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Ethics, Welfare and the Future of Vet Med with Dr. Caroline Allen · Under The Fur

• speaker-0: Hello, welcome to this week's edition of Under the Fur. I am joined by Dr. Caroline Allen, who is a small animal veterinary surgeon with over 25 years experience, founder of Pet Lighthouse and ex-RSPCA Chief Vet. She has an RCBS certificate in small animal medicine and has spent several years in the charity sector. Caroline's passionate about welfare. Ethics within Veterinary Medicine and has been awarded the Fellowship of the Royal College of Veterinary Surgeons in 2025 in recognition of a contribution to the profession. And today we're going to discuss a little bit of Caroline's life throughout veterinary medicine, challenges she faces, what she's passionate about and what she's doing now. Thank you very much for joining me and for making the journey, even though you got stuck in Ascot for a while. speaker-1: Yeah, the joy of the trains. But thank you so much for having me. speaker-0: No problem. I think you've had a really fascinating career and a lot of experience and ⁓ you seem like someone I would like to learn a lot of things from. When I was looking, I saw that we went to the same university. We both Cambridge veterinary graduates. And I thought we would maybe start there. And I want to know how your experience of Cambridge was. speaker-1: All right. Yeah. I I love so many things about Cambridge, but it is quite a unique experience. In six years in what was then actually quite a small town in some ways, but with this dominant university and you are, you are privileged to be there. I mean, I didn't come from a privileged background, private school or anything like that, but it is a place that you are privileged to be there because speaker-0: This is what I say. ⁓ speaker-1: the teaching that you have and the environment that you're in. It was tough at the time. mean, they worked you hard, but when I look back on it now, I think, you know, I'm so lucky to be there. And I think the really good thing for me is that it isn't just a vet school. You've got people, you've got friends who are kind of across the whole kind of academic spectrum. One of my best friends was a classicist, know, and very different. And so you have very different perspectives. And also you do learn a lot with the medics, which I think recently with some of the things about Cambridge, maybe closing with some criticism from the Royal college, some of which was very, very valid, but some of it was, ⁓ you know, they taught this with the medics. And actually I think that can be a real benefit because you really do have. A broader perspective. speaker-0: Similar to what I felt about it, I really struggled at Cambridge and a lot of my classmates did as well. And when they discussed closing Cambridge University, we didn't know how we felt about it because we didn't love it. ⁓ But I do remember going back about just, you know, like two, three, four years later, a couple of times and looking at it and thinking, I did not appreciate this when I was here. It's a beautiful town. The experiences that you can get there and just like the history of the place was amazing. I definitely didn't appreciate that at the time. ⁓ But I guess hindsight is a thing. But I did get my veterinary degree and I made very lovely friends and it set me up for my career and it's obviously set you up for your career. ⁓ So I think overall, I'm glad they're not closing it. That would be awful. speaker-1: I'm sorry that you didn't have a good experience. mean, it was a pressure cooker, but I would imagine that I was there quite some years before you. And I think when I've gone back, I've gone back through some confidence in things is what struck me was actually how little it had changed. And I think that it hadn't had the investment that was really needed. So, you know, and I think that's a real shame if, if, you know, students after me were of maybe let down a bit by that. So I do hope now they've decided to save Cambridge, which I am glad about because of its unique perspectives. I hope that they really invest and really make it a forward looking vet school. Yeah. I don't think there's any point saving it just to carry on. speaker-0: Absolutely. Yeah. I look at it, assess it and make the changes that are needed. ⁓ fingers crossed on that front. guess that's a watch and see, see how it goes. because they have everything they need to make the changes. That's what I believe they could do it. yeah. So, ⁓ okay, good. So I'm glad that you had a, an okay experience. When did you graduate? speaker-1: ⁓ well 1998. yeah, it was a while ago. What about you? 2000. Okay. Yes. speaker-0: 2008. It's not that long later. 10 years. Yeah. That's true. That is true. And then what did you do when you left Cambridge? speaker-1: A lot can happen in 10 years. So I went to a mixed practice first, because back in the day, that's what you did. Yes. And I very soon realized that that was a big mistake because I was only interested in small animals and I am actually allergic to horses. So, and I was doing small animal during the day and large animal on call. And that is the worst possible combination that you can have. But it was, you know, it was a little practice, you know, independently owned. very supportive for new graduates. they sort of changed the rotor and it split and I became, essentially became a small animal vet, which I was happy with. And it was, it was a good grounding. And I think, I'm not sure those good grounding sort of practices are there in quite the same way for vets now. So was, you know, very fortunate to have that. Then that was up in Norfolk. I really wanted to move to London. I always love London. So I After about two and a half years, I moved to work for Goddard's, their main hospital in East London. Yeah. So again, that was, you know, owned by Philip Goddard back in the day. It was, it was an incredible learning experience. I do look back and think, ⁓ my God, that was madness. But I still