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that we have not been able to communicate to these people that the services we render (e) Veteirinarians: If I had not encountered are by nature expensive and surgery cannot several experiences which proved me be performed at 1950 prices. The fault is ours wrong, I would still be under the im- not theirs. We have paid great attention to the pression that all veterinarians are great quality of our service. The students today are people. Some of them have proven to be better trained than ever before. The hospitals great and competent businessmen. Of in which they practise are subjected to stancourse you could generalize as with all dards of regulations that never existed before. people, there are those who take their Yet the public still expects fees to be charged work seriously and perform to the best of equivalent to those of the horse doctor of old. In summation, I feel that the general public their ability at all times and those who would rather get things done with as is ignorant of veterinary medicine in toto, its little effort as possible. The thing that many facets, its many services to the public. annoys me however, is that the average The city person is aware of my type of cliniperson has no way of finding out which cian, the farmer sees the large animal veterveterinarians are the former type and inarian and together this is supposed to be which come in the latter group, except of veterinary medicine. The regulatory officers, course by trial and error, or by referral, fisheries and wildlife experts, researchers, pubperhaps. Some kind of check should be lic health officials, university staffs, industrial kept to ensure high standards in veteri- veterinarians and veterinary members of the nary care, done by the public not CVMA. human health teams generally are lost to the Also vets should be more geared towards public's eye. It is not their fault. It is mine helping animals, by looking at their prices and as young people about to graduate it will I would suggest that their main interests soon be partially yours. With your help and enthusiasm, organized veterinary medicine may lie in their bank accounts. accept the challenges to enlighten the public. So those are five impromptu opinions from Progress can be made with a persistent and members of the Humane Society of a large consistent public relations program. With our city. The Humane Society itself dispenses head out of the sand we must tell the public veterinary medicine and really they should be about veterinary research to help animals and more aware of our services than they have man, about foot and mouth disease, be proud revealed themselves to be by their comments. and brag about our accomplishments in the In 1976 with high land and building costs, past and our plans for the future, explain hospital labour, drug costs and a standard of brucellosis, heartworm in dogs, lymphosarpractice expected by the public almost equal coma in cats and taxoplasmosis. We have a in completeness to the general medicine dis- great job of educating ahead of us and perpensed for humans, it is a complete failure haps today is one of the first steps. with animals will get along with me and

mine.

VETERINARY MEDICINE - THE PUBLIC'S OPINION VIEWS FROM A PROFESSIONAL ORGANIZATION K. R. Kessler* THANK YOU FOR EXTENDING to the American Veterinary Medical Association and me the privilege of participating in "Probe '76". We are delighted to be asked to tell you what

*Public Information Director, American Veterinary Medical Association, 930 North Meacham Road, Schaumburg, Illinois 60196. 226

organized veterinary medicine believes to be the public's opinion of the profession. This assignment might be fairly easy to fulfill if I could quote some official association statement or a public opinion survey, but we have no such documents. What I'll offer instead are some observations from a representative of one veterinary medical association,

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and what I hope is a reasonably accurate consensus of a number of people I work and talk with in our professional organizations. I also hope you'll forgive my repeated references to the United States. I would be happy to discuss the profession's public image in Canada, but I am woefully ignorant of your situation here, and must limit my examples to what I am familiar with. As I see it, organized veterinary medicine is not really too certain of what the public's opinion of the profession is, although this has been a matter of concern to veterinarians almost ever since they first organized. In fact, I would venture to say that concern over the profession's public image has been the basic motivating factor in the development of all veterinary medical organizations. Continuing education, school accreditation, scientific publications, legislative activities, ethical matters, public relations programs - practically everything our professional associations do is, in some way, designed to upgrade veterinary medicine in the public eye. Historically, the profession has had a low profile. Dr. Alexandre Liautard, one of the founders and prime movers of the United States Veterinary Medical Association and its successor, the AVMA, told his colleagues at the 16th annual meeting of the association in 1878: "People are ignorant of what constitutes the elements of education of the veterinarian ... for the public ... the business of a horse doctor, of the cow leech, of the gelders, are all the same. The veterinary education of the people, then, is, I think, a subject which is worth our attention and deserving some of our efforts." For a long time, I think the real question was not whether the public image of the profession was good or bad, but whether it existed at all. Things are different now. Today, we can point to a number of convincing indi-

