Showing posts with label AVMA. Show all posts
Showing posts with label AVMA. Show all posts

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Tuesday, June 17, 2014

How Do Our Perceptions Lead Us?

Rizzy, sleeping at the Receptionists desk.
"To change ourselves effectively we first had to change our perceptions." Stephen R Covey.

We all have a foundation of belief that motivates us to move in a certain direction. As we move down that path the question becomes; How does our perception influence our belief? If the foundation is a belief is the rest of the road determined by perception?

I had a long talk with a rescue advocate today. We were talking about joining forces to help each other with the common goal of helping pets.

After a long conversation it seemed to me that she was trying to assess where I stood on many "hot animal topics." She is obviously dedicated to helping rescue pets (a subject very near and dear to my heart), and understanding how her efforts to address their challenges, needs, and problems can be resolved. She was also asking me about my perceived role in doing the same. Seems like a reasonable question. Vets have the answers to so many pet problems, So why wouldn't vets be doing more to help alleviate them?

The questions seemed to center around utilizing veterinarians to provide more for less. Hence, bridging the gap between need and availability. They included questions about; Why are we charging perceived high prices (example $15 for a nail trim)  for what we do? If we gave our services away, or charged less, the services and goods would help more people and save more pets. A simple marriage of ethical obligation and economics.

So, how did her perception of where the help is needed become a query into how vets can do more for less?

It got me to thinking? DO people think that vets are the source? Or even a part of the pet,,,,whatever,,,problem?

I  suppose people do.

Her litmus test for me, as a way to seek out my intentions and beliefs revolved around two questions.

Question Number 1. "How do I feel about vaccinations? Because veterinarians use yearly vaccines as a way to get people into the office AND because we over vaccinate."

Was I offended by the question? No, I wasn't at all surprised by it. It is a commonly held perception.

"At my clinic we use a three year distemper combo vaccine, and a three year rabies after the first year." That's my official answer. I gave her what she wanted to hear..but it isn't the whole truth.

Perception vs Reality Statement Number 1

Why don't other veterinarians use three year vaccines? Because I think that they believe that most people won't come back for their annual physical examination unless their pet also needs a vaccine.

For this reason there are veterinary practices now offering "Free for life vaccines." How is the perception different from the reality? Well, I believe that the most important part of bringing your pet to the vet is in the conversation that you have with me, and the things that your pet tells me. It is in the yearly examination,,not the vaccines. How do you get the most value out of your pets yearly exam, regardless of the vaccines needed? The primary care giver(s) should go with the pet. For some pets the examinations should even be more often then yearly. For young (1-6 months old) and older pets (cats and small dogs at age 8, large dogs age 5) I recommend an examination every 6 months.

The answer was given to address her underlying question, and still the perception is not wholly reality. How do I address the belief that the people won't come back? I recommend Lyme, Leptospirosis, and kennel cough vaccines be given yearly (the interval they are good for). For cats we stagger the 3 year vaccines..so that at least two out of every three years we see them..and I beg for the other. Do we over vaccinate pets? Yes, we probably do. That's why titers are a great option. But the problem with running a vaccine titer is that they are about three times as expensive as vaccinating. Ask me what's better for your pet. I will give you a list an arm lengths long. But it will be tailored to your pet. That's the value in my service and expertise.

And, sometimes, regardless of my deep seeded discontent in repeating this over and over, I still say, "I don't make any decisions based on money." Although should you ever be foolish enough to open your own business you SHOULD make decisions on what to do based on what is profitable. But for whatever reason it is not ethical to make decisions about running a business focused on pets based on profits..

I often want to remind those seeking free and discounted pet services, that I spent four years in high school and vet school getting A's so that I could get into vet school. It was decades of grueling, stressful sacrifice. And, after all of that I am asked and often expected to work for free, undermine my own business, and feel terrible guilty with every decision. It is not a profession any successful, business person who truly loves animals should ever venture into. There is a reason veterinary medicine is becoming corporately driven and owned. They can do it without guilt or remorse from a tower far, far away.

Bentley, here for his dental yesterday.


Question Number Two;
"How do I feel about RAW diets?"

