questions. These are designed to determine to what extent your views on ethics reflect a utilitarian, animal rights, respect for nature, contractarian or relational perspective. It’s quite an interesting exercise – you may find yourself taking a strong utilitarian approach in one scenario while a strong rights approach in another. This is because most of us use a combination of approaches to dealing with ethical issues.You are then presented with results (your profile) indicating what proportion of your position falls where.

Santa's Little Helper, the pet greyhound from the Simpsons, sand modelled at Cascais.

Of course this is just a rough guide. With MCQs there is always the risk that your view is not represented in the five options, so you have to chose something that is close enough. 

SAT has moved its HQ to Cascais in Portugal to attend the European College of Animal Welfare and Behaviour Medicine’s annual conference. Our group has undertaken the exercise together and discussed how it might be used in teaching, including whether it would be helpful for Faculty to wear a badge indicating their profile so students can understand where differences of opinion might come from. Would such a tool be useful for communicating with clients? Many disagreements occur because we are coming from very different ethical perspectives, but in the main we’re not great at articulating these. So we don’t always understand why we disagree or the nature of that disagreement. This is a topic that will be revisited through the week. So what do YOU think? Does it help to know where someone is coming from? How do you communicate about ethics and welfare - do you refer explicitly to theory?

Animals feature in many of the scenes.

(For those interested in travel, Cascais is a mere train ride from Lisbon, and was the scene of some of the filming for the James Bond movie On Her Majesty’s Secret Service (1969) starring Australian George Lazenby as James Bond. It is famous for stunning hand-painted tiles and thus far (n = not many and only the ones I’ve seen in the street) the companion animals of choice her seem to be golden retrievers and chihuahuas).

It's Portugese for "entry only for dogs on a lead."

Why do some conservationists eat swordfish, and why the world needs small changes

I found this pasted on the back of a veterinary hospital door.

“I know excellent biologists who spend much of their professional lives condemning unsustainable fisheries or reporting high levels of toxic contaminants in marine megafauna, yet when eating at a restaurant they order swordfish or tuna from overfished and declining stocks.” – GiovanniBearzi.

If you want to experience a bit of a brain shake-up, there’s a two page editorial by Italian conservationist Giovanni Bearzi that will do the trick. The essay, though aimed at conservationists, is relevant to just about everyone. We all do it – we support causes like cleaning up the ocean or improving the welfare of animals, we’re happy to debate and petition, but we consistently overlook the impact of our private behaviour. As Bearzi writes,

“We think of ourselves as professionals who are aware of environmental problems and work hard to solve them, but we pay little heed to what we do, buy, and consume.”

I’ve attended animal welfare conferences dedicated to discussion of how the raising and slaughter of animals for food can be humane. To date, not one of those conferences has aligned its menu with its concerns. Caterers are given free reign to source animal products, with costs the key consideration, when it would be more appropriate to adjust the menu, either sourcing humane animal products or plant-based alternatives.

And at home, convenience, time and finances dictate when and where we shop, and what we buy, much more than considerations of major problems like environmental degradation, unsustainable fishing and poor animal welfare practices.

Why don’t we make the effort? Couldn't wanting to be good be good enough? Isn't it better than nothing that conservationists spend their working week doing something good? That vets spend our working weeks doing good things for animals? Maybe. But if everyone thinks that way, what will change?

According to Bearzi, there are a couple of factors (and I’m paraphrasing here) that most of us don't align our living with our values.

