Hello everyone, good afternoon and thank you for coming out on your lunch break to meet together like this and go through how we can better care for our clients during their animal's end of life. And as some of you are probably aware, this is a topic of growing interest within the veterinary profession and veterinary clinics, and there are different people around the country who are providing training. There's Hilary Odair and colleagues down in the Southwest with an ally for all, Belinda Johnston of our special friends, and I myself calling myself the Petlos vet.

So we're all trying to help our colleagues in veterinary practise who are as concerned as we are, but like us, didn't have the training of that school. And so very often in practises, there isn't a total approach. And the good news is there's plenty of research out there that can help us do an even better job for our clients and make that easier for us as well as for them.

And so that's what we're going to be touching on today. And as Antony said, everyone's role is equally important. So going left to right at the front desk reception, or if you're upstairs in a special telephone team, you'll work on, on the telephone, the veterinary assistant, the boss, and the veterinary nurse, we all have an equally important part to play in client care.

And before we get in more into the substance of the talk, it would be great to know what your role is as you're listening in. What is your role in client care within your practise? So I'll hand that back to Andy just to run that poll, please.

That poll's been launched. I think Anthony has muted himself. Are you there, Anthony?

Yeah, no, no, I've just unmuted. I've just unmuted myself. I've launched it and it wouldn't unmute.

While we're doing that, Caroline, just to let you know, there are quite a lot of people who are watching this as a group, so they'll probably find that a bit more difficult to answer. Upstairs and downstairs, nurses and reception. Tom Bridge, we've got 2 vets, .

Somebody at a further education college in staff room vet and receptionist, another vet hoping to join soon. So, it's nice we've got a little crowd of people in. And as far as the, yeah, well, I was gonna say as far as the poll goes, obviously there are people who are listening on their own or, or are going to do some sort of, vote for the group.

11% are receptionists. 37% of veterinary nurses, and I think that kind of shows what an important role, you know, the veterinary nurse plays in the whole process as well. 58% are are vets, 2% veterinary care assistant, kennel assistants, and 8% practise management.

I hope that all adds up to 100%. It might be some of those, but we're, we're getting a, we're getting a good mixture of, of people attending, which is great. That's great.

So I'll take it back, shall I, Antony? Yeah, that's fine. Thanks, everyone.

That's great. There's a whole mixture of we're all represented here and that's fantastic. So just one second question before we then talk about, the different aspects of client care.

It would be really good to know within your particular role, what do you find hardest about client care during animal's end of life? So it might be answering questions how much is the euthanasia or it might be consoling a client who's become angry after the event and has written in or phoned in to complain, or it might be a man weeping over his cat, whatever it is, if you could just pop in the message box just Let us know what you find hardest, then we'll put all of that together, and that'll help us going forward to make sure that any training we then go on to offer is really tailored to the different needs of different sectors of the team. So thanks for doing that.

We'll just give you a few seconds to, to type in if you, if you'd like, please. Great. So I'll, if everyone's OK with, with, doing that, I'll carry on and get us right into the talk.

So in terms of context, there are approximately 3 million companion animal owners who are newly bereaved by euthanasia every year, and that's just by euthanasia. We're not talking hit by cars or even the animals say that disappear because that's the sort of bereavement too, or the ones who die natural deaths. And that number of companion animal owners who will be newly grieving is about the same number approximately as the number of the people who are newly grieving a human loved one.

So large numbers of people. And the point here for us in veterinary practise is that we are the agents of their bereavement. All these 3 million people, it is you and I in our work in veterinary practise who for good and humane reasons are proposing euthanasia and then carrying that out on behalf of the owner.

So it's so important that knowing all of this, that we really take a total practise approach and are ourselves educated about grief and bereavement and everything we can say and do to make it as easy as we can if that's even the right word. And before I say more on that, none of this is to say that anything we do already is bad, far from it. We're empathetic and kind people and everyone takes this very seriously, this business of euthanasia and what our clients are going through.

So nothing in what I'm about to talk about for the rest of the talk is in any way criticism of what you're doing already. It's simply showing the scope and what else is possible if you aren't already doing that. So what happens if we don't take a total trained approach?