see nurses and vets around who were there at that time. And actually some of them have gone on to do amazing things in leadership as well. So I think it was a good grounding, but. kind of think back to the Saturdays where you had clients waiting for an hour because it was so busy and a row up of sort of, mean, the staff were all amazing, but it was just busy and it took the cases from the surrounding practices. So you'd end up with all the emergencies sort of lined up to see you. by the time I left there, I kind of knew that I could cope with most things. speaker-0: and I'm just. Yeah. sounds like a sink or swim situation. speaker-1: It probably was. I'm sure it's different now, but that very much it. speaker-0: I think, no, no, I'm wrong. I think we're trying to do, you know, there's a lot of new graduate support schemes now and a bit more of this, probably not the right term, but hand holding or guidance. We should say that and said more guidance, more support. I, yeah, I think my start was similar, but I actually loved that. That was great for me. I came up very confident. have no idea why, but I did. And was, was quite quickly, soul charging on my own and dealing with things. And that was okay for me. I did not, however, ever have to get up in the middle of the night for farm or equine emergencies. I'm not sure how that would have gone. speaker-1: Don't recommend it. Don't recommend it. speaker-0: And would you then go out by yourself and see things you've never seen before? speaker-1: Yeah, I mean, it was in the middle of Thetford forest that I would be driving around one time I was called to a deer and you know, obviously it's really important to me that we do go to wildlife, but I was called to a deer by the police and managed to get my car stuck in a kind of draining ditch and had to be pulled out by wait for a kind of police emergency vehicle to pull me out. yeah, you you can look back on those experiences now and sort of laugh, but at the time. it could be really challenging. And I think you're right when you say sink or swim. It could definitely help you build your confidence and you get through these things. But I think there just wasn't any structure then. And I think now there is more structure that hopefully enables people to have these challenges, but with a bit more support. if you start to sink, someone's going to be there to kind of cue up. speaker-0: Yes. net for you. So when you would go out to these things and I imagine you were called out to carvings and collects and everything, were you on your own? Did you have someone you could call? speaker-1: There was always a backup and to be honest, I was calling out the backup so much. And they just sort of said, let's just split this. You do the small animal and we'll do the large. There was much more small animal, but I was just happier. Cause it was back in the day of bleeps. We didn't have mobile phones. It's not going to be hard for the younger people to appreciate, but there was no signal in the forest and you'd have this little bleep. And so the bleep would go off and you'd sort of be dreading. Is it going to be a horse, a cow? goat one time. And actually as soon as you saw it was a small animal. So yeah, quite quickly that split happened. And I think it is something we really need to be talking about more as a profession is we've still got this idea of omni-competence. You must leave vet school being able to do all the species. And I didn't mind doing equine, you know, I had to stand at the back so wasn't sneezing, but I wasn't paying tuition fees. speaker-0: Yeah. Yeah speaker-1: I wasn't paying for that time. think if I was paying and spending a lot of time learning about species that I really knew that I wouldn't be working with, I think I might feel quite differently about that. And I know it's very political and other countries and, but you know, when people are paying so much money for their education and the world that we're in is so specialist now, I'm just not sure. speaker-0: I didn't pay tuition fees. And the thing is I would not have a clue. I, I mean, I grew up in rural parts of Wales, so I'm fine with farm animals. I'm very happy ⁓ to jump in, you know, with, with cows, sheep, whatever, obviously sheep. But if you called me out for something medical to do with a horse, absolutely no idea. I actually would be like a person with no veterinary knowledge. I don't know what to do with horses. I can just about ride one, but... No idea what to do with them, but it is an expectation still that even as a small animal vet that I have knowledge about these other species and could treat them. And we often, another thing we have, a lot of people bring chickens into the practice. And for me, ⁓ farm animal and I'm not set up. We can do some stuff, but ⁓ yeah, it's weird. You are still expected to know things about these animals. speaker-1: That's a f- I think the profession as it's become more specialist has also really diverged a lot in a kind of ethical and welfare way as well. You know, I think that the way that we treat dogs now and the way we treat pigs, for example, has diverged so massively and the ethics is so different that it almost feels in some way like two completely different professions. speaker-0: Yep, so maybe we should split the professions, is that... speaker-1: I don't know about splitting. I think we need to talk about it more. think, you when we are, you know, you see some of the things that are being done to dogs to keep them alive to, you know, maybe not in their best interest, but that's what the owner wants. And then, you know, on the other side, you've got pigs, very intelligent, you know, equally sentient, where there just isn't. that consideration at all. We know that they suffer terribly through slaughter. There are vets heavily involved in that industry. I struggle to see how we... speaker-0: horrified the time that I spent, cause you know, we have to do that one week in the abattoir and I, I don't know a single vet that was okay with that time. I horrified me when I saw