It is no longer the norm to offer house calls as a routine part of general practice. Pressure of time and money combined, the need to make each minute as profitable as possible, ensuring that every practice has all the toys a new graduate expects (which must then of course earn their keep), the cost of continuing professional development (CPD) now mandatory and enough staff to enable an attractive time-off rota all seem to have conspired to consign the house call to history as an inconvenient and inefficient exercise. Clients are expected to be organised enough to get themselves to the practice and only in an absolute emergency will veterinary staff have to venture out of their comfort zone into the unknown territory of a client’s home. Few practices cover their own out-of-hours emergencies, and even then, the travelling must be done by the client to a designated night clinic, often miles from where they live.
There is no doubt that, technically speaking, pet owners are served to a very high standard, but what a wealth of information we may be missing if the environment in which our patients live is largely unknown to us. It would sometimes seem that farm animals have the better deal in this regard. Management systems and environment are routinely considered to have a bearing on their physical health and the incidence of disease and are therefore automatically included in the large animal veterinary surgeon’s remit. Not so for the small animal veterinary surgeon and their patients, pet dogs, which may be skidding uncomfortably on a fashionable polished wood floor, subjected to the impact of noise from a multitude of electronic household gadgets or contained and trained with electric shock. Yet their veterinary surgeon may be completely unaware of their plight. How can we truly say such animals are under our care if this is the case?
I may recall with horror the blood and indelible marks of styptic pencil left on what seemed like an acre of pale pink Persian carpet after a home nail clip on a pampered pug went badly awry or the distaste at finding myself in the house of a hoarder, every wall stacked floor to ceiling with newspaper. But such memories are countered by the pride one felt and gratitude received after attending an emergency. My first emergency call-out was to a dog left home alone who had managed to smash its way through a plate-glass window, badly lacerating a leg in the process. As I jumped out of the car, a shopkeeper who happened to recognise me from school days was standing by the stricken animal. He said comfortingly, ‘Don’t worry, love, the vet’s on his way.’ With no time to remonstrate regarding gender assumptions, I was more than happy to reply, ‘I am the vet.’
Information gleaned in home contexts can be invaluable and at least some record should be kept of a client’s home circumstances. Vital to the veterinary behaviourist in order to assess environmental impact upon a patient’s behaviour, such information should be considered as important to all vets.
The cost of veterinary attention has, over the course of my career, spiralled out of all proportion, to the extent that few clients, apart from the very well off, can afford the thorough, technologically aided care that can now be provided for their pets. Unless, that is, they are insured. To the benefit of conferences seeking sponsorship as well as dog owners’ minds being put at rest, pet insurance has become big business. There may even be a tendency to look upon an uninsured client who finds themselves without the financial wherewithal to afford our excellent services as in some way irresponsible. The lack of financial foresight and planning seems to relegate them to the realms of second-class citizenship. But as with the chicken and egg, which came first?
In this case, I believe the evidence points firmly in the direction of the insurance companies who saw a lucrative niche market to be derived from owners worried about the worst happening to their pet. After all, it was not initially in any general practice’s best interests to raise the cost of its services out of the reach of the vast majority of the general public. But with the rise in uptake of insurance policies, specialist vets could afford to splash out on kit which was initially a luxury and then became an essential necessity. Throw media-enhanced client expectations of the miracles that vets could perform into the mix, and the vicious (or virtuous, depending whose side you might be on) circle was complete.
And what of the now ubiquitous corporate practice? It was once anathema to the RCVS to imagine, let alone allow, a veterinary practice to be run by anyone other than veterinary surgeons themselves. Even allowing waiting room sales was unimaginable, as to do so would seem to lower the profession to the status of mere tradesmen. How times have changed. More and more sole practitioners have been forced to sell their businesses as they find themselves unable to compete with the corporate businesses in terms of attracting employees or keeping clients.
And the consequence? One would have imagined the result to be contented graduates who have everything that their lengthy and expensive education has led them to expect. All the state-of-the-art equipment they need, plenty of time off with no night duties, so as to better enjoy their earnings, and a multitude of grateful clients to add to their immense job satisfaction. I despair when I find that the opposite appears to be true. Unfulfilled vets who think themselves overworked and underpaid and dissatisfied clients believing vets are only ‘in it for the money’ have become the new norm.
What will help redress the balance? I am of the firm belief that following the principles of behavioural husbandry (see Chapter 2) will create better veterinary surgeons. It will increase day-to-day enjoyment of practice in the knowledge that one has not only enhanced the relationship between the pet and client but also between the pet and the practice as well as improved clinical outcome. How better to create satisfied loyal clients who feel they have been given real value for money at the same time as immeasurably increasing one’s own job satisfaction?
I will again show my age when I reveal that, at the time of this illuminating exchange, the basic consultation fee for dogs at the solely small animal practice where I worked was £4.95. it was the practice routine for the consulting veterinary surgeon to inform the client of the financial damage and for payment to be made at reception.