Perception vs Reality Point number Two;

I am a scientifically trained doctor. If the evidence points to something as being inherently dangerous why are people still choosing to use it? There have been multiple statements made and published and still the public ignores this. Is it because they think we are paid by food companies? (See the AVMA policy below).

I use prescription food exactly the same way I use prescription drugs. Do I make money off of the drugs I sell and the food I sell? Yes. But I don't care where you buy them. You can buy your drugs from me, from the human pharmacy, and the same goes for food.

Do I think that some people believe that their pet benefits from a raw diet? Yes. But did they try other diets? Did they ever get a professional opinion? If you, or your child were ill would you go to the grocery store to get advice about what to feed them? Do you think that the untrained attendant at the grocery store isn't going to sell you a food that they don't carry? They are trained to sell only what they carry. I don't know of one person on a raw diet because an accredited veterinary expert recommended it. People really hate that answer, I know. Although I still don't understand why?

She then went on to regurgitate the same slanderous misleading jargon that I hear everyday from people with no business calling themselves an "expert" in anything..it is usually about "prescription diets being inferior because the label starts with"..., or "the benefits of grain free, holistic, all natural," etc. etc. Unfortunately, the public has been mislead into believing that the perceptions of good food companies, and good products are not reality. Worse yet, you all were lied to by other food companies..or people who are willing to risk you and your pets lives because they no longer trust "the establishment."

If you want advice about food see a nutritionist..and if you don't believe that we have your pets best interest in mind then we have failed you and your pet.. Every nutritionist that I know is only providing advice for one single thing..(like the rest of us in veterinary medicine),,  to help your pet. But be careful who lays your foundation of belief and who provides your perception of what is optimal for your pet..

Somewhere along the line the people who spent decades learning about how to help you take care of your pet lost their credibility and the advocates for pets became the outspoken but untrained.  A veterinarian spends years to earn their DVM. Then we spend many more to understand the big picture and how every single participant influences it. You can't do it with one dog, one case, and one perception.

My advice; If you need expert advice for your pet go to a medically trained certified veterinary professional. If you don't like that advice get a second opinion..and if you are looking for an answer that's not the answers you get then ask yourself why? And what your perception might be?

Skittles. Found on the side of the road.
The people who found her believed that she was blind and suffering.
They believed she should have been killed.
In fact, she is visual, happy, and will be just fine.
She is with us, and looking for a home.


Where is my reality fading from perception?

I believe that helping each other is group effort, and this infighting divides  us from our goal. And, I don't want to be a part of the problem as I try to be a part of the solution.

What do I believe is at the heart of her questions?

Trust.

That one simple word. It defines everything we do, are, and hope to become.


Related Articles;
The Raw Food Blog

Raw Pet Food AVMA Policy

Charlie.. Whose perception and reality are one in the same..
Magpie is going to school him about who is in charge.
I appreciate your thoughts and comments.

And if you have a pet question you can ask me, or any of the rest of us pet lovers, at Pawbly.com. Pawbly is an open platform to help people and their pets. It is always free to use.

Or find me at the clinic, Jarrettsville Vet, or on Twitter @FreePetAdvice.

And as always,
Always Be Kind..


Tuesday, May 6, 2014

National Pet Week 2014



This week is National Pet Week.

Always the first full week of May, National Pet Week was started in 1981 by the American Veterinary Medical Association. The hope of this week of celebration is to remind us all how important our pets are in helping us live a long, happy and healthy life.



What do our pets mean to us? Well, for many of us they are our friends on the long dark days, our comic relief on the days that can't break a frown, a warm bundle of companionship when the shoulder of a friend to lean on is needed. They are the unconditional love when we need a break from the rigorous demands of life, and they are the ones that we share our greatest joys with and deepest sorrows with.


In honor of this week I wanted to introduce our pets to you, and share what they mean to me.

For me, my puppies are my confidants, the hand to hold so I never feel alone, my protectors, my home alarm system, my bed warmer and bed hogger, blanket stealer, and house mates so that I never feel alone.

Charlie and Jekyll

I can tell what my puppies are thinking. What they are looking forward to and what they want to do all by the tiny shifts of their eyes, their ears, their tales and their expression. I don't need a linguist, a word, or an interpreter. I know them as well as they know me.