a cow being slaughtered because of the fear in the eyes of that cow and it knew what was happening. It tried to escape and I had to watch the whole thing as part of my veterinary degree. ⁓ horrifying. So yeah, actually. it's also that thing about where do you draw the species line? Where is it okay to eat and treat these animals this way, but these ones not. speaker-1: Yeah. Very, very blurry. I just think we should talk about it more. And I'm pleased, you know, the last conferences there have been some sessions on ethics and welfare. I think we really need to face into it because otherwise I think as a profession, we are really open to a lot of criticism. ⁓ Yeah. Some of the positions don't always stack up. speaker-0: So do you think we're shying away from those conversations and actions at the moment? speaker-1: I think the BVA has improved a lot ⁓ and there've been some really great people involved in that. And now, you know, I know some really fantastic people on their kind of welfare committee. So Sam Gaines, who is a welfare scientist, I used to work with at the RSPCA. She's now on that committee with a lot of great vets. But I think, so the conversations are happening, but I think we do need to be pushing and keep sort of pushing, making sure that animal welfare is genuinely at the center of the debate. And you know, I know it's tricky. They've just done the report on animals in sport, which I know was quite difficult. But it is really important that we as vets engage in these debates and have these discussions because if we don't, who will? speaker-0: We're uniquely positioned to involve ourselves in these things. speaker-1: Yeah. And if we don't, if we don't, people are going to actually ask your vets, your professionals, you want to stand up as being the voice of the animal, the welfare professional, you're protected. Other people can't come in and do the stuff that you do. But if we, as vets are not discussing this, if we're seen to be turning a blind eye, you know, we are going to find ourselves on, you know, I think we're already on slightly infirm foundations. And I think speaker-0: fashion. speaker-1: It could get worse. speaker-0: There's a lot of uproar and change right now in veterinary. Just add some more in, why not? speaker-1: Yeah, let's just start again. speaker-0: So can we talk a little bit about the RSPCA and the work that you did there? speaker-1: Yeah, so I'd been working as a companion and more vet in London, which I loved. It was a great practice. Certainly had challenges, but it was a small practice, a small group of practice and I was essentially the clinical director. But we had a really lovely clientele and we didn't have a lot of pressure on targets. The idea was, you know, if you do a good job for the client, the practice will be successful. And I do think at that time that did play out. I'm not saying that it was a cheap practice, but we were able to kind of contextualize to different people. But whereas the practice had been lovely people and their pets, getting ill, having accidents, you know, that you could fix, all fairly predictable stuff. I started to really notice the change with the extreme confirmation. So it was in Islington. So we really started to see the pugs, the French bulldogs, the dachshunds. speaker-0: Yeah. When was this? speaker-1: And probably 12 years ago, that sort of time. ⁓ And just feeling like, rather than fixing, there was a lot of managing really predictable conditions, which had a lot of suffering involved with them. Not obviously the breathing is the thing that you obviously think about, also the, with the French bulldogs, they get a lot of disc problems, a lot of skin, really severe allergies. which you know, know what it's like to feel itchy. Yeah. It's really bad from an animal welfare perspective. And the clients were, you know, great and the most part wanting to, to try and fix these, these dogs mostly that were affected, but we were just putting sticking plasters on the problem. Yes. And you know, I'd been there 10 years and kind of 10 years, I think it's my limit as well. I just thought I'd like to do something that's a little bit bigger picture. So the RSPCA job came up in London and then after a couple of years I became the Chief Vet. speaker-0: And what did that involve the Chief? ⁓ speaker-1: It was a really fascinating role because it was essentially overseeing the animal welfare, mostly within operations, but also advising, ⁓ might be work with parliament, bills, laws, ⁓ supporting press, engagement, those sort of things. It was a really diverse role. Obviously, we've got the RSPCA have the inspectorate going out. to all sorts of things and the things that you could get involved in. So from a sort of ceremonial goat, what is the process around, a ceremonial goat to the welfare of rats being slaughtered to be fed to exotic pets. mean, the variety was amazing, ⁓ but the focus really was ⁓ on welfare of animals in care. Is that pets? So yeah, so the dogs and cats that are predominantly dogs and cats, but again, a lot of species, but the animals that were being rescued essentially by the inspector, when they would come into care, how we could ensure their care was as good as possible, but also looking at that kind of upstream prevention. speaker-0: And what kind of thing were you seeing back then? Why were these animals coming into you? What had happened to speaker-1: them. mean, it is really fascinating spending time with an inspector. And if anyone got the opportunity, if you know your local inspector, ⁓ then maybe have that conversation, see if it's possible because it is really eye opening. ⁓ You're going to homes and I don't say this to diss social services because I know they're absolutely stretched, but you turn up RSPCA and you're like, it ought to be social services who are here. as well. But the person has actually called the RSPCA because they're worried about the animals. the person is really needing help as well. speaker-0: the majority of the time the person wants to look after that