Aug. 5, 2022

#73: Ethics, trust and the mythical 'gold standard'. With Dr Tanya Stephens

#73: Ethics, trust and the mythical 'gold standard'. With Dr Tanya Stephens
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Season 1

It’s very easy to get stuck in a mindset of “I’ve chosen THIS thing, so all other things are off the table, because once you choose THIS thing, then THESE are the things I HAVE to do."   But who says we have to? 

Dr Tanya Stephens' career is that it’s not just one thing. Her story clearly demonstrates that you don’t HAVE to do anything in a certain way. Clinical practice doesn’t have to take up all your time and exclude other interests. Practice ownership doesn’t have to be a ball and chain. Having young kids doesn’t have to mean you can’t run a business. Research doesn’t have to be done just by 'researchers'.

Dr Tanya Stephens is a small animal practice owner and practitioner who still very much enjoys practice. As a practitioner, she is particularly interested in professional ethics and promoting evidence-based medicine. She is also a wildlife researcher with original research on galactosaemia in kangaroos. Her interests lie in animal welfare, research, evidence-based medicine, professional ethics, wildlife and sustainable agriculture and she is a regular presenter and published author on these topics. She is the editor of One Welfare in Practice: the Role of the Veterinarian and is a Fellow of the Royal College of Veterinary Surgeons. Tanya is past President of the ANZCVS Animal Welfare Chapter, past President of AVAWE, the welfare and ethics branch of the AVA, an exec member of AVCB, which is the Conservation Biology branch of the AVA, Chair of the AVA’s Animal Welfare Trust, honorary consulting veterinarian for the Children’s Medical Research Institute, veterinary member of the NSW Civil and Administrative Tribunal, Chair of the NSW Kangaroo Management Advisory Panel and member of the Kangaroo Management Taskforce plus the Chair of the NSW Greyhound Welfare Integrity Commission Animal Welfare Committee.

Jump in with us to hear how Tanya followed her curiosity to create a career around what worked for her. Of course, we also talk about ethics and the line between thorough and too much, trust, and why Tanya thinks we might be losing it, the perils of defensive practice, the concept of "gold standard" and why aiming for it might not always be the best idea, how YOU play a key role in animal welfare in your consult room and beyond, and much much more.

 

Go to thevetvault.com for show notes and to check out our guests’ favourite books, podcasts and everything else we talk about in the show.

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Hello.Ed V is in welcome back.It's been a while, I know, but we've just had our long-awaited first, post covid, International family, and friends holiday in this Nono list.So podcasting took a backseat for a week and family time and sliding down mountains and high speeds with loved ones.
Took precedence.Oh, and negotiating and arguing with kids and getting kids dressed in twenty two, layers of clothing and looking for lost gloves and trying and failing miserably to teach a four-year-old ski.Pictured, trying to get a wooden marinade to stand up straight, on skis, on a cold mountain side.
But the matter in it has no strings and it has the ability to feel cold and whine and complain loudly, kind of like Pinocchio's come have to life, but with no ability to move, his limbs were, cheered me up that we're seeing so many other parents going through the same trauma.
I feel terrible about the degree of schadenfreude, or however you say it shouting shouting for out it that I felt about their plight, but it, Does make you feel a lot better to know that you're not alone.One particular highlight was witnessing, an interaction between a mom and a kid of about seven or eight.
I guess, although the layers and layers of perfect cold weather gear, makes it hard to say the protagonist which in case you were wondering, is always the mom said in a tone somewhere between the his and a shout and a little bit of cry.What exactly is it that you want from me?
What more can I possibly do to make you happy?Now, appreciate that, you might think Wicked.But what you need to understand is that that perm had expectations.She'd imagined the holiday where the family would spend Blissful days bonding on the snow while gliding down slopes and laughing over a press key drinks in Intimate cafes and she didn't waste it.
Not in significant amounts of money to do.So just as aforementioned layers of clothing would probably cover the bill for a fairly big lump removal where you work, I wanted to hug her and say I get it.I really do.Maybe I should have but this and so many, many, many, many other incidents like this made me wonder.
Why do we do it, seriously?Isn't it?Just easier to stay at home and watch a movie or something?Well, probably yes, but I know why we do it because just over a decade of traveling to all sorts of challenging environments with kids from the age of like one-month-old has taught me.
This while you're in the thick of those challenging moments feelings of what the fuck are we doing then?To dominate the moment.But look back at the trip month, six months, five years down, the line, All That Remains is the good stuff.The sun drying salty, drops of Indian Ocean on your back on a deserted Beach.
All your kid shows you.The shells is found.Seeing the look of exhilaration brought about by pure and simple fun on your wife's face when she reaches the bottom of the ski run.For the first time in over five years, even that moment, when your dad stitches up the massive gash, on your kids foot from a broken beer bottle in swimming pool.
Which at the time seemed like a catastrophe but unbeknownst to you at the time.This would be one of the last activities that you ever do with your dad.So what does all of this have to do with a Veterinary podcast and with our marvelous guest?Well I'll tell you it's because in my opinion this is what life is like including your work life.
As you'll see from this conversation those big challenges changing lanes in your career, starting a practice, when you have a newborn that difficult research project at, think that takes all the emotional energy, you can Master those things that might seem like a very bad idea.At the time, those are very often the exact things that create a full Career and a life that you could look back on with satisfaction.
So, who is our guest dr.Daniel Stevens is a small animal, practice owner in practitioner, we still very much enjoys practice as a practitioner.She is particularly interested in professional ethics and promoting evidence-based medicine.She's also a wildlife researcher with original research on galactosemia and kangaroos.
Her interests lie, in Animal, Welfare research, evidence-based medicine, professional ethics, wildlife, and sustainable agriculture.And she is a regular presenter, in published author on these topics.She is the editor of one welfare, in practice the role of the veterinarian and is a fellow of the Royal College of Veterinary surgeons.
Tanya is past presidents of the a in his it, CVS Animal, Welfare chapter, that's the Australian New Zealand College of Veterinary surgeons past president of.Aw, aw e.The welfare and ethics branch of the NVA and executive member of the a VC B, which is the conservation, biology branch of the A chair of the aviators Animal Welfare.
Trust only Consulting veterinarian for the Children's.Medical Research Institute veteran, a member of the New South Wales civil.And administrative tribunal, chair of the New South Wales kangaroo management advisory panel and member of the kangaroo management, task force, plus the chair of the New South Wales Greyhound welfare, Integrity commission, Animal, Welfare committee.
I'm exhausted.What I love about Tanya's career is that it's not just One thing it's so easy for us to get stuck in the mindset of I've chosen this thing.So all other things are off the table because once you choose this thing, then these are the things I have to do.
But if you remember episode with Philip on Conan, no, you don't have to accept in some extreme examples.We Are The Architects of our own lives, but as you'll hear Tanya, says that Architects often, create failure ravish homes for themselves and when it comes to our careers, I wonder if this is because of those expectations.
Of.I have to tiniest Story, shows, very clearly that you don't have to do anything in a certain way.Clinical practice doesn't have to take up all your time and exclude all other interests, like, researching kangaroos practice ownership doesn't have to be a ball and chain having young kids doesn't have to mean, you can't run a business research.
Doesn't have to be done just by researchers in egg whites.Jump in with us to hear about how tiny I followed her curiosity to create a career around, what worked for her.Of course, we also talked about ethics and the line between thorough and too much trust and why Tony thinks we might be losing it.
