This week I received an email that had a picture of a dog’s foot attached. The sutures I placed in the cut footpad three days previously were holding nicely and the wound was healing well. Relief ensued.
Then I read the accompanying message – ‘Looking great. Happy here. Do we really need to come back in for the check up?’. And with these simple words, my heart sank.
What’s the harm? It was a simple enough question and the picture was beautifully clear. However, this is (admittedly in a relatively simple form) an example of the somewhat gritty relationship between technology and the veterinary profession.
Under current regulatory guidelines, as a vet, I should not pass clinical judgement based on a picture.
Last month I attended the 60th anniversary of The British Small Animal Veterinary Association Congress. I was invited to the opening press conference and the topic for discussion was the role of telemedicine within the veterinary profession.
‘Telemedicine’ is providing any healthcare service through a remote telecommunication device such as a video call or wearable pet technology.
Currently, there is a ‘zero tolerance’ policy on making a diagnosis through telemedicine. The Royal College of Veterinary Surgeons, our regulatory body for the veterinary profession, is inviting opinion from within the profession and the general public to set up a framework over the coming years to balance this so called ‘disruptive’ technology. And time is of the essence if we, as a profession, are going to steer the direction of these advances to ensure animal welfare remains the absolute priority.
There are a number of examples where technology has already improved the service offered by vets. A lot of practices now use digital radiography. The traditional notion of a vet processing a film, holding it up to a light box and evaluating the grey shadows is almost a thing of the past.
Nowadays the digital image is loaded up onto a screen with an editing function to zoom, pan, darken, lighten, annotate. The list goes on.
But if the diagnosis is complicated and a second opinion is required, instead of physical films being posted to an external specialist for interpretation (the results of which would take days) the vet can now email the images at any time of day to a diagnostic imaging service and a specialist’s opinion is pinged back to the referring vet within the hour.
This access to referral clinicians has revolutionised how first opinion vets approach cases. There is a fee involved but overall the service to the client (and the welfare of the pet) are both improved immeasurably.
This vet-to-vet telemedicine service is essentially a form of referral and therefore is permitted. However, the question is whether this ‘online diagnostic service’ should be made available direct to the pet owning public.
Imagine a hypothetical scenario: an owner videos their lame dog on a smartphone and uploads it with a short history to an online ‘virtual vet’. Within 10 minutes, the owner is at the receiving end of a video call from a vet working for a 24 hour online diagnostic service. A diagnosis is made and the vet emails out a prescription for the owner to purchase the medication from an online pharmacy. The dog receives the appropriate treatment, the owner receives sound advice from the vet and all this without the owner (or dog) having to even leave home.
It is easy to see how attractive this may seem to those owners that are in rural locations or perhaps those that are reluctant to see a vet due to costs. If it were more financially competitive, would more pets receive the veterinary attention they need if access to an online veterinary service was available? If that would improve the overall number of sick pets receiving treatment, then I am in full favour.
However, as with most things in life, all this potential benefit carries with it a degree of risk.
How can a vet successfully conduct a full patient clinical exam remotely? As vets, we are trained to pick up subtle signs from animals to aid our clinical diagnosis and so much of that, whether consciously or subconsciously, comes from using our hands.
As an extreme example, I once had a dog present for a routine vaccination – the client gleefully unaware that her otherwise healthy companion was actually growing a tumour on his spleen, only apparent through abdominal palpation. It is only through physically touching that dog that I found the hidden problem.
Telemedicine is also a hot topic in the human field. However, a major difference between the two professions is that human patients can describe their own symptoms directly.
Our animal patients rely on an owner’s interpretation of signs given out by their pets. And owner interpretation, although well meaning, is not always particularly accurate (a rectal thermometer will give a reading to suggest hypothermia if the thermometer is inserted into a ball of faeces rather than up against the rectal wall – I had to explain to one of my more ‘hands on’ clients!).
Furthermore, there is the dreaded notion of liability. If a clinical decision is made as a result of a remote veterinary consultation and that decision proves to be wrong, who should be to blame, the vet or the owner? The vet has chosen to conclude a definitive diagnosis based solely on the information provided by the owner but the owner may have given the wrong information in the first place. There is a case there for both parties.
