New Pad & Exam (or not)

exam paperNew Pad & Exam (or not)

I am currently writing this whilst sat in one of the Ministry offices whilst missing my veterinary exam and whilst Monique bangs her head against a proverbial brick wall. The issue, it seems, rests with my experience, in as much as it has been decided that the small gap of about two weeks that I appear to have in my employment record last August means that I am ‘under-experienced.’ Poor old Monique is doing her best to explain things and highlight the fact that I have more than enough experience but what can you do? Oh, and whilst this is happening I am currently missing the exam. Couldn’t make it up 🙂

The exam itself is the one that all non-UAE vets must sit if they wish to be licensed fully, meaning to work in a solo capacity. I could, it transpires, be registered as an assistant, which means that I wouldn’t have to sit the exam at this stage, but eventually I would need to do it. The exam itself is apparently about an hour in length and is a mixture of short answer and extended answer questions on everything from Ministry regulations, such as “what is a vet’s responsibilities”, to notifiables across the species, material that I honestly didn’t think I would ever need to look at again. According to one of the new vets who came out last month and already sat the exam, it is quite a relaxed affair, with candidates free to talk amongst themselves and even ask the invigilator for helpful pointers and explanations (not the answers, of course). All the above seems *cough* academic, however, at this stage as I daresay I will not be sitting it for another month given what I have told you so far. Yep, it is now 11am so that’s pretty much the exam over. Ah the joys of moving overseas!

Yesterday saw me move to my new home for the next couple of months whilst I search for a more permanent option. I am staying in an area of Dubai known as The Springs, which is a large development of villas kind of behind the Marina area. The guy I am renting from, a triathlete and captain, as it were, of the Dubai Pirates club, is originally from the UK and has been out here for about ten years. He’s a really cool guy by the name of Kevin and has kindly offered me a room in his villa for a few months whilst I look for something more permanent, which is awesome considering that a) you need to pay all of your rent in advance – or in four cheques if you’re able to negotiate such an arrangement. One thing to note, however, is that over here, writing a cheque means that you have to be absolutely certain there will be funds available when it is cashed as a cheque that bounces is a criminal offence and will land you in hot water. As such, finding the cash to stump up rent is a bit more of a big undertaking than it is in the UK. In the meantime, my villa pad will do very nicely, although the absence of an internet connection means that I am going to have to go cold turkey on the old digital surfing for a bit (I am posting this from my boss’ house).

Right, got to go…. more to follow on this relatively eventful and insightful day so watch this space 🙂

Dubai – Blood, SMS & Stores

Blood tube, samplingStabbed on my first day. By a medic, granted!

I know I should have slept on the flight, especially given that it was an overnighter and would have really helped stave off jet lag, but then they have so many awesome films on demand. How can I sleep through that?! As a self-confessed movie addict the whole point of a flight for me – other than the obvious, doh – is to catch up on some serious marathon film consumption. I am not sure that my choices were particularly worthy of celebration but hey ho, they were darn entertaining so who cares. (in case you’re looking for a couple of movies to waste some time then Maverick Riders and Pitch Perfect were both adequately entertaining – epic surf and a decent music mashup! What’s not to love?!)

Anyway, major digression – I blame the mild jet lag as I write this – so back to the main narrative. At last I have arrived in Dubai. After all of the preparation, recent delays and the near miss at the airport, it was awesome to finally touch down, pick up my nice new employment visa and march on out of the airport to kick off the adventure. Chandy, who works for the clinic I am now employed by, collected me – a true sight for sore eyes – and I know that pretty much every taxi driver in the area let out a big collective sigh of relief as I promptly loaded up the car with the mother of all bike boxes – honestly, that thing is HUGE!

Now I am not going to bore you with descriptions of the weather so lets just assume that it was hot and sunny, which would be a good default assumption to make. The first port of call was to complete the obligatory health screen, which all new workers have to do. This involved a surprisingly quick blood sample – given that this was the first sample I have ever had taken, I will admit that I was somewhat nervous about the whole process as majorly wussy as that sounds. The truth is that I am more than happy blood sampling patients but the thought of having a needle plunged into my own vein had always freaked me out. The fact that I barely noticed the sample being taken has reshaped my views and I really wish I had grown a pair whilst back at home and donated blood. The mind truly is a powerful machine!