When I am sad they stay close. When they are bored and anxious for a walk we go together. We keep each other motivated to play on the cold snowy mornings, and rainy muggy evenings. We have a mutual obligation to look after each other, even on those days where the comforter calls me to sleep a few minutes longer.


This year the AVMA has chosen the theme of  "Love your pet, see the vet." to remind pet parents that one of the most important ways we can show our pets that we love them is to provide them with veterinary care. Your veterinarian is an expert on detecting and treating disease, injury, and illness, and assisting you in maintaining optimal care for your pets. They can often detect early signs of disease before the parent can. Even for those of us parents who spend almost every single waking moment with our pets. Pet care has too often taken the back seat to pet accessories but I know first hand that the knowledge and advice that I give my clients about our patients every single day helps them to live longer, happier and healthier life.

Charlie yawns,, a bit bored with the whole photo-thing.

My pets are a daily reminder of how vital the role of a veterinarian is in taking care of my family. There is never a day where I am not feeling grateful and blessed to have my pets beside me. They are my greatest joy and my deepest sense of responsibility. To help protect them and provide them the stepping stones to achieving a lifespan into their late teens, like Savannah had, or their early 20's like the first generation my kitties got, I know that it takes a team effort. A full examination every 6 months, vaccines as needed, monthly heartworm, flea & tick, yearly fecals and blood checks, and the daily teeth, ears, coat and nails regimen.


And as much love as they will tolerate...
Even when this is the face I get in return..sometimes it's tough to have a slightly overbearing mother...

And for my kitties. Who are the center of my heart. 

I know that some of you have a pet preference, and that perhaps you are not privy to the complex nature of a feline..but to truly know a cat whose trust you have earned, (because everything in the cat world is on their terms), is to truly know what loving something unconditionally implies. 

Jitterbug, who is his own man on his own terms. He is loud, demanding, and in charge.. He can also be the most submissive docile love bug..Who wants an easy transparent cat?I love him for his independence and fierce sense of entitlement.
Jitterbug
 Magpie, a rescued kitten who came to me with a badly broken ankle. One month of strict cage rest and it healed beautifully. However, in the one month I got a bit too attached..my Achilles heel is a kitten, no doubt.

She is the most daring, adventurous, spirited little thing. Always hidden inn the shadows, you will never see her as a guest in my house, but she is there watching you. Sometimes under a blanket, barely visible  as a tiny wrinkle in a sheet, and sometimes a flash of black at your heels. But if you are quiet enough and trustworthy enough she will melt in your arms when you pick her up. And purr louder than you can believe a little 5 pounds could produce.
Magpie
 Wren. Most definitely the peaceful gentle foundation of my heart. The first words out of my mouth every morning and every day I come home are for her. "Wren-wren!" and there she is at my feet. Little "mew" to greet me and a belly flop to say she missed me too. No kitten had a harder start in life and no cat ever asked as little in return. She is the official greeter of the home and loves and trusts blindly and without reserve. Not one single person can resist her charm.

Wren
 Oriole. The abandoned orange chick who was lucky enough to be friendly even after having been cast away, brought to the clinic for vaccines and a spay, and purred her way into our house. She remains an energetic, spastic, effervescent, dynamo. She can often be heard running like a water buffalo through the house. Making as much noise as she can, disrupting as much furniture as she can only to arrive traveling full tilt to full emergency stop at your face with a little "MEWK!" to announce that she's here for a short pet before the engines fire up again and she's off!

Oriole and Wren...

Oriole, She knows she's hard to resist.
Pets come in all sizes and shapes. This is our pet pig Strawberry. A rescue from the Johns Hopkins heart study. She was bred and raised to donate her heart valves to science. But her study ran out before her number came up. So she came to live with us. She reminds me every single day that love knows no boundaries. No lines of species, no definition of "normal" or "acceptable." She is her own person, with her own thoughts, feelings, preferences, fears, and I love her in spite of her hooves, her lack of fur, and her bratty attitude. How can I be a vet to all species if I can't see the unique qualities of pets in all things?
Strawberry

Go hug your pets this week! Or call your vet and ask for their help in taking even better care of your beloved, two, three, four, eight, or no legged pet..


With love to all of your pets from my clan to yours!

Please join us in sharing the love of all things pet at Pawbly.com. Free to use, Pawbly is all about helping pets live a longer, happier, and healthier life!

