Hello, it's Anthony Chadwick from the webinar Vet, welcoming you to another episode of Vet Chat, our er leading veterinary podcast, and I'm very pleased today to have Caroline, Alan, I'm sure Caroline is known er by many of you, er but obviously if you're outside of the UK we're gonna be talking a lot about Caroline's new venture which is the pet lighthouse, we'll talk a bit about what that is. In a moment, er, those of you who don't know, I'll let Caroline fill in the gaps, but Caroline has been for many years the chief vet of the RSPCA. But I'm gonna pass over Caroline, cos I'd love for you to perhaps give us a little bit of a history of why, one, you decided to become a vet and then maybe a little bit about the, the journey, thus far up to, Pet Lighthouse.

Yeah, well, thanks Anthony so much for having me on, really delighted to be here. So yeah, I suppose I was. I don't know, quite I guess quite a typical vet in that from quite a young age.

I loved animals and loved science and had my own pet. Experienced them being treated at the vet and, you know, from probably about the age of 13 wanted to be a vet. I also saw the old James Herriot on the on the TV, so a bit of a cliche.

I trained at Cambridge, which. You know it was a bit quirky but I did, I did enjoy it, a little bit old, old school at times and then went into general practise where you know I did spend the majority of my career and I would still very much class myself as a as a proud GP vet. As a generalist, I, I did my medicine certificate and obviously thought about do they want to go into specialisms, but actually for me it was always about the, the, the variety of being a GP vet.

So I did that for kind of close to 20 years and then. You know, after a while, even the less routine things can become a little bit routine. I'm still enjoying it, but starting to see some of the bigger welfare issues coming through around extreme confirmation and how that changed practise, I think.

And so when the opportunity arose to, to join the RSPCA as the London event director, yeah, I was excited to do that and then, yeah, it became the. The chief vet, which I think was a really great job for me because it was so broad, there was so much variety, you know, there was, there was never a dull day at the RSPCA, and just working, you know, with amazing vets and behaviourists and scientists and yeah, really grew my understanding of animal welfare. Which I kind of realise now as a vet was actually quite narrow.

So that's really kind of what I've taken forward into, into pet lighthouse, that kind of combination of being a, a very experienced GP vet, having a good knowledge of animal welfare, and also my experience as a, as a pet owner. Yeah, I suppose my journey is probably a bit similar to yours as well in the sense of we had, you know, that, that sort of generalist 20 odd years there doing a dermatology certificate, so I did referrals in dermatology, but we're still very much doing first opinion and then you get to about 2025 years out, obviously I went off and was looking at internet conferences and came up with the idea of webinars. I think as vets we're often quite adventurous, aren't we, and we like to be creative and and perhaps move around a bit and that's the beauty of the career in that we've got so many things that we can do as well as obviously work in a in a practise.

Yeah, so I mean at one point I was quite seriously thinking about opening my own practise and sort of looked into that, but I, I really wanted to stay in London and it was a little bit more challenging at that time and you know, also trying to live in London and afford to live in London. It, it just didn't sort of work out for me at that time. But you know that that's all those different kind of sliding doors, those different paths that that you can take and I certainly got no regrets to where I, where I ended up now.

And the RSPCA is such a great charity, you know, I support RSPCA we did a lot of work with them in Liverpool when I had my practise, inspectors going out, you know, into quite horrific, Scenes as well and then obviously one of my good friends David Grant running one of your big hospitals in London, so, RSPCA sort of walks the talk as well as the kind of, you know, the the more legal type stuff that it does, it's very much at the front line, caring for, you know, animals in distress as well isn't it, so it's a, it's a super charity I would imagine, you know, to work for with the with the amount of work that's out there. Yeah, I mean it's never, never a dull day at the RSPCA. It can be really challenging, I think, particularly kind of post pandemic, it's been very challenging.

I think unfortunately we are seeing a kind of increase in cruelty of both kind of pets and wildlife, which is really worrying to see. And yeah, I mean, I think that the frontline officers, the inspectorate, they, they do an amazing job, you know, having spent time out with, with the inspectors, you are finding yourselves in very challenging. Situations and I hope that one of the things that I managed to achieve as the chief vet was just building a little bit of a better understanding between vets and the RSPCA because there was a little bit of anti-RSPCA sentiment, but kind of, why don't they do this, why don't they do that, why haven't they paid for this straight, why haven't they, and it, I think it just came from a place of just not understanding the, the sheer pressure and volume on the charity, so being able to.