pet but cannot. speaker-1: I'd say that's true. Obviously we do see, we saw, I still seem to say, it always stays with you RSPCA. But ⁓ yeah, I think that they definitely see really awful faulty and that's really, really hard to see. But a lot of it, the neglect is, yeah, people just- speaker-0: I'm quite traumatizing actually, because I imagine almost everyone that works for the RSPCA is just absolutely there for the care and love of animals. And then they're seeing a lot of abuse cases or poorly treated animals and suffering. speaker-1: Yeah, I mean, it is very challenging and it's something that I was quite heavily involved in having almost sort of learned from time on RCVS involvement with my matters was actually kind of bringing those concepts of moral injury, compassion fatigue, sort of ⁓ the trim, which is the trauma informed management. All that into the RSPCA because it was very new. speaker-0: without while you were working there, did you have anyone? speaker-1: providing you or having mean, was increasingly available. I think it's something that, you know, there was a lot of growth in knowledge. ⁓ particularly, I mean, the XL bully ban was really a very difficult time for everyone. ⁓ and yeah, we got some, got some support about that around that, but yeah, it's, it's hard. You want to help the animals. speaker-0: You can't always. Were you having to take on those dogs? speaker-1: So we, I mean, we couldn't because we weren't able to rehome them. Obviously, you know, that we had dogs in care and also we had dogs who were, you know, people who were wanting help with their dogs and we weren't able to, we were obviously trying to influence the government because it is just a really, really bad idea. It doesn't actually solve any of the problems which are, you know, actually much more deep rooted. So that was a difficult time. speaker-0: And did the government involve the RSPCA in the XL bully ban? speaker-1: Yeah, I mean, there were lots of meetings. There was dialogue. There was probably some minor changes, but, ⁓ you know, we, and along with the whole sort of sector, there is a lot of good collaboration actually. ⁓ Really advised that it was not the way to go and that there are much better ways of going about things. And, you know, sadly, I think the incidents are... continuing and we're just seeing different breeds coming to the fore. speaker-0: So the XL Bully is a replacement for the Pit Bull, is it not? speaker-1: Yeah, more or less. Now, you know, we've got pocket bullies, they're shorter ⁓ and just other breeds coming in. And unfortunately, kind of an increase in people doing bike work as well. And that's something that's appearing on social media. speaker-0: Is it bite work with breeds specifically or like are they using XL bullies ⁓ speaker-1: No, think Malinois is definitely... speaker-0: And so what people are getting pet malinois and doing bike work. speaker-1: I mean, I'm not as close to obviously now, but I think it's really important that the, not just the charities, but actually the vet world, think are keeping an eye on these really worrying emerging trends. Because I think when we look at Excel bullies, I think that the profession was actually seeing these dogs quite early on and seeing, you know, the patterns around some of the behaviors and the people who were getting them. And it's how do we kind of have that horizon scanning? How does the profession inform? government, the charities about these risks that coming? are you seeing in your speaker-0: That's what I'm wondering because I've obviously seen, ⁓ I'm horrified when people walk in with malinois as pets, actually horrified. And I'm waiting for two years later, the euthanasia request. That's what I see. Someone gets a malinois as a pet. They're puppies. They're fine. Then they get older. And I love malinois by the way. They're one of my favorite breeds. And I've got some, ⁓ couple actually at my clinic that I love and they're so soppy and you know, they lick my face when they come in and that's fine. But we know what that breed needs and it's often not provided by a pet owner. It's not the environment for it. And then what emerges is behavioral issues, which are bites primarily, and then they're requesting euthanasias. And I don't think we've done right by that dog by allowing it to be a pet or a household pet in particular. speaker-1: Yeah. I think we need to, and it's interesting, Dogs Trust and RSPCA have just brought out this sort of pet, responsible pet ownership sort of concept that they're putting out at the moment, which I think is great. ⁓ But I think we do really need to focus much more on what is it that the animal would want and actually using behavior and welfare science to try and hear their voice. And that's one of the things I'm kind of most proud of my time at RSPCA was developing the behavioral team because that really wasn't there. And it's so important. I have learned so much from the brilliant behaviorists that I've worked with. And I really think that you kind of the veterinary, the physical health, and then the behavior, the mental health, I see it is two sides of the same coin. And in the same way that in humans, we're now talking much more about mental health and much more. confident around using medication for our mental health. We really need, we are starting to go on that journey in veterinary, but we really need to accelerate that. And I think how we engage with behaviorists. I mean, I'd really like to see a multidisciplinary conference. You know, I was thinking about this at BVA live. was speaking there a few weeks ago. was like, yeah, we should, we should have a conference where we've got the behaviorists, the physios, you know, the paraprofessionals. Absolutely. And we should. be talking through some of these issues. yeah, think we need to lift our head out of, know, we have got quite a lot of our own troubles, but actually lift our head up and look at who else is out there to create this kind of multidisciplinary approach. speaker-0: Yeah. Well, we have a