Discussing the cost of living with Professor Ian Ramsey

Back in the last few months of 2012 the economy was slumping again and fear of a new recession loomed large in everyone’s mind. I was chair of BSAVA’s Congress Programme Committee.

A situation not unfamiliar to vets, the last of our number arrived to the meeting late and clearly emotional. She’d a sad and complex case of a dog needing treatment with an elderly owner on a tight budget. She asked the rhetorical question: how do I know which corners I can cut?

Like many committees in BSAVA, we were a mix of specialists and first opinion practitioners. It’s important to have both among our ranks and the conversation that followed neatly demonstrated why.

As our colleague explained the case, we were able to tease apart the details and use our experience to identity where the budget could be most effectively spent.  We discussed which diagnostic tools were most likely to give her the pieces of the jigsaw that would give her the fullest picture and which were ‘nice to have’. We talked through the treatment options for the various outcomes trying to balance effectiveness and affordability, as well as management options which would contribute to longer term care of the animal.

Her response was simply ‘we need more of this’. And so the idea for a suite of resources which considered ‘medicine on a budget’ was born.

Since 2012 the British pound has lost 24% of its value against the dollar and since 2021 inflation has soared. The cost-of-living crisis and its effects on households is in the news daily. The need for ‘economic medicine’ is arguably greater today, than it was back then.

Reflecting on those resources we put together, and those that have been added since, a number of themes emerge. There is the clinical balancing of risk, reward and cost, the need for excellent communication skills, and last but certainly not least, the empathy and kindness for yourself, your colleagues and your clients.

While it can be frustrating knowing you could do more, it’s vitally important to recognise that working to a tight budget is no less valuable, no less caring and is very much doing ‘a good job’. You are still helping the animal and its owner.

Still, it is important to remember you and your colleagues, armed with less diagnostic information are more likely to get it wrong. That is statistics. Not a reflection on you, your knowledge or your abilities.

Extend that kindness and understanding to other members of your practice. The cost of living is likely to be disproportionately affecting some our team. Those on lower wages such as our receptionists, nurses and the younger vets, for example, will be feeling the pinch, and be more stressed as a result.

Don’t judge your clients, you never know who will be able to afford more and who will not. You do not know who has had a sudden change in circumstances or why.  Instead, bring the owner with you on the decision-making journey and share the responsibility of the risk-taking.  Where there is less money to spend, it’s an effective use of resources that will pay dividends if or when clinical management plans have to be adjusted or outcomes aren’t as you’d hoped.

Draw on the experience of your colleagues and specialists at referral centres. Often, even without the cases being referred, appropriate specialists will discuss such cases with you. They have often seen similar cases and will be able to recall the outcomes, giving them more insight into the relative likelihood of a given ‘diagnosis’ or the risks of omitting a test. But respect their time – prepare a summary and remember that pictures are worth a thousand words.

With the cost-of-living crisis unlikely to abate anytime soon, demand for veterinary care on a budget is likely to increase. BSAVA has created a collection in the library which covers many aspects of ‘economic medicine’. There’s everything from clinical content to client communication and is a valuable open access resource: https://www.bsavalibrary.com/content/veterinary-practice-in-a-time-of-budget-constraints