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35 to 45%. We think this is a very positive indication that increasing numbers of young people are seeing veterinary medicine as a desirable and attractive vocation, and that the profession is no longer thought of as second rate or an alternative for people who could not make it into medical school. In fact, we suspect that pressure from students, and families of students, who have not been able to get into veterinary medical school probably is an important factor in the recent outcropping of new schools in the United States. The first new college of veterinary medicine to open in North America since 1957 took its first class in 1974. Two more are scheduled to open this year and a third in 1979. In addition, two states have contracted with a third that already has a veterinary medical school to expand and jointly use the existing facilities. In times of budgetary belt-tightening at all levels of government, we view these developments as an expression of positive public opinion regarding veterinary

medicine. Federal support of veterinary medical education in the United States over the past decade has also been encouraging. In 1966 our government decided to support education in a limited number of health oriented professions. Veterinary medicine was one of them. At first, veterinary schools received funds for construction only, but two years later they began to get additional aid according to a student cost factor. This is the same basis of support used for medical and dental schools. Two prestigious organizations in our country, a special Senate Committee on Government Operations in 1962 and the National Academy of Sciences in 1972, have published in-depth analyses of the profession's contributions to Society. Both concluded that we need more veterinarians, and called for increased enrolments and new programs at our colleges of veterinary medicine. It now appears likely that federal support for all health education may decrease in coming years, but whatever happens, we have indications from both houses of Congress that veterinary medicine will be treated equally with other health

cators that veterinary medicine has made significant gains in visibility and stature. One example all of you should be familiar with is the difficulty of gaining admission to veterinary school. Twenty-five years ago, the 19 colleges of veterinary medicine in Canada professions. Of course, we do not get everything we and the United States were admitting fewer than 1,000 new students each year - about want from Congress. About a year and a half half the qualified applicants seeking admission ago we lost an Animal Health Research Act at that time. Today, we have 22 colleges with which would have provided up to $47 million an annual first year enrolment of nearly 2,000. a year for research on livestock diseases. The Yet, only about 15%, or one out of every six or proposed legislation, originated and supported seven applicants, are accepted. We under- by AVMA, was not signed into law by a newlystand, incidentally, that the acceptance rate at installed President who had promised to hold medical schools has recently been ranging from the line on federal spending. Even so, the fact 227

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that the bill had passed with strong support in both houses of the Congress demonstrated in a very real sense public recognition of the important role veterinary medicine plays in seeking and promoting better means of producing livestock. Public health and biomedical research are two areas where we see increasing awareness of the veterinarian's competence and value in endeavors other than animal treatment. A couple of decades ago, veterinarians in these professional activities were engaged primarily in pure zoonotic disease control and support roles in research. Today, significant numbers are involved in many different public health activities, often interchangeably with physicians. Many more are principal investigators in a broad spectrum of biomedical research projects. Increasing numbers of veterinarians are assuming positions of high visibility and respect in government, industry and education. Additional evidence of a positive attitude toward veterinarians is found in the increasingly harmonious relationships developing between many veterinary and humane groups. At a national level, AVMA has recently found it possible and rewarding to work with The Humane Society of the United States, a group with which veterinarians had been at odds for many years. We also have worked more closely with and received a good deal of favourable credit from The American Humane Association, an organization we have long been on amiable terms with. The focus of our mutual agreement and cooperation has been the so-called "surplus animal problem". When the animal overpopulation issue first began to emerge, there were highly-charged debates, open hostility and much ill will between veterinary and humane organizations in many places. Gradually, however, many of these factions have come to understand each other's particular views and problems, and are now working together on issues of mutual concern. We like to think that a major factor behind this most gratifying turn of events was the National Conference on the Ecology of the Surplus Dog and Cat Problem coordinated by AVMA and co-sponsored with The American Humane Association, The Humane Society of the United States and two other national organizations in May of 1974. The success of that conference and another much like it which ended just two days ago, combined with feedback we have received since the first meeting, gives us every confidence that a great many pet owners and humanitarians have recently gained new re-

