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News & Reports bsava congress
We can – but should we? A stream of sessions at this year’s BSAVA congress considered some of the ‘big issues’ currently facing the veterinary profession. Among them was ‘Just because we can, does it mean we should?’, which explored ethical and other questions surrounding advances in veterinary medicine, surgery and practice. Discussed at a press conference as well as in a mainstream congress session (see p 401), this subject raised a number of points for debate. Kathryn Clark reports
400 | Veterinary Record | April 18, 2015
Photograph: S. Burden
The panel taking part in a discussion of ‘Just because we can, does it mean we should?’ at a press conference during the BSAVA Congress in Birmingham last week. (from left) Howard Brown, David Catlow, Hilary Orpet, John Innes, Patricia Colville and Mark Goodfellow
the reputation of the veterinary profession. Leading scientific nations were discussing the ethical and welfare issues surrounding veterinary treatment. ‘We’re in a fabulous position where we can do a great deal, and so this debate is coming to the fore,’ he said, ‘and it is quite right that the profession, as the guardians of animal welfare, help inform the debate.’ But, he added, it was not just vets involved in such discussions – the general public had an interest, too. Hilary Orpet, a senior surgical veterinary nurse, who was representing the veterinary nursing point of view on the panel, added that often the discussion of the question centred on new and novel veterinary procedures, but it was important to consider the nursing aspects, too. New techniques would be needed for nursing animals that had had novel procedures, she pointed out.
balance was key, he said. When asked how his company decided what procedures were allowable under an insurance policy, Mr Brown said that clients had a sum of money available towards the treatment of their pet. It was not for Petplan to say what treatment should be pursued – such decisions were up to veterinary surgeons. However, Petplan was ‘incredibly keen’ that vets pursued evidence-based medicine, although he acknowledged that when a new treatment emerged, evidence for its efficacy might initially be absent. That said, he later indicated that, as the evidence base developed, it could allow insurance companies to challenge some decisions made by veterinary surgeons if they did not appear to be following the best available evidence. ‘That will be a more interesting world,’ he said.
Pet insurance
Who decides?
The role that pet health insurance has played in advancing veterinary treatment was also discussed by the panel. Howard Brown, national relationship manager with Petplan, pointed out that the dilemma being discussed was not a new problem from an insurance perspective. Indeed, Petplan had been started with the aim of helping owners afford expensive treatments for their animals. But there was still a need to contain costs, as there were limits to what owners would pay for insurance premiums. Therefore, striking a
Discussing the question of who should make the decision on treatment in more detail, panellists emphasised the importance of all parties being involved. Dr Goodfellow said that all the available options should be discussed with the owner, but that this did not necessarily mean that they would be undertaken. It was important that the ramifications for all involved were fully understood. The importance of a team discussion – between the vet, veterinary nurse and owner – was emphasised by another member of
t
A TIPPING point may have been reached between what is possible and what is affordable, particularly when it comes to advanced veterinary medicine and surgery, according to John Innes, an RCVS-recognised specialist in small animal orthopaedic surgery. Speaking at a press conference held on April 9 during the BSAVA congress in Birmingham, Professor Innes remarked that pet owners might no longer be able to afford pet health insurance premiums unless the veterinary profession focused on value for money as well as the efficacy and safety of what it was doing. Careful decision making was required, rather than always doing what was possible. ‘I think we are entering an era of health economics,’ he said, adding that there was a need to work with pet insurers to make sure that the situation remained sustainable. The press conference was organised by the BSAVA to highlight some of the issues surrounding the difficult treatment decisions faced in veterinary practice. A panel of representatives from veterinary, veterinary nursing, insurance and regulatory backgrounds gave their perspectives on the current situation and answered questions from the media. Introducing the session, Mark Goodfellow, a veterinary oncologist working in referral practice, and the BSAVA’s public relations officer, said that vets today were less constrained by their abilities and facilities, and by finances, than they perhaps had been in the past. It was, he suggested, a new era for veterinary medicine and surgery, but decisions had to be made about when to use the new therapies that were available. There was no one-size-fits-all approach to veterinary treatment, and individual decisions had to be made on their own merits. ‘There are situations where owners will say to me that they will undertake treatment in one dog, but in another dog that they had at home, they would not. There are individual factors for individual patients.’ Another member of the panel, David Catlow, chairman of the RCVS Standards Committee, commented that the College took a great deal of interest in the issue under discussion. The RCVS needed to advance veterinary standards, but also had to maintain
Downloaded from http://veterinaryrecord.bmj.com/ on August 16, 2015 - Published by group.bmj.com
News & Reports the panel, Patricia Colville, then BSAVA vice-president. Mrs Colville said that an honest discussion, including of the costs of a procedure, was a very important part of decision making and obtaining properly informed consent. Mr Catlow added that, ultimately, the decision on treatment, and what was right for their pet, had to be made by the owner. Veterinary professionals could lead the discussion, but must not dictate what should be done, he said. Professor Innes highlighted the importance of considering ‘pain, prognosis and price’ in decision making. Discussion of the last – price – could not be avoided, he said, and he had a lot of sympathy with owners over the costs of procedures. Veterinary schools in particular were constantly developing and improving diagnostic and surgical techniques and, while these might initially be expensive, the costs of therapies often reduced as they became more established. ‘When things become affordable, they’ll be do-able,’ he said.
Impact of television
Asked whether they believed that television programmes showing cutting-edge veterinary procedures might have a negative effect on objective assessment of animal welfare in first-opinion practice, panel
members expressed a range of views. Dr Goodfellow believed that such programmes were great at showcasing the veterinary profession and what could be done for animals. However, he pointed out, they would be received by different viewers in different ways, and he had heard clients in his own practice expressing completely different perspectives on cases shown in television programmes. With all programmes showing cutting-edge techniques, there would always be a conflict of perceptions among the viewing public, he said. Vets would have to explain to their clients the context in which their particular case sat in relation to what they had seen on screen. Professor Innes suggested that there was a tension between the advancement of practice by the publication of peer-reviewed research and progress as depicted by the media. The stories selected for television tended to be the ‘feel good’ ones, but the fact was that many cases undergoing pioneering procedures did not have successful outcomes. ‘We present these things on TV as “giant leaps for mankind” but actually, the reality of research is incremental progress over decades,’ he said. ‘We have got to be careful as a profession that we don’t keep presenting “giant leaps for mankind”.’ Mr Catlow agreed that the portrayal of the profession in television programmes
might add to client expectations and pressure on practitioners to deliver. ‘There’s a lot of pressure on practice to deliver and, increasingly, society, when it doesn’t like the outcome, is looking for recompense or otherwise,’ he said. However, he believed that media coverage enjoyed by the profession over the years had hugely enhanced its standing in the eyes of the public. Another benefit, highlighted by Ms Orpet, was how television programmes could help to promote the different roles of veterinary surgeons and veterinary nurses; getting this across to clients had to be a good thing, she said. From an insurance perspective, television programmes showcasing veterinary treatment were having a very positive effect on the public’s perception of what vets could do, said Mr Brown. Petplan’s website and telephones ‘went wild’ during advert breaks in such programmes, he said. Clients saw television as ‘real’, although he appreciated that the situations shown might have an impact on first-opinion practice. ‘In my head – and I’m not a vet – surely you [vets] have always been pushing boundaries,’ he said. ‘I’m surprised that more of the profession hasn’t rallied round and helped it, pushed it and ridden the back of it.’ doi: 10.1136/vr.h2012
April 18, 2015 | Veterinary Record | 401
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We can − but should we?
