Episode Transcript
[00:00:05] Speaker A: Welcome to All Cats considered, a new podcast from the American association of Feline Practitioners, where we interview professionals from across the veterinary world and take deep dives into the latest evidence based research, development, studies and guidelines that improve feline health and well being. We are the home for veterinary professionals seeking to improve the care of cats through high standards of practice, continuing education, and evidencebased medicine. In each podcast, you will hear interviews from a variety of experts throughout our field, covering a wide range of topics and recent developments in the practice of feline health, sharing the key points you need to know to improve your patient's care. Let's dive in and take a listen with this week's experts.
[00:00:52] Speaker B: So welcome everybody. I'm Natalie Dalgrey from ISFM and I'd like to welcome my special guest today, Linda Jacobson. I'd really like to thank you, Linda, for agreeing to be our first open access special collection guest editor for JFMs and I was wondering if you were able to maybe just start by telling us a little bit about your veterinary background and how you became interested in the topic of accessible care.
[00:01:17] Speaker C: Yes, of course. And thank you so much for having me on the podcast, Natalie. I qualified in South Africa in the late 1980s. I spent about three years in private practice, and then I did a residency in small animal internal medicine and then a PhD on canine babesiosis, which is a tick borne disease that's really common in South Africa. So my interests have always really centered around infectious diseases, internal medicine, targeted diagnostics and therapeutics, and evidence based medicine. And that collection is all really important for accessible veterinary care. In terms of how I became interested in accessible veterinary care, I don't think there's really a point where one becomes interested in it. I think it's just the water that we swim in as veterinary professionals. So we're all here because we care about our patients, their welfare and their bonds with their caregivers. And obviously, a lack of veterinary care is a substantial animal welfare concern. So we really want to try and expand veterinary care to as many cats and other patients as possible and to stop access to care from shrinking to a more privileged group.
[00:02:26] Speaker B: Brilliant. And when we started this special collection within us internally in JFMEs and yourself as well, there was a lot of discussion about what we were going to call the special collection. I think it took us a while to agree that accessible care was going to be the best title. Would you be able to explain a little bit more what was meant by the term and how we came about it when we were looking at what the scope of the special collection was going to be?
[00:02:52] Speaker C: Yes, and even though it seems like quite an obvious term, it's not necessarily obvious to anybody, and it's not necessarily known to everybody in the veterinary profession yet, although I think that's coming.
We talked about calling it affordable care versus accessible care and ended up choosing accessible care, because what we're really looking at is perhaps not so much access to care as barriers to access to care. And among those barriers, affordability is a really important one, but there are many others. So just looking at cost is a very narrow view of the reasons that pets, and cats in particular, frequently lack access to care.
The Canadian Animal Health Institute has allowed us to add some accessible care questions to the 2022 pets in Canada survey. And that was very interesting, because in american surveys with similar questions, we found that they found that affordability was by far the biggest barrier to access to care among families who couldn't access care for their pets in our survey, and possibly this is because it was in the tail end of the pandemic emergency. We found that although affordability was the major factor, inability to get an appointment was almost as big a barrier. So the veterinary resource capacity shortage is really playing into that, as well as potentially pandemic related factors. And then we found there were many other barriers to care as well that included fear of being judged, veterinarians, not taking new patients, not knowing where to go, language barriers, transport, and then lack of a leash or carrier. I'd lastly just say that I think it's a mistake to think that barriers live in isolation from one another. They're often interlinked. So if you think perhaps of a person with a physical disability, they may be facing financial limitations. They may not physically be able to pick up their cat to put them in the carrier, they may not be driving, they may have trouble administering medication. So these things are often very much tied into one another.
[00:05:04] Speaker B: I think that's really interesting. And one of the things I was reflecting on when we were preparing for this lecture, and I was thinking, you being based in Canada, which is a very large landmass, I'm based currently in the UK and I'm from New Zealand, both of which are actually quite small land masses, so for us, less so in the UK. But when I worked in New Zealand, some of my clients, it was a two hour drive to come to the vet clinic that I worked. And I imagine for some of people living in Canada, 2 hours is seeming potentially quite a short journey to the vet clinic. So I guess there's also physical barriers as well, that may play a role.
[00:05:40] Speaker C: Yes, in Canada, we have very substantial geographic barriers. We have some communities that are extremely remote and have no veterinarians and often no veterinary care. When they do have access to veterinary care, that's often clinics that go in once or twice a year to do vaccinations in Spain, so very limited access to care. Even in more affluent communities in Canada, sometimes there are three, four, five hour drives to certain types of care, particularly emergency clinics.