Another form of telemedicine is wearable technology (think FitBit for pets). This has huge potential to give vets and pet owners information about their pets that might revolutionise how that pet is treated. Examples could include monitoring devices that track brain activity to predict the onset of a seizure; GPS devices implanted to deter pet thieves; diabetes monitors to remotely control insulin dosages or gait analysis devices to highlight subtle lameness.
We need to ensure that any wearable technology has a proven accuracy before we, as vets, endorse the use of such gadgets to influence our clinical decision making. And all these technologies need to be accredited and proven safe before they are physically implanted into our pets.
Either way, it is clear that pet technology is a booming market. I managed to judiciously encourage the owner of the dog with a cut foot to come back in for a post operative check up (for free and in exchange for plenty of treats!) but I know that is not the last email (or text, or direct message, or tweet) that I will receive of such a nature.
I can’t imagine the virtual vet would ever fully replace a visit to the consulting room. I would suggest the majority of pet owners enjoy having a trusted one-to-one relationship with their vets, especially when it comes to making difficult decisions (such as euthanasia).
However, these technological advances are happening whether we like it or not. New technology can seem daunting, but only if you refuse to keep up with it. There is definitely an opportunity to make technology work for us, as vets, to improve animal welfare but these advances need cautious regulation.
However, in conclusion – I confess, I became a vet because I love interacting with animals. So until we have a structured protocol for telemedicine from our governing body, I don’t mind admitting that I would much prefer to keep treating my patients in my consulting room. And not, perhaps, through the lens of a webcam.
Spring has finally arrived! This is my favourite time of year. It’s the time that I really appreciate spending time with Oliver, my one eyed Labrador. There is a certain excitement in the air – it feels like there are new pastures to explore, new beaches to find and new adventures to have.
So when James Wellbeloved, a pet food company based in rural Somerset, challenged me to take part in their ‘Reconnect with Nature’ campaign – of course I jumped at the chance (as did Oliver!).
The first part of the challenge was to visit the James Wellbeloved team at Crufts. My heart lifted the moment I spotted the six dogs I was due to meet. From a distance, it was clear these were a mixed bunch – different sizes, different ages and different personalities but all with their own special story to share. I quickly realised I wasn’t here to meet any fancy pedigrees, I was here to meet the James Wellbeloved ‘Scruffts’ finalists! ‘Scruffts’ is the largest nationwide competition for mixed blood dogs and out of the 1,800 dogs that entered, these were the six finalists and what an absolute pleasure it was to meet them.
Vinny was the ‘Golden Oldie’ finalist, a thirteen year old Jack Russell cross in fine nick for a gentleman of such vintage! Fleur was the ‘Best Rescue’ finalist, a collie cross brought over from Romania after being found on the street with her intestines protruding through a wound.
Then Ginny, a stunning Cavalier cross up for ‘Prettiest Bitch’ and the ‘Most Handsome Dog’ was King Tommy, the first ever Indian street dog to step foot in a Crufts arena! Bonnie was so gentle, the perfect example of a ‘Childs Best Friend’. Biscuit was the finalist for the ‘Good Citizen Dog Scheme’, a German Shepherd cross owned by 14 year old Joshua King and it was immediately clear that there was such a strong bond between Joshua and Biscuit. They really were an example to many and I was thrilled to see Biscuit crowned the ‘Scruffts Champion’!
The one thing uniting all these amazing dogs is that they are all cross breeds. As a vet, it is so refreshing to see a company like James Wellbeloved champion these mixed breed canine companions.
I should add – I am not ‘anti-pedigree’. My dog is a pedigree Labrador (I confess – he lost his looks before he came to us when, as a 6 week old puppy, he got attacked and lost an eye) but on paper he is a Kennel Club registered pedigree!
I am, however, against poor breeding and I am definitely against dogs being used as a throw away ‘fashion accessory’, a worrying trend we have seen grow through celebrity endorsement of certain toy breeds.
Dog ownership trends are changing. We have seen a huge surge in popularity of certain pedigree breeds, which has led to poor breeding standards and puppies being illegally imported from puppy farms overseas. It is time we raised the profile of the cross bred dogs, who often suffer far fewer health concerns than their pedigree cousins but make for equally wonderful companions. It is for this reason that I am whole-heartedly behind a campaign like ‘Scruffts’.
