Compromise in the face of the cost-of-living crisis

Back in the last few months of 2012, when I was chair of the British Small Animal Veterinary Association (BSAVA) Congress Programme Committee, the economy was slumping again, and fear of a new recession loomed large in everyone’s minds. In a situation not unfamiliar to vets, the last of our number arrived at a committee meeting late and clearly emotional. She’d had a sad and complex case of a dog needing treatment and an elderly owner on a tight budget. Then she asked the rhetorical question: “How do I know which corners I can cut?” Like many committees in BSAVA, we were a mix of specialists and first opinion practitioners. It’s important to have both among our ranks and the conversation that followed neatly demonstr­ated why.

As our colleague explained the case, we were able to tease apart the details and use our experiences to identify where the budget could be most effectively spent. We discussed which diagnostic tools were “nice to have” and which ones were most likely to provide the pieces of the jigsaw that would give the most comprehensive picture. We talked through the treatment options for the various outcomes, trying to balance effectiveness and affordability as well as the potential management options that would contribute to the long-term care of the animal. Her response to this discussion was simply: “We need more of this.” So the idea for a suite of resources that considered “veterinary medicine on a budget” was born.

Since 2012, the British pound has lost 24 percent of its value against the dollar, and since 2021 inflation has soared. The cost-of-living crisis and its effects on households is in the news daily. The need for “economic medicine” is arguably greater today than it was back then. But what can we do in the face of this crisis? How can we, as my colleague said, know which corners we can cut while still providing the best care we can?

While it can be frustrating knowing you could do more, it’s vitally important to recognise that working to a tight budget is no less valuable and no less caring

Reflecting on the resources we put together back in 2012 (and those that have been added since) a number of themes emerge: there is the clinical balancing of risk, reward and cost, the need for excellent communication skills and last but certainly not least, the empathy and kindness for yourself, your colleagues and your clients. While it can be frustrating knowing you could do more, it’s vitally important to recognise that working to a tight budget is no less valuable and no less caring – you are still, very much, doing “a good job”. You are still helping the animal and its owner. Still, it is crucial to remember that you and your colleagues, armed with less diagnostic information than usual, are more likely to get it wrong. That is statistics, not a reflection on you, your knowledge or your abilities.

Extend kindness and understanding to other members of your practice. It is likely that the cost of living will be disproportionately affecting some of your team. Those on lower wages, such as our receptionists, nurses and the younger vets, for example, will feel the pinch and be more stressed as a result.

Don’t judge your clients – you never know who will be able to afford more and who will not. You do not know who has had a sudden change in circumstances or why. Instead, bring the owner with you on the decision-making journey and share the responsibility of the risk-taking. Where there is less money to spend, it’s an effective use of resources that will pay dividends if or when clinical management plans have to be adjusted or outcomes aren’t as you’d hoped.

Draw on the experience of your colleagues and specialists at referral centres. Often even without the cases being referred, appropriate specialists will discuss them with you. They have often seen similar cases and will be able to recall the outcomes, giving them more insight into the relative likelihood of a given “diagnosis” or the risks of omitting a test. But respect their time – prepare a summary and remember that pictures are worth a thousand words.