Veterinary Record 2015 176: 400-401
doi: 10.1136/vr.h2012 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/176/16/400
These include:
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Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
News & Reports bsava congress
We can – but should we? A stream of sessions at this year’s BSAVA congress considered some of the ‘big issues’ currently facing the veterinary profession. Among them was ‘Just because we can, does it mean we should?’, which explored ethical and other questions surrounding advances in veterinary medicine, surgery and practice. Discussed at a press conference as well as in a mainstream congress session (see p 401), this subject raised a number of points for debate. Kathryn Clark reports
400 | Veterinary Record | April 18, 2015
Photograph: S. Burden
The panel taking part in a discussion of ‘Just because we can, does it mean we should?’ at a press conference during the BSAVA Congress in Birmingham last week. (from left) Howard Brown, David Catlow, Hilary Orpet, John Innes, Patricia Colville and Mark Goodfellow
the reputation of the veterinary profession. Leading scientific nations were discussing the ethical and welfare issues surrounding veterinary treatment. ‘We’re in a fabulous position where we can do a great deal, and so this debate is coming to the fore,’ he said, ‘and it is quite right that the profession, as the guardians of animal welfare, help inform the debate.’ But, he added, it was not just vets involved in such discussions – the general public had an interest, too. Hilary Orpet, a senior surgical veterinary nurse, who was representing the veterinary nursing point of view on the panel, added that often the discussion of the question centred on new and novel veterinary procedures, but it was important to consider the nursing aspects, too. New techniques would be needed for nursing animals that had had novel procedures, she pointed out.
balance was key, he said. When asked how his company decided what procedures were allowable under an insurance policy, Mr Brown said that clients had a sum of money available towards the treatment of their pet. It was not for Petplan to say what treatment should be pursued – such decisions were up to veterinary surgeons. However, Petplan was ‘incredibly keen’ that vets pursued evidence-based medicine, although he acknowledged that when a new treatment emerged, evidence for its efficacy might initially be absent. That said, he later indicated that, as the evidence base developed, it could allow insurance companies to challenge some decisions made by veterinary surgeons if they did not appear to be following the best available evidence. ‘That will be a more interesting world,’ he said.
Pet insurance
Who decides?
The role that pet health insurance has played in advancing veterinary treatment was also discussed by the panel. Howard Brown, national relationship manager with Petplan, pointed out that the dilemma being discussed was not a new problem from an insurance perspective. Indeed, Petplan had been started with the aim of helping owners afford expensive treatments for their animals. But there was still a need to contain costs, as there were limits to what owners would pay for insurance premiums. Therefore, striking a
Discussing the question of who should make the decision on treatment in more detail, panellists emphasised the importance of all parties being involved. Dr Goodfellow said that all the available options should be discussed with the owner, but that this did not necessarily mean that they would be undertaken. It was important that the ramifications for all involved were fully understood. The importance of a team discussion – between the vet, veterinary nurse and owner – was emphasised by another member of
t
A TIPPING point may have been reached between what is possible and what is affordable, particularly when it comes to advanced veterinary medicine and surgery, according to John Innes, an RCVS-recognised specialist in small animal orthopaedic surgery. Speaking at a press conference held on April 9 during the BSAVA congress in Birmingham, Professor Innes remarked that pet owners might no longer be able to afford pet health insurance premiums unless the veterinary profession focused on value for money as well as the efficacy and safety of what it was doing. Careful decision making was required, rather than always doing what was possible. ‘I think we are entering an era of health economics,’ he said, adding that there was a need to work with pet insurers to make sure that the situation remained sustainable. The press conference was organised by the BSAVA to highlight some of the issues surrounding the difficult treatment decisions faced in veterinary practice. A panel of representatives from veterinary, veterinary nursing, insurance and regulatory backgrounds gave their perspectives on the current situation and answered questions from the media. Introducing the session, Mark Goodfellow, a veterinary oncologist working in referral practice, and the BSAVA’s public relations officer, said that vets today were less constrained by their abilities and facilities, and by finances, than they perhaps had been in the past. It was, he suggested, a new era for veterinary medicine and surgery, but decisions had to be made about when to use the new therapies that were available. There was no one-size-fits-all approach to veterinary treatment, and individual decisions had to be made on their own merits. ‘There are situations where owners will say to me that they will undertake treatment in one dog, but in another dog that they had at home, they would not. There are individual factors for individual patients.’ Another member of the panel, David Catlow, chairman of the RCVS Standards Committee, commented that the College took a great deal of interest in the issue under discussion. The RCVS needed to advance veterinary standards, but also had to maintain
Downloaded from http://veterinaryrecord.bmj.com/ on August 16, 2015 - Published by group.bmj.com
News & Reports the panel, Patricia Colville, then BSAVA vice-president. Mrs Colville said that an honest discussion, including of the costs of a procedure, was a very important part of decision making and obtaining properly informed consent. Mr Catlow added that, ultimately, the decision on treatment, and what was right for their pet, had to be made by the owner. Veterinary professionals could lead the discussion, but must not dictate what should be done, he said. Professor Innes highlighted the importance of considering ‘pain, prognosis and price’ in decision making. Discussion of the last – price – could not be avoided, he said, and he had a lot of sympathy with owners over the costs of procedures. Veterinary schools in particular were constantly developing and improving diagnostic and surgical techniques and, while these might initially be expensive, the costs of therapies often reduced as they became more established. ‘When things become affordable, they’ll be do-able,’ he said.
Impact of television
Asked whether they believed that television programmes showing cutting-edge veterinary procedures might have a negative effect on objective assessment of animal welfare in first-opinion practice, panel
members expressed a range of views. Dr Goodfellow believed that such programmes were great at showcasing the veterinary profession and what could be done for animals. However, he pointed out, they would be received by different viewers in different ways, and he had heard clients in his own practice expressing completely different perspectives on cases shown in television programmes. With all programmes showing cutting-edge techniques, there would always be a conflict of perceptions among the viewing public, he said. Vets would have to explain to their clients the context in which their particular case sat in relation to what they had seen on screen. Professor Innes suggested that there was a tension between the advancement of practice by the publication of peer-reviewed research and progress as depicted by the media. The stories selected for television tended to be the ‘feel good’ ones, but the fact was that many cases undergoing pioneering procedures did not have successful outcomes. ‘We present these things on TV as “giant leaps for mankind” but actually, the reality of research is incremental progress over decades,’ he said. ‘We have got to be careful as a profession that we don’t keep presenting “giant leaps for mankind”.’ Mr Catlow agreed that the portrayal of the profession in television programmes
might add to client expectations and pressure on practitioners to deliver. ‘There’s a lot of pressure on practice to deliver and, increasingly, society, when it doesn’t like the outcome, is looking for recompense or otherwise,’ he said. However, he believed that media coverage enjoyed by the profession over the years had hugely enhanced its standing in the eyes of the public. Another benefit, highlighted by Ms Orpet, was how television programmes could help to promote the different roles of veterinary surgeons and veterinary nurses; getting this across to clients had to be a good thing, she said. From an insurance perspective, television programmes showcasing veterinary treatment were having a very positive effect on the public’s perception of what vets could do, said Mr Brown. Petplan’s website and telephones ‘went wild’ during advert breaks in such programmes, he said. Clients saw television as ‘real’, although he appreciated that the situations shown might have an impact on first-opinion practice. ‘In my head – and I’m not a vet – surely you [vets] have always been pushing boundaries,’ he said. ‘I’m surprised that more of the profession hasn’t rallied round and helped it, pushed it and ridden the back of it.’ doi: 10.1136/vr.h2012
April 18, 2015 | Veterinary Record | 401
Downloaded from http://veterinaryrecord.bmj.com/ on August 16, 2015 - Published by group.bmj.com
We can − but should we?
Veterinary Record 2015 176: 400-401
doi: 10.1136/vr.h2012 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/176/16/400
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