Keeping a dog healthy takes a lot of commitment. Dogs require exercise, mental stimulation, veterinary care and a good quality diet. They say ‘you are what you eat’ and I don’t believe it is any different for our canine friends. As a vet, I have seen plenty of dogs being fed a poor quality diet that go on to suffer from poor skin, bad guts and even behavioural problems (the additives and preservatives found in cheap dog food have the same effect on dogs as e-numbers do on children!). If you are going to feed only one type of food for the entire lifespan of your pet dog, you need to choose a high quality and balanced diet.
James Wellbeloved is a wholesome and naturally healthy food with simple, hypoallergenic ingredients. Unlike other pet foods, the protein is sourced from a single origin inspired by nature – if it says ‘lamb’ on the label, then it is 100 per cent lamb in the food and no other animal ingredients. That means if your dog is allergic to one type of protein, you can choose a suitable food from the James Wellbeloved range with confidence that there will be no ‘hidden ingredients’. In a nutshell, it has all the goodness your pet needs and nothing they don’t.
Oliver, my Labrador, has a surprisingly weak constitution! Labradors have a reputation for being ‘dustbins’ and whilst he will gladly accept any food on offer, unfortunately it rarely does him any favours in the ‘toilet department’.
After a lot of detective work – I eventually worked out it is in fact grain that he is allergic to. For the past 5 years he has maintained a grain free diet and he is so much better for it. However, the food I am currently feeding is an imported Canadian brand so for some time now I have been on the look out for a British equivalent. The perfect solution could lie within the James Wellbeloved grain free range. I am going to transition Oliver over to the grain free senior range over the next three months. Keep a look out as I will be posting regular updates on our progress as well as tales of our escapades into nature!
Bye for now,
James and Oliver
Ps…Look out for the new James Wellbeloved advert on TV (or watch it below!)
My first blog post for the Huffington Post has gone live! Read it here.
Otherwise, read it here!!
Growing up as a child, I was surrounded by animals and art, the two running harmoniously together. Eventually I had to choose. I played it safe. I followed the defined career path to become a veterinary surgeon.
It may come as quite a surprise that the veterinary profession is currently navigating through stormy waters. The idyllic notion of James Herriott has been replaced with KPI’s, corporate deals and the most recent survey suggests that disillusionment is rife.
Despite these uncertain times, I remain immensely proud of our veterinary profession. Vets are a committed and honourable breed. I have always held a deep empathy for animals, their role in our society and the injustice some face through human cruelty. Everyday I feel like I make a difference and it comes as no surprise, therefore, that I love being a vet.
However, the emotional combination of working with animals, people and money can begin to take its toll. A few years ago, I was suffering from ‘compassion fatigue’. My standards never slipped, no animal under my care was at risk but I couldn’t see the ‘good’ in the job I was doing. I knew I didn’t want to leave veterinary, but I recognised that something had to change.
I decided to re-evaluate my priorities and dropped to a four day working week.
With the extra time off, I enrolled onto a pottery course. Here within lies the metaphorical and physical transformational power of clay. I loved it. Word got out that I was becoming ‘the vet that pots’. Creative people started entering into my life. A close friend donated me his spare potter’s wheel as an act of encouragement. I started re-connecting with influential, artistic people from my past.
I saw an advert online for a major new television programme focussing on pottery. I felt a sudden urge of excitement and unusual creative confidence. I was starting to believe that science and art don’t have to be mutually exclusive. Through discovering a new love for clay, my love for veterinary science was skyrocketing.
Move forward twelve months and one winter’s night in November, I was to appear as a contestant on BBC Two’s ‘The Great Pottery Throwdown’.
Television, in my experience, does not afford personal validation. But I use it as an example of how far I have come by simply giving myself that wonderful privilege of time. Time to work out who I was, why I wasn’t fulfilled and what was missing.
We all have a natural talent within each and every one of us. I ignored my creativity for too long, I can’t answer why. But I am guessing there are others out there also feeling shy of themselves.
There is no such thing as finding happiness. Happiness is created through doing something you are innately very good at and therefore you love doing it.