And apart from issues, for example, like really busy days when people are off sick and an emergency euthanasia comes in to the days when there's a locum and perhaps there's no one there to show them the ropes, and they don't take the same approach as we do and all that sort of thing. But this is an example of what can happen in a really caring practise where you don't have a total approach. And this was something that was told to me some time ago, a very caring practise, just opened a second branch, very committed staff who hadn't been trained.

And a woman came in with her pet, and euthanasia had been discussed as likely to be needed in the long run. And sure enough, the consultation was had and the conclusion was, yes, the time has come. We really need to plan this and we need to carry it out.

And at that point, an emergency came in and the vet had to leave the owner in order to go in-house to attend to this emergency. And all that the front desk staff knew was that they could hear this woman sobbing loudly and apologising to her pets, saying, I'm sorry, I'm sorry, and this woman was very upset and front desk were very upset because some of them felt awkward around grief and none of them quite knew what to do. So one of them who was very empathic and, and didn't find grief as awkward as some others did, she went in and she sat down with the owner and she was comforting her and she was reassuring her and saying, you don't need to feel guilty and it's all OK and we're here for you.

Now I wasn't party to any of this, so I'm giving the account that was given to me, but I, as you may be aware, there are a number of shortcomings here which nobody intended, and very briefly, they are first of all abandonment, and this is something that's quite well described in human medicine that bad news is given and then the physician has to go, especially in human hospitals. And although it's not intended, it's a sort of physical and emotional abandonment of the patient and their family at this very sensitive time. So although I'm sure the vets said, Look, I'm so sorry and I'll be back and this and that, the reality was that the owner was suddenly left with this awful news that she had to face that it was time for euthanasia.

So there was abandonment. There was lack of communication, so front desk didn't know this had happened. There was lack of training, so front desk didn't know what they might do.

Some were awkward and they didn't feel empowered as part of a total approach to take initiative. And then for the very kind and well-meaning person who went in, she made a very, very common mistake that we all make, myself included, which is that we seek to reassure people. So in some sense we avoid their grief or their feeling by trying to offer a solution.

So we say you don't need to feel guilty, and we get, get onto that. And a more powerful way of being with people which is uncomfortable for us often is simply validating that this is a really painful situation that they're in. Now, a further part of this, and I don't know the outcome, is, of course, that that's the kind of situation when a client may not feel that they ever want to come back, not because we were unkind in any way, but because ultimately, they associate the clinic with this awful experience.

So do you see the, the how, despite being really well-meaning and nice and well intended, unless you have a total approach where everyone is part of a system, if you will, and knows exactly what to do in different situations, and this kind of thing can happen and clients can fall through the cracks and we can end up feeling badly as well. What else happens when you don't have a total practise approach? Compassion fatigue, that's something that is quite prevalent and, and very probably amongst nurses in particular.

We don't have time to talk about it today, but it's something what I'm in training with practises that we cover in some detail. And, I wrote a paper about it in the veterinary nursing Journal last December. So we get compassion fatigue amongst different sectors of the team.

About 30% of bereaved owners struggle with their grief for many different reasons, and one of the biggest is that society doesn't support them. Society doesn't support expressions of grief for pets. And so everything we say and do and the support we offer is especially important.

But it seems that up to 30% of people really have difficulty. And the latest research from ReMA over in Ontario suggests that dog owners who have highly anxious attachment styles are particularly likely to struggle. Client attrition is the other thing, as Antony, said, in my last talk, I quoted Allison Lambert of On Switch and her research of 500 bereaved pet owners, and 2/3 of them got a new pet, and of that 2/3, 19.1%, took their, their pet to a different vet altogether.

So that's about 50%. And the reasons people gave, and this doesn't quite add up to 100% because I think of the structure of the questionnaire, but of those people who chose another practise, 25% said we just couldn't face going back to the same building. So that's the, the, the blue bit of the pie chart there.

25% couldn't face coming back. 12.5%, we were looking to change and this was a good reason to try somewhere else.

So now we're up to more than 1/3 of the clients have left for reasons to do with the practise. So that's a lot of people. And the cost of post-euthanasia client attrition, just that, not other attrition, is likely to average about 20 to 30,000 pounds on average per vet per year.