The Perils of defensive practice, the concept of gold standard, and why aiming for it might not always be the best idea how you play a key role in animal welfare, in your counseled room and Beyond and much much more.Please enjoy dr.Tanya Stevens Stephens, welcome to the red ball, and thank you very much for inviting me.
I've been looking forward to this for a long time.This has been coming for a while, right?We've been chatting about all our topics for ages, yes, we have.And we have a lot of potential things to talk about.My biggest challenge in preparing for this, is to pick the things that I want to chat about.
And in summary I'm probably going to miss stuff.But you are a practice owner.You're a researcher.Is that accurate you call you a researcher?Yes.Your kangaroo conservationists that the right word for it.Oh well constant.
Yes.I'm interested in kangaroo management management.Yeah, you're involved with their racing Greyhound somehow, is that right?Yes.So I chair the Greyhound, welfare Integrity commission Animal Welfare committee.After the greyhound racing was banned in New South Wales and they set up a welfare Integrity commission.
And I chair the Animal Welfare committee that was established at that time to really oversee.The greyhound racing industry and to provide advice on Animal Welfare issues and helped write the code and involved in regulations.
And I also sit on their race review panels.So we look at injuries.He's on the track and just look at the whole big picture of greyhound racing and provide advice and just see how we can really manage it.And as a greyhound found, its way into your home and your heart yet.
No look, I don't do the Greyhound races.This look it's more of a oversight code writing regulatory role but it's really interesting and somebody who knew absolutely nothing about the gray hand industry.
It's been quite so.Quite interesting.I'm a firm believer that that's instead of just sort of talking about Animal Welfare actually do something about animal welfare and I suppose the Greyhounds and the kangaroos allows me to actually get involved and do something hands dirty as it were rather than just sort of sit on the sidelines and say, oh my God, you know, Racing's terrible, but difficult than right nasty comments on Facebook.
That's right.You know that we should ban Greyhound Is it and look people are going to use animals and if people are going to use animals, the whole idea that you then walk away because you don't agree with them using animals.I think that's a really not very useful.
It's not useful for the animals particularly so I think that's really should get involved in areas even if they don't necessarily agree with them.Yep.Where people live animals.Yeah, because if you by just turning away, you can no influence on it.
That surprised by getting it.So I've got a, an old colleague of mine works on.Or does some work on one of the live?Export ships?Hmm, yes.That's, that's a taboo.That's like a no, no no.But again, she says look, I have an influence.I don't like it.
I don't love it, but it's happening.I might as well be there and have have an influence on it and trying to make it better.Well, that's right.And I think if that's put themselves, Into these roles.Then we do have an influence and people view us in a very positive light.
So if we want to be the primary source of Animal Health and Welfare, we have to be involved in these industries like your friend on the ship.If you're not involved, then people don't look up to.They don't turn to you for advice and I see that as really part of the work, I do animal Ethics Committee is Kangaroo management and the Greyhounds, and it's interesting.
And you make some really nice people who really care.And this perception, for instance of kangaroo, Harvesters of being whatever people might think of kangaroo Shooters is, you know, mostly simply not true by getting involved in these.
It raises the status of the profession rather than people saying I don't agree with shooting kangaroos, I don't agree with racing greyhounds therefore I'm going to say we should stop doing that because people Are going to use animals, you see, this is exactly what I was concerned about, because we haven't even finished our intro.
It I really have a whole lot of questions this getting involved in Guelph, a thing and what you say there, but getting involved a big stumbling block for.A lot of people will be time, which brings me back to your introduction because on top of that you're also a mom.
Yes.Yay boy.Children.Wow.Tonight, eight grandchildren and your ethics Guru, you're an author time.How the hell do you do all of it?That's the late lights.
Not only in mornings late nights.No, look, I have a passion.I've find the time that I bit of a procrastinator as well.So, who knows?I sometimes.Look back and I go.How did I do that?No idea, no idea.You just just do it.
I'm really Fascinated by that procrastination.This wasn't on my list of topics to talk about, but I want to talk about that.I want to talk about it because im a champion procrastinator.Oh, it's a big challenge for me.Is I have all these things?
I'm passionate about them that I want to do but then I always have 20 little things.I just need to finish quickly.Do before I get started, I was counting.Is that something you still struggle with?You feel?Yeah, yeah, yeah.You know, I'll come home from work and I think I really In the shed article and you know, did that bit of stuff to publish a paper or get involved in the book?
And I've been asked to edit a new book as well and I would say here, I really bought to put in that application.I really think about.So I go to bed at night and I think about things, and then I'll make some notes.And next morning before I go to work and I was going to say when we talk about influence.
So I think practice is great.I love practice and I think people Don't acknowledge or that's, especially, and even the public doesn't acknowledge the significant impact that the average practitioner has on Animal Welfare.
You might think that you're not doing anything for Animal Welfare or you might read books, or write articles or whatever, and be a bit of a philosopher.But the reality is, when you go into practice and you deal with people everyday, you influence their behavior.
So you influence the way that they deal with their Animals so changing human behaviors, the big issue and improving Animal Welfare, you can't improve Animal Welfare without changing people's behavior, or AMO highlighting their behavior towards animals.
That's a great inside because it is something that for a long time, I struggled with, at the start of my career, and I think it's possibly with growing up in South Africa, which has that sort of a third-world component to it.Where Where you have genuine animal neglect and then we have the big Wildlife component as well a conservation.
So when I went into veterinary science, I had this idea that I was going to do the big picture stuff, you know what, save the wildlife or have an impact like that.Those sort of things you talked about and then I sort of got sidetracked into the small is practice thing.And for a long time, I did struggle with feelings of well, this this really matter in all this time and effort and energy that I'm investing in.
Is this individual little poodle and spending thousands of thousands of dollars and outside just down the road.There's a thousand dogs that don't even have food.I did often struggle with that and it's still, sometimes, I do still still get stuck on it.
Sometimes, do you have any thoughts on that?Yes, I do.And I went through the same ideas and which is one of the reasons I get involved, another big picture issues, but on a day-to-day basis, I think we do have wider influence in smaller animal practice than we realize and I thank you.
If you look at the fact that something like 78% of that's an Australia are in practice.That's a lot of its that's a lot of influence and whether it's just the local community or your poodle owner and doing your anal glands, you can influence people which you think it might be in small ways for them to look at the big picture and I think that happens to be honest with you.
I think you sort of not aware of it when you are doing your nail clipping around or grounds and whatever you don't understand the influence, you might have him generating trust in the professions.So if the Pooh Delilah trust you and think that that's is wonderful.
Then they'll trust you if you're making a pronouncement on one Health, epidemiology and I think that's portrayal of, that's As a profession to trust, just in a small animal, practice is probably more important than you realize.
And that is a big thing that I probably chat about the just quickly and H trust him professionals, and Trust in our profession has fallen.So the latest survey shows it we're well below, nurses were down to, we were on 78% of public, trust in us.
We're now on 71 percent either.That's a real worry and I thank Considering that most vets are in practice.It's how the public views practitioners comes back to very important.So, you might think that, you know, your dog space or whatever unimportant.
But your relationship with your clients and society and that setting influences, how they feel about you as a primary source of information on Animal Health and Welfare.So if you look at these surveys and you look at trust in the profession, So which is falling and we need to do something about that, the public wants accountability and they want transparency.
And to me, that comes back to using best evidence which is one of the reasons I promote evidence-based medicine, we've got to stick to the science because it's not ethical opt to do it, you know, flogging useless stuff and and all that such a big issue in practice.