• We want our Governments to take care of the hard stuff, like the environment and ethics. We’re busy getting on with our lives! Problem with this approach: Governments won’t unless they have evidence that this is what people want.
• Working out what products we should buy and which we should avoid is time consuming, hard and inconvenient. Problem with this approach: companies that sell products which have a negative impact continue to make money and continue to do what they’re doing. Consumer laziness/apathy/procrastination etc. are their win.
• Lack of role modelling. We tend to model our behaviour on those around us. Problem with this approach: what we say (save the environment) and what we do (drive a fuel-guzzling car to work when we can walk 20 minutes) is often different and sends a message to all around us. It’s basically saying, “don’t worry, that stuff isn’t as important as my convenience”. As Bearzi writes, “If my beloved science professor comes to campus riding a bike, I might admire his example and possibly even reconsider buying that sporty coupe.”
• We love our comforts. We’re happy to blame others and call for them to be more virtuous, but we don’t alter our own behaviour. Bearzi writes, “it is striking to see how many people committed to conservation have not abandoned a single consumptive pattern, despite the eco-drama before our eyes.” Problem with this approach: no one changes, they just keep telling everyone else to change first. Everyone else thinks, “hey, would should I change? You’re still doing x,y and z – you can’t point a finger at me.”
• Criticising consumption is taboo. If you want to see defensive behaviour, try benignly questioning someone’s eating habits. Actually, don’t. The reactions are generally emotive, angry and unpleasant. The other night someone found out I had transitioned to a vegan diet (from a comment someone made), then started on a ten minute, increasingly emotive monologue on how they cared and didn’t eat fish but they didn’t want to stop eating beef and mostly this was okay and how dare I threaten the beef industry (I hadn’t said a word about any animal industry), before storming out. For all she knew, I might be vegan because of dietary intolerances. Consumption is taboo because its private, it’s about our comfort, our habits, we see it as a RIGHT. Problem with this approach: actually, it’s all of our consumptive patterns that add up to a huge problem and we need to have the guts to question them. Our habits and our private behaviour indirectly impact others. Take food security. We’re worrying about it because no single person’s appetite is an issue, but on a big scale, if we don’t change patterns of consumption, this will be the biggest crisis we face in the next few years (that and the fact that the impact of Western diets will kill our health system).
• It’s too hard. Even the laptop I’m typing on has likely been produced at high environmental and human (cheap labour) cost. Problem with this approach: it can lead to apathy, and failure to do anything at all. But knowledge is power. Knowledge about how laptops are made should impact my future choices. Knowledge about conservation, sustainability and animal welfare should inform our choices as much as possible.

Bearzi and others argue for a need for more accountability in conservation science – for some requirement to practice what one preaches. He also acknowledges that no one can be perfect.

Ultimately, Bearzi’s is a message of hope. Waiting for Governments, or big organisations, or someone else, to solve big problems is a flawed approach. We need to focus on how, as individuals, we can effect change, because that is the only way we can make a difference.

Can money buy love?

Cook Islands currency. This story didn't unfold in the Cook Islands but their money is certainly stunning.

We stumbled across this news piece and were floored. Does love have a price? We may be showing our age here but back in 1993 there was a film starring Robert Redford and Demi Moore called Indecent Proposal. Remember that one? Some rich dude offers a couple a million dollars for a romantic night with his wife. It’s an interesting if uncommon ethical dilemma. They take a utilitarian approach, weigh up the costs and benefits, think they can hack any negative consequences and off they go. Of course it turns out that life is a bit more complicated than that (and as every ethicist knows, one downside of a utilitarian approach is that we can be awfully wrong when it comes to predicting consequences).

So what if a wealthy person turned up to your open house and offered you $140,000 for your cat? They’ve just paid over 2 million for the house, you may not be in need, but $140,000 might be nice, right?

One family thought so. The thing about this story is that the cat wasn't for sale. But, knowing that "everything has a price", the buyer of their house offered them another 140K in exchange for their family cat Tiffany. They decided to take the cash and leave the cat. Their 19-year-old son wasn’t too pleased. After all, he bought the cat himself.

But in the Sun Herald article mum justifies the decision thus:

“We’re thinking we’ll put $20,000 in a pile next to the cat and say to Sam: you choose.”

Interesting. Is this family selling the right values to their son? What about the family who purchased the cat for their child - will that child grow up thinking love can be bought? And what about Tiffany's say in this matter? I'm gathering she's not getting a commission.

What if this were not a middle class family but a family in need of money to pay for live-saving medical treatment?

My hope is that Tiffany is happy to stay in her home with her new owners.

If a mystery buyer or indeed Robert Redford strolled into your life, what would you do? (And, Sam well may ask, “what about the other $120K?)

Education and animal welfare, and Ag-Gag laws

Conference delegates recieved a goodie bag containing, among other things, an International Fund for Animal Welfare (IFAW) plush dog. Pox the chihuahua raided my goodie bag and had a very exciting morning!!!

We’re back from steaming, hot (33 degrees C) Darwin back to Sydney (15 degrees on the tarmac) and inspired after the AMRRIC conference. The theme running through yesterday’s talks was education.

You can have the best dog management program in the world, you can aim to vaccinate hundreds of dogs or desex thousands – but if you don’t convey the reasons you are doing so, the program will fall flat.