So, blood sample done it was off to the radiography department next for a quick chest X-ray, again all achieved in record fast time. Sweet! Health check, um, check. Next on the list was my first taste of a supermarket in the city to stock up on the basic essentials of life, principally an Emirati SIM card. You know you’re definately a child of the digital age when the first things you concern yourself with upon arriving someplace is a) whether you can get online and b) how to get cell reception. Dubai is like most other cities in the world in as much as getting a PAYG SIM is soooooo simple. 40 AED and a 50 AED credit top up later, I was the proud new owner of my very own Emirati cell number. Woo hoo! How to start feeling at home.

One of the things that its probably going to take a couple of weeks to get used to is the fact that over here, Sunday is a normal working day as the weekend takes in Friday and Saturday inclusive. As such, many of the people I immediately sent text messages to were at work – a reminder that Sunday is the new Monday 🙂 Not that it applies to me quite yet, as I am currently sat writing this in shorts, T-shirt and flip-flops – in sharp contrast to the thermals I was having to wear all of last week back home in Norfolk! Winter Sun: loving it already 😉

Travel Tip:

If you are looking to make the move over to Dubai then its a great idea to bring several photocopies of your passport, as to get things like a cell number requires you to provide ID, a copy of which they keep. Copies of any visas would also be a smart idea, for the exact same reasons.

Dubai – The Vet Chronicles Begin

AeroplaneDubai – Vet Dune Under

“There seems to be a problem with your booking.” Not exactly the words that you expect, or want, to hear at check in when you’re looking to board a plane to move country. Not go on holiday. Move country. As in live there. For a while. A good while. And yet that is what I heard about an hour and a half ago. The issue, it transpired, was that through some relatively simple yet potentially catastrophically disruptive error on the part of the airline reservations team, I had apparently had my flight changed from the day and time that I had duly turned up to Heathrow for, bags and nervous excitement in tow, to the exact same time but the next day. A full 24 hours later. Long, boring story short, I grimaced, the reservations clerk apologised, he called someone in Dubai, he apologised again, I was put on the standby list, I waited.

The options, it was explained to me, were to initially wait and essentially play the ‘standby lottery’, in which I rather perversely was encouraged to hope that some other traveller, with a seat booked on the flight, was unable, for whatever reason, to get to the airport on time, thus enabling me to step in and fill it for them. Failing that – and the odds of success were slim – I would always be able to board at my allotted time tomorrow evening. This option kind of sucked for a number of reasons (you may be able to guess from the tone of this narrative that I was a ‘lottery’ winner on this occasion).

First of all, I could either hang around London for 24 hours, all at my own expense (sucky!) or return home with the rents and repeat the entire process the next day (less sucky but still sucky nonetheless). Either way it would require me to fire off a series of emails, the main one being to Monique, my new employer, to explain that fate had dropped trou and decided to take a big old movement right on my head. As I was expected to attend a medical, pick up my visa and complete various bits of essential paperwork on the Sunday, a delay was altogether a bit shit. Still, what was I to do if the flight was fully booked? No matter how much I whinged, that negative energy wasn’t going to magically lead to the creation of an additional seat on the plane. As such, there was little choice but to shrug, file it away as a mildly amusing blog entry and see what was to happen.

I guess I gave it away earlier but the upside was that I did indeed get a seat (although not the First or Business Class one that I was most definately praying for), and even better still was allowed to add to my already overweight luggage, meaning that I was now heading out to start my new life with a little more than a bottle of Clinique Happy, a skydive helmet, pair of boardies and bag of assorted USB cables. Good stuff. Maybe Murphy has a sense of humour and decided to overlook his Law on this one occasion. Good lad.