spect for veterinarians and a much more positive attitude toward the profession. Apparently this is true in Canada, too. A Saskatchewan veterinarian who attended our first conference tells me the Canadian Council on Animal Care, the CVMA and the Canadian Federation of Humane Societies have been meeting jointly and plan a similar conference to be held in Toronto in June. Then there are the two books by British veterinarian James Herriot, All Creatures Great and Small and All Things Bright and Beautiful. The first became a best seller in the United States and was made into a 90 minute television play broadcast nationwide about this time last year. Although no one on this side of the Atlantic can take any credit for it, the popularity of these books certainly is a positive public response, and many practising veterinarians believe that clients who have read them now have a greater understanding of and appreciation for the profession. In a somewhat similar vein, we at AVMA have been extremely pleased with the response our film "The Covenant" has received. For those of you who have not seen it, this is a 20 minute motion picture that shows the essence of what is involved in veterinary medical education and the various professional activities veterinarians engage in. Basically the film is a sales pitch for the profession. During the three years we have had "The Covenant" in circulation somewhere in the neighbourhood of 25 million people have seen it. In one of our distribution programs, schools and community groups can borrow the film free of charge - at their request - through a distributing firm which handles the mechanical details for us. By the end of 1975 "The Covenant" had been shown more than 33,000 times to well over a million people through this program. Last year our distributor had to turn down nearly 900 requests for the film, even though we had 170 prints available for loan. By the end of December more than 2,400 reservations had already been made for this year. We have also made "The Covenant" available to television stations for broadcast during public service time. As of December 31 last year our reports showed that during the 37 months since we started this program, "The Covenant" had been telecast 1,127 times and seen by an estimated 24.2 million people. Stations must ask for the film and they are under no obligation whatsoever to televise it. This means a lot of people whose jobs depend on giving mass audiences entertainment and information they want or will accept have appar-

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ently decided their viewers would react favorably to a film about veterinary medicine. The profession also seems to be getting more and better coverage in print media. Not many years ago, newspaper and popular magazine articles about veterinary medicine were virtually nonexistent. Today we have a rather impressive file of clippings we have picked up in recent months from many newspapers, including the prestigious and widely read "Wall Street Journal" which last year carried an article about the profession, emphasizing the difficulty of gaining admission to veterinary school. Pet and animal health columns authored by veterinarians also are becoming more common, as are favourable comments about the profession in columns and articles written by others. The October 1975 issue of "MD", a magazine for physicians, published a lengthy cover story and several related articles on veterinary medicine. The editors decided their 350,000 physician readers should know more about your chosen profession and its contributions to medical science. AVMA, along with a couple of other national organizations representing health care interests, was also invited to join the American Medical Association in planning and sponsoring a National Rural Health Week to be held this year as part of our nation's bicentennial celebration. These, I think, are positive indications of recognition and respect for veterinary medicine on the part of other

health professions. Additional evidence of a positive change in attitude toward the profession is found in the growing acceptance of preventive medicine concepts and contract veterinary service. Many livestock producers nlow regard the veterinarian as a knowledgeable consultant and a useful partner in management. The practitioner is viewed as an economic asset rather than a fireman to be called only when home remedies and the feed salesman's medications have failed. I wish I could stop there. Considering all these favourable indications, you might assume that I believe the veterinary medical profession is well thought of by its various publics, and that the image is getting better all the time. In large measure, I do believe that. But unfortunately, I have not given you the whole picture yet. There is some writing on the wall that is making leaders in the profession more than a little uneasy. Visibility is a mixed blessing. Many of the things which have helped raise public esteem for the profession have, at the same time, made it a bigger target for criticism. As vet-