You can also find me on Twitter @FreePetAdvice, or at the veterinary clinic, Jarrettsville Veterinary Center in Jarrettsville Maryland.

Sunday, March 16, 2014

Fairness To Pet Owners Act, H.R 4023, Where Do You Stand?


It is a dirty little hushed secret that the laws in this country can be made based on the amount of influence and money you throw at our elected officials. If you think I am being cynical or pessimistic take a long look around. We have been trying to break away from foreign oil dependency for over 30 years. We can put  a man on the moon within a decade of proclaiming it a mission, but we can't produce an electric car for four decades? Or, figure out a way to provide healthcare to our own citizens even though we are by far the most medically advanced nation in the world? Poverty, well, it is alive and well in the richest (debatable term these days I agree), country in the world. Drug companies, car companies, insurance companies, "fill in the blank" companies, if they get big enough, rich enough, they get powerful enough to bankroll huge numbers of lobbyists to strategize, schmooze, woo, and cohort with our elected officials to manipulate our consumer landscape. Every well formed successful company has an account in place and available for the single purpose of placing dollars in front of people who can influence.

I was a part of a union for a decade. Every quarter my dues were collected (or my ability to ascertain a job was nullified), and every quarter it was expected that I contribute something to the political action fund. If you asked any of us worker ants where that money went to we would either regurgitate a union provided script, or we would shake our heads and plead the fifth. If you want to believe in the fairness of a democratic system then lobbyists and PAC's seem somewhat counter intuitive.

The road to getting better.
 I received a Facebook request from a fellow veterinarian the other day asking me to use the link provided to appose "HR 4023." I replied back asking "Why?"

What followed was a short dialogue about protecting our revenue streams and influencing the democratic process to benefit us, the veterinarian, the veterinary hospitals, the very small majority.

I own a small animal hospital. It is a business. I understand as much or more than anyone else how a private practice makes money, stays alive, continues to provide a service for the members of not only the community that I serve but also for the families of my employees.

One of my favorite patients, in front of our pharmacy.


Until a few years ago the veterinary pharmacy was considered the cash cow of our business. Benchmarks for revenue streams generated by our pharmacy were supposed to be about 33% of our total revenue. The pressure from price matching our 'routine services' like spays, neuters, examinations and vaccinations were widely available by cold calling and requesting prices. But the pharmacy was the golden egg. Once you got in the door you never asked about comparison prices from the clinic down the street, nor could you go down the the human pharmacy and buy your dogs de-wormer there. We had that part of the business locked down and you were at the mercy of the clinic you walked into.

The main hallway at Jarrettsville Vet.


I remember when I was in vet school in rural Virginia in 2001. It was pretty common knowledge that the old practice one town over was by far the cheapest option in the county. As a poor vet student I drove the 20 minutes past the seven other closer clinics to go to ole doc's practice. I wasn't a client there, I had never brought a pet there, but when I asked for a sedative for my cat the receptionist went to the back put two pills in a small envelope and said "33 cents." Clearly ole doc was not a member of the new generation of veterinarians attempting to run their practice as a business, or providing contributions to the veterinary political action funds. Ole doc was my first take home lesson on running a profitable business. There is a fair price for everything, but drugs should cost more than gum. Not to mention the whole legal muck of prescribing them to a patient after the client-patient relationship has been established. What if my cat weighed a pound?, or had a heart condition? Or was a figment of my imagination..Ole doc was popular among the locals but a medical malpractice field day.

Jarrettsville Vet's front desk.
Every single person who owns a small business feels the pressure of big companies nibbling at our heels. Can I compete with Wal-Marts four dollars prescriptions? Heck, some pharmacies give the meds away for free! How do I compete with trying to match prices with companies who can buy the drugs in such ginormous volumes that I can't buy them for as cheaply as they can sell them? The answer is I cannot. They are so big that they are in a league of their own. Shoot, their league is so big I am not even in the same universe.

Another happy customer.

The first sign of our pharmacies impending demise came when the once "veterinary exclusive" flea and tick products (aka our bread and butter) went OTC. You could find Advantage at PetsMart. Why go out of your way and spend more at the vets office? Once these flood gates opened (and by the way Bayer the manufacturer of Advantge/Advantix had massive rocketed increases in sales, very, very smart move on their part and met by very happy shareholders), everyone else started producing flea and tick products for sale in stores. Remember the guidelines for producing and selling a product for pets is far more relaxed than it is for human use. (All your product has to NOT do is kill or harm them. Does it have to work?,,no).