And the reason for that is that it's cumulative. It's cumulative. Every, pet, on average, the pet ownership level in this country is 2 non-fish pets per owner.

Average spend per pet, 200 pounds. So every time a client walks out the door and doesn't come back, that's 400 pounds for that year alone. And then next year they're missing as well, so that's another 400 pounds.

When you add it all up, it works out to thousands of pounds. And I wrote a paper about that that's in the Veterinary Business Journal last year, and that's referenced at the end. So summing up, there are an awful lot of reasons why lacking a total practise approach to euthanasia is problematic.

First of all, millions of people are bereaved by us due to euthanasia. If our teams aren't trained, they're likely to suffer from compassion, fatigue. Our clients are likely to struggle, and we get attrition that's worth thousands of pounds per vet per year.

And to address this, we need knowledge and skill. And we need practise policies to support us. So we need management to have policies in place to support us as individuals in our very demanding work with clients.

And it's to that end that the webinar vet is offering these expertise series of, to help front of house, veterinary nurses, vets, and practise management in, to, to plug any gaps in their approach to client care at end of life. So when we talk about expertise, it's more than experience and being nice, and that's how most of us are at the moment, because we weren't trained at vet school or veterinary nursing college or in our, reception training. For most of us, we're relying on our natural human sympathy and our kindness and our experience, the cup of tea, the, the saying, I'm so sorry, giving people time to talk, and those are very fine things.

Those are very fine things. And our clients appreciate them very much. So again, I'm not criticising any of this, but what I am suggesting is that this is what any kindly lay person would do, and we are a professional outfits who are about the business of giving animals humane deaths, and we do that very professionally.

And so it behoves us to also be professional in our understanding of grief and a bit more sophisticated than we've been able to be so far because we weren't trained. So what is expertise? Well, expertise is special skill or knowledge in a particular field.

And if you look at front of house, here's an example. If you don't have knowledge or skill, and Allison Lambert of Onswitch was mystery shopping euthanasia inquiries by phone last, last autumn, and she's got to find a very mixed range of ability, if you will, at front of front of house or reception. And none of this was to say that the personnel there were were not kind people.

Probably they weren't trained. They were very, very busy. Their their partner who was meant to be at the front desk with them was off sick.

The world and his brother were lined up at the front desk, and how on earth are you then expected to answer the sensitive question, which is often vaguely put, which is along the lines of, I think it might be time to, you know, or people saying how much is it to put my, my pet to sleep. And this is an example of, of the answer that one of the mystery shoppers got. She, she asked the question rather awkwardly, and the reception said, OK, bear with me while I just get your notes up.

What's your surname, please? So then she went and got the file and there was jolly hold music, you know, la la la la la la la la la. So here's the grieving owner on the other end listening to this music, and then the receptionist came back and said, OK, I've got some prices for you, and she gave her the prices.

Now, that is factually absolutely correct. The owner asked how much it was, the receptionist told her, but that demonstrates a lack of sensitivity, and that's what can happen if you don't have knowledge about grief or skill in communication. An expertise-based response would gently take control, to say, yes, I can certainly get that information, and I'm so sorry you're having to make this inquiry.

So rather than diving into the traditional thing when someone phones up, which is you've got to get their name and make an appointment and this and that, the first thing that you do when someone inquires about euthanasia is you empathise. So you put yourself in that position, imagine what they may be feeling and demonstrate that you understand that and just say, I'm so sorry you're having to make this inquiry. So knowledge and skill there, a trained receptionist would know, for example, the research that shows that for some people they remember the whole issue of having the animal put to sleep as being in the words of one person like Hammer House of Horror.

In a focus group by Dawson and Campbell, one of the participants said it was like the hammer house of horror discussing when to end my animal's life and where. So you and I are here and we're being as nice as we know how and we're saying we could go to your home or you could come in and we'll give you special time. But for the client, it's a total nightmare.

And some of them will remember it that way. And a trained receptionist, trained vet, trained nurse, and really understands this and knows the research proves that we can imagine people might feel this, but sure enough, the research is out there too. We'd also be aware there are different styles of response to loss, so it's important not to smother people and be too sympathetic because for some people they have a controlled response.