Just make that case, remind vets of their obligations and and just be clearer about what the RSPCA could and couldn't do, that was something that I did a lot of work on and and I think it helped, I hope that it helped. Yeah, I think it's, you know, no charity is a, is a bottomless purse and there's a lot of pressure on charities, I know when I speak to charities they're all struggling a bit sort of post pandemic as well, aren't they, so it is . Difficult, but I think nevertheless, er you know, you as an organisation have done, incredible work, improving animal welfare, er in those very extreme cases, but also looking at the legislation as well to make sure that we make er the legislation tighter as well.

Yeah, definitely. I mean, the Animal Welfare Act is coming up to, well, this year it's 20 years old. So I mean it was really groundbreaking legislation and obviously it is legislation that, you know, the RSPCA and others use all the time.

I think it does need a refresh. There's a lot of gaps there, but also I think, you know, vets do need to make themselves aware of what that legislation says. I think it's a big gap in vet training, CPD.

It's actually quite empowering if as a vet you do understand what that legislation says. But yeah, there are also responsibilities in there for vets, you know, the, the. If animals are suffering or you know, likely to suffer if their circumstances don't change, that is in certain circumstances that, you know, that's against the law and vets we need to be really careful that we're not kind of allowing people to break, break the law and kind of turning a blind eye.

Yeah, because I think it's, you know, obviously we've got a confidentiality to our clients, but only up to the point where we can see that the animal's suffering, and I know. For me it was often people coming in, you know, with that, emaciated cap that they sort of placed on the table, moribund, and said, well, I didn't want to bring it sooner because I knew what you would do, and I said, well, you know, you've given me no choice now, but this was the sort of cruelty cases which is, it's not done, you know, for malicious reasons, it's, it's a lack of education and as you say, even amongst vets, I remember for a number of years we filmed the AWF. Meeting down in London and you know for the first couple of years I went and I thought oh gosh there is so much, even as a, you know, an older vet, I could know more, so it definitely is an area that I think we We avoid and sometimes you know I, I used to say, there's 3 people in the room, there's myself, yourself and the pet, but the most important person in the room if you like is the pet, we have to make the right decision, and a lot of the time that was around, you know, timing of euthanasia and so on.

Hm, yeah, I mean that's another big piece of work that I'm really proud of at the RSPCA is developing the concept of animal voice, because you know, the animal is, You know, the most important, obviously the, the, the client, the owner is really important as well, but the animal in terms of our oath is the most important, but they are the one individual in that room who cannot actually say what they want or say how they feel, or they can't say it in our language. Actually, when we use welfare science, when we, you know, understand welfare is not just about health, but it goes across the, the five domains, that's the, the. The most up to-date welfare science, so we also need to be thinking about environment, nutrition, the different elements of behavioural interaction.

When you take that as a whole, you can actually and and look at the behaviour, you can actually build a picture of what that animal is trying to say to you. Yeah, no, I, I absolutely agree, I think, you know, we have to be the advocate for the animal. It's really interesting, I was at a conference, I think in the UK I can't remember which one, and a company which I will not name says, you know, something along, it was a, it was doing diagnostics and it says because your pets can't communicate with you, and I went over to them and said, do you really think that the cat who adopted us during the pandemic is not very good at telling us what he wants when he wants it.

You know, communication, if you, if you can kind of understand the signs as you were saying, you can pick up so much, can't you, from that nonverbal communication. Yeah, but I'm glad you mentioned the AWF because I am actually a trustee of the AWF, so that's the, the BVA's, own charity. And our focus is on kind of empowering vets and and allied professionals, obviously vet nurses as well, to, to be more aware about animal welfare, to make sure that vets, And others around have the kind of tools and knowledge to put the animal at the centre of everything that they're doing.

