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So, after months of speculation, the Panorama documentary: It shouldn't happen at a vets' finally aired last night. Early reaction from most of the profession seems to be one of mild relief that by focussing so heavily on Medivet, the documentary has left everyone else more or less unscathed.
There's also a great deal of sympathy for those hard-working and professional vets and nurses who work at Medivet. They're the biggest losers in all of this, tarred by the indefensible behaviour of a very small number of colleagues, and by the very nature of most of the filming in the documentary (give me a fish-eye lapel camera, and I could make even Mother Theresa look like a crack dealer).
But can everyone else really sit back, think 'not my problem', 'sensationalist rubbish', or 'it'll blow over in a week' and move on?
If you consider only the more headline-grabbing elements of the documentary, any of those would be a reasonable position to take. But look beyond 'Vet Makes Fraudulent Insurance Claim', and it seems the producers might accidentally have hit upon some big challenges facing the profession. Might now be a good moment to reflect on and debate some of these issues?
The first story covered by the documentary was that of an owner who'd found their cat 'weeing blood', taken it to Medivet and been quoted £815.05 for a bank of tests. They'd left in disgust, and visited another practice. This one gave a diagnosis without tests, the bill for which came to 75 quid, including £28 worth of food.
Veterinary costs were a recurring theme throughout the documentary. At the start, Jeremy Vine pointed out the £20,000 lifetime cost of owning a dog, and the £15,000 cost of owning a cat. He said vet bills have trebled in a decade. Mid-way through the programme, the voice-over read: "Veterinary medicine is increasingly high tech, and increasingly expensive. The new generation of vets is taught that working up to an accurate diagnosis may involve extensive tests. More veterinary work means more costs. And later in the documentary, Alex Lee, the reporter, was said to have found evidence of two clients that had spent over £100,000 on their pets over a ten year period.
At the end of it all, the real issue is not about the disparity between one vet's bill and another's, but whether the profession is becoming over-qualified or over-equipped for the job, and consequently at risk of pricing itself out of the market.
Commenting on state-of-the-art care, Professor Innes from the University of Liverpool said in the programme: "We would never push clients into procedures that are unnecessary, but if people want to access the best healthcare for their pet, that's up to them."
Surely every pet owner wants to access the best healthcare for their pet? Of course, Professor Innes is right, there is a market for complex procedures and diagnostic tests. But there's a very fine line between 'pushing' a client into a procedure, and recommending a procedure (to someone who feels emotionally duty-bound to do the best for their cherished pet).
For me, it was ironically one of the Medivet staff who seemed to hit the nail on the head when she said: "The 'Medivet Way' is to work it up to find out why straight away, so... And people can't afford it now really, you know."
Is the word 'Medivet' in her quote interchangeable with a growing list of practices? Does something need to give? Is it time to call a halt to the development of increasingly complex procedures and diagnostic tests developed to save the life of what is, after all, just a cat or a dog?
Or is it a question of veterinary surgeons ceasing to recommend any particular treatment above a certain cost, and instead simply laying out the options available to the client: "Mrs Jones, you've got three options here. Option one is my best guess, and I might be wrong. Option two is my best guess plus these tests, which will help confirm whether I am right and will cost x. Option three is referral to the world's leading expert, who is based in Dallas, but that'll give time for the MRI on board the specially chartered 747". I'm being flippant, but my point is a serious one: as more expensive treatment and diagnostic options become available, so it becomes ever riskier recommending them, rather than simply informing the owner of their choices.
The next story was an important one too. It was the one where a student nurse and the unqualified reporter were tasked with catheterising a dog unsupervised. They struggled. As did the dog. Thanks to the hidden camera, and the reporter interjecting: 'What a nightmare', it made for dramatic TV. But as many have commented in the VetSurgeon forums, a difficult to catheterise dog is not exactly out of the ordinary. And who thinks this was the first time the procedure has been done by lay staff?
More interesting was the polar opposite interpretations of the law on this issue expressed by Medivet on the one hand, and Professor Sandy Trees for the RCVS on the other. In response to the question of whether a trainee should be placing a catheter, Jeremy Vine read from a statement in which Medivet insisted that everything it allows its trainees to do is legal, and that there was no definitive list of procedures that could be carried out by trainees. Two minutes later, and we had Professor Trees appearing to contradict Medivet's statement.