I have learnt that by allowing both the time and headspace to let your natural talent breathe, doors will open and the opportunities that may follow are endless. Trust me. Try it.
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When I was training as a vet, towards the end of the five year course, the sheer volume of information seemed so overwhelming. I can remember at the time feeling exasperated and looked to my mentor who said ‘don’t worry, it will all just suddenly fall into place’….. and he was right.
5 years into my pottery endeavours and I reached a plateau. After the Great Pottery Throwdown, I hit a bit of a wall. After all the excitement had settled, I looked at what I had achieved and remember thinking I still hadn’t found my own style. I phoned my pottery tutor who, ironically, said ‘don’t worry, it will all just suddenly fall into place’…….. and he was also right!
Over the past few months, I have been developing a range of personalised dog bowls. The clay is a flecked stoneware, very hardwearing with a ‘food safe’ matt green/grey glaze. I love making them and thankfully the results are consistent. I introduced the design onto social media and it has proved more popular than I could ever imagine! I am now selling to customers up and down the country (and even overseas!).
Here they are for you to see, what do you think? Let me know…..
My name is James Greenwood and I am a vet. I initially turned a blind eye to the plight of our junior doctors. Then reports of disillusionment, emigration and even suicide started to follow. For two professions that historically share a friendly rivalry, I fear we have found some unsavoury common ground.
I will attempt to shed light.
It comes as no surprise that being a vet is an emotional vocation. For each consultation we take on a different script and persona. Every 10 minutes our patter must shift effortlessly from an air of condolence to that of celebration, suppressing our own emotions to remain ever ‘professional’. From euthanasia to caesarean, this roller coaster never stops and we are expected to hop on board whether we feel like it or not.
There’s also the issue of money. Most of you have to fork out to see us and most of us hate talking about it. Put bluntly, you pay and we perform. The pet owning population has a long held perception that vets earn high as vets bills are expensive and unwanted, both financially and emotionally.
Without doubt, as more private practices are selling out to venture capitalist groups, there are a good number of practice owners reaping some heavy reward. But what about the employed vet, the veterinary equivalent to the ‘junior doctor’?
The most recent survey suggests new graduate veterinary salaries have dropped 3.7% and a vet qualified 11 to 15 years can hope to earn an average £48k compared to a doctor earning up to £83k and dentists £110k.
Perhaps that goes someway to explain why a Vet Futures report by the British Veterinary Association and The Royal College of Veterinary Surgeons in 2015 revealed an alarming level of career dissatisfaction amongst vets qualified within the last 8 years? Over half of those interviewed said the career had not matched their expectations and 1 in 10 were thinking of leaving the profession entirely.
I can’t speak for the generation of vets ahead of me, or those just starting out. But I can speak for my own and I know feeling overworked and undervalued is a common factor in many of my graduate peers re-thinking their career choice.
But are we just a whining generation of underperformers? Do we expect too much reward for too little input?
Interestingly, CM Research surveyed 3000 vets from across Europe and the US. Vets in the UK see on average 29 patients a day – the highest daily caseload throughout Europe and the US.
However, salaries for UK vets remain far lower than their US or European counterparts. No surprise then that UK practice performance has grown, with 45% of practices doing ‘slightly better’ and 13% doing ‘much better’ than last year.
It seems junior vets are working pretty hard after all but it also appears they are not reaping fair reward, and with limited reward, what of motivation? Obviously, the clinical work itself offers massive personal reward and is a major motivational drive but is it so ethically wrong for a vet to aspire to earn enough to start paying off a mortgage?
In my opinion, compassion fatigue is the result of feeling undervalued and unmotivated. For the general population, I imagine the idyllic notion of being a vet does not conjure images of depression, let alone suicide.
Tragically, vets are statistically four times more likely to take their own lives than the general population. Yet, for decades, the veterinary profession has brushed this grubby little secret under the carpet hoping the black dog of depression would move out and scratch at someone else’s door.
Junior vets are suffering an unprecedented level of career dissatisfaction in a profession that already struggles with alarming rates of mental health issues. Ultimately we are on the brink of a mass exodus of an entire veterinary generation. From looking at how the veterinary industry has been shaped over the past 8-10 years, young vets are choosing flight over fight.
