Vet Bills…..Panorama….BBC 1

Our small animal vets are independent and fantastic - both cost and service wise. We're very lucky. they also have an equine branch, which I don't use, but only becaue I've been with my current equine vets forever, they know the horses well and I really like them too.

However, when we had our old man cat PTS, they put a catheter in and needed to sedate him to get it in, before administrating the lethal drug (He'd spent quite a lot of time in the vets in the year before PTS due to eye ulcers and eye removal). Before his eye issues, he'd
always been very good with needles, so I think he found the catheter insertion traumatic and fought it - they took him away from us for this bit, which is something I will always regret allowing. He was incredibly weak and 'ready' due to a large tumour growing in his stomach very quickly. It cost lots of money, and was incredibly upsetting as we felt he didn't know if we were there in his last moments as he was heavily sedated. We took him home to bury him. He was the kindest and most gentle cat and did not deserve an ending with added trauma.

When we had our old lady cat PTS last year, we specifically requested that she didn't have the catheter or sedation and has the drug injected directly. this is how they'd always done it previously and we're happy to do so. Meant we stayed with her the whole time, and she knew we were there. Much better, and also a fair bit cheaper too! she's also buried at home.

I do worry about vet bills, but we have back up just in case... but sometimes even if it's affordable, it feels like a head and heart decision where this amount of money is concerned.

I think one of the biggest issues with vets is that they don't have their prices available to view, and unless it's a big procedure, they rarely discuss cost, that, alongside added extras that just don't make sense. One of my current cats has epilespy that's controlled with a drug called Epiphen... the drug itself is cheap, and the 'dispensing fee' is actually more expensive that the drug. After a battle, a letter and them realising I'd actually had some vet nurse training and wasn't a complete novice, would they give us three months worth, not one month... which is much more sensible!
 
anguscat said:
I just find him rather predictable in his takes on issues. I find him in his bubble/camp and inclined to stay there and argue from it.
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He's the opposite in many ways. He changes his mind through the hour on certain topics, especially since he went through therapy (during lockdown I think). He has a blind spot on the economy (from my point of view) and on anything he thinks is extreme left (Corbyn for example), he's a bit small c conservative so tends to go with current perceived wisdom in terms of the economy (ie capitalist and right of centre compared to the 60s and 70s, struggles to move away from the household budget model).

He has shifted, and does shift, on quite a few things. I would imagine he's further left than you, so it can feel like he doesn't change his opinion as he changes from one type of left of centre opinion to another (broadly). Has Nick Ferrari ever changed his mind within an hour's phone in? I can't listen to him for more than the last 15 minutes, or in clips where he's actually not simply repeating DM headlines, so no idea.

I'm not sure I know any other chat show host who shifts his position as much and seems to enjoy the process. I mean he even calls them "ping pong" topics where he shifts back and forward throughout the hour.
 
Trot_on said:
I think one of the biggest issues with vets is that they don't have their prices available to view, and unless it's a big procedure, they rarely discuss cost, that, alongside added extras that just don't make sense. One of my current cats has epilespy that's controlled with a drug called Epiphen... the drug itself is cheap, and the 'dispensing fee' is actually more expensive that the drug. After a battle, a letter and them realising I'd actually had some vet nurse training and wasn't a complete novice, would they give us three months worth, not one month... which is much more sensible!
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To be fair to your practice, because Epiphen is a Sch 3 Controlled Drug, the new prescribing regulations stipulate prescribing a maximum quantity of 30 days supply at one time.
You can prescribe up to 3 months, but this can only be in truly exceptional circumstances and for a justifiable clinical need. In these cases robust documentation of the reasoning for the exceptional circumstance must be made that will stand up in court. I think you have been very lucky with your practice here because just not being a 'complete novice' is not something that would normally be considered an exceptional circumstance in the eyes of the law.
 
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@sbloom maybe I should re-listen to him again. Haven’t for years. Your comments don’t reflect how I recall him. Quite liked a book he wrote a few years ago. I’d like to get some time to read Follow The Money.
 