physiotherapist, she's actually on the podcast as well, comes into the clinic with us and ⁓ I rely on her heavily. So although I am primarily an orthopedic vet, ⁓ she is better with the soft tissue of it. the muscles and sometimes I can't work out what is wrong with the pet. She does a session with them and she will pick it up instead. ⁓ And we work together that way is so important. And I definitely couldn't do my job without her. I wouldn't operate on any knees if I didn't know that they were going to go to her afterwards for physiotherapy. So yeah, there's a lot of collaborations and that's an amazing idea. And let's just do that. I'm in. speaker-1: I went to an event for newly qualified physios, which was really interesting. And one of the things that came out was in some circumstances, the physios are getting the referrals from the vet too late. So the vet has tried things and it's not worked and the dog's not doing well. And then they refer to the physio. But if the physio had been part of that plan early, it sounds like that's the case in your practice. speaker-0: Yeah. speaker-1: then actually you've got a much better chance for good outcome. And I appreciate not everyone can afford a physio or have access, but if they can, then I think that kind of that early consideration. that is kind of something that I'm thinking about around Petlighthouse as well is how do I kind of facilitate a bit more networking, a bit more of a multidisciplinary team? How do I help with that? Because vets are really busy. speaker-0: Okay, so let's talk about Pet Lighthouse. What is it? What are you doing? speaker-1: So yeah, so it's a new concept. ⁓ It's providing a online second opinion service for pet owners who are struggling with sort of decision fog around their pet's health. So, I mean, I've been here myself, actually, the inspiration was my own pet Tilly really, where you have an unwell dog, maybe particularly an older dog, but not necessarily. And the vet has given a number of options and the vet, you know, has 15 minutes in a consultation to go through the options, the costs, the drug side effects. So much more than when I first qualified. know, we had a pot of pink tablets for arthritis and a pot of yellow tablets for and clients just tended to believe what we said. Now the vet has 15 minutes, but there were so many more options. There were so many other more things to discuss. You have to talk much more about the risks and the side effects. It's really hard to do that in the time available. so clients are leaving overwhelmed with information, not really knowing how to make the decision. Unfortunately, we have seen a trust gap develop, you know, that we've seen kind of through all the comms around the CMA. clients are more questioning, is this actually the right thing or is my vet just doing this for the money? I don't think there are very, very many vets at all only doing it for the money. But you know, we know that vets want to know the answer. They like to do the tests and really they do like to know, but the client isn't always sure is that the right thing for me? Is that the right thing for my pet? So it can get complicated. ⁓ You can get a little tense and it just needs a bit of time and space and maybe someone independent who, and that's what I do. And a vet can refer to me or the client can come to me and just like, you know, I'm a bit stuck and get the vet history. Client fills in a questionnaire and it's very much a whole animal. So using five domains of animal welfare, the question is. based on that, looking at all the aspects of the animal's life and also the client and their life, actually their welfare, considering caregiver burden. And then we collate all that together and then we have a kind of 45 minute to an hour consultation. I don't prescribe, I don't sort of treat, but the idea is that I help the client navigate what is important for them and what is important for their pet. speaker-0: almost like a therapy section session, but with your veterinary medical knowledge. speaker-1: Well, yeah, I mean, I think it is a little bit like that. ⁓ and, but it's also, if you like, kind of a bit of therapy for the pet, because although they can't verbalize and tell us how they're feeling through the questionnaire and the owner can also provide obviously photos, video, which they usually do, you know, we can start to have a good understanding of how that animal is feeling in the home environment. So if we just give one example. I was helping a family with an old Labrador, ⁓ had some neurological and arthritis issues and they'd sort of been told that, you know, the stairs are no good. Stairs are not good. Yeah. So they'd stopped the Labrador going up and down the stairs, but poor thing was barking when he was left downstairs and they went upstairs. They didn't understand. They were upset about the barking and it was disturbing them. speaker-0: Thank you. speaker-1: It's like, okay, so when we take that kind of whole animal view, we've got some negative welfare here. So it's all about how do we maximize positive feelings and minimize negative. So this is not good. This is negative welfare. You know, we can see that through behaviorally, the barking and other behaviors. Let's look at how we can make the stairs safe. So. you know, yes, there is a small risk with stairs, but they were very willing to, you know, get an appropriate harness, put some padding down, you know, do something with their stairs. that actually, you know, they'd moved from this stairs is bad to, we can kind of manage the situation. speaker-0: They're clearly invested in their pet because the vet has said some stays is bad. So they're like, we are not going to hurt my dog. We're going to no stays for this dog. So they were invested enough in their pet as the majority pet owners are to do whatever is needed to make the pet happy. speaker-1: Yeah. And I think my clients are not anti-vet or anti their vets. I'd say they actually really respect their vets and actually sometimes it's quite interesting that they're