BSc (Hons) Path Sci., BVM&S,
The consultation is at the very epicentre of veterinary medicine. It is the cornerstone of communication, diagnostics, client education, practitioner fulfilment and practice revenue. Sadly, in general veterinary practice today, it is almost impossible to achieve.
The average length of consultation in vet medicine is about 10 minutes, according to Robinson et al., writing in the Veterinary Record in 2014.
Bizarrely, within the 182 consultation study, the 9 minutes and 49 second median consultation time does not count time spent reading or writing clinical notes before or after the consultation, talking to the client in the waiting room, or preparing medications or samples once the client had left the room.
Maybe the authors live in an ideal world where irksome things like walking, greeting and doing a good job are now superfluous? Whichever may be true, it would suggest that a ten-minute vet consultation is typically not fit for purpose.
By my calculation, the 'average' (i.e. perfect, swift, uncomplicated, sterile, business-like and totally unrealistic) consultation, there needs to be nine stages: Preparation and note reading (at least 60 seconds), greeting (30 seconds), understanding owner's concern (at least 30 seconds), examination (at least 120 seconds), summary of findings (30 seconds), treatment (90 seconds), explanation of vet's expectation (at least 60 seconds), conclusion (90 seconds) and note writing/sample preparation (at least 60 seconds). This adds up to an absolute minimum of nine and a half frantic minutes.
“I'm getting palpitations just thinking about it”
That's 2 hours consulting in the morning, then 2 hours in the evening for most of their career. Is there any wonder that vets are renowned for heading up the professional suicide rates and mental health is now a hot topic.
Of course, some consultations will be shorter, some longer, but I would suggest all have a degree of rush, stress and compromise. Add simple and everyday complications like vet inexperience, complex cases, vets new to a colleague's ongoing case, long written histories, chatty clients, nervous animals and unforeseen circumstances, and you have the recipe for the perfect storm.
The consequence of this stress bubble (the consultation) is poor communication through lack of time (increasing the chance of litigation), overuse of pharmaceuticals to 'get the client out the door' and migration of very able vets out of general practice into industry, child rearing or quitting vet medicine altogether.
Corporate practices are now prominent across the whole of the UK. Here, turnover of vets is high, often using younger clinicians, some with English as a second language and consultation length is tightly controlled. All these factors increase vet stress in the consultation, reduce consultation quality, helping neither the vet, the business, the client or the pet.
“The pharmaceutical and pet food giants supplying veterinary practices are delighted with this stressy status quo”
pressured vets prescribe more drugs…
Pressured vets prescribe more drugs, treat less well, increasing the likelihood of repeat visits, so needing more drugs and further costly diagnostics. Who shoulders the brunt of the fallout created by short consultations?
Your animal is the put-upon partner in this pressurised medical interaction. They suffer more vet visits, longer periods of ill health (as they are passed from vet to vet), increased likelihood of unnecessary intervention and living with an anxious, frustrated owner.
We vets need to put more emphasis on time spent listening to and educating owners and less on numbers and production-line medicine.
The word 'Doctor' derives from the Latin, 'docere', to teach, after all. We must increase consultation length and charge appropriately; the better the communication, the less need for drugs and tests, the better the health of the patient, their guardian, the veterinary surgeon and the whole veterinary community.
For the sake of the animals in veterinary care, not to mention our sanity and professional satisfaction, we vets must consult more wisely.
Robinson, NJ., Dean, RS., Cobb, M., Brennan, ML. (2014) Consultation length in first opinion small animal practice Veterinary Record Published Online First: 26 September 2014. doi: 10.1136/vr.102713
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