So we need to if we want to be accountable in the See, and for the public to trust us and we have to be scientific.We have to be Beyond reproach in the way, we approach things.
So why has that we know or why do you think that trust has decreased?There's expectations of the public, their fur babies.The growth of the fur babies costs of veterinary, services or big issue.And again, that goes back to evidence-based medicine and we've shown that Ford abilities, a big issue.
I think that's one of the issues on Lots over servicing overdiagnosis, were not really sure of the extent of that.This is not a fact.As the celebrity vets heroic treatments is quite a complex area.And it's something that the fellows of the Royal College of Veterinary, scientists, as surgeons has been looking at and I said on their science advisory panel and this is an area that we've been looking at and had a couple of seminars this whole area.
Set affordability, over servicing over diagnosis.I think it's a problem and I think we're not going to be accountable and transparent and this we use good science.So it's interesting, you mention the, the celebrity weights and the heroic interventions and stuff like that, how does that erode trust to?
I always thought that people at, to me, it lifts the standard.Well, at least the perception of the profession and people go.Wow, look how amazing greater is there.Evidence that it's counterproductive in some sense.I think it comes back to unrealistic expectations as well.
The expectations are going to be able to do that but the costs associated with it and then they can't do it.Okay.So is it people see it on TV and then they come to the GP V8 and you go.Yeah, now I can't do it.Titanium knee for your dog?Yeah, but we could do it on the road but it's 20,000 dollars in people.
Right?Well, that's right, it's a is a mismatch.And in what they Big thing that now, that's really interesting.Yeah, expectations and look, I think there's an interesting area, but I I'm thinking I put in a proposal to do a new book, I'll contemporary Veterinary issues, which will deal with all this.
It's something we've been chatting about four years and then you mentioned selling or pushing use of flogging useless stuff?Oh yeah.That's a big issue.What sort of useless stuff?Are we talking like I immediately am defensive?I'm like, no, I don't sell this list of Are you talking about like yeah, give us examples.
What was the problem the commission bias where people come in with an animal?Human behaviors are really important aspect of Veterinary practice.And that's most of the state's a make is nothing to do with lack of knowledge as to do with biases.
And this commission bias comes in big time and commission bias is the urge to do something and it's very strong.Somebody comes in and they've got no kennel cough.Its raging here at the moment.They've got a dog with kennel cough.We know from the evidence that they're going to get better anyway, they don't need antibiotics.
If you're getting Mandy royalties, they get better in the same time.So commission buyers is one of the reasons for the overuse of antibiotics in human medicine and I think we can say that probably true.So, if we're going to look at antimicrobial resistance and reducing them antibiotics and we have to look at Human behavior.
And this whole concept of it's not just clinical practice.We need to look at the fact that people want to do something.So what do you do?Somebody comes in the dogs, keeping them awake all night because it's got a hacking cough, and there's a urge to do something about it.
So that's one issue.But then there's lots of in effective therapies.And if you look at the alternative therapies at the moment, all the useless supplements and stuff like that, it's just overwhelming.It's worth.Millions of dollars a year and it's making some of these people, very happy, very wealthy, the floggers of these things.
So we've got to stop doing that because there's some research that shows that the best way to get trust, maintain trust and to move forward and to make a have Affordable Veterinary Services which is really important and now we've got Rising inflation.
This is really going to come into the fort before the abilities and to be a big issue.Ooh, so you know, don't do useless stuff, just do evidence-based medicine and then we come onto the big issue of the environmental impact of pet ownership, which is huge.
And if you look at some of this stuff, I people buying coats for their dogs and fancy colors.And if you look at the statistics it's just amazing and all the supplements I undertook as bit of an aside an interesting exercise, I wrote one of the manufacturers Isn't these products and said could you send me the evidence that your tablets do this but they say they're going to do on the label and they sent all this stuff and the research papers were old, they didn't relate and about 20 of them are went through them.
So I replied and I said, look, none of those papers point to any evidence for the stuff that you're selling a twenty or thirty dollars a bottle, which tells people their dogs going to live longer and happier lives.And you know, what's what's the answer?
And they said, oh yes, well we admit there's no evidence for any of this products.Then they actually admitted it but we're going to do some research which I thought was hilarious and I've written to pet food manufacturers as well.And if I'm concerned I asked questions and you know I mean why were using fish oil is absolutely no evidence with his short.
Why are we using good quality deep-sea?In pet foods, for instance.So I think it's a huge area, not just the food, which, and every practitioner can make decisions on this.And of course, you know, I tell everybody to feed their animals kangaroo, which makes sense.
We've got 46 million, really good sources of protein hopping around the country, which can be humanely and sustainably sourced.But that's another aside and I think that's really got to sing.About why people trusting us as much as I used to what is causing this erosion of trust.
And I don't think there's a simple answer, it's not a simple answer.That's tricky one because I agree with you in I would definitely lean towards if it's not proven to help then don't use it.I remember our first year pharmacology.
Lecturer said the first principle he wants to teach us about pharmacology as don't use it if you don't have to.Because he said was most, things will get better, despite what you do.So that's right.If a living for you and I think that's always stuck with me.
But then on the flip side, people come and they do want something hmm.They want you to be seed to do something.So if you go, I will give you this thing knows I'm going to do any harm that could sometimes there is that desire to, as you say to appear, to be useful, to do something that's going to help.
But so part of me goes, yeah, I know, it's not going to help but it makes the people feel better while the pet it's better.I think that's one reason and it's some in some of the but it is a time back into the affordability as well.Yeah.And that Dre really rapidly leads us into the financial viability of practice.
The one of our big issues and greatly science, is this income is where we underpaid people paid their work too hard.They don't make so we got to make money.Yep.That becomes a, the big thing for me right now, all we've got to do stuff to make money but we don't want to Over service and have a child, and I'm very sensitive about over servicing.
Ask anybody who's ever employed me but how do we tell those two?How do we go all?We want to create a business that is profitable and we people can earn it, a decent living comparatively to others but still be perfectly.Ethical, that's where you're going to go straight back into your ethics.
Well, yeah, I've had my practice for a long time and I'm not a millionaire but I can't say I make a lot of money.I pay everybody.Well, keep a staff with her.Thirty years and all that sort of stuff.I think that's very important, but I think, you know, thinking about over the years and I think what we've really got to do is to make our money out of our services and eye surgery rather than out of flogging other stuff.
And I think we should.I've never wanted to be a supermarket so I don't I sell virtually nothing and I think that's okay.And I'm not sure about the research on this but I I suspect that if you don't have these high overheads of, while some of its useful, maybe but stuff that people can buy at supermarkets, then you probably slightly more profitable.
If you can tap into, really selling your services rather than selling extras, if you know, the mean things that can be bought at a supermarket, I'll write scripts are right?Lots of scripts if people can get nonsteroidals and the chemist for their Rottweiler cheaper.
Than I can sell it, then I happily write a script.And now I'm not much of a financial whiz but I I'm happy financially, if that makes sense, but I'm only one and there's probably a different scenario when you pop corporations whereas I only ever wanted to be the small community Veterinary practice looking after the local community and that's what I do and that's what I enjoy doing.
So, is it probably a very different scenario My practice to bigger practices or country practices.And what about?Because we talked about vlogging.It's not in fact I see less and less a duty.We went through a period with it.
Sold a lot of food and a lot of merchandise is stuff but I see that less and less.I do feel we are moving towards selling services then sometimes the real question comes up about over servicing.So we selling a service.So do you bump into the the concept sometimes of?