erinarians build modern hospitals, use the latest diagnostic equipment, practise the sophisticated medicine the profession is capable of providing and charge commensurate fees, the public is bound to expect more and more. This fact became abundantly evident to many practitioners not long ago when certain vociferous humane organizations took them to task, asserting that they should be less concerned about making money and donate a portion of their time and services to surgically neutering animals, or at least to reduce what some considered to be outrageous fees charged for the operations. We have also noticed a decided increase over the past few years in the number of letters we receive from animal owners asking for information and advice, or complaining about veterinary service. The American Animal Hospital Association gets a lot of letters, too. The Executive Director recently told me AAHA had received more than 1,000 as a result of an article in a widely circulated national newspaper which indicated that readers who were shopping for a veterinarian could get a list of AAHA-approved hospitals by writing to the association. A couple of years ago we had a similar experience after a nationally syndicated advice columnist suggested, in response to a woman who complained about a disappointing experience with a veterinarian, that readers with similar problems could write to us. More than 200 did, some of them just within the past few months. Not too frequently, although more often than we like, unfavourable views of the profession also surface in the press in the form of articles and letters to editors. The most notable example we have seen lately was the lead article in a Sunday supplement published in about 100 newspapers two years ago. The article described several alleged examples of con games and bilking by veterinarians, and implied that they were fairly common in the profession. One example was a so-called "hardware hustle", where the veterinarian allegedly places a nail under a dog's stomach so it shows up in a radiograph, indicating surgery. Another allegation, labelled as "the latest twist in dog-napping, which keeps cropping up in new suburban housing developments", claimed some veterinarians drive around at dawn with a bitch in heat lashed to the rear bumper of a station wagon, drawing male dogs away from their owners. The "lost" animals are later "piously" returned in exchange for several days' board. Most of the allegations were so far fetched they bordered

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on the ridiculous, as we tried to point out in ever, is a major change of philosophy that apa letter to the publisher and to all the papers pears to be emerging in two government agenthat carried the feature, but the article made cies that watch out for consumer interests it painfully clear that increased visibility can the U.S. Department of Justice and the Federal Trade Commission. These agencies are be a two-edged sword. Some of the apparent expectations and com- raising serious questions about professionalism plaints evidenced in the types of letters and as we know it today, and challenging some of articles I have referred to are unjustified, but its basic principles. They seem to be intent on they exist nevertheless, and many do seem to eliminating all possible barriers to free comhave at least some valid basis. Right or wrong, petition and free enterprise, with little regard the fact that unfavourable comments are pub- for quality of service. Veterinary medicine would not be singled lished and that significant numbers of laymen are concerned enough to write the letters we out. Lawyers, physicians and engineers, among see indicates clearly that not all veterinarians others, have already become involved, and it are held in the highest regard. People just do appears likely that other professions, including this one, will not be immune. not believe the doctor is always right. Among the principles and practices we may A prominent leader in one of our speciesoriented allied groups recently put his finger soon find ourselves called to defend are: on another aspect of current public attitude when he said, "My clients used to think I was - Licensing examination procedures - these are alleged to be a device for limiting entry and 'God.' They would never have considered keeping demand for professionals high, rather buying medicine from a little red wagon that than a means of assuring quality and protecting came down the road. But now," he comthe public. plained, "they buy their own medicine from who knows where, then ask me what I think - School accreditation and procedures for certifying the competence of foreign veterinary of it and how to use it." medical graduates - consumerists say these are This attitude, and the increasing numbers additional means of keeping the numbers of of complaints and questions we are seeing, unprofessionals small and the cost of their services doubtedly are part of the widespread public high. attitude we have come to refer to as consumerism - a phenomenon which promises to - Private professional ownership and operation of establishments providing veterinary medical have far-reaching consequences for nearly care - these practices are thought by some to every segment of our economy and society. be a restraint of free enterprise designed, not I do not know what your situation is here, to assure sound medical care for patients, but but on the other side of the Great Lakes at rather to reserve profit-making opportunities least, people are challenging many institutions for veterinarians. and philosophies long considered sacrosanct and immutable. We seem to be living in a - Restrictions on advertising by veterinarians from the consumerist point of view, these inclimate of suspicion and, in some cases, hoshibit free competitive enterprise and interfere tility and belligerence. People are defining and with the consumer's ability to obtain services at demanding all kinds of rights most of us never the lowest possible cost. realized we had. Consumers and those who look out for - Fee-setting - according to the letter of the law nationally and in most if not all states, practitheir interests are seeking protection from tioners cannot consult with one another about profiteering businessmen, careless craftsmanfees in any way, as veterinarians in three sepship, hazardous food substances - even vetarate localities leamed the hard way last year. erinarians. For instance, I recently answered a number of questions from an editor at a The consumerist philosophy toward profesmajor publishing firm in New York who is preparing a consumer complaint guide. He sional people, with no apparent lack of enwanted, among other things, a directory of couragement from certain members of the state and local veterinary medical associations legal profession, seems to include an increasand a list of heads of state licensing boards. ing propensity to sue. More than a year ago, I suspect our state associations already receive before medical malpractice got to be headline many more complaints than we do, and with news, the AVMA's Professional Liability Insurthat kind of help, they will undoubtedly get ance Trust became sufficiently alarmed about this changing attitude that the trustees decided a lot more. The greatest concern to organized veterinary to produce a film designed to show veterinarmedicine in the United States right now, how- ians how to reduce their chances of being sued 230