Gamebird said:
To be fair to your practice, because Epiphen is a Sch 3 Controlled Drug, the new prescribing regulations stipulate prescribing a maximum quantity of 30 days supply at one time.
You can prescribe up to 3 months, but this can only be in truly exceptional circumstances and for a justifiable clinical need. In these cases robust documentation of the reasoning for the exceptional circumstance must be made. I think you have been very lucky with your practice here because just not being a 'complete novice' is not something that would normally be considered an exceptional circumstance in the eyes of the law.
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Just to follow in from Gamebird’s post, all of which is correct, I would like to point out that this is a LAW. If a vet is found to not have the robust clinical reasoning documented in the notes, then they can be reprimanded legally, including prison time, and will be struck off, thus unable to practice their profession again. ‘Because it saves a dispensing fee’ is absolutely not an appropriate reason, cost is also not a justifiable reason to go ‘off cascade’ with medicines, we legally can’t just use a human one because it’s cheaper, or tell you to buy a human one on the hush hush, because, yep, jail time.
Dispensing fees are a bundled together fee added to medications supplied by a practice that reflects the cost to the practice of ordering, stocking, appropriate storage which includes refrigeration, appropriate dispensing vessels for each medication, the cost of labelling the drugs including printing, the cost of countersigning the drugs, delivery, paying staff to manage the pharmacy, paying staff to dispense the medications stocked in the pharmacy etc, dispensing fees are perfectly reasonable to charge, it costs a lot of money to hold stock and medication accounts, and fulfil criteria to be allowed to stock and supply them in the first place. Oh but online pharmacies do all that and are cheaper I hear you cry. Yeah, because they only employ one vet to check (maybe two or a job share), and they have a huge warehouse with insane buying power that practices JUST DO NOT HAVE AS WE CANT STORE THAT AMOUNT. I have said it many times before, but a lot of folk just like to have the same old arguments in their head and trot it out for the ‘big vet scandal’ discussions, online pharmacies sell their drugs cheaper to owners than we can buy it in WHOLESALE. So obviously, we cannot compete, and obviously, our costs will inevitably be higher to us as a business, and therefore higher to consumers
 
Redders said:
Just to follow in from Gamebird’s post, all of which is correct, I would like to point out that this is a LAW. If a vet is found to not have the robust clinical reasoning documented in the notes, then they can be reprimanded legally, including prison time, and will be struck off, thus unable to practice their profession again. ‘Because it saves a dispensing fee’ is absolutely not an appropriate reason, cost is also not a justifiable reason to go ‘off cascade’ with medicines, we legally can’t just use a human one because it’s cheaper, or tell you to buy a human one on the hush hush, because, yep, jail time.
Dispensing fees are a bundled together fee added to medications supplied by a practice that reflects the cost to the practice of ordering, stocking, appropriate storage which includes refrigeration, appropriate dispensing vessels for each medication, the cost of labelling the drugs including printing, the cost of countersigning the drugs, delivery, paying staff to manage the pharmacy, paying staff to dispense the medications stocked in the pharmacy etc, dispensing fees are perfectly reasonable to charge, it costs a lot of money to hold stock and medication accounts, and fulfil criteria to be allowed to stock and supply them in the first place. Oh but online pharmacies do all that and are cheaper I hear you cry. Yeah, because they only employ one vet to check (maybe two or a job share), and they have a huge warehouse with insane buying power that practices JUST DO NOT HAVE AS WE CANT STORE THAT AMOUNT. I have said it many times before, but a lot of folk just like to have the same old arguments in their head and trot it out for the ‘big vet scandal’ discussions, online pharmacies sell their drugs cheaper to owners than we can buy it in WHOLESALE. So obviously, we cannot compete, and obviously, our costs will inevitably be higher to us as a business, and therefore higher to consumers
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I understand all the points you are making but client's simply cannot afford to buy from vets so have to buy online. My cat for example is on thyronorm. It is around £47 online and vet charges me £120 for the same quantity. What am I expected to do.
 
I was trying to steer clear of this thread for my blood pressure, not saying all of you are a problem for me on the thread, but that the argument is exhausting. I will say though, that by far and away, the biggest amount of complaints/expressions of displeasure from owners, are because they want top tier treatment, but only want to pay bottom tier prices (caveat not everyone but, my days, enough for it to be the most common treatment plan discussion I have). Example:
Me -
I suspect xyz is wrong with pet, my recommendations are A, B or C. By choosing B or C, these are the trade offs, the things we may miss, side effects etc, but pet still has reasonable chance of resolution.
Owner -
A then please.
Me- ok the costs are 1234
Owner-
WHAT? Why so much?
Me -
Because of A, for this reason, B for this test, C because this drug causes this issue and the more expensive one doesn’t, D because we ideally need to know bla bla or such and such may occur. Options B and C cost this much respectively
Owner -
But I want A
Me -
Ok then, shall we go ahead?
Owner -
But I don’t want to pay that!! It’s ridiculous!
Me -
Ok then we go for option B, middle of the road?
Owner -
But you said without that test that we wouldn’t know xyz and I want to know xyz, and that the drug might not be as good
Me -
This is true, but I also said there is a reasonable chance of resolution with option B and C
Owner -
I don’t want reasonable chance, I want the test and the other drug
Me -
Ok, well then, that is option A
Owner -
But why is it so expensive???!!
Me -
………… and rinse and repeat.
 