And I think that's really interesting what you say about that kind of diagnostic test because I think we maybe don't need as many diagnostic tests as we sometimes do if we actually listen to the voice of the animal through the history, through a really good clinical examination, they can tell you so much more I think than we sometimes kind of, kind of give credit to. There can be a tendency to throw every test at it and then try and work out whereas actually as you say if you take a history and a physical exam, you come up with a differential diagnosis list, you then know, kind of what are the most useful tests to take, don't you? Yeah, I think that kind of problem orientated approach is very much at the heart of the book that I'm currently writing on contextualised care which, It's exciting.

I've got a month until it's due in, so also slightly stressful at the moment, but, I hope that it's gonna be useful. We've got some really great co-authors cos I think it's very important that when we're talking about contextualised care, it can't just become shortcuts. Yeah, very much has to be structured.

So, and I'm writing it with a, a fellow kind of ex-charity vet, Ian Futter, who was my equivalent in Scotland. We're very conscious that when we have written things in the past, there can be a bit of, well, you're a charity vet, you would say that, wouldn't you? But we're writing it alongside a lot of really brilliant specialists to really give vets the confidence that, you know, this is OK.

You know this is good enough, you don't have to be CT scanning everything or you know, or what do you do when the owner doesn't have money, you know, you don't panic, there's a, there's a pathway through in a lot of these situations. There are other options. I was about to segue into it would be good if we had an expert on contextualised care cos we were going down that road, but we do cos you're, you, you've got the book coming out very soon.

I, and I, I think, I think you're right because. That gold standard, that whole idea of gold standard is actually, it's not really very helpful, is it? Just doesn't hold up, you know, when I, and the, the, the reason for writing the book, it actually came out of some articles that we wrote, which came out of looking at journals and seeing all the case studies in the journals and realising that they just did not reflect our realities as charity events but also didn't reflect, Our realities when we've been in practise, because there was never any mention of the owner's life complications, there was never any mention of the animal's welfare, actually, or preferences, the complications in their lives, so.

The gold standard is really unrealistic except in a very small, in a, I would say in a small percentage of circumstances because everyone has things going on in their life, and I think it's really important to make the point that contextualised care is not money is one of the contexts, but I it's really not the, the main or or even most important one. Animal welfare is the most important context in my view. So yeah, hopefully we can help move the conversation forward about contextualised care, but give people confidence.

You also see that you know I, I've had this cat buddy who was meowing outside sometimes he comes on the podcast, it ruins it becomes it becomes a podcast then. But he's meowing outside the door, he hasn't come in, but very much, you know, he sort of adopted us during the pandemic and it was very much we've tamed him a little bit in that I couldn't hardly touch him for the 1st 6 months and now he jumps on your lap and wants to be cuddled rather than, you know, you actually grabbing him. I think he came from a very busy house with kids, so the cats, dogs, and basically he was 14, he's now 20.

He just wanted a retirement home and it's just me and my wife with a bit of a garden in the front so he can. He can just get himself comfortable there, and if he needed a lot of really complicated treatment, you know, he does not, toilet in the house, he goes out, so, At his age, if he needed a lot of complicated treatment. The stress and the welfare for that would be really difficult for us to put him through it, so you then start thinking.

You know, maybe we would let him go, whereas with a dog that you know you could manage more, you might be able to do things, so you've. As a, as a client or as a pet owner, you begin to see it differently as well, don't you, than if you're, you know if you're just the vet looking at it as well. Well, I mean that is, that kind of circumstance is one of the, one of the inspirations for setting up Pett Lighthouse, so I had a rescue dog, Tilly, gorgeous stuffy, but she had not had a good start in life, she had some vision issues, and she hated the vet.

You know, she, she was absolutely gorgeous, lovely dog, really happy at home, loved her walks, not aggressive, but you could not do anything with her at the vet's. She, she just hated it, you know, obviously we had all the kind of fear-free approaches, went for the desensitisation sessions, but she just wasn't having it. So she had to be heavily sedated for any kind of interventions and she developed really kind of severe chronic diarrhoea and obviously did some, some basic tests to rule out obvious treatable things, but I did, didn't get a definitive diagnosis, but really ruled out all the treatable things, leaving, you know, cancer risk condition as by far the most likely thing.