Once the grocery store shelves started carrying the most popular flea and tick preventatives vets got worried. The veterinary market responded by making "veterinary exclusive track and trace" products. Diverters would be found  and banished from ever selling the exclusive drugs in the future. What happened?, well, many of us now carry and sell products that you can only buy within our walls. The cheap stuff like bargain old antibiotics, we let some of those slip through our doors with prescriptions to Wal-Mart.


1-800-PetMeds became the next villain in the conservancy of our pharmacy. Once again they could buy huge volumes of product and undercut our ability to match them. Never mind the massive marketing campaign about how much more convenient and cheap your pets meds were from them. They too made record sales (damn, why didn't I think of this?). The faxes vomited out requests like parvo puppies. There were multiple daily requests and many practices just decided to let those dollars go rather than pick up the phone call the client and discuss what the value of their choices might cost. Me, well, I call every single owner, and I match every single request (that I can, and if I can't we discuss why, and who the heck this pharmacy is that they found on the internet?). I don't win them all, but I care enough about my clients and the safety of their pets to have a discussion.

Lola, recovering from her spay surgery.

When the request came from my colleague to appose the Fairness To Pet Owners Bill, or H.R. 4023, which essentially requires every veterinarian to provide a written script for every drug we prescribe, I asked her to explain to me why I should appose this? The answer I got back, "I have had human pharmacies change scripts (I believe this will be resolved soon to help insure everyone's safety, and we ALL need to write legibly or else who's fault is it?). I also think that for the most part this will force the cost of other things in vet med to go up. I know we aren't supposed to make our money on the drugs we sell but at least in a smaller practice like mine I have to."

Is there truth in those words. Yes, of course. If my ability to earn a profit is impacted by a loss in the sales of any part of my clinic I will have to adjust prices elsewhere.

All hands on deck.

But we vets are consumers too. Would we want to be going to the grocery store and find that we can only buy bread from one store? Or go to our doctor and be told that we can only buy our prescription from them? Wouldn't that store and that doctor naturally increase the price of the bread or the medication if they were the only game in town?

Let's expand this out to our ability to buy a gallon of gas, or fuel oil to heat our homes, or medicines for our kids. How is it any different?

Is it right or just to influence the people who are supposed to be governing for fairness among all of the citizens so that the minority benefits?

When I visited the AVMA (American Veterinary Medical Association, thankfully a whole lot nicer and more honest than the last Union I worked for), their reasons for asking their members to oppose H.R. 4023 are, "It is burdensome and unnecessary to require a written prescription be provided, regardless of whether or not the client is having the prescription filled by the veterinarian. Clients already have the flexibility to fill a prescription at their veterinary clinic or off-site at a pharmacy of their choice.  The AVMA is supportive of a client’s right to choose where they have their prescription filled."

Me, my vote, well, I have to maintain a profitable business, it will happen by adjusting prices as any responsible business owner does, but I am also a consumer. Wouldn't it be nice if we all made decisions to benefit each other?

My prediction?, That convenient pharmacy in the back of my clinic is on the endangered species list. It will shrink and disappear and I will have to charge more for my ridiculously underpriced spays and neuters (which I am banking Wal-Mart won't want a piece of,,at least for a few more decades). We veterinarians are going to have to learn how to market ourselves so that our clients and communities see the value in our services, because the goods, well, they are a hot commodity and likely will be squeezed to the point that we willingly (or not so willingly) will have to surrender them.

Dr. Morgan performing an ultrasound.



Me, I am providing exemplary care in a diversity of services (acupuncture, ultrasound, orthopedic surgeries, high quality dentistry and the most welcoming family like compassionate setting imaginable,,bring it on Wal-Mart and 1-800-PetMeds!

Me and Preston
If you have a pet related question, or want to just read stories about other pets, or share your pet with the rest of the world you can find me, and all of the above, at Pawbly.com. Or you can find me in person at the clinic Jarrettsville Vet, or on Twitter @FreePetAdvice.