The potential last minute spanner in the proverbial works would have come on the back of an initial delay, whereby a combination of the typical January ‘lets mess up the country’ snow that decided to turn up like an unwelcome smell and result in my initial flight being cancelled anyway, plus an assortment of other factors, led to me pushing my start date in Dubai back until now. The fact that this move has been about six months in the making seemed not to matter to old Murphy in January, but the delay was not unwelcome then. Today it would have been. Most unwelcome indeed.

Travel Tip:

If you are moving country, or otherwise reckon you’ll need to take more stuff with you than is strictly speaking permitted by your airline baggage allowance, try and arrange to turn up at the airport with someone else and a bag of ‘extra stuff’ that you can always just shove in your main backpack/ suitcase should the nice folks on the desk decide to overlook the fact you’re over. Chances are that the ‘just in case’ bag will go back home with your friend/ family member but hey, it’s worth a go, right?! Oh, its probably worth pointing out, however, that if it weren’t for the fact that I was taking a 25kg bike and accompanying box (& associated stuff) I would have had a tad more than the 5kg I ended up officially having left for the rest of my worldly possessions 🙂

(Needless to say, if anyone from the airline on which I traveled is reading this then of course the above is completely ficticious and I was well within my allowance. Honest)

Technology Advances & Its Impact on Veterinary Practices

Technology advances and its impact on veterinary practices – including e-CPD and e-learning options

(as printed in the Vet Nursing Times – see links to PDF versions at bottom of post)

The word technology means different things to different people. Many of us think of smartphones or sophisticated computers as cutting-edge technology and perhaps don’t imagine that there is much in the way of technological advancement occurring in everyday clinical practice.  The truth is that there is a lot of advancement in a variety of technologies taking place in veterinary practice, and it is some of these that I aim to share with you today.

Technology is, for me, anything that helps us to do our jobs better, whether it be enabling us to perform tasks faster, more effectively, or to enable us to achieve a better outcome for our patients and clients. In essence, technological advances should, and usually do, enhance both our personal and working lives. There are three areas in which we see advances in technology in practice. The first is clinical technology; the classic ‘vetty’ gadgets, gizmos and systems that make the process of diagnosing, treating and managing our patients easier and more effective. Secondly, there are the advances in practice management and client communication technologies, an area which in my opinion has probably seen the biggest changes and which offer the biggest opportunities for really impacting on our clinics’ bottom lines. The third area for focus is the use of technology in education and CPD, important in ensuring our personal and professional growth and where technology is certainly having a big impact.

 

Clinical Tech

Although our focus is on first opinion practice, it is worth noting the fact that as general practitioners we have ready access to the very latest clinical technology and cutting-edge diagnostics and treatments through our ability to refer to our specialist colleagues. We are, as vets, able to pretty much do anything that is clinically possible and this is, in large part due to the huge advances in knowledge, expertise and technology at our disposal within the specialist fields.

Imaging is probably one of the main areas in which technology is at it’s most obvious. Gone are the days, for many of us, of long periods stuck in a dark, hot, generally uncomfortable radiography suite taking multiple radiographs and getting more and more frustrated at how long it can take just to get a simple series of images. It was a revelation when I moved to my second job and discovered the joys of digitial radiography. No need to fumble in the dark with open cassettes and film or handle noxious chemicals, and the images were pretty much instantaneously available. The system I first encountered was CR-tech, or Computed Radiography technology, involving the exposure of a plate, as per traditional methods, and then the processing of these films by way of a digital system. Since then there have been further advancements with the emergence of DDR-tech (Direct Digital Radiography), in which the plate is exposed and an image almost instantaneously appears on screen without the need to manually place the plate into a processing unit. This is possible due to the use of a syntillated plate, or direct digital panel (DDP), which effectively replaces the plethora of film cassettes that we’re used to using at present. Never has the phrase “take a quick X-ray” been so accurate!