They don't want to display their feelings at all. They just want the facts. So a simple expression of, of empathy is appropriate, but too much would be just that, too much, and it will put them off.

So a knowledgeable person knows this, and then they have the skill in empathy, and they would know different wordings that can be used to express empathy. There are different ways of doing that. And that's one of the things that I talk about in the expertise series.

And in addition to having knowledgeable trained staff, you need to practise policy as well. So for example, what are you going to do when all hell's breaking loose at the front desk and that phone call comes in? Are you going to say, Hold the line?

Are you going to say, What's your number? I'll phone you back. Is there someone else who, who is always going to be backup so you can automatically transfer them, and they can get their questions answered straight away.

So that's where practise policy comes in so that the person at the front desk isn't put on the spot trying to figure out how the heck to manage this. But there's a whole structure in place that everybody knows. So that's expertise in, in front of house.

And the particular points, of course, that front of us are dealing with are the phone inquiries, the euthanasia appointment itself, people arriving, also perhaps being asked to accompany them, which might be part of the practise policy, accompanying people at the time of the euthanasia, being in the room with them, taking payment, you know, how do you take payment? Isn't that awkward? Departure, when, when the person leaves, who sees them to the car, who carries a pet's body, that kind of thing.

Now, not all of that part of the euthanasia appointment would have to fall to front of house. Departure might be overseen by the vet or the vet nurse, but those are the elements. And then is of course, you know, making the phone call, and then when people come in to collect ashes.

And again, you need really a practise policy around that and then within it as, as a member of front of house, you need the confidence and the skill to, to help clients in different ways when they come in to collect the ashes. And those are the things that this upcoming package will be covering, and I'll give you the details of that at the end. But moving on, expertise for veterinary surgeons very briefly.

What do clients want from us? Who knew? They want empathy.

They want empathy. Michael Meehan, who's a vet presently at the Ontario Veterinary College, he worked here for 6 years and then went back to Sydney to do his PhD, and this was very clear on the research on clients there. They want us to empathise.

They want us to demonstrate we understand what they're going through and to reflect that understanding back to them. That's what empathy is. Fernandez Miller, a big survey of bereaved pet owners in Switzerland, about 38% of the sample, which was 2,0008 bereaved owners, 38% said that they wished the vet had talked about the final destination of the pet's remains earlier in the animal's lifetime.

And you think, well, how the heck do you do that? Well, I vaccinated your dog, and by the way, have you thought about what you want to do when, when he dies? Of course, we wouldn't raise a subject like that.

But in a way, it shouldn't surprise us that people want to know in advance, you know, you and I as we get older, many of us will be thinking about or are thinking about, you know, would I want to be cremated or buried or this or that. These thoughts do cross our minds, and we shouldn't be surprised if for some of our clients, this may be going through their mind. And so the skills we need are to open the door to such a conversation if somebody is dying to know.

And then for the people who don't want to think about it or talk about it, they don't feel intruded upon. And that's a learned skill, you know, what wording do I use? When, when do I raise this?

How do I raise it? What else do clients want a pre-euthanasia consultation? Doug Muir from Pet Cremation Services was telling me at BSAVA last year that they surveyed 1600 pet owners.

Now they weren't bereaved. There were 1600 owners. 84%, 84, let's say, effectively the whole lot, but 84% said they would welcome the offer of a pre-euthanasia consultation and be prepared to pay for it.

Now, what we say we'll pay for and what we do with different things, but that can be part of a practise policy and a whole end of life service, but there might be different packages and one might include this and one might not or however you want to structure it. And that's something again that I talk about with practises when we're really digging into detailed training. So, also, knowing how to discuss worries and fears with people, that's in a way related to the, question of how to, or, or raising the issue of disposing of a pet's remains with people.

Survey of bereaved human or people bereaved of a human loved one, England and Wales, the Voices survey 2012, that was done by the Office of National Statistics, so it was nationwide for those two countries. 14,000 respondents to this question about whether or not you were able to discuss your worries and fears with the GP. So these are the bereaved families talking about the time when the loved one was ill, and afterwards, were you able to discuss your worries and fears with the GP?