[00:06:08] Speaker B: And I guess we also have to think about cat factors as well. There are a lot of cats that they themselves are the physical barrier from going to the vet clinic, too. It's something that both ourselves at ISFM and our colleagues at AAFP recognise with our cat friendly clinic and cat friendly practice programs, that that kind of messaging around the importance of getting your cat to the vet, but also creating an environment that doesn't put the cat and the cat owner off. Coming back to the vet can be quite important, too. And you mentioned medication, which may be a physical side of things for owners. But I guess also there are some cats that are very resistant to taking medication as well.
[00:06:50] Speaker C: Yes, absolutely. And it's a reason that this collection belongs so nicely inside the Journal of Feline and Medicine and Surgery, simply because cats lack access to care compared with dogs. So we did a study that will be published in January in the Canadian Veterinary journal, looking at trends relating to accessible veterinary care in Canada from 2007 to 2020. And over that period, it was fairly consistent that about 85% of dogs had seen a veterinarian in the past year, compared with in the region of 55% of cats. So a really substantial difference. And we're hoping that the cat friendly practices, and particularly I know for me personally and my cats, being able to give them a mild sedative before transporting them to the veterinary clinic. We're hoping that will start to help close that gap. But I think there are a number of other reasons for the gap, and we're hoping that having the special collection in a feline journal will make a real impact there, too.
[00:07:50] Speaker B: Yeah, I think it is an interesting one, and definitely in some countries, and I think I can say this is probably still true in the UK, that cats, pets maybe aren't valued quite in the same way that maybe pet dogs are. Again, depends on the situation and the owner, but there is sometimes perhaps less of that bond that may drive the more regular visits to the vet? Potentially, yes.
[00:08:15] Speaker C: I think that there is often less perceived value and perhaps people aren't willing to make the same kind of financial commitment for cats, although I hope that gap is narrowing. But the other factor is that cats are so good at hiding illness, so if they aren't receiving regular preventive care and people are only taking their cat to the vet when they're sick, that would mean that many cats would not be seen until the illness is quite far advanced.
[00:08:41] Speaker B: That's true. And then potentially affordability starts to creep in at that point as well, because we all know a lot of these conditions. The longer you wait, the more cost there is often associating with sorting it out as well.
[00:08:54] Speaker C: It's very interesting. In our survey, something like ten to 12% of respondents said that the barrier to accessing care was fear of being judged. So the concern is that if people wait too long, either because they haven't realized the cat is sick or because they felt that they couldn't afford the care, but then they get to a point where it's urgent that they may still not access care because of a fear of being judged. So we do find there are some veterinarians, I think, definitely the minority, but some who are so focused on the pet that they are then judgmental towards the caregiver, and then that creates a vicious cycle of people being afraid to come back and seek care.
[00:09:36] Speaker B: Yeah, I think that's a really important point, and it's such an interesting topic and it's one that there's been a bit of discussion in recent times in the UK, although the term here, contextualized care, is the one that seems to be being used, but essentially it's a lot of the same concepts. And I went to a lecture recently that had this really nice triad of what we're talking about, and it's the vet and it's the owner and it's the cat or the pet itself, that it is this three way. It's a three way conversation, I think, isn't it? There's different factors on each side that are potentially causing barriers to the cat getting the care that they need. Yes.
[00:10:17] Speaker C: And the term human animal family is really helpful there because we're never looking at the animal in isolation, we're always looking at in the context of its family.
[00:10:26] Speaker B: That's a really nice term. I hadn't heard that one before, but I think it's a perfect term to use, isn't it? Because we all know none of our cat clients take themselves into the vet clinic and take their own medication without someone else doing it. So I think that's a really nice term to use.
You mentioned earlier with the survey that you'd done in Canada, and the fact that it was done around the sort of end of the COVID period, I guess we call it now.
And this does seem to be things, especially around that lack of availability of appointments. This does seem to be something that's cropping up in many countries that we potentially have had maybe a loss of poor retention of some of our clinical vets in our industry. Definitely in the UK, we saw an increase in pet ownership during COVID so there was more demand on services.
I'm really interested to know what sort of impact that has had on the work that you guys do at the Toronto Humane Society.