And I'd elected to euthanize her without getting a diagnosis for that, without putting her through biopsies, surgeries, anything like that. And at the time that was really hard. In some ways it wasn't because she obviously wasn't well, but also anticipatory guilt, guilt, you know, the feeling afterwards of oh what have I've done the wrong thing.

You know, which is even as a vet you get that, so it must be. Even worse for a client, and I was really helped by my vet friends. You know, being able to discuss it with my vet friends and you know them saying well come on Caroline, of course, you know, you did the right thing for Tilly, and looking back, you know, looking back on the photos of her at the time and thinking, you know, I absolutely did the right thing, but at the time it was really hard and that kind of concept of the vet friends you wish you had.

Yeah, and that should be us in the consulting room because that triangulation, that second opinion if you like, you know, of the client coming in and saying what should we do, the vet being able to come in, but of course sometimes. You know, even the, the vet sometimes will struggle to make a diagnosis, so I, I know you've set up Pet Lighthouse to deal with some of those situations, so again, maybe just for those listening, explain a little bit more of how that kind of works. Yeah, so it is a new service, I don't think anyone else is offering this service, it's a second opinion service for pet owners, which is primarily online.

I don't prescribe, I don't treat. It's very much designed to work alongside the primary vet, and I very much want it to be in support of the primary vet. So vets can absolutely refer their clients to me, but equally clients are also finding me.

Themselves when they are in this what I call decision fog or just really in a kind of state of struggling, and I think that what the main thing I can add is actually the time and the space. You know, it is really difficult to have these conversations in 15 minutes and also sadly, I have kind of identified this, we've, I think we all know this trust gap that has opened up that clients will sometimes be, well, you're only recommending that because you're gonna make money. Which is unfortunate, but it, it exists.

So being able to come to someone independent, obviously I get the full vet history, get consent, get the full vet history, the scans, blood results, everything like that. And then the client fills in a questionnaire which is based on 5 domains of animal welfare, to sort of assess quality of life, what's important to that pet, what maybe isn't so good for them at the moment, what are the opportunities, and also looking into caregiver burden. So that's obviously really important, what the client can actually deal with, how they're dealing with it.

It's often, you know, there's often a lot to delve into there. So then we have, well, it's, it's gonna have to be increased, actually, it was 45 minutes, but it's gonna be increased to an hour because I'm finding that that is the length of time really minimum that people need to talk through all of these aspects. And the aim is to come out with, them being clearer on what's important to them and what's important to their pet.

Options to discuss for plans, I don't kind of go this is the plan and this is what you must, you know, because that's not my role, my role is to send them back to the vet, clearer, Yeah. Knowing the right questions, and then I'm available to the vet to have a conversation with afterwards as well, that can all be booked through my website. So it's really, I hope that it is about, it's obviously about helping owners who are really struggling, but I think it's also gonna be really helpful for vets.

I think if you see you've got that client who's on the phone all the time, they can't decide, maybe it's even you're like, hm, is this heading towards a complaint? Not once he's got to the complaint stage, but that kind of pre, you know, that client who, oh no, they're here again, I, I just don't know how we're gonna move forward, giving them that, that option of an independent referral with someone, you know, I'm not a specialist, but I am, I've got a lot of deep experience and expertise across that kind of general practise. Yeah, and I would think a lot of the cases that you're seeing.

Not all obviously, but a lot are around end of life as well or you know, it's an old dog, it's quite an expensive, complicated treatment, as you were saying, you know with your dog, which way do we go down and that contextualised care actually. Does need a lot of time, I, I, I did referrals in dermatology and and obviously I knew a bit more dermatology than, than perhaps you know a GP across the road from me, but, I think the biggest thing for me was I was having an hour with the client and just sitting down with the client, taking the history, looking at the dog while I was taking that history, then examining the dog, often within 20 minutes, half an hour. I had a pretty good idea what was going on and then could obviously spend the next half an hour trying to help the, you know, the client, but most importantly the dog or cat, so I think time is, is invaluable and and time is in short supply and busy practise isn't it?

Exactly, exactly, and I think that's why when people sort of say, oh, contextualised care is just what we've always done, sort of thinking back to 20 years ago, you know, I think that's a little unfair because when I remember practising 20 years ago, life was much more simple. There were not as many options. People couldn't really offer CT or MRI because it wasn't there.