7% said they had no fears or worries to discuss. But 56% said yes, and I could discuss as much as I wanted, so about half, 17% said yes, but I wanted more, and those folk were younger. They were the younger respondents, so under 60.

8% said no, I wasn't able to discuss them, but I tried to, and 19% didn't try to discuss it. So they, they had stuff, but they didn't open the conversation. So 20% didn't open the conversation, and that's where for us again, our skill, as we talk to people about this very upsetting subject of end of life and euthanasia, our skill is as caring professionals to be able to open the doors so people can talk about things if they wish to.

For example, when people say, how long has my cat got to live, sometimes that's because they've got a, they're caring for an elderly relative with dementia who's deteriorating rapidly and they're wondering, how am I going to Tell my mother this, or what do I need to know for her? Perhaps they've got a child getting married and they're wondering, will this cat who's been part of my daughter's life since she was 6 and now she's getting married, is my cat going to live long enough? All these kinds of things.

So we need to have skills in opening the door when people ask us factual questions. We need to be thinking about what might be underlying it, not presuming, but knowing how to open the door so folk can talk more to us if they want to and have some support and further resources. And that we can direct them to.

So expertise for vets, our bit of it is breaking bad news, handling difficult euthanasia discussions, the convenience euthanasia. You know, I want you to put my cat to sleep because she's scratching the furniture and I don't want anybody else to have her because I'm afraid that they wouldn't, won't look after her. You know, how do we deal with that?

That's more than we could cover in any expertise package, but it's a workshop that I do for vets and in, in, in practise, we look at what kind of policy might we have around euthanasia, so that vets and owners alike have guidelines. The other difficult PTS discussion, of course, is when it's obviously needed for welfare reasons, but the client seems unable to see that. How do we handle those discussions?

We need expertise there. The pre-euthanasia appointment, as we've mentioned, the euthanasia and the condolence letter. The condolence letter, which has 7 core elements.

Expertise for veterinary nurses. That's everything, and then some, right, because you do everything. You answer the phone and you're breaking bad news and you're can be involved in the pre-euthanasia appointment so super, super added clinic or service for veterinary nurses to offer.

Euthanasia, of course, you're involved, the condolence card and ashes collection. So it's the whole gamut for veterinary nurses. And practise management and the main thing here is is policy, not some dried out thing in a dustrial file, but something that makes sense to, to everyone on the ground as we implemented.

So joining up care at all these client touch points, the phone call, the Breaking Bad news, the pre-eth consultation, the euthanasia, the condolence card, the Ashes collection. So everybody knows what their piece is and how to go about it. And then a policy about compassion fatigue.

So we can really support each other within the practise. Compassion fatigue can come about when we don't take care of ourselves, and that's a big professional responsibility to take care of ourselves. But the other part, of course, is a workplace structure that's, that's explicit about the demands that are, are, that we're going through and that, that encourages us and makes time for debriefing and so on.

A third policy is the ethics guidelines for euthanasias, as we've said. So, we've covered a lot there. We've said for front of house, vets, vet nurses, reception.

And, I wonder if I could ask you, please, what would you most like to see covered in these expertise webinars? What would you most like to see covered to help you with your client touch points at animal's end of life? So you've told us earlier the things you're struggling with most, and perhaps that's what you'd most like to see covered.

But now that I've touched on a few things, it would be great to hear from you. Anything else, you know, what's striking you there, because the more you can tell us, then the better we can make the webinars for you later on. So thanks very much.

If you could take it just a minute to, to write something in, in the message box, that would be fantastic. Caroline, while you, while people are just doing that, I thought I'd give you a couple of the comments that were made earlier. Sure, thank you.

Sue said that, you know, one of the most difficult things for her is supporting both the client and the pet, doing the best thing for the pet when the client cannot make the right decision. Yes, OK. Yeah.

So that's, that, that's great. I think Catherine has said dealing with emotional people without crying myself, despite the fact I've been a vet nurse for 11 years, I know that's . That's tough, isn't it, because I think, you know, especially when you've developed a real relationship with somebody over 10 years with the pets as well, you see they're upset.