like, ⁓ no, I don't really want to ask my clients vet this question because they're so busy. And I'm like, no, know, book a console. You don't need to take your animal in. yeah, they, they sort of want to have a bit of a safe space to discuss things as well. speaker-0: It sounds like this should all be a collaboration and that you have actually an amazing thing to offer to busy practices that can't do this. ⁓ But what I often find when I find people like you doing these little alternative things is ⁓ almost a negativity from the vet side. ⁓ I probably annoy a lot of vets by saying this, but it's like when someone goes for a second opinion, it's either that you haven't provided something that they need ⁓ or you have, but they want to make sure. And the vet that that's happening to might feel a little negative or a bit ⁓ sort of protective about what they're offering. However, it should actually be a positive thing. So sometimes people ask me for a second opinion and they say to me, for example, I don't want to tell my vet I'm coming here because I don't want to upset them. But actually it's okay. It's okay. I can give you a second opinion and the majority of the time I'm going to agree 100 % with what your vet said, but now you know for sure. I'll write back to your vet. We can all work together and you can feel confident that you've made the right decision. So I would like it to be collaborative and that vets are happy to refer to you and you back to them. Is that happening or you're resistance? speaker-1: It's very early days, like you, I thought there would be some resistance. And I have to say that everyone I've spoken to has been really positive about the idea. Amazing. think the biggest challenge is when you're in that busy consult, do you necessarily think, ⁓ you know, I could refer to outside, people might be worried, is that allowed even? ⁓ So it is, and it's a new concept. you know, just really need to get the word out there, but When I have had clients come to me direct and I've written reports, there's always a QR code, the vet can book a free call with me to discuss at any point, anything on there. They haven't, but clients have reported back that the vet has already read the report when they've gone in and it has actually helped them move forward and the vet has seemed quite happy about it. yeah, I'm really, the thing about my second opinion is I can't steal your client because I don't. Don't do that. know, it is just. speaker-0: Yeah, you actually can only add value to the situation. speaker-1: And if I, I think it could be helpful for vets who are kind of seeing that maybe a relationship is slightly going in the wrong direction that could come to a complaint. So a kind of preemptive, if it is already kind of in that complaint situation, then I'm going to really signpost to the vet client mediation service. I don't want to be getting in that situation is very much about empowering that kind of vet client relationship. speaker-0: Yeah, but I wonder if we can catch these a step before, because I've seen when we are losing clients and I've seen when we're losing their faith and the majority of the time it's because we've given them too much information almost. So you've got a complicated case, you don't have a diagnosis, but you've done a lot of tests and then they are frustrated. Why isn't there a diagnosis? I've spent this much money and time and I would give everything to my pet, which I have done, still haven't given me an answer. I'm now confused or you've given them information which they've interpreted a different way to what we meant it, that kind of thing. And that if that, if we don't get them at that point, that's when that goes to a complaint. And then nobody's a winner because you haven't helped the pet. You haven't helped the owner and you yourself, despite your best efforts and working your absolute butt off for that pet are actually getting negative feedback from everybody. speaker-1: Yeah, there was a situation where a client did just want some help to understand what a diagnosis had been. It wasn't actually a definitive diagnosis. It was a diagnosis of exclusion. Just going through step by step, they've done all the right things, but obviously they'd been this week, this would done, this week, this would done. They hadn't been able to tell the whole story. There is an element of storytelling in this. I was able to tell the whole story of That's why this was done. It ruled out this, know, talking about the differentials, the possibilities, and then showing how through the very good testing that they'd done, they'd been able to rule out all the treatable things. So, you know, actually it wasn't really appropriate to go in. And this is what happened with Tilly, my staffie. You know, she had a number of different health issues and she developed really bad chronic diarrhea and she was 10. And obviously... did the bloods, was kind of quite severe hyperprotonemia. So obviously her gut was kind of leaking protein, did all the fecal tests. It wasn't really any other cause for it. And she was rescued and she hated the vets. She was really fearful. She had slightly abnormal brain. visits to the vets were not good for her at all. And I decided that, you know, when we ruled out all the possible treatable things, to treat for an inflammatory bowel disease, no progress. This is neoplasia. This is cancer. That's really all that we're left with. And I euthanised her on the basis of that without a diagnosis. And I look back on that now and I absolutely did the right thing. I look at the photos of her. just before and I'm like, ⁓ you know, she really wasn't well. And at the time, even though I am, you know, very pragmatic for her, all into contextualized care, I like had that anticipatory guilt. I had to go afterwards. It was very difficult, but I had some really great friends that I could talk this through with. absolutely like, come on Caroline, you know, you did the right thing and talked it through with me. And I suppose, you know, part of that vet pet