These are the vets with experience, often popular with clients and clinically sound. Like the junior doctors, these vets are valuable. They are profitable and the future of the veterinary profession depends on them to remain in practice.
If I had chosen to study medicine at university, I would probably now be categorised as a ‘junior doctor’. Back in May, I invited junior doctors to email me their thoughts on the then proposed contract via social media. I received reports of disillusionment, frustration and plans to emigrate.
The new contract suggested junior doctors should work even harder by spreading themselves thinner, working more unsociable hours as a proportion of their working week to provide cover at weekends and evenings.
Despite a base salary increase, major cuts to the banding pay system (the doctor’s equivalent to overtime) would have essentially required them to perform this task with little to no increased remuneration. In fact, some would potentially be paid less than they do currently.
As a junior vet, this all sounds strangely familiar. Many UK junior vets are already working under such ‘Jeremy Hunt’ style contracts. It is written into contracts to work long, unsociable and weekend hours as standard with no additional overtime pay and an expectation to cope.
I’m sure there will be some reading this thinking ‘he doesn’t care about the animals, just the money’. However, this is the reality of working within a caring profession. You care. In fact, you care so much that you will sacrifice your own health to meet the demands of others. But this is a job and we should not be made to feel guilty for raising the issue. We need to earn a living and that should correlate fairly to the hard work performed.
Vets cannot compare themselves directly to the union led, public sector medical profession. The government dictates the future of the NHS. However, vets have an advantage over doctors in that they can steer the future of their profession in whichever direction they choose.
Vets have always been in competition with each other. We compete to get into university, compete for jobs and compete viciously as practices to retain clients. It’s a game of ‘every (wo)man for themselves’.
As with the doctors, vets must learn to find a unified, cross-generational voice. We must come together to collectively decide the future of our profession, both clinically and economically to ensure all vets at all stages of their career can benefit mutually and gain fair reward.
I have an appreciable empathy for those junior doctors that fought for a fair deal and I admire their bravery to speak out. I am not generally in favour of strike action but in this case, I am. With the support of consultants (possibly in fear of being next in the firing line), the strike has not put anyone at risk but effectively highlighted the desperate situation. The proposed contract has subsequently been withdrawn and a referendum vote for a more balanced contract is due on Wednesday.
Junior vets, similar to the junior doctors, are clearly struggling and we need support from within our veterinary profession. Junior vets cannot go on strike and I doubt many would actually want to, but instead I ask our senior vets, currently with all the power, to consider where our future lies.
I love being a vet. Every day is different and every day brings with it a new surprise. And I love animals. I get to spend all day in the company of animals and for that I am eternally grateful. It is a wonderful privilege.
In the recent weeks of turmoil and unrest, the conclusion to the Junior Doctors fight may fall on somewhat distracted ears but I for one will congratulate them now, which ever way their vote sways and say their plight has been courageous and worthwhile. More importantly, they have set an example to us vets. Treat each other fairly.
Today, a Vet Futures summit is being held by The British Veterinary Association and The Royal Veterinary College in London to discuss the future of our profession. During the coming days, our doctors will seal their own fate. I, for one, am hoping that today may also mark the start of a new era for our vets too.
Since I released this article on 4/7/16, it has had over 16,000 views.
Despite the BMA members rejecting the deal reached in May, the Junior doctors’ contract was imposed on the 6/7/16 regardless. What happens next is yet to be decided…
On the 7/7/16 the BVA and the RCVS released a Vet Futures Action Plan in response to the issues raised at the Vet Futures summit. The action plan covers many of the issues felt in this article, and more, and is a positive step forward for our profession.
The action plan can be viewed at: http://vetfutures.org.uk/resources
Shery Crow…….the greatest. End of. Why start with that I hear you cry? Well…..when I paint, make or cook, music is the one thing that stays constant. And it has to be loud! And, usually, it starts with a Sheryl Crow album!
I started this painting after returning from a holiday to the South of France, a market town called Valbonne. I wanted to capture the busy life of the market but also the light streaming through the trees. I haven’t painted for over 10 years and after the pottery show, I needed to take a bit of a break from ceramics after such an emotional roller coaster! So i decided to go back to what I love – which is painting with oils.