It, it can be difficult to keep it all together for ourselves as well, can't it? And this is. Probably where this compassion fatigue and And the stress levels that we see within the profession, we, we're dealing with death almost on a daily basis.

It's that can be tough emotionally and physically and spiritually, can't it, Caroline? Very much, very much. And something about crying in front of our clients.

I mean, of course it's unprofessional to break down and sob and completely lose control of ourselves, but it is fine if a tear is coming and it's raining down our cheek. We can say, . I really feel for you and I often get upset at these times, but I can still do my job, but it doesn't stop me from doing my job.

So we can say something like that to acknowledge we're, we're in sympathy with the client, and we are distressed for them, but we're not out of control. So that's something that I've, I said myself and that I've, I've seen recommended. So, you know, I really feel for you and I often get distressed at times, at these times, but it doesn't stop me from doing my job.

So that's just I tossed that out there just as a, off the top of my head response to, to Katherine there. So I'm thinking we'll press on Anthony and just that's great, great, thank you. So just to give you a, a little bit more about what's coming up in this expertise series of webinars for front of house, and they're taking place Tuesday, May 26th, Tuesday, June 2nd, and Tuesday, June 9th from 1 to 2.

And briefly, this is what we're covering the first day, we'll be looking at the basics of grief, what affects it, some myths about grief that are quite common in veterinary practise. And then some core communication skills. And what we're touching on there is transferable.

So it, it's helpful in, in all the different kinds of work we do with clients, not just when they're grieving or talking about end of life. And then we'll be, looking at a little action plan for the week ahead. So you'll have a bit of a structure to jot down, the, the core thing that you've learned at the webinar that you're going to implement and try out in the week ahead.

So that'll be Tuesday, May 26th. Then Tuesday, June 2nd, we'll review and we'll catch up. So I'll be encouraging you to, to write into the message box or even email us before and say, look, I tried this and it just was useless.

So I tried this and it was fantastic, whatever it is. So we'll get a bit of a community of learners going. So we'll be sharing our experience.

And then we'll get on with the learning and we look at what do I say, you know, what do I say when I get a phone call about euthanasia? How do I talk about cost? How do I take payment?

How do I deal with that silence at the front desk, you know, what to say, what to do, what not to do. So we'll be really digging into the nitty gritty there. And then again, you'll be taking away a core point or something for your action plan for the week ahead.

And then we'll meet again a week later, Tuesday, June 9th. We'll be catching up again and hopefully sharing our stories and our, our successes and what we're learning. And then we'll dig in again to the nitty gritty Ashes collection, how do you offer grief support resources to people, and again, your action plan for the longer term going forward.

And so that package of 3, it's not the same as having someone come in and do, say, role training where you have a bit of a go and you practise and you see what it feels like to use different expressions and express empathy in different ways. But it's a good start and, do join us if you can, cause we'll be a community of learners. So, it won't just be, or it needn't just be you on your own in front of your computer, feeling isolated, perhaps, but just know you're tuning in with a bunch of other people who are also learning.

And are really interested to hear your experience and we'll be sharing theirs. So, the idea is that we really connect for our lunchtime for those 3 weeks and, share our stories and learn together. And the good news is there's an early bird offer.

So if you're thinking, yeah, this could really be helpful to me and maybe some of my colleagues, there's an early bird offer until next Wednesday, May 13th, and then full price after that. And the details are there. So if you're a platinum member and it's just you, just one front of house person who'd be signing up, it's 47 pounds for the 3.

And if any of your colleagues want to join you, it's just an extra 10 pounds each for any number of them. So say if there were 4 of you, it would be 77 pounds for the lot of you to, to, to have the package. People who aren't platinum members still have very good savings to be made, and you see the prices there in the middle, slightly more per head for, for each other colleague could be joining.

But don't forget, if it just saves one client from leaving, apart from the fact if it just saves them from feeling as bad as they otherwise might, from a practise point of view, if you're having extra know-how and training and expertise and an action plan that you're then implementing and working with each other to implement. If all of that helps in the course of 1 year, just one client to stay with the practise, that saved £400 in that year alone. So apart from the fact that it's CPD which is useful for you, and hopefully, makes your job more satisfying, there's a real benefit to the practise to in, in investing in you.