lighthouse is to be the vet friend you wish you had. speaker-0: I was just thinking actually, so I have similar situations, one really silly, some quite, you know, end of life type of thing. ⁓ My best friend is an internal medicine specialist who is in Australia. ⁓ But I once called her at, it was probably 3, 4 a.m. time for her because my very, very large Akita had eaten one grape. And as a vet, I should have been able to decide the risk involved in that. And it had been a while, it was past vomit time. And I was like, he is going to die. This is horrendous. That's it. That's over. And I walked her up and she's, and she just says to me, Vanessa, 40 kilogram dog and one grape. I think he's going to be okay. You can do blunts if you like, but you know, chill out. And that's one situation. So yeah, I had a vet friend that I could do that for. And then again, with a dog of mine that had a, a, torsion, a GDV, so a twisted stomach. And I operated on him, but he just wasn't doing well afterwards. And I sort of knew that and I sort of knew he was septic, but I couldn't make the decision with all the, you know, the knowledge that I had and my experience. I wasn't a new vet at the time. I had seen it many cases and I still couldn't decide. So. She actually had to make that decision for me as well. So yeah, I love that, that you can be the vet friend for people that don't have the vet friend. The thing I wish was that their actual vet could be that for them as well or stand alone. And I think me personally, pride myself on being a very good friend to my clients. I don't really draw a line between professional friendship and I would hope. speaker-1: you speaker-0: that they could come to me and have those conversations with me and that I can be honest. ⁓ and I do advise when I think it's euthanasia time, I'm not a here's options, a B or C. I'm a, is what you should do if that's not, or, you know, then present other options, but, ⁓ is that lacking in practice? speaker-1: One thing that's coming through loud and clear is issues around continuity. People are not feeling that they've got that relationship with a vet. And that's a shame because when I was in practice, know, that nice little practice, you know, I had relationships with my clients. I knew them, I knew their pets. I was not someone to get into personal life. You know, that's not how I am, but we still had, I think, a trusting relationship. speaker-0: Right. speaker-1: that isn't really possible when you're saying seeing the different person each time. And I know it can be more challenging with more part-time, but I think it is achievable. We would have part-time vets and I think it is achievable with, you know, asking the right questions, you know, the front of house staff is so critical. And the clients didn't even realize that I spoke to that they could ask to see this same vet each time. that was obviously, well, ask, you know, which, who's the vet you like? asked to see them. They should be delighted. yeah, think ⁓ building that relationship, talking earlier about euthanasia, bringing euthanasia up, it's one of the topics that we covered at BVA Live. Vets do seem to be reluctant and I do worry that they're increasingly seeing euthanasia as failure. me, like... speaker-0: There's a last line. speaker-1: Well, actually as a failure, you know, a thing to kind of be avoided. But from my perspective, know, 5 % of dogs might get liver disease, 10 % might get kidney disease, know, 100 % will die. It's about a good death that we, you know, we are really privileged that we can offer our pets a good death at the appropriate time. So, and that's the challenge, isn't it? We don't want to deprive. pets of a life worth living, of good quality time with their owners, of a good life, of lots of positive experiences. We don't want to deny them that. But we also don't want them to have a life worth voiding where those negative experiences are overpowering the positive and they are suffering. And I think that's where I learned so much at the RSPCA from amazing welfare scientists. to really get me thinking. And I do think back on my time in practice. like, yeah, I pushed some things that I wouldn't now. I didn't think enough about welfare in its broadest sense. So health is not the same as welfare. You know, we need to be thinking about, yes, the health is important, but what is this animal's life like at home in terms of their agency, how they're interacting with other pets, with people, their environment, the nutrition, you what are all the positive experiences that they have, that they have the opportunity to have against the negative and the things that we're coming up with, the protocols, they really need to be aiming towards maintaining that kind of positive. speaker-0: How do we bring up the discussions and get this message across to pet owners? Because it is a little, unfortunately, little distrust in the veterinary industry at the moment. speaker-1: Yeah. mean, I think starting to talk about quality of life early. Yeah. ⁓ There are some tools out there. think that they're not quite there yet, but hopefully we'll sort of start to see. There's a lot of different tools and there probably isn't one that's quite right, but exploring the world, the tools that might be appropriate for your, for your clients. Yeah. Using, talking about quality of life, talking about welfare. even when the pet, you know, isn't unwell, asking about things at home and, you we're not asking vets to do a full welfare assessment in every consult. That's not possible. Is there just one or two other questions that you can throw into the mix? What does a good day look like for your pet at the moment? What does a bad day look like? You know, what is important for you right now? What do you think that your pet would want to tell us about how they feel. And this is, think, at the heart of it. And it's something I'm doing a little bit of work on at the moment and hopefully will come out in my book later this year, that we need to be much more confident and happy to talk about