Then we see the reporter and a student nurse taking a blood sample from a cat, before the arrival of a vet. Medivet says: "This procedure was completely legal, normal and was carried out at the direction of a vet. This means that the vet does not have to be present at the time. [The tasks] were not illegal. The trainee veterinary nurses were properly trained and experienced. RCVS inspectors have never raised this as an issue, and it is common practice." But when Jeremy Vine then asked Professor Trees: "Would it be OK for a student veterinary nurse to take a blood sample before a vet arrived into the practice", the answer is no. When pressed: "So supervision means that the vet has to be in the building", Professor Trees hesitates before delivering his more ambiguous reply: 'I would say so, yes'.
How on earth did that happen? How did one of the biggest veterinary groups come to be at loggerheads with the regulator on TV? Remember that Medivet would have had some time to prepare its response, and presumably had it checked by a team of lawyers first. Professor Trees may or may not have had the luxury of as much warning. Still, if el Presidente himself cannot give more than a personal opinion in answer to such an important question, something is amiss. After all, people's careers are at stake here.
The issue here is whether regulation needs to become more prescriptive. For example, is it fair that the responsibility for defining precisely what is 'minor surgery (not involving entry into a body cavity)', and therefore able to be performed by a qualified veterinary nurse, currently rests with the individual veterinary surgeon. And if it comes to it, the only way the veterinary surgeon is going to know whether he or she made the right call is if and when it comes to be tested in court.
Talk about closing the stable door after the horse has bolted.
Surely it is time now, particularly in the (like it or not) increasingly corporate and less personally accountable world we live in, for the profession and everyone in it to have clearer leadership in terms of what is and what is not acceptable.
I won't dwell on any of the other stories covered by the documentary, because I don't think any of them are individually revealing of very much.
A student nurse struck a dog. 'Walloped' according to the reporter; 'smacked' according to an onlooker. There's a difference. Either way, a difficult one to defend.
Then a member of staff (and I couldn't work out whether it was the vet or the nursing assistant) started playing with an anaesthetised kitten as if it were a puppet. That was damning for the lack of humanity it showed.
Next we saw a new grad trying to intubate a cat. For some reason, it didn't go as smoothly as it should. Some speculation in the VetSurgeon forums as to whether she applied the local anaesthetic correctly or not, but the cat was fine. Mistakes happen.
Next we saw a dog that had a condition which made it susceptible to cuts. A 'new girl' says she thinks she must have accidentally cut its pad as she closed the kennel door. Not the end of the world, except we then see the staff plotting to tell the owner that it happened before the dog arrived at the practice, and that they would need £13 worth of Fuciderm. Again, it isn't what you would call the crime of the century. But it was nevertheless a damning piece of film for the lack of honesty shown by the staff.
Then we had the case of the dodgy insurance claims, where the practice allegedly split what should have been one claim into three 'by accident', so that they could effectively increase the total amount the owner would be able to claim. Difficult to get really het up about this one. I mean, I know it's wrong. But it wasn't exactly in the same league as Lord Brocket taking the oxyacetylene torch to his car collection. And as far as I could see, the unwitting beneficiaries of this one were the dog and its owner. No, the real problem was that in the same breath as Medivet proclaimed its innocence, its employee was there in technicolor explaining exactly how and why the deed was done.
Guy Carter, one of the Medivet partners was next on the rack. The Panorama reporter alleged that he instructed staff to bill a client for a monitor that wasn't used. The company says it was. So it's their word against hers. Unfortunately, the company's word wasn't looking that good by this stage in the proceedings.
As I said earlier, these things don't individually tell anyone much. But collectively, I wonder whether they don't highlight another important issue, which is the apparent 'disconnect' (hate using the word like that, just can't think of a better alternative at this time of night) between what the public wants (i.e. a close, trusting relationship with an accountable James Herriot-type-figure, personified in the film by Bob Stevenson), and what the corporates can realistically deliver.
I was chatting about this with a locum vet this afternoon. His experience is that in small practices where the owner is present, there is always a better atmosphere. Staff take more pride in their work, and deliver a higher standard of care than in the corporates.
Isn't that really what the documentary showed? Yes, they were especially excruciating examples of how people behave when they don't have a real sense of ownership in a business. But isn't a lower, less personal standard of care an inevitable consequence of corporatisation?
