No one has ever said that walking the tightrope between securing the best possible outcome for an animal and the need to charge for veterinary services is easy, but I wonder if the time has come to take this more seriously.
That is not to suggest any veterinary graduate is cavalier about the issue, but have we all lived with it for so long that we no longer give it a passing thought?
In an edition of Veterinary Times1, James Westgate reported on a possible conflict of interest in the public’s perception of the vaccination debate, which might, it was suggested, be contributing towards a rise in anti-vaccination sentiment among UK pet owners. This isn’t a new issue and, indeed, the BVA hosted a discussion on the subject last autumn at its annual congress, which drew considerable interest.
One of the more challenging aspects of the argument is not that some of the more vociferous protagonists are rejecting the veterinary science behind – or the efficacy of – small animal vaccination per se, but that more people are attributing the narrative of necessity for vaccination to self-interest and greed on the part of the veterinary profession.
Pru Hobson-West, from the University of Nottingham School of Veterinary Medicine and Science, said: “These people are questioning the success narrative of medicine and the same thing is now happening in companion animal work. Trust in vets is undermined by these perceived conflicts of interest.”
As part of her expansion of this argument, she went on to suggest that some pet owners believed vets were only promoting vaccination and regular boosters for pets under their care as a means of increasing revenues.
Some vociferous rebuttals of the argument have been made by practising vets, who have suggested more revenue would be generated from allowing a pet to become sick and then treating the resultant disease, but it seems to me this misses the real point and such an argument may be part of the problem. Surely the real issue here is one of trust, and some might say that is a rare commodity in Britain today.
Looking the other way
Certainly, world leaders on the largest stage of all have ensured truth, honesty and respect are easily dispensed with when it comes to ensuring they get their own way and, as members of the public, every one of us must shoulder the blame for looking the other way and allowing them to get away with that. Why we do this is unclear, but the fact remains that fake news is now largely indistinguishable from reality and there seems not to be any mechanism of removing anyone who wilfully misleads us for personal gain.
Should we, then, be surprised that the corrosive nature of social observation is addressed at our own profession when we remain reluctant to engage in a meaningful discussion about what we do, why and how we do it, and why it costs what it does?
Most clients still leave their practice having paid a bill without any detailed breakdown of the cost, unless it’s a sizeable bill possibly for surgery or a more complex procedure that seems to warrant a better explanation or justification of the bottom line figure.
Few vets like to discuss money and, in many cases, it’s left to the reception staff to deal with, but every time a client leaves the building without fully understanding why the bill is larger than he or she had anticipated, we run the risk of alienating that client.
It was the late 1980s when the profession recognised the long-established practice of inflating drug prices to subsidise artificially low professional fees was neither sustainable nor transparent. The scale of adjustment necessary meant it could not be undertaken too rapidly and now, 30 years on, although the dynamics have largely been re-addressed, there remains a legacy of suspicion about drug pricing that has been exacerbated by the cheaper pricing of internet sales.
Rules of engagement
The current veterinary practice business model requires pet owners to come in as frequently as possible to buy services and products, and we fool ourselves if we think maintaining a discreet silence will dispel suspicion. If we cannot change the model then we have no alternative but to change the rules of engagement if forces exist out there that are suggesting we cannot be trusted.
A problem clearly exists if PDSA is reporting almost a 20% drop in the number of dogs, cats and rabbits being vaccinated, and the reasons for such an attrition are complex and not entirely related to the veterinary market. However, when people no longer cross our thresholds, we have very limited means of engaging with them at all, and a happy ending to this unfortunate situation cannot exist if we simply sit back and watch it happen without engaging differently with those pet owners who do come into the practice.
Some of the argument is about public perception of what we actually do and the fact veterinary practice doesn’t make a fortune from vaccination is poorly understood by the pet-owning public.
We might think it unprofessional or unnecessary to describe in some detail what we are actually doing when we examine, treat or vaccinate an animal, but until we discuss each stage of what we do and attribute a measure of health care value to it, consumers will continue to confuse price with value.
Unlike bankers, lawyers or politicians, the public really does want to trust the veterinary profession, but is that best achieved on a practice-by-practice basis? I would contend that, while we have to change the way we interact with clients, it would be more effective for the profession to mount a unified and well-organised campaign to ensure pet owners fully understand that, while veterinary surgeons need to earn money, the principal driver is – and has always been – to care for, and ensure the health and well-being of, all the animals under their care. That is a message that has been allowed to fade into the background in many cases, but is entirely based on trust. Sadly, in today’s world, trust is not a commodity that can survive without our own investment of care and attention.