UNDERSTANDING THE VETERINARY PROFESSION

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UNDERSTANDING THE VETERINARY PROFESSION

• What does go on behind those closed doors?

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How Does a Pet Owner Choose a Veterinary Practice?

• Word of mouth
• Location
• Appearance
• Belief in the quality of their work
• Value

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What Makes Us Who We Are?

• We believe that our pets are a member of the
  family
• We are a healthcare providers first and a
  business second
• Two basic aspects of who we are
• What we do well
• What we dont do

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Things We Do Well

• 30 minute appointments
• Client education
• Patient friendly staff
• Nurse visits
• Continuing Education
• Anesthesia/Analgesia
• Client access
• of staff involved

• Dental management
• Surgical management
• Renal disease
• Dx driven Rx
• Urine bacterial c/s
• Constantly looking for ways to upgrade our
  practice
• Arterial BP, rehab, acupuncture

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Things We Do NOT Do

• 3 way HW test
• Unnecessary Rx
• Corona, Giardia, FIV, FIP, Ringworm vaccines
• Selective Feline Leukemia, Leptospirosis vaccine
• Vaccinate every year
• Use less safe vaccines

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Who Sets the Standards of Care?

• State Government?
• Federal Government?
• American Veterinary Medicine Association?
• American Animal Hospital Association?

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NYS Veterinary Standards of Care

• New York State has no written veterinary
  standards of care nothing that describes how to
  perform professional duties
• There are regulations written that describe what
  each professional is allowed to do only

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How Valuable is Postgraduate Training?

• What is the experience level of a graduate
  veterinarian?
• 4 years to cover all disciplines species
• How many DVMs have postgraduate training?
• Should pet owners value postgrad training?
• Does the average private practice owner value
  postgrad training?

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Professional Simplification

• When are shortcuts acceptable?
• Airline pilot
• Private pilot
• Bridge or Building engineer
• Home builder
• Physicians
• Veterinarians

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Anesthesia Pain management

• 17 year project at ASAH
• Patient comfort and safety are not exclusive
• The typical patient experience
• Cookie cutter anesthesia
• Assembly line surgery
• Misguided pain management
• The ASAH experience
• Each patient is viewed as an individual

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Neonatal Parallels

• Is there something about a spay, neuter, or
  declaw that makes the procedure less risky or
  less painful?
• Are young, clinically normal children denied
  proper supportive measures?
• We generally worry more dont we?

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Neonatal Parallels

• Postsurgical morbidity and mortality is lower in
  those neonates afforded proper analgesic support
• Children undergoing surgery at an early age
  exhibit significantly higher vaccination related
  pain scores at 4 and 6 months of age
• What is the long term impact of early painful
  experiences on the pets future?

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NC State Study 1996

• Practices often say that their patients are not
  in pain
• Researchers filmed dogs after spay/neuter
  surgery, first when they were by themselves, then
  when a person entered the room
• When a person entered, they appeared normal
• When the dogs were alone, they exhibited signs of
  discomfort and listlessness

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Natural Selection

• Pets often hide their discomfort - they are
  genetically programmed not to show pain.
• They have inherited the instinct for
  self-preservation that tells them to never show
  weakness

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How Pain Aware is the Profession?

• NWPVMA
• Our staffs experiences at other practices
• Recent case management without analgesia
• 2 urethral obstructions, foreleg fracture with
  fractured jaw, fractured teeth, bite wounds
• Local Veterinary Technician Program
• Humane shelter surgeries

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Attention to Detail

• Variety of protocols
• Multimodal pain Rx
• Detailed records

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Attention to Detail

• Variety of protocols
• Multimodal pain Rx
• Detailed records
• Monitoring
• Intubation Oxygen
• IV catheters Fluids
• CRIs
• BP support
• Emergency sheets

• Supplemental heat
• 2 3 staff per patient
• Regional anesthesia
• PF epidural drugs
• TIVA
• Proper drug selection
• Proper drug dosing
• Deadspace management

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National Recognition

• University Of Florida Charlie Bild Program
  Awardee
• Diplomate status, American Academy of Pain
  Management
• Anesthesia/Analgesia Consultant/Editor to the
  Veterinary Information Network
• Acupuncture Certification
• Rehabilitation Certification
• VASG recognition

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Veterinary Anesthesia Analgesia Support Group
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Dental Disease Management

• Typical patient procedure
• Typical patient experience
• Awake procedures
• Intra-oral radiographs
• Extractions
• Local anesthetics
• Deciduous and missing teeth
• Resorptive lesions

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This tooth looks healthy to the naked eye
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But a deep pocket of infection was revealed when
X-rayed probed
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This tooth looks healthy to the naked eye
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But a deep pocket of infection was revealed when
X-rayed probed
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Unerupted teeth can cause fractures in the lower
jaw only X-rays tell you when theyre present
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Dentigerous cysts caused by unerupted teeth
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Dentigerous cysts caused by unerupted teeth
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Surgery and OR Etiquette

• Example major orthopedic surgery
• Simplified CCL patient management
• ASAH CCL patient management

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When Can Bad Care Look Good?

• When a practice fails to disclose just what is
  being sacrificed
• Pain meds, monitoring, supportive care
• Hypotensive consequences
• Inadequate pain management consequences
• Meds rather than urine c/s, ear cytology, etc
• Performing awake dental procedures
• NOT performing needed extractions and Rx

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What Defines Medical Value?

• Business consultants often focus on the average
  client charge per visit
• Do our clients think we would be average, above,
  or below this average?
• We spend more time with each OP visit and each
  procedure. How should this affect our average?
• We have lower average charges per visit than
  those recommended by business consultants

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Our Concern Client Perception

• Age of building
• Our decision NOT to sacrifice anesthetic safety
  or proper dental care for ANY patient
• That the average client cannot differentiate
  between a well structured program and a
  simplified program
• Practices may not even allow their veterinarians
  to offer better options

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1989 Before Remodeling
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1989 Before Remodeling
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That Same Room Today