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of people as veterinarians are, and as many wonderful contributions as they have made, they are only one small group among thousands. You can bet that the members of those In our consumerist society, the old rule of other groups think they are just as important Moreover, they caveat emptor, or let the buyer beware, has been and just as underappreciated. not going to care much about widely revised; more and more, the rule is let the probably are one way or another unless they veterinarians seller beware. or have some other direct At the same time, a revolution of increased ex- happen to need one, in profession, such as a the interest personal pectations has taken place - particularly among son or daughter who wants to be a vetconsumers of health services: today, the physierinarian. cian's patients and the veterinarian's clients fully There are also very real limits to what vetexpect that therapy will be successful. medical organizations can do - parerinary In this climate of consumerism and high expecin a society where virtually every ticularly tations, all medical professionals - veterinarians organization and institution appears to be not excepted - have become increasingly subject inherently suspect. Some of our members do to suit for malpractice. not seem to understand why we cannot just When the film was premiered at Cornell march into the halls of Congress and get whatjust two weeks ago, the president of the insur- ever we want - or more specifically, whatever ance consulting firm that handles the AVMA they want. They think AVMA fails them beprogram summed up a new client attitude the cause they do not see public service announceTrust sees emerging with the words, "When ments for veterinary medicine on television every night. They simply do not seem to comin doubt sue!" Incidentally, this film is available to veter- prehend the scope or sophistication of cominary medical groups free of charge through petition in the public marketplace for ideas. our motion picture library. I heartily recom- Some of them also have some rather unrealismend it for any practice management or tic notions about their potential for gaining jurisprudence courses you may have, or even public favour. Let us be brutally honest. If the shoe were a Student Chapter meeting. If you can work out the timing, you probably could even get on the other foot, how much would you really a veterinarian representative of the Trust to care whether or not the guy who treats your come along for a discussion after it is shown. dog spent six or more years in college? KnowThat pretty well exhausts my observations ing that might give you some confidence when on what I think people in organized veterinary you take Poopsey to see Dr. Jones, but it is medicine see as indicators of the public's whether or not Dr. Jones can make her well opinion of the profession. However, in her let- that counts. You are paying for the veterinarter of invitation, Susan Reesor indicated that ian's expertise, but how he or she acquires it your purpose here today is to crystallize a is not your concern. As a consumer, do you not figure you have critical assessment of the profession. If I may, I would like to close by offering for your con- a right to wholesome, disease-free food for sideration a little personal philosophy and a your hard-earned dollars? Do you really care who makes sure it comes to you that way? If couple of suggestions along those lines. As you ponder the question of how various you were not quite so close to the profession, publics view your profession, be realistic. would you really be impressed to know it was Realize that there are definite limits to what a veterinarian who discovered that insects you can legitimately expect. We frequently transmit infection between animals and man, hear veterinarians bemoan the fact that they or that a veterinarian solved the mystery of are not sufficiently appreciated. How many botulism, or that another developed a fracture people, they ask, know that we have to spend immobilizing device for a dog that was later six or seven years in college absorbing knowl- modified for use in human beings? We are all edge and learning the skills we must have to glad that we no longer have to worry about practice our profession? How many know we yellow fever or polio, but we do not pay protect them from disease and assure them of homage to Walter Reed and Jonas Salk every safe food supplies? How many know about the day of our lives. And let us be realistic about this matter of contributions veterinarians have made to medesteem, too. Not so long ago, we got a letter ical research? Believe me, I have a great deal of sympathy from a solo practitioner who conducts a small for these points of view, but, as great a group animal practice, without any assistants, in the 231