In parallel to advances in the technological hardware itself comes developments in software, meaning that the process of taking, processing and working with radiographic images is much more user friendly and clinically helpful. There are, for example, bespoke software packages that will guide the vet through the correct measurements required for planning a tibial plateau levelling procedure, for example. The reduction in the sheer size and amount of necessary hardware, coupled with the options of cloud storage, where digital files are stored on a remote server away from the clinic (think Facebook, whereby your profile is actually hosted on a server in the US, or elsewhere, and not all on your desktop) has meant that even the smallest of clinics can boast an impressively powerful and versatile radiography capability, with none of the hassle associated with the secure storage, organisation and retrieval of hundreds of radiographs. Much simpler and much more elegant.

portable ultrasound scannerUltrasound technology is another area where we have seen impressive changes in practice. From super-powerful, all singing, all dancing set-ups, such as the Logiq S7 Expert, which makes use of new matrix probes and B-flow technology, useful for assessing vascularisation in tumours, for example, to the miniaturisation of the scanners, allowing us to both reduce the amount of space taken up in our clinics and ‘take the scan to the patient,’ whether in a hospital or out on calls, the changes have been staggering. To have the kind of imaging power that we have in a device no bigger than a laptop computer is a sure sign of the advances in technology that we are enjoying as vets.

vgel endotracheal tubeOne of the key attributes of a true technical advancement is one which takes an established way of doing something and completely rethinks it, or revolutionises it. One such example of new technology that does just that is the v-gel, a new airway system for ventilating anaesthetised patients. The point to note is that it isn’t an endotracheal tube – that’s the revolutionary thing about it. Instead of inserting into the trachea, through the larynx, the v-gel creates an effective seal around the pharyngeal, laryngeal and upper airway tissues, thus positioning a large diameter opening directly over the larynx to permit normal gas exchange with no trauma to, or even contact with, the larynx. One of the key advantages of this new system is that rather than needing a tube that is in effect smaller in diameter than the trachea, the v-gel allows the tube to be larger in diameter than the patient’s trachea thus maximising air flow and exchange. The soft rubber tip, that atraumatically ‘plugs’ the oesophagus, also serves as a good counter to the risk from regurgitation under anaesthetic. Currently available for both rabbits and cats, with dog versions in development, these new tubes represent a fantastic example of a smart, cleverly designed advancement of an existing technology.

 

Client Engagement

MailChimp screenshotWe’re all aware of the need to better engage with and market to our clients, both current and prospective, with the level of competition between practices apparently increasing all of the time. The methods for doing so these days have never been so plentiful nor powerful, yet many of us are still failing to maximise on the potential returns that doing so could bring. One of the simplest ways of better engaging with our clients, and those who show an interest in our services, is through email and the careful but MailChimp email marketingeffective management of email lists. Email management services such as MailChimp, which enable even the most technophobic of users to set-up a mailing list, design a web form to be posted on a website, social media, or even accessed via a link which can be emailed, and then organise, manage and communicate effectively with the people on that list, are brilliant and it is amazing how useful they can be for practices. Imagine, for example, how impressed your clients would be to receive an email on their pet’s birthday wishing them many happy returns. Combining such a thoughtful gesture with a suggestion of a senior health check if the pet has just turned seven, for instance, could be an easy yet effective way of driving more business through your doors. Through careful segmentation of lists, such as having a list containing only those clients who own cats under 7 years of age, for example, it becomes much easier to provide them with relevant information that they will find interesting and useful, with the result being a much greater level of trust in and bonding with you and your practice. How many of us actively ask our clients or new prospects, for their email address? My guess is very few. The truth is that these days people almost expect to be asked for it and we should be making a greater effort to make use of the advances in email and online marketing, much of which is available either free or very low cost, especially when compared to other marketing media such as print. Done well, email could be the best use of technology you have in your practice at present.

Social media is another potentially powerful way to engage with our clients and to help make us stand out from the crowd. People are interested in what we do as vets and what can often seem like the most run of the mill, mundane, day to day event in our clinics may form the basis for a fantastic Tweet or Facebook post, which can encourage a conversation between people and raise the prominence of us and our clinics in a good way. Obviously care has to be exercised, like with anything, but Social Media is one surefire example of a recent technology that veterinary practices have a lot to potentially gain from. Some clinics have embraced this aspect of marketing, using it to converse with clients and to provide updates, information and education through the use of videos, for example. Engaging clients in such a manner is a great way of strengthening the bond they have with your practice.