For example, Dr Ganga de Silva from the Blue Paw Trust in Sri Lanka explained that when they designed their Colombo rabies vaccination program, many locals knew rabies was fatal – but had no idea it was preventable. This lack of knowledge itself can be fatal – people bitten by rabid dogs might not know how to treat a wound, where to seek help, what to do. Locals are more likely to participate in the dog program if they appreciate that vaccination of dogs will reduce the spread of rabies.

AMRRIC organisers and delegates with Dr De Silva (second from right).

Most dog programs now incorporate school talks, but the Blue Paw Trust also used street dramas and public multimedia displays to get the message out. Dr de Silva talked about the pros of cons of each of these methods and potential improvements for future programs.

Dr Frank Ascione, from the University of Denver, talked about the societal response to the link between animal abuse and domestic or intimate partner violence. This was a really positive talk – many organisations had developed resources to prevent families being separated from their pets in the time of most need. A number of women’s shelters had also incorporated areas where pets could be kept so they too can be protected from perpetrators of violence. As he pointed out, it’s nice to see messages from the number-crunchers in the ivory tower filter down and change practice in the real world.

Dr Debbie Marriot, Senior Specialist in Clinical Microbiology and Infectious Diseases at St Vincent’s Hospital in Sydney, gave a fantastic presentation on potential zoonoses and did much to allay fears about “germs” from animals. She knows a thing or two about dogs, co-habiting with four.

She talked especially about dog bites, which constitute a big public health problem right across Australia – approximately 2% of the population is bitten annually by something (human or animal – yep, humans bite too), and around 80% of these are bitten by dogs. Bite wounds cause damage in two ways as they are a combination of a penetrating wound plus blunt trauma, and she talked about how the blunt trauma may be implicated in severe, fatal bites to the head and neck.

Ultimately, companion animals should not be feared – zoonotic transmission of host-adapted pathogens is uncommon, although we need to respect that domestic animals could be potential reservoirs of these organisms.

It was a fantastic, stimulating, motivating and wonderful conference.

In news from around the web, this story (click here) raises a number of concerns about the treatment of animals by a group of police officers in Canberra.

In this instance incriminating footage sparked an investigation which will, we hope, improve the attitude of these police towards animals. But what if we didn’t have video evidence?

The event would not have been investigated. This brings us to the so-called Ag-Gag laws. The laws have been designed to protect farmers against activists.

This is a tricky issue. On the one hand there is the right for farmers to privacy, free enterprise etc. But on the other, it is only because of people taking footage of animal welfare abuse that this is known about. The victims cannot speak or testify.

Ag-gag laws criminalise covert surveillance of commercial animal enterprise, and require all footage to be handed over to enforcement authorities. Animal welfare groups, however, claim that authorities rarely act – whereas when the media airs the footage it allows the public to respond.

But they also require potential employees of commercial animal facilities to disclose current or past ties to animal protection groups. This, argue some, is important in ensuring that employees are on the same page as employers. But animal welfare groups say this is a gross invasion of privacy. Two people, for example, may be members of an animal activist organisation. One may be very active in the organisation, the other may simply pay a membership fee and bin the newsletters. Regardless, do employers have a right to discriminate against potential employees based on their association?

Voiceless is one organisation that has been campaigning against Ag-gag legislation and you can read more about it by clicking here. If you have an interest in ethics or law this is particularly fascinating stuff.

The proposed legislation was defeated in South Australia.

According to Voiceless:

"SA legislators have voted against the Surveillance Devices Bill, which sought to criminalise the public release of information collected through the use of surveillance devices, including a maximum penalty of $75,000 for a corporation and $15,000 or imprisonment for three years for individuals.

This Bill would have had a significant impact on how the media reports on matters of public interest, including the treatment of animals in factory farms. Its tabling attracted fierce opposition from media outlets, workers’ unions and animal protection groups who use such footage to expose cruelty within Australia’s animal industries.

Thankfully on this occasion, cooler heads have prevailed and the Bill was defeated. This is a win for consumer advocacy, workers’ rights, freedom of the press and, of course, animal protection." 

Pharmaceutical philosophy, discount conference registration, free online forensics course and a giveaway!

Some dogs I met during an AMRRIC program in Central Australia. The early-bird registration deadline for the AMRRIC conference has been extended til August 18 (see below).