[00:11:28] Speaker C: So in terms of the impact of the pandemic and what we've been seeing after the pandemic, there are really three big factors at play. One is the veterinary capacity shortage. And whether that's a shortage of people or a shortage of time is an interesting subject. One of the aspects to that is that my sense is that veterinarians are spending more time per patient. So even with the same number of hours available, they would be able to seek fewer patients. And our sense is very much that there are fewer hours available because a lot of veterinarians are working shorter hours. So there's a veterinary capacity shortage. There's also shrinking of disposable income because of escalating housing costs, food costs, inflation, and then growing inequality in many countries. And then veterinary costs have far outstripped inflation over the past, from 2007 to 2020, which was the period of the study that we did. So in Canada, there are approximately 30% fewer clients per veterinarian compared with 2007. But costs have accelerated very substantially in that period. So we're seeing in Toronto, and from the perspective of the Toronto Humane Society, we've seen a real crisis in the city, post pandemic, with pet caregivers really struggling to find a lot of different needs for their pets, not just veterinary care, but veterinary care being a really important one of them. So as an organization, we have really been shifting to a much more proactive approach to pet human families in terms of really not just accepting that relinquishment is the solution to caregivers who are struggling. So we start off with our pet parent support network, where we try and understand what the problem is and whether we can help to keep that pet in its loving home, if that's what the caregiver really wants. But they see no need to do it. We do some counseling. We have training services that can sometimes help people. We can offer food carriers and other kinds of support as well as preventive veterinary care. And then we also have an urgent care foster program where if people are in temporary trouble, we can foster their pet for six months and sometimes up to a year while they get back on their feet.
We have a really sad cat story around that happened recently where we were sent a photograph by an older man of him and his cat, and he said he was about to be evicted and that he wanted us to help his cat by finding a foster home for her because he was worried that she wasn't going to be able to withstand the cold. And there we were thinking, what is this poor man going to do in the cold?
So one of the things we've done is we've hired a veterinary social worker, and she actually has very good connections with agencies in the city, and hopefully we'll be able to reach out to them and see if we can actually help this person as well as just helping his cat. From the veterinary care side, we have substantially expanded our vaccine clinic appointments and our spare neuter appointments, given that preventative veterinary care is so critical for keeping animals healthy and in their homes. And finally, we've seen, like a lot of other cities, we've seen a very substantial increase in homelessness in the city, with a lot of encampments developing all over the place. We have started taking our care out to those environments, to some encampments, to some shelters that allow cohousing with people and pets, and providing vaccination and behavioral counseling, as well as food and other needs for those pets. Really trying to take the care to where it's needed.
[00:15:16] Speaker B: Brilliant. That's really interesting, and really interesting to hear the proactive approach that you guys are taking.
I just picked up on a term that you mentioned there around a veterinary social worker, and this is something I've heard of a little bit. I think they're becoming perhaps a little bit more common in North America, but it's not something I feel that most of our UK and european audiences would necessarily be familiar with. Would you be able to just briefly tell me what that sort of skill set looks like?
[00:15:46] Speaker C: Yes, and it's one of those things that I think we'll look back in a few years and think, that was so obvious. Why didn't we do that before?
Because when you really think about it, we work at the interface of people and animals, and we're pretty good at the animal side, and there's a lot we don't know about the human side because that wasn't what we were trained to do. So veterinary social workers can do various things in organizations at the organizational level. They can help staff with stress, compassion fatigue, burnout and those types of issues.
And they can also help both staff and clients with grief counseling. In shelter environments, that's really important because people become very attached to the animals in our care, and then they also, as in this kind of situation, they act as an interface between us and people who are in trouble and the agencies in the city who support those people.
[00:16:43] Speaker B: Brilliant.
You're right. It's one of those roles that when you hear about it, you think, why haven't we got more people doing this? It's hopefully an area that maybe in ten years time it'll be a common job role throughout most of the sort of western world. I think it's a fantastic idea.
[00:16:59] Speaker C: Absolutely. And our social worker is working actively with agencies, for example, who shelter unhoused or homeless people. And that's critically important because for many people in those kinds of circumstance, what keeps them alive and what gives them something to live for is their pet. So in the pretty recent past, if people were being housed in a shelter, they would have to leave their pets behind. Now we have circumstances where the shelters are allowing the pets in, but they often don't know what to do about them. They're not too sure about infection control or disease outbreaks and so on. And that's where we can step in through our veterinary social worker and really help to maintain those bonds.
[00:17:45] Speaker B: Brilliant. I think that is really important, isn't it? And again, knowing some work that some of the groups have done in the UK, one of the biggest barriers for people that are homelessness in terms of seeking out shelters is often they don't want to lose their pet if they actually go into a more suitable accommodation for them. So it is such an important piece of work.
One of the other questions that I did just want to cover with you, because it is one that has popped up a little bit on the UK side of things as well. And I suspect in other countries. Is there a concern within the canadian veterinary community that sort of our regulatory bodies may take a stand against vets that aren't providing so called gold standard care if we're taking a more contextualized or accessible approach to some patients? Definitely. On the uk side, there were some people that were concerned that may put them at risk for someone complaining about them and then having a sort of complaint type procedure raised with the regulatory box.
[00:18:48] Speaker C: I'm very pleased that you mentioned the term gold standard. I've been saying for some years now that it's a term that really shouldn't be used. It's not clear, really what gold standard means.