Incidentally, my apologies for labelling Medivet a corporate rather than a partnership, but like it or not, that's the public perception of a chain.
Finally, the star of the show made his grand entrance. Kfir Segev, charged with recommending £2200 worth of MRI scan for a dog that was obviously dying. Now that is despicable. He's found guilty of unprofessional conduct, and struck off. I suppose 'vet commits fraud, is found out and punished' is not the stuff of which great documentaries are made, so Panorama tried to make something of the fact that he continued to work for 28 days whilst deciding whether to exercise his right to appeal. And? Perhaps sensing they still had a bit of a non-story on their hands, they tried to make an issue out of the fact that he'd continued to work as a practice manager after being struck off. It was all a bit lame, really.
Still, not as lame as the finale, which was the 'revelation' that Medivet collected blood from rescue dogs, in return for donations of food and supplies. Panorama claimed the blood was sold at a profit. Medivet claimed it is subsidised. Does anyone actually care either way?
Since the documentary was broadcast last night, Medivet has issued a further statement in which it does the honourable thing, and takes responsibility for everything it needed to. Medivet will recover from this. If the professionalism of the response is anything to go by, it will emerge stronger. Still, the big questions remain. How to address the spiralling costs that accompany the latest advances. Can the profession afford, any longer, to leave so much to the discretion of the individual, or is it time to demand a more prescriptive regulatory environment? And finally, how can the corporates deliver the kind of service that the public seems to want? Doubtless there will be some who'd like them to fail in this regard. But as we've just seen, it does nobody any favours if they are allowed to do so in a way that threatens to bring the whole profession into disrepute.
PS: Whilst you're here, take a moment to see our latest job opportunities for vet nurses.
I felt really sad after watching panorama. I am proud of my practice and the company i work for, as i am confident the patient care is of a very high standard.I am sure that many of the Medivet practices are also good too. Panorama obviously picked up on a few bad apples (and they were very bad) and decided that this is common place in most practices. Personally I found it quite irresponsible of the bbc - people's livelyhoods are at stake here. I think it also highlighted the importance of having experienced, registered veterinary nurses in each practice - something i have always tried to promote in my profession.
Lastly I think it lost sight of just why most vets and nurses go into practice - because we love animals! It failed to mention that despite the years of training, long hours, demanding and stressful job roles - which unfortunatley mean high suicide rates (esp for vets) we continue to go to work every day and make sure that we give animals the best care we can,not to mention keeping cleint happy and informed.
I feel quite defensive about how hard most of us work and how dedicated we are and think sadly that was completely missed by the bbc.
A lot of the problem with the big Corporate companies stems from the fact that most of them are on Comission and therefore are going to push clients into having loads of tests done when some are not necessary. Bring back the smaller more personal Vets that we used to have a few years ago. Its become too 'Big Business' now in my opinion.
Putting the financial points aside, I would like to address the other aspect of the documentary because in my opinion, the rough handling or physical punishment of ANY animal in our care is not acceptable and there is a fine line between justifying a slap or a whack.
Some of the feedback I have read on other forums states that the public would be alarmed at 'normal restraining techniques' and some of them have even tried to justify what goes on. This makes me wonder if violence against animals in the surgery is not quite as isolated as one would think.
But however anybody trivialises what the staff did in this documentary, I can tell you now that if you restrained or treated an animal this way for your veterinary or nursing exams, you would fail - simple.
I also know that those I spoke to when I spoke about the cruelty that I witnessed many years ago as a student nurse, it was said to me'Oh well, these things happen - and by publicising it, its causing damage to the profession' and that was said to me on more than one occasion.
Trouble is though, if you are a good vet/nurse then you shouldnt take offence to publicity surrounding any cruelty that may occur in the profession. The bad ones need to be named and shamed and yes, there will be a fallout but keeping quiet or belittling it for fear of pet owners not taking their animals for treatment is in no way a valid reason to not say anything.
If these situations are not dealt with then it will continue and whilst a majority of veterinary practices and staff are professional and caring there are some that are not.
Young students coming into the profession cannot be allowed to think that smacking an animal is the right thing to do, they need to be taught by example and what kind of example is being taught if they see violence and a distinct lack of compassion as a method of control? - it is not fair, it is cruel and must be stopped.
Not just for the pet owners trusting the vets with their animals, more importantly for the animals - they have no voice.