How was your weekend? I joined a fellow ethics-academic for a night out watching a play all about neuroscience and ethics. The Effect, currentlyshowing at the Sydney Theatre Company, isn’t about veterinary topics but it is related in the sense that it tackles some big questions about science, research and knowledge.

Connie, a psychology student, and Tristan, a serial drug-trial participant, enrol in a trial for a new antidepressant. They’re isolated from the real world and develop feelings for each other – but the feelings grow as the dosages escalate, raising some big questions: are these feelings real? What is real infatuation/love/lust anyway? Does it matter if it is real or not?

Meanwhile the psychiatrists in charge face their own ethical questions. Is the study really blinded? Should it be? What is a reasonable risk to expose the subjects to? Is there a difference between risks in a controlled environment versus in real life? What are the consequences of pharmaceutical intervention for conditions of the mind and can these be justified? And is the history of medicine really just a history of placebos?

It may have been observational bias but my impression was that the audience were almost entirely made up of psychiatrists and doctors. 

The play runs until August 16 so you don’t have long to catch it, but you can read a review here and another here. It is the kind of play that makes you think long and hard about some huge ethical issues.

We would love to see the playwright Lucy Prebble tackle the issue of anthropomorphism in science.

Dog health in indigenous communities – discount rate for conference

Veterinarians, veterinary students, nurses, environmental health workers, infectious disease physicians and researchers and anyone with an interest in dog health in indigenous communities may be interested in the AMRRIC 10th anniversaryconference.

The early-bird registration rate has been extended until August 18.

This three-day conference in Darwin, from September 23-25, will cover a range of really important topics include:

• Animal health and welfare in remote/developing community contexts
• Zoonoses
• Rabies
• School and community education and awareness
• Cultural awareness
• Dog behaviour
• Community social aspects of animal ownership
• Environmental health
• The link between interpersonal violence and violence towards animals
• Invasive animals, National Parks and indigenous communities

To register or find out more, click here.

Free online course on Forensic Science

I knew that doing a MOOC on Coursera would suck me in. I found the Animal Welfare and Behaviour Course quite interesting, and just on the eve of completion those clever Coursera people sent an email recommending other recommended courses, including this introduction to forensic science.

Tempting as it is, we’ve committed to Pauleen Bennett’s course on Animal Welfare, but if you have the time and interest in forensic science sign up here.

SAT Giveaway - open til August 21

Finally, if you’ve not heard, SAT is running its second awesome giveaway. To find out how to enter, click here.

Cognitive enhancement: is this something the vet profession needs?

One surefire way I could enhance my academic performance would be to somehow prevent Hero from sitting on and eating my notes.

Have you ever had to have three, four, five, even six coffees to stay awake to cram for exams? Or maybe get through a late night exploratory surgery? I always thought of performance enhancing drugs as something that only high-level athletes indulged in, but in fact they are used by desk jockeys, students, veterinarians, surgeons, concert pianists and people in just about any field.

You might think you’re taking that No-Doz out of choice, but use of these kinds of drugs to facilitate work output is quietly becoming the norm. One pill to stay awake won’t hurt, will it? Think about it: if everyone did this all the time, it would become the new norm. Suddenly, the decision not to take these may not be a choice.

Take study for example. There are plenty of reports of people using drugs like Ritalin to enhance their concentration. And have you heard about people using beta-blockers to get over stage fright when defending their PhD? But Drs Nicole Vincent and Emma Jane reckon that taking smart drugs, or cognitive enhancement, is ethically risky business.

Check out their argument in The Conversation here. (Here's one of my favourite quotes below).

Advances in science and technology subtly shape our lives by gradually, and often imperceptibly, changing the moral, legal and social landscape. What we expect of ourselves and of one another also changes with the times. It changes with what we think people are capable of doing and what we think is reasonable to expect people to be capable of doing.

You can also view Dr Vincent’s Ted Presentation here.

If you don’t like the idea of an employer or indeed colleagues expecting an artificially enhanced you – to the point that you can’t fulfil your duties adequately without some form of cognitive enhancement - then it’s worth considering whether you indulge in any enhancers at all. We're already connected to employers and colleagues 24/7 via ever-present smartphones. Do we really want them, in some sense, inside us?

BTW, if you’re currently studying and stuck for study tips, check out this post on exam study tips;  or this post on how to study in vet school.

What's best practice? Insights from the AVA conference, days 3&4

Another pic of the brush-tail bettong at the conference...just because its a whole lot cuter than photos of people speaking behind lecterns. 