vet using ipadSome clinics have embraced technology more than others with some even rewriting the rule books on how we can manage our practices. Vets Klinic in Swindon have just one desktop computer in their practice, with each vet and nurse issued their own, personal iPad on which the clinic’s bespoke practice management system is accessed, meaning that patients’ records are readily accessible no matter where you are in the clinic and making the consulting rooms, and other areas feel clutter free. Use of tablets also enables patients’ time within the clinic to be recorded, and photos and notes about their stay easily uploaded to their clinical ‘timeline.’ Owners can access their pet’s timeline and see in realtime how their pet is getting on. Clients are actively encouraged to register and book everything from appointments to surgery online, with an airline style booking system showing prices and times of appointments with each vet, with real-time variable pricing a feature and a discount on offer for clients who prepay in advance of their appointment.. Tablet computers do appear to be excellent devices for use in a busy hospital environment, with the ability to readily access a patient’s notes wherever you, as the vet or nurse, happen to be within the clinic.

 

Electronic Learning

nerdy vet with laptopThe internet has quite simply revolutionised the way in which we access and consume CPD, with webinars and online learning resources becoming ever more commonly used, and available across virtually every platform, from smartphones to tablets and the trusty desktop computer. The advantages are clear: access to reliable, interesting CPD without the need and expense of taking time out of our busy clinical lives or the hassle of travel to attend lectures. With a plethora of providers, including many of the drug companies, learning online can be achieved at little to no cost and represents a very cost effective way of ensuring we keep our CPD current and maximising our CPD budgets. The only limitation that I could see from my experience of ‘attending’ a webinar was the fact that as the event was taking place on my computer and in the comfort of my own home, unless the speaker was particularly engaging, it was very easy to get distracted with other activities whilst convincing myself that I was still learning as I had the lecture playing. This coupled with the knowledge that I could always go back to the lecture and view it again at another time only acted to fuel my distraction. Somehow there just seems less risk of this happening when you’re physically present with the lecturer and other CPD attendees present in the same room. But then, maybe that’s just me and everyone else is a consumate good student at home. With so many other distractions constantly vying for our valuable attention the challenge, as I can see it, is for e-CPD providers to ensure that their content is as engaging and interesting as possible, including the use of mixed media, from standard lecture-style presentation slides and speech, to clever use of graphics, video and animations to really bring subject matter to life and inspire people. After all, the last thing any vet wants after a long, hard day in the clinic is to sit through a dull lecture, even if they do have the option of switching over, as it were.

One of the exciting challenges for the future will be in seeing how e-CPD can deliver more practical training, with a physical presence still very much required at present for practical CPD courses. Maybe a stepping stone will be the provision of ‘learning kits’, complete with necessary equipment and materials which the student can make use of whilst receiving remote instruction via a webinar or other means of e-learning. Although e-learning is delivering a wider and more accessible range of CPD to the profession, available at any time, anywhere and in any format, it is unlikely that it will completely usurp the strong desire we have as humans to actually congregate in the same space to receive educational instruction and socialise, as is clearly demonstrated by the continuing popularity of congresses, such as the London Vet Show.

Whether we realise it or not, technology and advances in it are all around us in practice. From the scanners we use to make diagnoses to the equipment we employ to safely manage our ill patients, or the plethora software tools, both bespoke and consumer options, technology is pervasive and empowering. It has changed the way we engage with clients, market our services, and continue our professional development, and all pointers are in the direction of yet more innovation and technological advancement, I for one watch on excitedly.

Links to the PDF versions of the original article, as printed in the Vet Nursing Times:

VNT Tech Article Feb2013_p1

VNT Tech Article Feb2013_p2

Compulsory Microchipping – Hmm…

dog being scanned (microchip)APRIL 2016 – this is the date by which every dog in England will have to have a microchip by. This comes after an announcement recently by the Environment minister, Owen Paterson. According to figures, nearly 60% of the 8 million dogs in the UK are already chipped, which is excellent, but with so many remaining untraceable, especially in light of the numbers of dogs dumped, lost and euthanised each year due to their owners being impossible to contact, there is still a long way to go.