Well, I mean, I remember when I first, I mean I think this was probably a few years after I qualified. If you wanted an MRI you would sneak the dog into the human hospital out of hours. I mean it seems kind of bonkers now, but that was what we used to do.

Brush the hair off people, people didn't love their pets any less and. And you know, they, the, you know, a lot of outcomes were very, very good still. So I think we do need to keep things in, in perspective.

But yeah, I, I think a lot of people need more time now because there are more options and you know, it is really difficult in a 15 minute consultation to go through, you know, the risk, benefit, and I think that's why vets can sometimes default to that kind of. We do this and we do this, we do this, do this because it is, it is just simpler, and there's time pressure on them and they've got a busy waiting area, I mean I, I think this is, is a service that to me looks like it can be really beneficial to the practises because. If you have a client that just needs a lot of time, potentially you can sort that out, you know, with timetabling, but using somebody who is an expert in the area in the sense of with all the welfare considerations that often come in with these cases, obviously most people listening to the podcast are going to be better and nurses rather than clients.

I, I do think it's a great service. For practises as well as for the clients. Yeah, and certainly if any practises are interested in.

Speaking to me and maybe offering it a little bit more formally then that's something I'm really, you know, open to having that conversation because I, I absolutely my independence is really important, but that I think that can really benefit the practise in sort of saying, look, we know that you know we we are, Struggling a little bit here, here's an independent perspective. I think especially if you have got someone who's maybe starting to get a little bit suspicious, why are you offering this, why are you offering that? You know, I absolutely bring it back to to animals, animal welfare.

I don't have any skin in the game as to whether that CT or MRI scan gets done. I can really talk through the pros, the cons, you know, the options for the owner. Very kind of non-judgmental towards both the practise and the owner, and the the starting point for the owner is a, is the, you know, which can be booked on my website, which is a free, kind of initial chat consultation where it's obviously I don't get into anything clinical because I don't have a history at that point.

But it's just an opportunity for them to explain what they're struggling with and for me to sort of say whether I think it's a fit or not. So there have been some people where I've actually said, you know, you'd be better off going to a specialist because I'm not a specialist, so if it is very particularly around one condition, but if they are more looking at the bigger picture, the welfare, obviously there are some end of life sort of situations, but maybe not as many as I thought, actually. It's been a real kind of interesting mix, so, yeah, just general owners struggling with decisions, feeling overwhelmed, feeling.

That their pet's healthcare is maybe overwhelming their life a bit. Hm. Struggling to cope, wanting to understand if there are other ways of, of approaching things.

Yeah, I, I'm, a couple of things really that I've thought about with that is, you know, I stopped practising in 2016 and then 2020 hit, nobody could see their vet, so all these people who knew I was a vet were ringing me up saying, you know, we've got this and that going on and. For me, even when I was doing dermatology consults and sometimes seeing cases where you could obviously pick some holes. You know, the, the dog, I remember one case coming in and the dog came in and.

Took a history, I was watching the dog and it was pretty clear it probably had scabies, I took it out the back, I found scabies mites. They'd spent thousands, hundreds, well I think it was over 1000 pounds on blood tests for allergies and food allergies even though food allergy blood testing isn't that, you know, positive a thing to do. And you know he said oh I'm really annoyed you know you've found this out and I said well you know that's cos I'm a specialist and I can do that.

So the key I think also for vets is that we, we will always try and support colleagues as much as we can because you know we all can't, none of us are perfect, we all make misdiagnoses, we miss things, we, we don't have the chance perhaps to spend that time. Talking to a client that a dermatologist has or you know somebody like yourself doing, running the service that you're doing so it's, It can really be supportive because in the end of the day we just want all of us want the best for the pet, don't we? Yeah, I mean your story just immediately takes me back to a a a case where I'd kind of missed Emerdex, and kind of went down that other path, so of course I've I've been there, I'm very sympathetic.

I, I'm not naive enough to think that there aren't gonna be people who, You know, are looking to make a complaint coming to me. Now if that's very explicit, I will always, and I have sort of referred them back to have the conversation with the vet in the first place and also, you know, it's got to that point raised that the, the vet client mediation service is also a really good resource. So, but yeah, you know, I'm sure that will happen, but as I say, I'm kind of very judgmental on both sides and always keeping the animal.

