Vets and owners can make most of medicine with mutual trust

Veterinary medicine is up there too, utilising the advent of MRI and CT scanners and such like for the benefit of our beloved animals. Alongside the farrier, the vet is probably regarded as the other most important person in a rider's stable, most particularly because the patients cannot verbally communicate their problems so in the absence of heat, swelling or blood a diagnosis can sometimes be difficult. Similar to the doctor or the dentist there must be confidence and mutual respect in the practitioner's ability. After all, you have to know that the person rooting about in your mouth is providing the most efficacious and sympathetic service possible.

So why, with all this state of the art technology and medical advances, am I hearing sorry stories of misdiagnosis and cavalier attitudes of some vets?

Perhaps it is that having read publicity on developments from the Animal Health Trust that drop through the door on a regular basis, plus hearing stories of successful treatments, our expectations are now sky high with failure not seen as an option. More likely is that the problem comes because people still use practices that treat all species but do not always understand that these vets do not know everything about the horse.

There is, however, a huge push from within the profession towards gaining more knowledge. The Royal College of Veterinary Surgeons (RCVS) advises strongly that vets do re-training, but it's not compulsory. Young vets particularly are keen to learn and the knowledge base has increased tremendously, especially with equines. Graham Munro, a consultant vet, conducts training courses for vets of all sorts of levels. "There is a strong drive to learn more," he said. "It doesn't exist that a more specialist person is not available within a 30 miles radius in England. There are plenty of practices in Yorkshire or people within practices that specialise in equines."

Practising vets can further their knowledge by taking further education certificates and diplomas, for example, the Certificate in Equine Practice, depicted as Cert EP on the vet's letterhead. There are also equestrian certificates in medicine, stud medicine and surgery. Information on veterinary practices is listed on the RCVS website. It would be a very comprehensive site if kept updated, but the omission of two of the most notable Yorkshire practices indicates some flaw in the service.

Mistakes do happen, vets are human after all. The onus is then on the owner to do something about it. Take Miss A's maiden mare who rejected her foal. The advice from her vet, over the phone because he refused to come out, was milk the mare and bottle feed the foal. When this didn't work and three phone calls later the vet admitted there was nothing else to be done. Miss A was conversant with cows' calving so, although inexperienced with horses, did not believe there was no treatment available. She rang another vet who visited and gave the mare a hormone injection to release the milk and the foal was saved. Miss A was so angry she never used her former vet again. "If the foal had died we might have done something," she said. Cases like this where vets refuse to attend or the treatment is inappropriate should be reported. The RCVS website has a category for complaints.

Horse owners are becoming increasingly insistent on a higher level of expertise and therefore tend to go to more specialist equine practices. The whole system of referrals has changed considerably. Equine practices now obtain more equipment and become more hospital based than the average vet. There is a big trend to referral practices following the emergence of further education courses available. There are more specialist practitioners who can deal with problems that in the past would have been sent to one of the universities.

Bob Ordidge from the Rainbow Equine Clinic, a referral practice, said: "We have a hospital so the horse can stay, which is a big advantage because you live with them and learn more about them. We get the advantage of more time and more facilities to do a deeper job."

Referrals are only part of the business, however. "We would have trouble surviving if we relied on referral work. The bread and butter is simple work like vaccinations, skin problems, and coughs."

The one seemingly endemic feature, apparent in human and veterinary medicine alike, is an autocratic attitude. Trust and respect is a two way affair. The consultant or the vet should have the same respect for the owner's observations or opinions as he expects to receive. After all, the owner's knowledge of the horse can be instrumental in a diagnosis. Such as the Intermediate eventer who, during one day schooling, suddenly bucked and refused to jump. After four years of competing him when refusals were not on his agenda, the rider knew there was a physical problem. After consultation with her vet and the owner, the horse was referred to an eminent specialist. The scan revealed some 'hot spots' but the final diagnosis was a psychological problem, which the specialist said they could not treat. The horse was returned with an accompanying large bill. Back at home the equine physiotherapist suggested that the local referral centre look at the scan. There, the view was that the condition was kissing spines and was treatable, and the horse enjoyed a further two years' eventing. The owner, who incidentally is a barrister, felt humiliated by the cavalier treatment she received from a distinguished professional. She felt her observations were totally disregarded, indeed disbelieved. The outcome was a serious dent in relationships with her vet and a deep sense of disappointment in the profession.

Unfortunately, all too often more knowledge and eminence brings an egotistical sense of self importance, leaving little patience for those whom they regard as having little knowledge. Extensive exposure living and working with horses brings experience that should be listened to.

Vets will probably say these comments are unjustified because extenuating circumstances, such as lack of knowledge, prevail. Indeed they close ranks at the first hint of criticism. True to say, though, there is an increase in the less knowledgeable owner. "Half of what we deal with is mismanagement and lack of understanding by owners," said Graham Munro. "Horses are often regarded as pets. As much information as there is, it doesn't make up for the basic experience built up working with people and horses over the years. There is a lack of practical knowledge."

The bottom line is probably the same that filters through all of our life, that of communication. There is nothing that clears the air better than a good discussion. The typical attitude these days is to go behind people's backs. If there is an issue, it needs bringing out. If the owner feels the need to change practices he should tell the vet, not cause greater embarrassment by sneaking off to a new one. Vets, on the other hand, could do well to examine their sometimes holier than thou attitude.

I do remember vividly taking my horse to Donald Sinclair (aka Sigfried Farnum of James Herriot fame) for a second opinion. Following the examination Mr Sinclair invited me to have a drink in the huge consulting room that more resembled a farmer's kitchen than a vet's surgery. As it was mid afternoon, a cup of tea would be nice I thought. It was something of a surprise when he opened a cupboard and produced a large whisky bottle from which he half filled two tumblers. Something to dilute it was obviously not an option. Some time later I left the surgery charmed by Mr Sinclair, absolutely clear on his diagnosis, confident in the proposed treatment and prognosis, but more than a little anxious about the drive home.

Gone are those days but we are fortunate in this country to have a first rate veterinary profession. Let us make the best use of it by all working in harmony.

Published: 01/07/2005