Vets Gone Bad

I recently participated in a brief Facebook conversation with some of my colleagues about the highest rated program on National Geographic Wild. I have not seen it, but I have certainly heard and read a lot about it. I may have the name wrong, but it's something like "The Appalling Dr. Pol".

Off stage, Vetography lawyers: "You can't say that! You know it's not called that. We'll get sued!"
Me: "Come on, get real. Nobody reads this blog." 

People appear to love this guy despite the fact that he is manifestly a quack.

Lawyers: "OMG!!"

You would be hard pressed to find a veterinarian who feels otherwise. But I'm not going to talk about the show or the details of his practice. I only mention him because his story is a useful illustration of the weakness of the professional disciplinary process.

One the hats I wear is as Chair of the Peer Review Committee (PRC) of the Manitoba Veterinary Medical Association (MVMA). I've been Chair since 2011 and sat on the PRC as a committee member reviewing complaints for about ten years before then. Veterinary medicine is like most other professions in that it has been accorded the right to self govern and self regulate.The reason professions are permitted to do this is that the government recognizes that only those who actually do the work are in a position to determine what is appropriate and what is not, and which errors are avoidable and which are not. Lay people are also appointed to the PRC to make sure that the public interest is kept in mind and that it doesn't evolve into an "old boys and girls club".

It's an interesting job but it's also a stressful job. Standing in judgment of your peers can feel like an onerous responsibility at times. A more subtle stress though is the knowledge that the worst offenders are getting away with it and that we are only seeing a skewed sample. This is because the process is necessarily complaint driven. Clinics are inspected for equipment, record keeping, sanitation etc, but nobody swoops in and looks over your shoulder to see how you are handling a case. There aren't the resources to do so and it would be pointless as you would be on your best behaviour when observed. The legislation states that for the PRC to investigate a complaint it must receive the complaint in writing. That's it, that's all. So we sit and wait for letters to arrive, our hands otherwise tied.

Think for a moment about your GP. Is he or she "good"? If so, how are you assessing that? Do you know enough about medicine to understand what is proper medical practice and what is not? Honestly? No, more likely, when you say that your doctor is good, you are saying that he or she is nice, and listens to you, and seems to care, and doesn't keep you waiting too long etc.. You have no real idea if the right test has been run and even if it was run, whether it was interpreted correctly. Your doctor could easily be incompetent and it would be very difficult for you to tell. Consequently you probably would not complain about your doctor to the College of Physicians and Surgeons, even if you had a poor health outcome. However, if you encountered a rude doctor with terrible bedside manner and had that same poor outcome, chances are higher that you would complain, even if he or she did everything right and the bad outcome was due to bad luck.

And so it is with veterinary medicine too. In all the complaints I have seen, the great majority have been due to poor communication by the veterinarian rather than poor skills or knowledge. Those of my colleagues who are a little more awkward around people, or perhaps are short tempered, but are objectively quite competent attract far more complaints than those who are charming and charismatic, but are objectively less competent.

The good news though is that given enough time, eventually the charming quacks trip up badly enough or often enough that they are unmasked and professional discipline can take action. As Churchill said regarding democracy, it's the worst system, except for all the others. Dr. Pol has been disciplined, albeit lightly.*




* And another more recent successful disciplinary case against him was reversed by a higher court in a ruling that effectively questioned the scope of authority of regulatory bodies. It doesn't impact us here, but it is interesting/frightening nonetheless.

Bee Med

One of the most fascinating aspects of this profession is the range of creatures veterinarians treat. Personally I have cared for animals from as small as a hummingbird to as large as a bull moose, although I will confess that both were while I was still in vet school. In my own pet practice the range is somewhat more restricted, running from mice to mastiffs. But my colleagues out there will attend to the full spectrum, from bees to whales. Whales, ok, you can probably picture that. Sort of. But bees? Surely I must be exaggerating or joking. I am not.

I am aware of at least three conferences this year that featured sessions on honey bee medicine. The Honey Bee Veterinary Consortium now has 345 American veterinarians listed in its database and there is also a British Bee Veterinary Association with a cool website (britishbeevets.com), as well as a Veterinary Invertebrate Society. The latter appears to be more focused on spiders and lobsters, but it is certainly interested in anything which creepeth or crawleth or buzzeth.

Ok, you can get the obvious jokes out of the way now. You must have a very tiny xray machine! It must be hard to give it a pill without getting stung! How do you take its temperature?! Har har. Nope, nope and nope. Bee medicine is like the medicine of many other food producing animals and is directed towards diagnosis and treatment of large groups at once rather than individuals. Dead bees are tested and then, if appropriate, something is prescribed for the entire swarm.

What has changed recently and made this something more than an obscure reference buried deep in the veterinary literature is a change in the laws governing antibiotics. Since 2017 in the US, and as of the end of this year in Canada, the regulatory authorities will require a veterinary prescription for most antibiotic use in bees. And a veterinary prescription requires a valid "veterinary - client - patient" relationship. Yes, the vet will have to have a relationship with the bee (bees). He or she will have to see them and make a diagnosis before anything is prescribed. This is because in the past bee keepers were able to buy the antibiotics over the counter and misuse, largely due to lack of knowledge and training rather than actual negligence, has led to antibiotic resistance and residues appearing in the honey.

So now vets will have to learn about "varroa mites" and "acarine mites" and "nosema fungus" and "small hive beetles" and "Israeli acute paralysis virus" and "black queen cell virus" and the wonderfully medieval sounding "chalkbrood" and "foulbrood", among many other bee ailments. Foulbrood, a highly infectious bacterial disease killing bee larvae, now affects about 25% of hives in Canada and is the main reason for antibiotic use. With correct diagnosis and careful prescription of appropriate antibiotics at the appropriate doses and times this can be managed better than it has in the past. Veterinarians to the rescue! Other veterinarians though - I'll stick to my mice and my mastiffs, and most of what's in-between.