Of course, the Holy Grail is to arrive at a point whereby every dog owner is responsible and stumps up the negligibly small amount of money required to implant a chip – a quick and safe procedure in the right hands – to ensure that their pets are traceable should they ever go missing, for whatever reason. There have been announcements by various dog charities, most notably Dogs Trust, that they will be willing to supply free microchips to practices in order to spearhead the campaign. This is to be applauded but unfortunately I personally feel the whole matter rather misses the main points.

There are some important questions that are raised by the issue of compulsory microchipping and which we still don’t have the answers for. The first is how will the new legislation be enforced? Even if vets do start getting better at routinely scanning dogs when they come into the clinic and subsequently find dogs that are not chipped, what are they to do? Will it be our responsibility to “dob in” our clients – a rather precarious position to be in – or will we have to issue said owners with an ultimatum of “we either chip your dog now or report you.” The danger of this stance is that we may simply not even see those dogs when they are ill, with the risk being that people attempt more home treatments or abandon their pets in preference to taking them to a vets to seek help. This would definately not be in the best interests of dogs. Are the police really, honestly, going to be that interested in enforcing this law as well? Personally, as much as I support the idea of all dogs and cats being microchipped, with the cuts being placed on the Police and Crime Prevention in general, I would not be overly chuffed at the thought of Police resources being directed to policing and enforcing microchipping. It just doesn’t sit high enough up the Crime and Prevention register to make sense to most people, even to a vet such as myself.

Another issue I can see with the plans are that they are likely to make no difference whatsoever to the small minority of dog owners who are, quite frankly, irresponsible. Good, considerate, well educated, sensible, responsible pet owners listen to veterinary advice and see the sound logic in microchipping – after all, what good reason can there possibly be not to have your pet chipped?! – and are happy to cough up the nominal fee to have a veterinary professional implant it. In the grand scheme of pet ownership costs, the £10-40ish that is charged for the service is insignificant, and as much as offering free chipping makes sense on the face of it as an incentive to owners to do the decent thing, I don’t personally see it doing anything other than take even more revenue out of practice. I would hazard a guess at the very same owners who take advantage of the free chipping service being the exact same ones who would have happily paid for the service anyway, in which case the only difference between the two scenarios is that the clinic loses out, having had to pay for the vet or nurse’s professional time. Once people get used to the idea of free, whatever form it may come in, it is very very difficult to revert back to a paid-for model. If by offering free chipping this would achieve a significant rise in dogs being identified then I would be all for it and personally spearheading a concerted campaign to “Get Your Chips For Free” but I am personally not convinced. Unfortunately no matter how easy it is made for some people, they will choose to ignore advice, even the law. And the key issue is what to do about those owners and those dogs? I am not sure I know the answer to that question.

One very important point that was made in relation to microchipping was the importance of keeping your details linked to your pet’s chip up to date. I have, in my working life, seen many cases of stray animals being handed in, or presented as emergencies, with a positive scan raising hopes of a reunion, or at the least informed owners, only to have those hopes dashed frustratingly when its discovered that the contact information on file is out-of-date and invalid. I would argue that this can even more frustrating that the animal not being chipped at all. I, personally, try and ensure that I scan every cat and dog I see in the clinic, as part of a routine health check, and ask if the details are still likely to be up-to-date. With the busy lives we lead, our pet’s hidden microchip is often the very last thing on our minds and I am fairly sure that if I were to move house, remembering to update my dog’s chip details would slip right to the bottom of my mind. A gentle nudge and reminder, whether from my vet, or even technology in the form of the annual email vaccination reminder or an app on my phone, would be all that is required to prompt me politely into action.

As a vet and, I would like to think, responsible member of society in general, I personally strongly advocate the principle of all dogs and cats being microchipped and see our role, as vets, nurses, pet owners and, well, animal lovers being to continue to educate, advise and guide pet owners to make the right decisions. Unfortunately, as much as the principle behind the changes to the law is sound and well meaning, I don’t see very much changing as a result of compulsory chipping and believe there are still many questions that need answering. Lets hope I am wrong.