Blogging a five-day conference turns out to be a huge challenge when you are attending it at the same time. So we’ve been a little slow – mostly because we’ve been busy attending every possible breakfast session, lunchtime lecture, plenary, special-interest-group dinner and mini-lecture possible. And still we missed a few! (There were eight concurrent streams and over 200 sessions to choose from during the week).

For me there were two stand-out sessions in the last two days that I’d like to single out.

Martin Whiting discussed business and veterinary clinical autonomy. He noted, particularly with reference to the UK but it is also happening in Australia, the growth of veterinary practice franchises or chains. There are of course big benefits of standardising veterinary care – centralised services, bulk-buying and cost-savings for clients, sharing of high-value, short-life products such as blood products between practices, standardised employee training and education, centralised after hours services, better working conditions and so forth.

But there are some very clear disadvantages, depending on the way these are run. What happens when you are treating a patient and the standard operating protocol dictates that you need to work it up in a particular way and you disagree? What if bulk purchased medicines or foods are not the optimal treatment in a particular case? Some practices incentivise vets to sell particular products, or force veterinarians to refer to a particular service. Many pay on a commission-basis or give bonuses for invoicing over certain thresholds. These business practices have serious consequences for vets and patients.

Commission-based remuneration in health care can lead to abuse and generate distrust between the client and clinician. Clients may be unsure if the recommendation is being made for commercial reasons or in the best interests of their pet. Individual veterinarians must always abide by the professional code of conduct, which trumps private practice policy in the event of a disciplinary hearing. Dr Whiting made some excellent observations and the presentation generated a lot of discussion. This potential conflict between practice protocols and clinical autonomy has huge ethical implications and is something that the profession needs to address.

Dr Ilana Mendels from VetPrac won a prize for visiting the AVA's Wellness Stand. Ilana is always well coordinated but note that her glasses, lanyard and shirt are totally coordinated with the prize. Seriously, do us mere mortals stand a chance?

Meantime when it comes to communicating costs in veterinary care, Ontario Veterinary College’s AssociateProfessor Jason Coe had some fascinating data to share. A lot of veterinarians feel awkward talking about money. Some perceived it made them look like they were money-focused, some felt that their job was just to worry about the animal and let reception discuss costs with clients. Dr Coe has done some great work. The upshot is that upfront communication about costs improves clinical outcomes.

When he asked how many vets enjoyed talking to clients about money, 45 per cent disagreed and 28 per cent strongly disagreed. That’s a pretty clear majority.

But time and again, studies have shown that client satisfaction is increased when the client understands the costs involved and why these are incurred.

Vets get a bit defensive. In a study Dr Coe ran, he found that vets often justified costs in terms of their investment in time, overheads, the skillset required etc.

What the clients wanted to know was what the costs meant in terms of their pet. For example, this operation will give Rusty X chance of cure or 6 months additional survival, relieve pain and allow you to manage him without medication…etc. The time taken, the equipment needed etc. weren’t so relevant.

Veterinarians said they felt undervalued or guilty when talking about money which made them a bit gun shy. But pet owners felt that a failure to discuss costs upfront could lead to clients being over-extended financially. One point of discussion was the client who comes in and says “costs are irrelevant”.

This actually means different things to different people and often these clients challenge the bill when they finally see it. So it is important to discuss costs even if the client says that costs do not matter. Knowing what to expect does matter.

In one overseas study, almost 50 per cent of veterinary clients left the consult room without an idea of what costs they would be up for. In another study by Coe, Adams and Bonnett (JAVMA 2009 234:1418-1424) of 200 veterinary consults, only 29 per cent of visits included a discussion of costs, and 25 per cent of vets never initiated cost discussions.

Dr Coe discussed the different ways that veterinarians might initiate cost discussions in an emotionally charged environment. The use of empathy ranked very highly. Interestingly in an Australian study by McArthur and Fitzgerald AVJ 2013:91:374-380), veterinarians expressed empathy in only 41 per cent of consults – and 73 per cent of those occasions involved directing empathy at the animal. Which is fine – except only the empathy statements directed at the client had any impact on client satisfaction.

Dr Coe talked about the use of partnership statements and “I wish…” statements to express our concerns in a way that is meaningful to clients (for further info see Hardee, Platt & Kasper J Gen Intern Med 2005, 20:666-669). You can think empathic and helpful thoughts all you like, but if you don’t express these to the client they won’t have an impact on client satisfaction. 