Well, what is Too much.Which too many tastes too many.There's two that, is that something that you think about or write about?Oh, I certainly right about it.Three an ascetic profiles is just a minor one.Well, baby and overdiagnosis and I had Brendan Mackenzie from America, he writes kept vet and he's a good friend, he spoke at the APA conference on this whole issue of over servicing doing tests, I wrote an article that was published in the ABA, a Vijay.
If he is ago entitled, you want fries with that, it was all about the fact that there's absolutely no evidence of Priam aesthetic profiles and it's to do with pay easy and probability if you wanted to read the article.And so it's a bit statistical but the we don't do it.
So a better use of a person's money as it were better Animal.Welfare to me is if this old dog comes in its teeth are falling out its and a obviously needs a Well, there's no point during the pre Angus edit profile that dog's owner needs Dental regardless, and as long as it looks clinically, you know, over all else fails, look at the animal.
There's all these tests are carried out and not necessarily very useful so we don't do it.And this old dog comes in with terrible teeth and it's in pain and it looks in pretty good, Nick then instead of doing them very anesthetic profile, which would happen elsewhere.
You just put on IV fluids while we do the surgery.End of story.Easy and I, yeah, and I get stuck on this one because I've had some other very, very smart people agree with you.Yeah, I've had some really equal to IC as really, ethical practitioners and business, owners, say yes, but we do it and once in a while you get that surprise result, that potentially saves, an animal, or stops the stuff up.
So that's why that's why we do it.So but the research shows that even if you untie me, You know, all all dogs got elevated, liver enzymes, one way or other.And the research has shown that people do not change their an setec profile.They don't change what they do regardless of the result.
So we take the approach to well you just careful.Anyway, once you start doing all these tests, they say oh what if what if then it becomes defensive medicine and defensive medicine is bad medicine.And that's what leads to a lot of over servicing and we must do this.
We must To do that.Just in case, you know, we've got to get away from that mindset as practitioners, I think.But again, to counter-argument people will say, yes, but I also don't want to get sued.I've got this and this and this for all these reasons, we need to practice more in this way, to cover ourselves, which is a bit sad, but not entirely untrue.
And how do you sad, you see that aspect of it of saying, well, like if I do my spay in a six month old and I didn't do prej Bloods.And there is some weird disorder.I'm trying to think of something what a blood clotting issue or doesn't have any platelets or something like that, and it dies and then aesthetic.
Is there a going to be a liability where they can as with the clients can say?Well, most practices would have done prej Bloods.You didn't now, there's a problem, it's a liability.There is that total rubbish, I think it's total rubbish.Look, if you've got, you know, young Rottweiler Doberman, you're going to spay then you'll probably nowadays, do a DNA test.
Which is quite cheap instead of plotting profile, you know, that they genetically predisposed.So look, it's good, clinical judgment.And if you and you can always take some blood, put it on the side, save it clots after 5-10 minutes.And that's what we used to do back in the old days.
And so, then you go ahead with the spay.Yes.I think it's rubbish.And when new grads come to my practice and students upstairs, say what if you get sued and you say, well, you know, the client might go.Go to a solicitor to sue.
You is going to cost some 15-thousand dollars minimum to take you to court and that fee is temperate rather inexpensive.That's a jaundiced view.I mean that's that's a terrible.I mean you still should practice properly just because solicitors are expensive and nobody's going to sue you and all you can get if you dare do you can't get emotional damage.
You'll only get the cost of the dog or cat and the board Dax very responsibly in these situations anyway.Then the big issue with costs really is the merchandise and the uses probiotics and those sorts of things they had Farrah gnomes.
I Rise a regular column for the friends of Science in medicine and they're a great group and never heard of them.No, I don't know.Well they're human group but i writes a regular Veterinary column for them talking about all these issues.
Yeah.Okay I'm gonna have to look into that will put it in the The in the show notes as well, they've got quite a few different members of.And the reason I like doing that is because their newsletter has the pharmacology and the pharmacologist and the nurses, and The Midwives, and all that stuff.
So, it's nice to think that people are that fits adjoining into this discussion.I like that view of yours of saying, well, even when it does go wrong, when there is a replication of some sort, mmm, at view of, and it's not really going to be that bad.
We make this Of emotional thing about if I get a complaint the shame and I'm going to lose my license.Well, and you do not, you just not.It's going to be annoying at worse than maybe a little bit of crust and, and life carries on.
And yeah, that's right.I've carries on.And I think boards handle these issues very well to be honest with you, I sat on the board some years ago.And now, I sit on the tribunal and we look at appeal cases, mostly and very few You major cases and go to the tribunal and it's mostly appeal cases quick, Interruption to things met V live baby, 22 to 25.
November Noosa do days of clinical content with brough Joe, Madison and prof.David charge the Oracles of Smalley's medicine, but this is not your average conference, we're going full-beard Vault, this means that our clinical content will be less lecture more interactive.
Lots of Kitchens interviews case studies.Yeah you're going to learn a few things but what we really want to learn is how to think better.And then there's the non-clinical staff.We kayaking in a world heritage site, we're doing yoga on the beach.We're surfing.We hiking we climbing a mountain.
We're doing cooking classes.Definitely a favorite eating, my favorite ice cream, shop is across the road from our venue for Day 2, which also happens to be across the road from the beach.And on the last day, we are doing a four hour session with Philip mckernan from episode 78.It is going to be epic, I'll put a link for the full event in the episode description but don't book their email us at Red Rock podcast at gmail.com and tell us that you heard about it here and we'll send you a red V listener.
Discount code thing.Number two, a red belt clinical subscribers.Already know about this conference and a bunch of them have already booked and what's more?They are almost certainly.A few steps ahead of most weights on the knowledge front when it comes to our topics for the conference, which is endocrinology conundrums And clinical reasoning this is because they've already listen to hours of amazing content without to conference guests on our medicine podcast plus around 80 plus hours and counting of other medicine surgery, and emergency and critical care content.
There is smart bunch of subscribers.The getting even smarter, which is why we call him David Felton, it's, you should be a nerd, check it out for free for two weeks, at VV, n dot super cast.com.I think in general, that's do, do the right thing.
I think maybe there's other issues like corporatization, which a Will May alter practice the way practice goes on.And I think, well, that's one issue because normally with your small practice like mine, you've got your relationship with your client, and your staff, and yourself, and the Animals owner.
So, it's a very small group to consider it.If you're The corporate then you have to consider the ethics of the corporate structure.So you're responsible, not just to yourself and your clients.You've got this extra Dimension which can make life a little bit more complex, because your views, might differ from the views of the corporate owner, for instance, and that can create conflict.
So, it's not quite as such a simple.I mean, it's always difficult because you've got this triangular situation where Between the animal and the owner and the vet, you've always got that.And if you add extra Dimensions like corporate owner into that, then it makes life and ethical decision making a lot more complex.
It certainly does minutes.It's hard enough with the triangle that you mentioned it.Should we talk about that?I don't know that we often think about the burden, that it puts on us as well with the having to keep everybody's interests in mind in your decision-making.It's very easy to sit in a lecture and Yep.
These are the things you should do even with a clinical podcast.I do those and you go are, I've got it, this is easy.The next time I see one and then you get under the consult room and there's that third factor in the client factor and the financial Factor again that clouds cloud is the water.
What do we do about that?Well, we put the animal first and that's the way we should operate because if you look at all the codes and all the legals regulations, they all say, the Animal Welfare is our first priority.Your first priority as welfare of the animal, not the welfare of the owner.