paddy555 said:
I understand all the points you are making but client's simply cannot afford to buy from vets so have to buy online. My cat for example is on thyronorm. It is around £47 online and vet charges me £120 for the same quantity. What am I expected to do.
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Oh I don’t mind people buying online! It makes sense to do so, and I write so many online prescriptions daily I lose count, I offer them to all clients where waiting a few days to order and deliver is appropriate.
The issue I have is people claiming the vets are terrible profiteers for charging so much more than pet drugs online, for example. ‘My vet sold me tablets that cost £43, but I bought them from online for £22. Vets are disgusting’

It’s ill informed and mean. And it doesn’t matter how well you inform these owners of the reasons, they still forget and call you disgusting, in it for money, don’t care bla freaking bla.

This isn’t aimed at you paddy555, and I completely agree with buying online if it suits and works out cheaper, but the same companies that own the big corporates, also own the main pharmacies. Animed = CVS; pet drugs online = IVC; vetuk = vetpartners; viovet = pinnacle pet group (not a vet practice owner but pet insurance and services)
So when owners state to me that they will just take their drug business to pet drugs online because they don’t charge our ridiculous prices and they will vote with their feet and we won’t get their money….. the company they don’t like because they are a greedy corporate, will still get their money anyway.
this is one of the points I wish the CMA actually investigated, and would actually remedy, this is something that actually corners a huge part of the market to corporates
 
Nice to see you back, Redders :)
I think you guys have it much tougher in the UK with your regulations, not being able to go off label etc than we do over here which sounds super stressful.
Re the euthanasia and the catheter- I would NEVER do a euthanasia without putting a catheter in. If that drug goes extra vascular it really hurts. Much worse than having a catheter placed (esp with the local anaesthetic sprays etc we have now)..
 
paddy555 said:
I understand all the points you are making but client's simply cannot afford to buy from vets so have to buy online. My cat for example is on thyronorm. It is around £47 online and vet charges me £120 for the same quantity. What am I expected to do.
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Ditto what Redders said - absolutely get a prescription and buy online. No one would expect anyone to spend nearly 3 times the price. Vets are totally happy with that.

BUT (and again, this may well not be you, but it is an awfullot of people, as this week has demonstrated) don't also yell that the £120 is disgraceful profiteering on the part of the vets. Take a minute to understand the many reasons the cost is so much higher, that we can't even purchase the drugs ourselves for £47, and the £120 does not represent pure greed on the part of the vets.
 
KEK said:
Nice to see you back, Redders :)
I think you guys have it much tougher in the UK with your regulations, not being able to go off label etc than we do over here which sounds super stressful.
Re the euthanasia and the catheter- I would NEVER do a euthanasia without putting a catheter in. If that drug goes extra vascular it really hurts. Much worse than having a catheter placed (esp with the local anaesthetic sprays etc we have now)..
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I would never give euthanasia solution off the needle either in an alert animal
It stings intravascular never mind extra vascular.

However, I rarely place catheters for euthanasias and my IM sedation puts the pet under a surgical level of anaesthesia before an intrarenal injection of euthanasia solution. This let's the owner cuddle the pet to sleep and they keep the front end for petting/loving on while I carry out the procedure. Easier and kinder in home.
 
druid said:
I would never give euthanasia solution off the needle either in an alert animal
It stings intravascular never mind extra vascular.

However, I rarely place catheters for euthanasias and my IM sedation puts the pet under a surgical level of anaesthesia before an intrarenal injection of euthanasia solution. This let's the owner cuddle the pet to sleep and they keep the front end for petting/loving on while I carry out the procedure. Easier and kinder in home.
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This is how my vets do it.
 
Gamebird said:
To be fair to your practice, because Epiphen is a Sch 3 Controlled Drug, the new prescribing regulations stipulate prescribing a maximum quantity of 30 days supply at one time.
You can prescribe up to 3 months, but this can only be in truly exceptional circumstances and for a justifiable clinical need. In these cases robust documentation of the reasoning for the exceptional circumstance must be made that will stand up in court. I think you have been very lucky with your practice here because just not being a 'complete novice' is not something that would normally be considered an exceptional circumstance in the eyes of the law.
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This is really interesting thank you - the vet who prescribed just said it was on a case by case basis and she was comfortable than I wouldn't overdose my cat! It's also a much better explanation as to why they couldn't prescribe more than 30 days previously. Thank you :)
 
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