And client satisfaction is a variable that has a huge impact on client uptake of recommendations and therefore clinical outcomes. We know why we are making a recommendation, but as a profession we need to improve our communication. The client wants to know why we are making this recommendation to Phil, or Rory, or Cliff (insert favourite pet name here).

However you feel about money, Dr Coe’s data showed overwhelmingly that upfront discussions about costs were helpful to clients, allowed them to plan better and improved their relationship with the veterinary team. 

Date with your dog: a cat and some philosophy

You know its getting colder when your multi-species household puts differences aside and relocates to your lap (astute observers will note the woeful count on my pedometer...aiming for 10K steps a day but last night it was either a walk in the cold or sitting under a pile of animals. What would YOU choose???).

Here's a question for you which probably seems like it has nothing to do with anything remotely vetty. A tram is careering out of control. In its path are five workers. On a track to the right is one loner. You're the driver of the tram. Do you run over the five, or change course and sacrifice the individual? How about, instead of being the driver, you are the controller. By flicking a switch you can change the course of the tram so that it mows done the loner but spares the group. Does your answer change? What if you are watching this all from a bridge. You can save the workers by throwing a heavy object in front of the tram. You happen to be standing beside a very fat man. Do you throw him off the bridge?

Sounds like a silly situation, but it the tram or trolley problem was posed in the 1960s by British Philosopher Philippa Foot and debate rages on about the appropriate course of action. If you want to read a fantastically entertaining, light book which introduces major ethical theory painlessly, I recommend Thomas Cathcart's The Trolley Problem Or Would You Throw the Fat Guy Off the Bridge?.

I'm giving lectures on veterinary ethics at the moment, and this book gives a very nice intro to theories like utilitarianism and deontology, and also covers major issues like moral intuition, evidence, psychological and emotional factors in decison making and even the impact of gender. All bundled into a crazy thought experiment. Despite the fact that I try to read as much philosophy as I can (for a vet), I learned quite a few things on the way.

AND I can now say that one can read it comfortably in a sitting whilst performing the role of a human hot water bottle for one sizeable cat and one small dog (just expect your lower limbs to be asleep when you're finished). 

What would you do about the trolley problem and why?

Is your animal welfare account in the black?

Hundreds of thousands of native animals (like this joey's mother) are killed by cars every year on Australian roads. Should all motorists be paying a small annual fee to fund the care of injured and orphaned animals?

In his recent book, AnimalWelfare in Veterinary Practice, James Yeates uses the metaphor of an animal welfare account.

“Every person in the world has a direct effect on animal welfare. How they treat animals they own or meet; what food and clothes they buy; which charities they give money to; what they enjoy as entertainment and their environmental impact can have an effect on the lives of many animals.

Each person probably effects a combination of harm and benefit (even the kindest people do some harm and even the most evil people may help animals by accident and has an overall impact on animals’ welfare. Each person has an animal welfare account, based on all their welfare impacts. If a person does more good than harm, this is to their credit. (Yeates, 2013, p1)

This is a great concept as it recognises that every intervention – no matter the intent – has an impact, but it also suggests that we can mitigate harm by taking steps to impact animals in a positive fashion. i.e. making a deposit into the animal welfare account. Kind of like paying for carbon off-setting when you purchase an airfare.

According to Yeates, veterinarians must be particularly mindful of their animal welfare accounts because, while we have the same general responsibilities and obligations to animals as everyone else, we have (by virtue of our proximity to animals, our ability to intervene when health problems arise etc) more opportunity to cause greater harm and fewer excuses because of our greater knowledge.

So how do we offset our negative welfare impacts? In his book, Yeates provides some great suggestions:

1)   Develop the skills to accurately assess the welfare of animals (so that we can recognise when there is a deficit and correct it)
2)   Engage in reflective practice: be aware of our strengths and weaknesses and work on these
3)   Consider the bigger picture: we can think of imaginative ways of welfare-offsetting
4)   Get involved with our professional bodies such as the AVA as well as organisations that promote animal welfare
5)   Give pro-bono time, money or fundraising efforts to welfare or charities
6)   Make good consumer choices when shopping or eating out – “embody the welfare standards we want others to emulate

I would love to hear ideas from others. Do you agree that vets have a greater responsibility when it comes to animal welfare? How do we offset harms?