It's probably best defined as referring to some kind of mythical ideal care. The term itself is really judgmental and value laden. And you can imagine that if you offer a client gold standard care and then anything else, you're implicitly saying that the other care that you're offering is inferior. We really like to move away from the term.
Secondly, veterinarians have never been required to adhere to any kind of gold standard or ideal care. That's just not a thing. What they are required to do is practice according to the regulations and the professional practice standards that are set by their regulatory body, which are generally broad and not very prescriptive at all. So the details are left to the veterinarian, and then the other term that people get very hung up on is standard of care. So this is a civil, legal term, but it is important. It's defined differently in different jurisdictions. It's also sometimes quite poorly defined. But Dr. Gary Block wrote a paper in Javma a few years ago, and he provides a definition that standard of care is the standard of care required of and practiced by the average, reasonably prudent, competent veterinarian in the community. So that's not the same thing as do everything gold standard academic level care. And the standard of care will differ depending on what environment you're in. If you are an aborted surgeon, you would have different standards of care compared with a general practitioner. So I think that's a really important misconception. I think there's a lot of fear out there among practitioners, and I think it's nearly always misplaced fear. Practitioners are really entitled to offer a spectrum of care that's appropriate to that animal and that family in that context and moment. As long as they communicate the options well, they're respectful and not judgmental, and they document anything that may at some point become controversial.
[00:21:08] Speaker B: No, I think that's a really great response. Thank you. And it is in some ways very similar to what came through from the UK regulatory side, was that ultimately there's a standard of care that what we as a profession, within the context that we're working in this place, in this country, would agree. And if you're working within that, then you shouldn't be afraid of anything else. And as you said, documenting anything that may be a little bit controversial, documenting the discussion and making sure that conversation has been held in a nods, judgmental way, I think is really important.
[00:21:46] Speaker C: I'd also say that although there's no getting away from the term standard of care. What I don't like about it is it implies there's a line, and you go above the line or below the line. Whereas the term spectrum of care, which has been used quite a lot here in the accessible care framework, what that means is that there's a range of care options that are valid in a given context. The trick and the professional judgment comes in knowing when you are outside of that acceptable range. But there are a lot of things within the range.
[00:22:18] Speaker B: I think that's a really good point. Spectrum is a really nice term to use. And again, I think when you've been in the profession for a while and you've seen the way the veterinary professional has evolved and seen that spectrum moving, I guess, as well, things that we considered to be probably the right thing to do 1015 years ago, we've now learned more, we've got new drugs available. And that spectrum has shifted, hasn't it? So I think that's always important to consider as well.
[00:22:46] Speaker C: Yes, and there are two sides to the coin of all the advances in the profession in the last few decades. We, I think, can be rightfully proud of all of the things that have changed and all of the things we can now offer to our patients that we weren't able to offer before. But that does also come with a downside, which is that there's a shift in perception among veterinarians about what is essential and what is needed, as opposed to understanding that a more conservative option or a less resource heavy option is still valid in a particular context, even when more advanced therapeutic and diagnostic options are available.
[00:23:23] Speaker B: Yeah, I think that's a really good point, isn't it? And I have to say, looking at the curriculum for vet students now, I'm quite grateful I graduated when I did.
Life was perhaps a little bit simpler plus years ago.
And just finally, just wrap up our conversation, I really just wanted to ask about what you'd enjoyed most with being a guest editor with the special collection.
[00:23:49] Speaker C: So there's a couple of things. In the beginning, what I was so excited about was that the editorial board really recognized the importance of this issue. I think that JFMs got on board a little bit before this idea started becoming more talked about in the profession as a whole, which I've really seen in the last, maybe six, perhaps twelve months. And then it's very satisfying feeling that through this collection, the concept of accessible veterinary care and removing barriers to care will be publicized in such a respected journal. And particularly a journal that is centered around cats. And then, of course, it's just been wonderful working with the team at JFMS and ICAt care. It's been a real oh, thank you.
[00:24:38] Speaker B: We've been delighted that you said yes because we know when we ask someone to be a guest edictor, it's a big ask. It uses up a lot of your time. One thing we can say across the whole veterinary profession is we're always a bit time poor. So thank you so much for all of your work.
[00:24:53] Speaker C: You're very welcome. Thank you.
[00:24:55] Speaker A: Thank you for listening to this episode of all Cats considered. We hope you enjoyed this interview. For more information on the topics discussed during the episode, please be sure to head over to catvets.com and explore the links in the podcast description. And please be sure to subscribe to this podcast and your platform of choice so that you don't miss any episodes as we release them, have thoughts or ideas about the interview you heard today, share them with us, leave us a comment on our Facebook page, or shoot us an email at info at thank you for joining us today.
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