And look, I think we talked about ethical dilemmas, but they're not really, it's just sort of ethical challenges.And I, I think most practitioners handle, these without, too much.Anguish, to be honest with you.And I remember years ago, I met up with Professor Don room in Cambridge.
And he said, to me, he said, you've acts are very lucky.I said, oh, why is that?And he said, well, you get to deal.Ethical challenges every day of the week and I said, well yes, I hadn't thought about it that way.But really, that's what makes life interesting.
This problem solving is a practitioner dealing with your client dealing with the animals but the animal always has to come first and that's what the codes of conduct saying.That's what the legislation says.And then I have students saying, I really think this dog ought to go to Doggy heaven.
But the owner won't agree and And the legislation clearly states that a dog is like your washing machine or your tires to chattel.And once the animals suffering, then the owner's rights are overridden by legislation.
So in actual fact, you can see that animal to destroy it and of course you wouldn't do that.You're trying to avoid doing that.I've only ever done that a couple of times.But there's this misconception that the owner has the final say, when they don't under legislation, Australia, if you really wanted to push the push that those buttons.
So you can say to the owner will look your animal this suffering.And according to the law, I can take your animal and destroy it.I mean, you never let it get to that, but that should be in your mind that enacted no idea.Yes, that should be in your mind.
Yeah.Uh, Nana and all the legislation's, you can see is a suffering animal to destroy it as a veterinarian, as yeah.Professional bit is under the pot to act.I did not know that in my head.The only did I thought that Chad's chattel chattel, chatter laughter, which I thought that room means that owner owns that thing given that is being.
And, and because they own that thing, it's their decision.What the not do with it.That isn't that it's not their decision, at all, not in the animals terminally suffering, it's their decisions overruled by legislation, and it's for any situation where an animal's terminally suffering.
The policeman go and shoot it or whatever.But yeah so that's can that.I mean, you don't but I think we need to keep in mind that most people know when it's time to go and there's a lot of work around the fact that some people leave it too long and there's that anguish and then they say afterwards, I left it too long so it's getting that balance, right?
But most people are satisfied with that decision.And so we sort of say it's a Tissue whatever it is.I don't think it's such a big issue.Actually, euthanizing, the animal, I think the big issue is coming to that decision and making sure you're comfortable with that decision and the clients comfortable that decision.
So goes back to end of life decision, making and this sometimes brings in this concept of heroic treatments and over servicing, that can really go a little bit Haywire at that stage where the owner just can't let the animal go.
Go, and then you're stuck with this situation.Was just making that decision.And, you know, you're looking at an animal and it sends stage, the owner says, oh, I think it's looking very good today.So this subjective assessment of animal welfare.
And then you get the place, the caregiver placebo effect Some of these decisions you mentioned a tricky, though, and especially considering the owners wants and needs and you want to give them what they want.So there's a few things you mentioned about the one thing.I'd love some help to help us with some of these decisions.
The like, how do you personally and what do you recommend as a guideline for making a decision to send out?This is probably too far and specifically, keeping that heroic treatments, but I'm an emergency veterinarian.Euro treatments, are we thrive on the course?
You did?I love ya.And it's great to do it when there's a good outcome, then it becomes very satisfying, but you do have those questionable ones.We go while we can do all these heroic things but I know the end result where there it's next month or six months from now, it's going to be this in this and in the when I have this discussion with a lot of people again Who I Really respect, they will say well that's up to the owner if they want another two weeks with the animal and you can give it to them then you should give it to them.
How do you feel?How do we think about this?I think we need to think about it.And the fact that we abrogating our professional responsibility on to the owner, they're not the trained professional.We are and I think we need to do a lot more of in my opinion to generate that trust not to say, well you can do this or you can do that.
So, like pretty honesty profiles.I mean, really, what would the owner?The average owner know about the science behind pre anesthetic profile?What the hell are we doing?Giving them a choice and I think it comes down to that?And look in.This is what the problem with human health as well, where this end of life over testing and over servicing was big-time likely to lead the collapse of the Health Care system and, you know, doctors have done this as well.
They've abrogated their professional responsibility.The trouble is, you've got to try and get that balance between being paternalistic and thinking your God.And my word is, is the end word and taking into account the moral views of the OWN No, so you need to get that balance, right?
Keep in mind that your dog can't see tomorrow animals, don't see him to the Future.They live in the present, their suffering in the present and say, in my opinion this is what I would do and it comes back to generating trust and for the owner to trust that your opinion as a professional is what they should go with.
So, rather than saying, well look, your dog's dying but we could do an ultrasound or CT scan more blood work etc.Cetera.Just saying looking, in my opinion he spoke he comes back to the clinical judgment doesn't it?And you do that to a lot of it is really not being paternalistic working with the owners and I find checklists are really useful and say to them.
Can your animal do this?And this is what I have in one of my papers about it.The checklist rather than going through ethical matrices.And who's going to sit down, do that?Really?I think it all becomes too much of An anguish.I find that 90% of my clients.
They come in and they say it's time to go.Yeah.Yeah, I read one of the things you wrote about the stuff.I'm there's a word in there that I just like the word have another heat of your Escalade escalope.Ian Authority is kill a Pianist.
Oh yes.Yeah.But what does that mean?So it's just sort of a main was people looking at to really because you have special powers look at you know we talked about that but I I'm not sure you touched on it, and it is something that bothers me, sometimes that I see in practice, I have seen all throughout my career.
Is that thing of we have special powers and delegating the decision-making to the owners.Sometimes is not really appropriate, no Stefan it.Not so you'll discuss a case and then I think well, why did you do X?Y and Z, was it entirely necessary and then the response will be.
Well, there's possibly an indication to do it.I've put it to the oh Owner and they said yes and then my internal response is there but they don't know, I find it hard to make a decision sometime.So you can't really.It's like when I go to the mechanic with my car, I don't understand the car.
So I dressed my mechanic to say.These are the things we need to do and not offer a thousand other things that maybe we eventually that could happen on but I don't know.Don't leave this isn't to me.Tell me what I should do.That is why I'm paying you.I need your wisdom.
I need your experience.Hmm.Yep.Well people clients say what would you do?They do they say what would you do?If that was your animal, which can be a tough one?Because again I've might feel different around my animal look.That think we do need to keep in mind that we're the experts, where the trained professional, not the owner and to act as the trained professional, not to say to the owner.
Well, you could do this or do that.That doesn't generate trust does in your decisions once you start saying, well, there's 101.On different tests rather than making a clinical judgment.I think sometimes it also comes about from a lack of trust in ourselves.
Hmm, Almost sure.Its this and this and this and that it's hopeless prognosis.But what if I'm wrong you know what if that thing's not a cancer, what if it's actually yeah very weird Feingold abscess that I could potentially treat so I should probably check.
Yeah.And I think that's the other thing that's very important in terms Unrealistic expectations as well as that.It's as I've written about this time to ditch the gold standards.No such thing as a gold standard medicines and an exact science.We need to use best evidence and this whole concept of the gold standard should be just tossed out and mistakes happen, stuff UPS happen.
And it's just unrealistic to assume that you're going to happily Trot along and practice and never make a mistake and Also, it's unrealistic to assume that you need to or you want to or you're going to do success and test every animal that comes in the door, there needs to be a lot more confidence in clinical decision-making.
First up and there's got to be no more gold standard.This doesn't exist, it's an inexact science is not physics.It's not chemistry.It's medicine and Medicine stuff UPS happen and I think that's a really important Point that's Not being pushed Enough by the Educators and by us people in the professional part.