This isnt about publicly 'attacking' the caring staff that do their jobs properly, this is about the welfare of the animals that suffer in the hands of those that don't treat their patients with the compassion that they deserve - we are here for the animals and they must come first.
Lets face it, we all have bad days at work but is it really acceptable to do what they do? And who on earth believes belting a cat/dog round the head will calm it down?
This makes for uncomfortable viewing/reading for many in the profession but it is now time for it to stop to give pet owners the time and opportunity re-build their faith in those they trust to care for their animals.
Excellent assessment of the documentary Arlo. I think that some of the issues raised in the programme can be used by us to postively promote VNs to the public and encourage them to choose practices that employ RVNs. "Veterinary Nurse" needs to become a legally recognised professional title just like Veterinary Surgeon and the Veterinary Surgeons Act and the Veterinary Code of Conduct needs to be seriously updated to define and exclude/include those procedures/treatments that can be carried out by Vets, Student Vets, VNs and SVNs and then non-qualified people.
I thought the decrepancy between Medivet's and the RCVS' interpretation of the Act and Code where ridiculous and highlights very strongly the need for urgent reform.
By the way the "trainee veterinary nurses" in the documentary were not student veterinary nurses, they were not enrolled with the RVCS and had not started a college yet.
I really feel for all those excellent unqualified staff working in practice as veterinary nurses with years of experience and I really believe that the new Diploma can help "mop up" these people. If you are an unqualified "VN" I urge you to find your local college and start the part time new VN Diploma course and qualify as a VN at last...you'll never look back! Costs and set-up and hassle for vet practices has diminished significantly so nag your boss to let you go to college and complete your training.
I agree with Arlo that the documentary did leave most of the Veterinary profession unscathed and may indeed have increased the client list on some of the smaller private practices.
What we have to remember is that 9 months of filming was condensed into this 1 hour documentary and there was no focus on anything positive.
Jeremy Vine also sensationalised this in his Radio 2 programme prior to the Panorama airing and had an array of callers recanting their own 'horror stories' from all types of veterinary practices across the country.
The programme for me high lighted that there were several members of staff, mostly trainee nurses, who did show lack of compassion and were unnecessarily heavy handed when restraining animals but we all know how difficult some patients can be and if procedures are to be carried out then a certain level of restraint is unavoidable. Would clients prefer that their animals were chemically induced into submission at an extra risk and expense - I think not!
It’s some time since I was in general practice but trainee nurses have always taken blood samples, inserted catheters and monitored anaesthetics amongst other things, these tasks have to be performed by trainees at some point as part of their training. I am sure there are still practices out there with staff who are not even undertaking VN training who are doing all of the same tasks.
The way the Shar Pei was handled was unforgivable the dog was upset and in pain and should have been given longer to recover from his ordeal before an attempt was made to remove the catheter. However I don't think the nurse involved should be dismissed (unless it is a repeated offence) I think he should be made to apologise personally to the client, he will be totally embarrassed and hopefully ashamed of his actions but we all know frustration can get the better of us, in any profession.
From the cost point of view I feel that the profession as a whole is very bad at justifying their bills, let a client know how much it genuinely costs to run a practice, I used to work at the AHT where clients often challenged the final bills, but if someone takes the time to explain some of the costs that have to be covered (even down to the cost of buying a DOOP bin or paying for clinical waste disposal) they are usually appeased. If a client wants the very best up to date treatments and monitoring then the ongoing costs have to be covered, all the equipment needs annual electrical testing and servicing, this costs...alot! It's always worth asking the client the question 'it's expensive compared to what?'
It doesn't matter what the profession is, service and goods cost and the hidden costs for any business have to be recouped and should be highlighted.
I think Medivet have handled the situation very well, and have issued a very thorough and professional response. They know there are some issues that have to be addressed and I have no doubt they will be.
At our practice we always offer clients the options to treat their pet eg wait and see, tests, pts etc I dont think any practice should not be offering clients choices - they are not their pets and its not their money to make the decisions. I am saddened to see the profssion being taken over by chains and corporates as the people at the tops priorities are profit not the patients and increasing pressure is put on their staff to increase income which may then result in procedures not in the interest of the animal being performd by certain individuals just to get their bonus. It is human nature there will always be people like this and this just encourages their behaviour.