Front and centre, so I really, I guess maybe vets might be a little bit worried of like, oh, you know, if I send this person to the ex-chief of the RSPCA, it could sound a bit scary, but I really, it, it is about helping strengthen that kind of bond between the, The client and veterinary services in general, I think that the whole CMA, the vet bashing, ultimately is really horrendous for animal welfare and, you know, while I'm not saying that everything is perfect in the vet world by any means, we have kind of got to find a way to communicate better, to build better understanding and to really put the animal back at the centre of all of this. I think also, you know, the other point that you're making with a complaint, when things, luckily thank God I I never had a complaint, there's still time, even though I'm not practising with the Royal College, but I've never had one, and I think part of that is, it's the way you communicate, if there is a complaint. I tended always to look at it from the client's side, and that meant sometimes that I didn't charge, probably what I could have charged, but I said look, you know, we can see it from both sides, etc.

What would you like to happen and sometimes, you know, what the client actually wanted to put it right wasn't nearly as big as maybe what you would have thought. So having a complaint, sometimes you turn them into your best clients if you are. Good at sorting out that problem, I'll use an example because I've been dying to use this example for a while, I, I went down to London on a vanti train so I don't care if they want to quiz me about it, because I have spoken to them and it's 28 days before they give you a response, which shows how many complaints they're having, and I bought the ticket on the train, the next day I go back to get on the train to come back home and they said, you can't use this ticket because it's not, Allowed on Avanti trains and you go well I bought it on an Avanti train, so I then went to the ticket office, no, no you're just gonna have to buy a new ticket.

And I just saw that there was nobody there who was wanting to solve a problem for the client. It was very much keep to the rules, make money, and and that's when it does get disappointing, whereas had they stepped in and gone, oh obviously, yeah we can see that this person was on the train, she sold you the ticket, which you could find from the ticket, you know, the information on the ticket. That could sort the problem out.

Er and I think you know complaints are an opportunity as well aren't they? I mean, absolutely, I can again recognise that in, you know, my times in practise, I, I would often be the vet who would end up maybe with some of those clients who were a little bit more, you know, ready to, ready to complain, who might be seen as kind of awkward clients. Then other clients, you know, I wasn't their cup of tea, if they were very.

Kind of wanting to get into all personal, you know, I had colleagues who were brilliant at that and chat, chat, chat, whereas I was probably the more serious one, who, who was better for the more serious clients, and I think that's another thing is to recognise your strengths and how they kind of align with what your clients might be looking for, and we're not all going to be everyone's cup of tea. Yeah. And I think it's something I've been doing a little bit of work on with the British Veterinary Receptionist Association around that kind of role of the whole team, so receptionists and obviously nurses will play a role in, in, you know, helping with that kind of fit, helping with contextualised care.

But yeah, I mean, complaints are are horrible and the immediate reaction is to get defensive, but that is the worst thing that you can do. I think it is about putting yourself in. In the client's shoes, I just wonder about how much autonomy there is for vets to fix things now and I think that may be part of the problem in, in some kind of corporates, but.

As I say, hopefully pet lighthouse in some of these circumstances will be a, a, a relief valve for sometimes when these things are getting a little bit heated. No, that's brilliant. Well, listen, you know, the other thing that I love doing on on the podcast is, is reviewing books and chatting about the book, so when the book comes out, feel free to get a copy and maybe we should do another podcast about the book, but good luck, you've got a month to hit the deadline.

Yep, so yes, I appreciate the hour that you've, you've given me today. No, it's been a pleasure. And yeah I really enjoyed it and I, as as I said before we came on, I love the Hilda Ogden ducks behind you as well, very nice.

Yeah, take, take us back, I mean there'll probably be a lot of vets watching this who are like what the earth are they talking about, but yes, those of us, look it up on Google, you'll work it out. Yeah, you're good, you're all good diagnosticians. Thank you so much Caroline and you know good luck with the book and obviously with Pet Lighthouse and looking forward to seeing you soon.

Yeah, thank you so much. And thanks everyone for listening, hopefully we'll see you on a podcast or a webinar very soon, take care and have a great rest of the day.