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October 4, 2012

Mobile Practice?

A recent article on Fox’s Atlanta news website describes how more and more vets in the USA are taking their entire working life on the road. Dr Leslie Neely is a vet who has done just this and as I read about the delight of one of her satisfied clients, it got me thinking… What are the implications of entirely mobile vets – not just for the clients, but the animal patients and the vets themselves?

As a vet who once upon a time worked in a busy small animal practice, my thoughts first jumped to the inconvenience of it all for the vet. To not have had a supportive, highly trained team around me would have made my job impossible probably more than once a day. Numerous scenarios involving the vaccination of unhandleable cats and angry dogs flashed through my mind. However compassionate I was and slowly I took things, my lovely team of nurses, skilled in animal restraint, were essential to get the job done on a number of occasions. Vindication of this point; the one and only time I got bitten badly by a patient was because I trusted the owner to hold their dog when they weren’t capable. Maybe this is more a reflection of my capabilities as a vet, rather than a comment about how it takes more than a vet to provide an acceptable standard of veterinary service, but I suspect I am not alone in feeling this way.

Working mobile, there will inevitably be more time though – something that almost all vets feel they lack. This is the first point raised by Dr Neely in the article and she says that it was the overly busy small animal practice environment impacting adversely on her client relationships that prompted her move to go completely mobile. Being mobile can also allow a greater degree of flexibility, perfectly suiting vets with childcare concerns for example.

For the client, I can definitely see the appeal; no need to battle with angst ridden Fluffy and her hated pet carrier. No dragging poor Rover over the surgery threshold as he desperately tries to back pedal his way out of there. A mobile vet is not going to be able to offer the full range of services that a conventional surgery based vet can though. No procedures under anaesthesia, no hospitalisation facilities, no IV fluid capabilities… The need to refer such cases is going to introduce a lack of continuity and potential administrative difficulties with notes/history transfer. There are practicality issues too. Sure, an abscess can be lanced, drained and flushed in a conscious cat easily enough, but is the client really going to want that to happen in their house?

But what of the animals? Surely they should be the biggest motivating factor? Some would argue that the difficult cases I referred to earlier were likely often the result of the anxiety that many pets feel going to the vets? In that case, by performing routine and first opinion visits at home, this anxiety is eliminated, perhaps allowing these animals to express their true nature rather than releasing the fear fuelled inner demon. My concern is that the anxiety is instead transferred. Animals that hate the vets do so, more often than not, because vets don’t generally do nice things to them. No doubt pheromone release by previous anxious patients will exacerbate the problem but ultimately, bad experiences lead to fear in most cases. Whatever measures are used to make the experience as positive as possible, injections/nail-clips/examination still cause some animals distress. By bringing these ‘nasties’ into an animal’s home – the one place that they should feel safe, are vets actually wielding a psychological sledgehammer on these poor unsuspecting souls?

I can’t help feeling that there are more flaws in this style of practice than benefits when all parties are considered. But there are flaws in traditional surgery-based practice that mobile practice neatly addresses. It’s one for debate, that’s for sure, with no doubt a lot of vets sat at either end of the scale – some in cars, some in consult rooms.