I took advice from a painter friend mid way through the painting who said ‘get rid of the grey’ and ‘paint the whole picture not piece by piece’ and I have to say it took on a whole new life of its own.
Anyway….here it is for your collective perusal, judgement, appreciation, criticism or just because!! Feel free to comment…..
January is coming to an end and that can only mean one thing, those dried up drinkers can get supping again!! Welcome yourself back into your happy place with my Mojito granita….
It could not be easier, there’s no mess and you don’t need to find an endless source of crushed ice! So here it is…
Place the sugar in a pan and add the water. Warm on the hob until the sugar has dissolved.
Take the mint and pick 2/3rds of the leaves. Place the mint leaves in your hands and ‘clap’ three times to bruise the mint leaves but do not crush them (otherwise they will turn bitter). Place the mint leaves and lime juice into the warm sugar syrup to infuse, cover with a lid and leave to cool.
Once cooled, chop the remaining mint leaves and add these to the cooled syrup with the Bacardi. Taste the syrup and adjust the lime/Bacardi ratio until you are happy.
Decant the syrup into a shallow dish and place in the freezer. After 2 or 3 hours, scrape through the frozen mixture to break up the ice crystals. Repeat this again 3 hours later.
Serve in glasses for a ready made, easy Mojito! You will not be disappointed and your guests will be utterly wowed!
I have been working recently on trying to develop a range of bowls to further reflect my love of the the coast.
Thrown in porcelain (tricky in its own right!) I have been working through various techniques to try and come up with the desired result.
I have hand drawn a pencil outline (that burns off in the kiln) onto the biscuit ware then used Royal Blue amaco underlgaze to fill in the shape. I have then scraped (or sgraffito) through the glaze to reveal the white porcelain underneath to add some depth to the design.
Unfortunately I think I have put the underglaze on too thick so the sgraffito detail has been lost a bit in the glaze fire, but I quite like how the mussel bowl has turned out.
Here they are…What do you think?
So we’re hitting the Great Pottery Throw Down semi finals this evening and chandeliers are the on the menu…..
Whilst I’m not there in person, I am with them in spirit! Yesterday The Veterinary Times published an article on my time in the show which brought back all the fond memories!!! Through the power of clay, I have made it on my own into our vet professional press….
Here are some pics of my main make challenges and the article itself….
Article published in The Vet Times 30/11/15 (above)
Challenge 1 (ab0ve) – 5 nested bowls at 30cm, 25cm, 20cm, 15cm and 10cm diameter
Challenge 2 (above) – a handbasin measuring 45 cm diameter
Week 3 – Throw 10 vases each with a tall, narrow neck. 5 taken through to Raku firing. The vases were to be of identical form but decorated individually.
Then…….. Me done!!!
Hake is great! It has a firm, meaty texture and holds together well on cooking. Even more importantly, it is sustainable. Give cod a break, try hake (hey…that rhymes!!!)
Keep things simple – simple flavours work well with white fish. Think lemon, garlic, parsley, capers and you have already started a dish to rival your local restaurant.
I also think fish works best if you combine it with varying textures like silky smooth mash to compliment the flaky, firm white fish and steamed kale to act as a little mop, soaking up all the juices and make sure every mouthful is full of flavour.
So here it is…. my pan fired hake fillet with olive oil mash, steamed kale and a lemon, parsley and caper sauce.
Peel and halve the potatoes, boil until tender than drain thoroughly before combining with a good knob of butter and then mash together. Season with salt and pepper. For a really smooth mash, pass the potato through a sieve. It is a bit of a faff but one taste and you will notice the difference. Drizzle in about a tablespoon (or more) of your best quality olive oil. The mash can be kept warm under foil in a glass bowl set over a pan of hot water.
Meanwhile heat about 75g of butter in a heavy based frying pan over a moderate heat. Dry both sides of the fish with kitchen towel and season the skin side with salt and pepper. Once the butter has started to foam, move it around the pan until it takes on a nutty brown hazelnut colour. At this stage, add the fish, skin side down. Don’t move the fish round the pan, let it sizzle, if it starts to ‘arch’ up out of the pan just gently push it back down. Allow it to cook for 2-3 minutes then once the skin is crispy, turn over and cook flesh side down for another couple of minutes.