feelings in our patients. Because the law says, we know that our patients are sentient. They have experiences, they have feelings, positive and negative. We don't really talk about that very much. And I think sometimes we're worried we're not going to appear scientific if we start talking. But I think our clients would really like it if we talked about their pet's feelings. speaker-0: quite what I think they'll think of us, but it's very subjective and we are very medical. So it's just, I just think it's difficult to quantitate it, which is what scientists want. speaker-1: Yeah, but I think we talk about, in our first science, we talk about critical anthropomorphism. So obviously anthropomorphism is bad where we kind of ascribe that animals are going to feel like we do. But what we can do is we can use our knowledge of that animal's behavior, physiology, neurobiology, to understand how they are likely to feel in a situation. mean, frankly, pain is a feeling. But we don't say, well, this is all, you know, this is unscientific. Pain is a feeling. And we have a treatment for it. And we do, you know, I could show you a picture of a dog and you would know if that dog were fearful. You know, then this is where the engagement with the behaviourist is so important as well. But, you know, it is a little bit uncomfortable, but I do think that we're letting our patients down by not engaging. speaker-0: and we have a cheap. speaker-1: not engaging in it because their feelings and their welfare, it matters to them. So it should matter to us. speaker-0: I mean, ultimately, that's why we are pets and we're working in this industry because we love them and how they feel is important to us too. speaker-1: Exactly. speaker-0: So it's, yeah, I'm actually thinking my brain is working all the time and the things you're saying and I don't know if I implement these things myself in my day to day. speaker-1: It is a change in mindset, definitely, but I've been really fortunate. I'm working with Sam Gaines, who's welfare scientist at RSPCA, but also Kat Littlewood, who was one of the team in New Zealand with David Mellor, who has developed the amazing five domains model, which is the kind of the modern welfare framework that we use. So we are talking about how we actually bring this to life for vets in practice. And I'm really passionate that It has to be something that is achievable in a 15 minute consultation. We can't be asking vets to do a whole welfare assessment, but there is something there about some additional questions, a bit of a mindset and opening yourself up to thinking about. speaker-0: Something that is easy is a questionnaire to send to them prior to their consultation or even afterwards if you didn't get around to it and to have a look at that afterwards. That's very easy to do. speaker-1: Yeah. And I think the whole team approach as well. I've heard people say, the book is actually about contextualized care. I've heard people say, know, contextualized care, it's, how's the vet expected to do this in 15 minutes? And the point is, yeah, if you kind of think of it that way, you are going to struggle. But in the practice, the last practice that I was in, you know, the front of house would already know, you know, ⁓ you know, Mrs X is coming in. just to let you know, she's a little bit upset because her specialist child has had a bad day and her cat peed in the basket and the nurses just had to. And I would have all that information and she said she didn't sleep well and you'd have some information before you'd even started that enabled you to be aware of that kind of caregiver side. And they can do so much more around the animal side as well. And I think, you know, there's a lot of pros and cons of AI and I wouldn't say that I love some of the AI things that I'm seeing, but. The way that that information, if it's questionnaires, if it's something that a nurse has observed or front of house, the way that information can be collated, I think that could be a really good outcome of AI. I think over time, hopefully we'll actually see that it is going to become easier to read the animal's behavior because they are talking to us. We just don't know their language. Yeah. The behaviorists often do. Yeah. We don't and that's not. speaker-0: vets were uniquely positioned to ask these questions and investigate. speaker-1: exactly. speaker-0: This is very thought provoking for me. Thank you very much. Thank you. Is there anything else you wanted to cover before we wrap up? speaker-1: No, think we've really, yeah, we've really covered the whole sort of gamut of it. yeah, it's been really great. accomplish. When is your book? So we have to have it finished by October. So hopefully sort of towards the end of the year. I'm writing it with Ian Putter, who was my kind of equivalent at the Scottish SPCA. yeah, we, and it was very much kind of conceived with the other charity vets. We just became aware that vets were proposing treatments and speaker-0: coming out. speaker-1: diagnostic protocols that weren't always appropriate for the animals in charity care or animals were being relinquished because you know, the protocols were always this sort of so gold standard, it just, there's no such thing as gold standard. It's, it's, it's not mine. It's not evidence-based. It's yeah. These, protocols, I think, you know, speaker-0: It's not a term. speaker-1: really not appropriate in lot of situations, but yeah, so we kind of were raging against them. just sort of thought, you know what, let's do something about it. speaker-0: I can't wait. It sounds like a feather ruffling book and I can't wait to read it. What's it called? speaker-1: So ⁓ it's just got a working title at the moment, which is kind of contextualized care, small animal veterinary practice in the real world. speaker-0: Okay. Fantastic. Can't wait to read it. Thank you very much for coming today and persevering with the trains to get here. It's been really interesting. Thank you so much. You're welcome. speaker-1: Thank you so much for having me.