For me, who does this sort of stuff all the time?Write about it.But I think that's really very important area to talk about to students, you know, things go wrong and often things go.Wrong is not to do with the lack of knowledge is to do with biases, human behavior.
And I think there's just a lack of acknowledgement of how much human behavior comes into.To decision making rather than just knowledge.Now, we can have all the knowledge in the world and stuff up.Yeah, exactly.
If we cuz if you wanted that job, that mindset of, let's ditch the idea of the gold standard and just do, what is scientifically proven then we have to be able to sit comfortably with the idea that occasionally, you will be wrong.If you don't do every possible test for every possible case and you using your clinical judgment.
Sometimes you will be wrong and then saying, and then when things go wrong, it's not a user where it's not a fuckup scary for the swearing.But, yeah, and it's not a, it's not a failure of you as a clinician or as a human being, it is just life.
Yep.Part of the part of the game at some point is and and now I come across students, they're really scared.They want to do all these tests and defensive medicine.They're scared.They said they're going to stuff up, they're scared.They're going to Be sued, they're scared.
They're going to be reported to the board.And then as a general practitioner, and in a practice, where we do virtually everything, they want to refer everything off, they're really scared.Then to undertake some surgery, which they probably quite capable of doing.
And then my big concern with this is then it turns general practice into a very, very boring.Her.Shoot, I look at you man.Gp's I often go when I go there go, wow, how boring is your life?Do you hardly touch me?You take a bit of a history and he said, okay, I want to send you here there and there.
Yeah, that's right.A few guys.And that's, that's what really worries me.And the whole concept that you might have huge practices where they do everything, which are very expensive and Branch practices where people just write scripts or whatever, or express anal glands, and its really very depressing in terms of our profession.
And I think we've Got to get away from that whole idea.We've got to encourage your GP vets.You've got to tell them how wonderful they are.We've got to say, you're part of the community, you need to generate trust and you've got to trust yourself a bit more.
And we've got to have new graduates coming out, confident that they'll have a go at things rather than referring everything off that they see.Just so that practice does is interesting, practice is lovely.It's really, really interesting and I think that feedback that comes from the clients that appreciate you is just really nice.
It's rewarding, I find practice very rewarding, I really like it but then we do lots of my practice.Now I'm going to play Devil's Advocate though because I agree with you again.Yeah, I'd hate to just sit there and write scripts and refer things off, but then that ability to refer /.
I feel like for a long time we can get stuck in their idea of I have to is that expectation that I should be able to do everything and that's quite exhausting.Oh yeah, yeah.I'm not mean that's a generalization.Sorry, it is nice.It's very nice to let it go.
Sometimes and go look at this is hard.I don't I don't need to be able to handle every case like in the Disco just so you know if you go go somewhere else where they are going to handle this that to me that was a big change of going to go, right?Look, I'm tired.I want to go home.I want to see my kids.I could stay back and read more and do this.
I can just say, okay, just go somewhere else, I'm sick of it.That was a generalization on my part.I do refer things.I refer eyes.Yeah, so it is a generalization and it's great to have you specialist, it's great but at the same time while it's great to have you specialist.
And I do refer, I think that for lots of bread and butter stuff that General Practitioners should be doing what they can, just because it makes life If much more rewarding and it's better for the client as well.
So that I think is that juggling act as well in those great to have specials.But we've I think we need to not downplay the role of the vet, we don't want the Jeep Yvette, we don't want them, turn them into scriptwriters.I normally start this with getting to know the guests first, the we just drove straight into the deep stuff.
There's back, Jack a little bit.I'd love to find out more about your career and how you manage your career talk us through your career.Inside our.Did you get what?Go, let's go from graduating through uni, through how you got involved in all the things you've got it.You are involved in.
Well, I started off and finally gave that science.I read an orphan Joey.And then I went looking for information on what to feed them and there wasn't anything much out there.And I also discovered a lot of these Joey's fed on Cosmic, but they didn't dive in.
You have diarrhea, they develop cataracts.And that really got me interested in that whole area.And I always like, like chemistry and so, when I graduated, I started doing a masters and that was on normal blood values.
Kangaroos in captivity in research establishments, I used to go out and collect loads of blood, but look, I didn't sort of pursue that, although, I've got loads of data and kangaroos in captivity, that really got me interested in that and I Wondered whether they were collectors, see me, whether they can metabolize galactose kangaroos.
So, proach, the Children's Medical Research Foundation, who are doing research on this and they gave me a research, Grant know all this time, I was also working in practice.So I was a doing locums and working in practice.
I had a really lovely boss first boss, which I think was very important and he set up a new practice and I ran it.So, I did that and then I had this research Grant from the children's hospital.And then I spent a year on this collecting blood from Joey's and looking at whether in fact they could metabolize galactose and we found that they couldn't, I used to keep Joey's at the Children's Hospital so that used to Delight, all the children used to come and visit my Joey's at the animal house and that's how I really sort of got involved in research and we published our first paper in nature and then we followed it up with some other.
Benson.That's how I really got interested in the kangaroos.So I was quite pleased with that.I had a full page article.Is it Morning?Herald etc.Etc.Felt like a bit of a celebrity and then the fellow Workforce sold is practices and I didn't want to become an academic and I should say that I married, my husband is an architect and wasn't academic when I was 19.
So we were married a student anyway.So he had to put up with all these kangaroos living in the bedroom.And it seems like that is, if he's very good at that, very good at getting up in the middle of the night and feeding the Wombats anyway.So then I had my first child and he was six months old, and there was an empty shop, and I knew a lot of the locals and they said, oh, we could do with the vet in the area.
So I practice and we just bought this house which hadn't been touched since 1912.So we lived in squalor and we still do a bit because I'm married to an appetite now.That's Bit like that's dogs with fleas and so we still don't live in a nice house.
Anyway, that's another story and so I, the practice I sort of think I must have had postnatal depression.Why the hell would you do that?Empty shop to practice six month old baby, that didn't sleep had to drive around all night to try and get him to sleep?I don't know why I did that, but look, I I did actually never really wanted interested in cattle practice, but Harry got a job.
You said, well, gee in Ian.You know, it's pretty hard to be a kettle practitioner in Sydney or a wildlife researcher, but there was no real jobs going in the veterinary Wildlife World.At the time, didn't really want to be a zoo vet.I was more interested in Australian wildlife and so I just sort of fell into practice but I've kept up doing the kangaroo work obviously, and and I did some more research on the Kangaroos and then.
So I just sort of know, ran the practice for children.It's allowed me the opportunity to which I couldn't have done, if I work for somebody else and it allowed me to juggle work and having children and I was really lucky.
I had lots of really great long-term.That's worked for me.And I had chill medicine with me for very many years, and what Jill medicine.Workforce as a new grad for many years.Wow, I think she was with me for about 20 years, Anyway, yeah.
So she was a wonderful positive influence on clinical decision making.So look, I've maintained the practices, the small community practice.It's just a walk in.We don't have appointments and we have very set hours so that you can pick your kids up for school in the afternoon.
So, it's very much geared around family and I quite like practice.But then I went on to do other things, I've always been on the animal Ethics Committee for the children's Spittle, Children's Medical Research Institute, I their honor Yvette always interested in research and animal Ethics Committee.
So I've done that continually for a long, long time, I sat on the vet surgeons, more was interested in doing that memberships in Animal Welfare.When kids are all grown up and then I did this Masters at Edinburgh as well and I've always liked writing.
So then I started writing out Chuckles for the a VJ and got involved in the welfare and ethics group a long time ago.So it's really took it from there and got involved in lots of other areas as the children got older.Really?