for malpractice and what to do if a suit appears likely. A brochure produced to go with the film expresses the Trust's concerns in these words:

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basement of his home. He complained bitterly that AVMA was to blame because veterinarians do not share the same public regard and professional standing as physicians and dentists. What can you tell a man like that? A properly-equipped, conscientious practitioner probably could render acceptable veterinary service in such a facility, but the people who view him in that setting simply are not likely to equate him with other health professionals. I think we also have to admit that both the monetary and psychological value of services and those who render them usually relate directly to the value placed on whatever or whomever the service is rendered to. An orthopedist, for example, does not have exactly the same stature as, say, a cardiologist. There is a significant difference between a child with a fractured proximal phalanx of the second left digit and a heart attack victim gasping for life in an intensive care unit. The finest breeding bull or the fastest Thoroughbred has some fixed dollar value at best, and even the boundless affection some people seem to have for their pets probably is exceeded by their love for themselves and for at least a few of their fellow human beings. No matter how sophisticated the practice of veterinary medicine might become, doctoring animals never will be quite the same as doctoring people. These statements may sound like heresy from a guy who some veterinarians probably think ought to be projecting a Marcus Welby image of them to the public. I hope you will not construe my comments to mean I think we cannot or should not strive to improve the profession's image. As I indicated earlier, I believe the very existence of veterinary medical organizations is a manifestation of concern

over what people think of the profession. Virtually everything our various associations do is in some way related to what the public wants or to what veterinarians want others to think of them. That is just the way it should be in a service-oriented profession. Veterinary medical organizations and their activities are necessary if the profession is to live up to its potential as a contributor to society. They also are a vital influence on public opinion of veterinary medicine. But we must remember that these organizations and the profession itself are made up of individuals. The same is true of this rather nebulous thing we keep referring to so glibly as "the public", which is really a diverse array of specific groups or "publics", each having its own special interests and opinions. With relatively few exceptions, the profession is, to each member of each public, the veterinarian or perhaps a few veterinarians who that individual knows personally. So, go ahead and examine the public's opinion of your chosen profession. Keep asking the questions you are raising today. I hope you can find some sound answers and valid conclusions. But while you are probing this and many other aspects of professional life today and during the years when you put a comma and the letters D.V.M. after your name, I hope you will remember once in a while to take a hard look at the mirror you stare into every morning. Just as surely as public opinion of veterinary medicine is made up of individual opinions, it will largely be a reflection of the acts and attitudes of individual veterinarians, and one of those veterinarians will be you.

THE VETERINARY PROFESSION: THE PUBLIC OPINION AS VIEWED BY THE FOOD-ANIMAL INDUSTRY C. A. Gracey* be invited to express some views on the veterinarian's role in livestock production. In the past fifteen years or so of association with the livestock I WAS

PLEASED SOME TIME AGO to

*Secretary-Manager, Canadian Cattleman's Association, 590 Keele Street, Toronto, Ontario.

industry, I have formed some of my own iinpressions on the role of the veterinarian and I have on numerous occasions heard livestock producers in all circumstances comment upon their veterinarian. To prepare this talk, however, I made a point of contacting several livestock farmers to check their more recent views. 232

Veterinary medicine--the public's opinion--views from a professional organization.

CANADIAN VETERINARY JOURNAL that we have not been able to communicate to these people that the services we render (e) Veteirinarians: If I had not en...
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