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Comments on the dilemma in the September issue: Performance indicators and prescribing antimicrobials
  1. Maureen Aitken

Abstract

In the dilemma discussed in the September issue of In Practice, a practice has introduced average amount billed per consultation as a key performance indicator for vets and, since then, a vet has been prescribing antimicrobials in situations in which he would not have done so previously or in cases which do not warrant it (IP, September 2017, vol 39, pp 382-383). Anne Fawcett and Thomas Gottlieb discuss virtue ethics and say that there is an expectation that vets do not pursue personal gain at the expense of their clients. They discuss the Tragedy of the Commons, which hinges on the belief that personal gain should not be sought at the expense of others, pointing out that imprudent use of antimicrobials contributes to antibiotic resistance. Fawcett and Gottlieb conclude that antimicrobials should be excluded from practice profitability calculations.

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MY concern on reading the ethical dilemma in September's In Practice was the fact that ‘average amount invoiced per consultation' was being used as an indicator of the performance of individual veterinary surgeons in the practice. In the scenario presented the reference was to a single key performance indicator (KPI) recently introduced. This suggests that it was not the only KPI used. It would be interesting to know whether all the KPIs were financial.

Is clinical performance measured and rewarded or, as the opening sentence of the ‘issues to consider' implies, is practice profitability the only or major consideration? If it is, that should be made clear to all clients.

The necessity to make sufficient profit to equip a practice and give all staff adequate remuneration is understood and accepted. However, to make profit the only or primary goal is - I would hope - still unacceptable and considered to be unprofessional by the profession and the RCVS.

Motivation of veterinary staff is desirable and where large numbers of staff are involved it is clearly more difficult to assess consultation skills, diagnostic skills, surgical expertise, uptake and application of CPD, teamwork animal handling and so on. However, these are the essential clinical and social skills of veterinary surgeons. Making money is the unashamed goal of business. If veterinarians' motivation has changed then we are no longer a ‘profession' and being a vet is certainly not, as it once was, a caring vocation.

The effect of this change on animal welfare is frightening. It has been clear for some time that many prosecutions for cruelty to animals arise from owners' fear of the size of the vet's bill: not seeking veterinary attention and/or buying and using ineffective over-the-counter medication.

Perhaps it is time this issue was debated more openly and the public reassured that ‘their vet' has not become a salesperson ready to profit from clients' devotion to their sick animals.

Everyday Ethics Poll

Last month’s poll asked:

Given antimicrobial resistance, should antimicrobials be excluded from veterinary performance indicators that lead to employee rewards?

15 voted yes, at a regulatory level

14 voted yes, at a practice level

11 voted no, it is up to practices to decide

(40 respondents)

Vote for this month’s online poll at:

inpractice.bmj.com/content/current

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