Yeah, so many questions.So, therefore, let's go right back to the start.So when you were working in practice and then did the kangaroo research, how did you make that work where you working full-time and then LED kangaroos?
Middle of the night or how did you juggle life then?Well, it was a bit of a Juggle.I can't really remember that.I'll just sort of juggled it with the work on the, normal blood values.But when I went to the kids hospital and the research Grant, I just spent the whole year there full time, and then I went back into practice.
I used to do locums, and then so decided to open my own practice.If they hadn't been an empty shop, I wouldn't have done it.It's really interesting.What you said there about hated the research but worked a little bit and it feels like you've sort of weave your way in and out between the different things, which is a really cool approach because I feel a lot of us feel like it's gotta be one of the other either going to go into being a clinical practitioner or I've got to become a researcher.
No no.Do you think is it still possible like has anything changed over time?Can people still do that?Can I still go?I want to do some research but I want to do some practice.Well I did some more research on the Kangaroos couple of years ago, I did the Masters and, yeah, go out and collect a bit of blood and do that.
I think to what we should remember is that we should all do research and practice.That's how we should advance.And that's one can make it a practice a lot more interesting if we can do clinical audits or find a research project, and you can get approval through an animal Ethics Committee.
So you can publish that, think about what you can do in practice.Actors.And that's a whole one of the wonderful things about evidence-based medicine and the use of evidence-based medicine, as you can set up a clinical audits or research projects within practice, which I don't do well, I did, you know, did a small one peers ago.
We randomly assigned cats with cat bite, absences or draining, do we give them antibiotics or not, give them antibiotics.And we discovered that they got better regardless.Was I really?So this is because we've had this on the clinical, but we've talked a lot about this.
And I still personally, it's really struggle with not giving a cat butt abscess antibiotics.I think it's that fear wasting again, it will, if I don't, and they come back with its defensive medicine.So use your research categorically showed no difference.No, I'm somebody else's research a couple of years ago and it showed no difference.
I think that was on Best Bets for this, which is the University of Nottingham, cite evidence based site where they They do a lot of that sort of work.No, it makes no difference and we should be reducing antibiotic useful, stop.So the research thing that's another mind shift for me because again you're either a practitioner or your research, the concept of saying, okay, I've had things all through my career where I went.
Wow, that's interesting.I wonder, you know, you do better reading and you can't find exactly the information that you're looking for and you go over, somebody should do this research but I've never actually thought, well I'm gonna do it because AI Time.Surely that sounds like a mess of time commitment that I just don't have time in everyday practice and of them just like, well, I'm not a researcher.
I'm too stupid to do it.Like you have to have some special skills to.Yeah, do that.Sort of stuff, is that a completely Miss?As it was totally misguided, totally misguided, and you can do, even if you don't call it exact research, you can do a clinical audit which is really what we did with the antibiotic use with the abscess has, you can do.
That and you can make a note of what you do in practice and what was the outcome, and that's you might do something a bit differently to somebody else in the practice.You can keep tabs of that and, you know, that's what the little bit of what that Compass is about.
So, if you look at what's happening in the evidence-based, World veterinary medicine World, some wonderful things happening, the systematic reviews, and there's so much information out there.This whole idea that you're going to Read your way through 22,000, new papers is just absurd that come out every year of veterinary medicine.
So you really we really got to rethink the whole concept of practice.What's vid Compass?Is that?Oh, look it up.It collects, collects data from practices about what they do and it leads you to focus on what practitioners think as a Important.
So the trouble is very much in a university setting.They'll look at something that's unusual because that's unusual, but they don't do stuff that practitioners do everyday.Like, what's the best way to deal with an aural hematoma what's this?
So I think this should be really bitter promoted.The whole concept of evidence-based medicine clinical Audits and that can make Just a lot more interesting does, make practice more interesting.So we do a bit of that practice but then you can also do research and practice might be a new surgical technique you can get approval from an animal Ethics Committee can put in an application and get approval from the committee that when I sit on with Vega New South Wales but number of practices put in these applications and then if you've got ethics approval then you can use that work to publish a paper.
We need to do.Do more of that.And we also need to push the idea that the systematic reviews.The evidence based sites have got loads of information, which you're not going to get.We're trying to troll through 22,000 new papers each year than the now produce compared to the 1970s, and it's a very different world to the world of James Herriot.
You know, there's so much information out there.You can't possibly learn all that.There has to be a move towards teaching students.To teaching them how to access best evidence.So where would you begin?
If I am a practitioner and I have an idea and I think I'm curious about this thing and I wanted to where'd you go to what's your first step?Well, I think the first step is to think about how you would carry out an experiment in practice, and might be a new surgical technique, think about putting in a research application to an animal Ethics Committee in your state.
So where do you find, like, who's the animal Ethics Committee?So, it's under the various departments in different states.Usually, so you Google with a vet board or not, the vet board itself with the New South Wales.It's see Department of primary Industry animal Ethics Committee.
It's the secretary's animal Ethics Committee.So for instance, you want to try out a new drug you chemotherapy drug for instance, you can put an application in with a proposal.How many animals you're going to use?Justification, big one, you've got to justify.
Why you want to do that research?And you've got the owner's permission to do all this.So it's a bit of a process but you can do it.And if you don't want to go through that process so that you can publish the paper you can do.Like I said a clinical audit, you can look at what you did and how well it worked.
So listen, it's about richest of.Let's keep track of what you're doing.Anyway.Yeah so that's more of a reflection on what you're doing and you might think well I've been doing that like giving antibiotics and cats with had sisters maybe I shouldn't bother.You know that maybe I should give that a mess and reduce antibiotic Take use.
Yeah so common things.It's like kennel.Cough is a really good example kennel, cough.Do I give these dogs with kennel cough?Anything at all?Well, no or probiotics.Haven't been shown to work anyway.Maybe you have dogs are diarrhea vomiting.
You know timer doesn't split them into to give some of these dogs probiotics.If you use them we don't and some of them you don't and then look back after a couple of months and say well that's interesting.The dogs that I didn't give probiotics to the diarrhea, cleared up just with dietary changes.
So the other thing that in your story there that I'm really interested in, you said that you couldn't have done the things you've done.If you didn't have your own practice, a lot of people feel the opposite will go.Well, I have these other things I want to do.So, I should never owned a practice because that's going to suck up all of my time.
So you clearly had a different mindset or a different way.That you ran your practice because I feel like a lot of practice and his will say on over no time for anything else, it's just the clinic and the staff management and all of this.How did you do it differently?That that gave you that sense of flexibility?
Well, I set it up right from the beginning, to have these no appointment system and consultation hours and 9 to 12 5 to 8.So, the middle of the day, we do the surgery and I can vary that.So the kids had a concert or something I had to go to Then I wouldn't book surgery and that day and then also because I the owner I could juggle a little bit in terms of time off, which I felt that I couldn't have done if I work for somebody else.
So I think in that regard that sense of autonomy in decision-making and also employing people with a similar mindset to mine and I was said, look after your staff long-term.
Stuff don't have business meetings, don't have practice, meetings, have pizza nights instead.Look, I don't know.I never pictured myself as a business owner.I sort of fell into it in a funny, sort of way when I probably post natal depression, like I said, non sleeping infant.
So most of the time it's worked out.I mean, I've had a few hiccups, where I haven't been able to find staff and that's been a problem.I've had some wonderful long-term people and most of the time it's worked.So when we did the panel discussion at a conference that you are a part of you said something there that I think I understood it correctly produce because when we talked about kids and career and trying to do everything while you have kids and then also trying to be super businesswoman and old, man.
They started.We can't say just remember.There are men who also just want to raise the kids or spend more time with the kids and you said that while you took time and you raised your kids and then Once they were old enough, then you re focused on Career again.Did I understand that correctly?Is that how you fast it?
Well, look, I never thought about careers and as such, I was always interested in animal welfare and I suppose once they were all grown up, that was then when I did my membership exams and the degree in Edinburgh, it wasn't so much.A refocus, it's just that.
I thought I want to do something else.Now, the kids are grown up and I was passionate about learning more.I think and that appealed to me, rather than sort of sitting around watching television or whatever I could do in my spare time, know that appealed to me, I don't know what drove me.
I don't feel like I'm a very driven person, but that's certainly appealed to me.How old were you when you did your memberships?If you don't mind me asking, I can't remember.Now, it's quite a long time ago.I can't remember 50s, or something like that.Yeah, I see that's interesting, because I think a lot of people feel like, well, I'm 20s to 40s is kind of be.
Got to do my career stuff to further myself with create the professional that I can.So the concept of saying well not necessarily you can in that child rearing age if you decide to have a family there's work but you don't have to be.
And then afterwards, you're not dead yet.You can see.You can still, you can still do the things you want to do.Well, I mean, I probably didn't think about doing all this.Well, look, I always did at animal ethics committees.I always wrote a bit.And so I haven't just done practice anyway, but I really it wasn't even so much as time management.
It was more of that and it wasn't so much as a whoopie.I've got all this spare time.Let's do something else.It was just that I thought I'd probably be, could have organized it earlier, but I just didn't really think about doing it.So it wasn't really.
Now I've got time.What else can I do?It was more.This looks interesting, I'll It.I mean I probably could have juggled that earlier if I wanted to but I suppose I probably didn't think about it but then I was probably busy.
I don't know, busy work for children.Well that sounds like you've just got an insatiable in sizable.Curiosity always overhead, maybe just curious curious person and I think I'm, I have to laugh my oldest daughters a doctor and she's decided that I'm a age.
What is ADHD?And I'm going, I don't think I am.You're putting a label and everything's like dogs, dogs are dogs, they don't all have problems.They Prozac I'm going to ask you about the book your butt looks.Just let me out Couple come out, has come out.
Okay.I'm at the end of last year one welfare in practice the role of the veterinary.Right?Yeah.So I've always been interested in environmental issues.It's always been a bit of a passion couple of years ago.I gave a talk at the one welfare conference on land.
And somebody obviously heard about it and out of the blue, which I thought was a Spam call, I had a email from the chief Acquisitions editor for CRC press, who put this saying, would I be interested in putting out a book on one welfare in practice?
And when I worked out that they were actually real, I said, sounds interesting.Now I've been organizing conference programs and I knew a lot of people in this area.So you have to look at the cover though because my husband design that it's very fancy, there it is, sometimes handy to have an architect in the family, even if they live in squalor.
So I got together all the big issues and really all about professional ethics.Professional ethics is really one welfare.The whole idea that, that that's a concern for the environment and Mankind is really, what professional ethics is?
It was never about just being concerned.About you in client and your dogs and cats.It was always about this concern for the wider world, so it's a book for veterinarians.It's not for the Sentinel.NADA, it's a book for veterinarians and for others who might be involved, I want to say it's for vets who are interested in this sort of stuff, but it kind of sounds like, what?
All of us should read it, it should be required reading all of this shit because that's what one welfare is.That's what being a vet is.That's what professional ethics.Its So we are concerned about climate change.We are part of the solution.Yeah.
Alrighty lit.Start wrapping up.Do you obviously read a lot?Where do you listen to podcasts at all?I do occasionally, the most of the things I listen to it.They Tasmanian Symphony Orchestra online and Ice.Well, I'm working.
Is that it?Is it a podcast or is it just on the radio?Look on the radio, but they do have podcast as well.Because they did a daily dose in the first year of the lockdowns.So the TSO, a daily dose of you want to look up the TSO daily dose, wonderful music, why the Tasmanian specifically?
Because that you did you say that's where your son is?Yeah.Well, so you by his title but they're the only ones that did a podcast.All the other orchestras, went a bit quiet and the tea is so jumped up and started doing these daily podcasts.
All right?Right.And then well, let's say then books that you've read recently that we've made a big impact that you feel we should all read if we got anything in mind.No.I tend to read a lot of Articles rather than and journals.I think Journal reader I like reading books but I haven't read novels for ages which I feel a bit sort of remiss about but I really want to relax.
I love poetry, I'll sit down and read a book of poetry rather wrote reading a novel.I mean You like novels, but I'll do that.And if I veg out, I watch television and then we'll wrap it up with a last question today.You're at a conference of sorts and you have all of the veteran in your grades of the world, listening to you.
And you got a few minutes to give them one message.What would your message be it?This is a vocation.Not a job, you're in it because you want to be a vet.It's good fun.Enjoy the ethical challenges.Just see that's part of the job.
Job, don't say, oh is why was me be a social worker, lot of the jobs social work, unfortunately, or fortunately, enjoy, helping people be Collegiate.Just enjoy the role.Use evidence-based medicine, which makes the job much more rewarding and acknowledge that you're not perfect, and that things go wrong and don't blame yourself.
Don't blame yourself when things go wrong and this is really your fault, but It's what I would say, I think unfortunately but we live in this post truth Society where opinions matter as much as science and you know, we got to get away from that point on, WE nearly really got to promote science evidence, based medicine and enjoyment of practice.
Look at ethical, it situations as challenges to be solved.Rather than dilemmas and woe is me.I really like that is the two things that you said that.That stood out to me because it comes down to and you've said the word expectations, several times expectations and mind said to some degree.
And is that the one thing is that enjoy the challenges.So we have that expectation that it should be easy or you know, just if it's if I had days are hard day then it's a bad day and I like that, you flip that around and say, no, this is what it's about, this is what life is about.
As it's, if, if you don't have those challenges, then it's boring.So focus on enjoying and then the other one that And if Perfection that expectation that I'd will can know everything and do everything and do everything perfectly and never make mistakes, that mindset of going, that's ridiculous.
And that's an expectation.You're bound to be disappointed.So I really like those are really good Tanya, thank you so much for your time, your Legend, you're an inspiration.I think I listen, this will take a lot from this.Thank you.I've babbled on a bit but anyway, no, that's what I suppose is.
We have conversations, it's not babbling, it's so Turkey.I'll go get us, a big, do you have conversation like the one?You just listen to.
It will give you inspiration and fresh ideas on how to create a thriving and happy career and life as a bit.You'll know by now that our focus is on the life skills that we need to navigate this challenging and rewarding profession about the something that I've realized over the last few years of exploring ways to increase enjoyment of the drug that, That the Vets who are confident in their skills and knowledge are as a whole more satisfied with their careers, which makes sense.
When you feel Rusty, or uncertain your knowledge.It's very easy for those imposter feelings to sneak in, I don't know enough.Now I good enough conversely, we know that feelings of growth and Mastery are some of the greatest predictors of a happy career, which is why we created the V8, V clinical podcast, three highly practical episodes every week conversations, not lectures with World-class Specialists tips, updates, real insights not textbook Theory short enough to listen to on your drive to work.
But with enough content to ensure that you'll be a little bit better at your job than you were before you listen.Join us on our journey to better by trying out.Our free two week, trial @vv in the super cast dot tick.

Dr Tanya Stephens