And then finally, the full price you see there. And again, lined up against the, the, the value of a client to the practise and the animals that they would bring back if they do return after euthanasia. We hope that this represents really good value for you.

So thank you very much for your attention. If you're interested in, coming along and signing up for the package, the Wendy will be sending out the, the full link, and I've squeezed it into the top of the, slide just there. It's www www.theebinar vet.com.

Caroline Hewson-expertise series. And that's me there in the picture. I really hope you can join us.

Any questions, type them in. I'm here until 2. So if you've got some things that are on your mind, something you thought, oh, I don't like the sound of that.

What was she talking about? Goodness me. Or you've got a question about, a case you've just encountered, anything like that, type it into the message box and, I'm here and I'd be glad to, to answer anything I can in the time we have left.

Thank you. Caroline, that was fantastic. A really good, introduction to this.

I suppose there's a, there's a danger that we all kind of think it's quite simple. You know, we've done it for many years. I think, you know, as a profession, we are a caring profession.

I think there is, you know, is a degree of empathy, not in all of us, but in, in most of us there will be, you know, empathy and, and sympathy and understanding. But, you know, just that one idea from today's webinar about the pre-euthanasia consultation. And not only an idea, but a statistic to back it up, which says that, you know, a very good majority of people would be happy to come in to kind of have that discussed with them.

And I know we do that kind of sometimes anyway cause euthanasia can be a process that's spread over several weeks in consultations. But, you know, what a great idea just off the back of that, to, to bring that into your practise as a policy, we'll just. Sorry, Auntie, go on.

No, I was going to say we'll just probably improve how people perceive the practise, but most importantly, give the pet and the pet owner, you know, a nicer kind of final journey, as it were. Yes, and it is that the, with the pre-euthanasia consultation, it's an opportunity for the owner to review their decision with the vet. Because they may have Googled or talked to other people, but then it's an opportunity for them to plan, to plan for it and think about how they might feel, who they might want to come with them if they're coming into, to the clinic, or who they want to with them at home to talk about, grief and how they might cope and how other family members might cope.

A big, thing which we Forget for our clients is for many, many people, the whole issue of euthanasia creates a lot of fear because first of all, it challenges their sense of them as a good owner that they're abandoning their animal even for the right reasons, but there can be a lot of fear and also for family members, the person we're talking to might be fine. But for example, I heard just the other day of a family and it turned out the 16-year-old son was being bullied at school and the dog was the son's confidant. And now the vet never saw the son at all, but it turned out a team member who was trained in accompaniment for pet bereavement, she got chatting to the owner, and the next thing the owner comes back with the son, and he sat with this accompanier counsellor for 2 hours.

This young lad sat with her for 2 hours crying and telling her his story, and those are the kinds of things that we miss without a pre-euthanasia consultation. So it's a great opportunity to, to let people, to explore those things that people can find for support is needed. And, you know, we can as business owners say, but, you know, we can't afford to do that 2 hours.

But actually, you know, I think that's in the end, why are we here? We're here to, you know, make life better for other people, you know, do unto others as you would have done unto yourself. And those sorts of things, you know, that, that 2 hours that that person spent with that young boy will live with him for the rest of his life, and you can't, you can't value that.

And the other thing is that that emerged after the event because it was in a practise that didn't offer pre-euthanasia consultation. So this all emerged after the event when the owner was talking to, to the person concerned. So it wasn't part of the practise policy and quite possibly, if there had been a practise policy, no one need to spent 2 hours, not as you say, Antony, that would begrudge it, because this would have been discussed.

Is there anyone else at home? Da da da da. And then resources and other counselling and so on could have been offered.

So, so this young man could have found his support perhaps at the practise or been taken elsewhere or directed elsewhere. So that's where the pre-euthanasia consultation is such a service to people and it doesn't mean we have to do the support in the end. We can direct people to the most best support for them.

I, I, I spent some time looking at your website, which I think is fabulous. You know, there's some really good resource on there, and I know you do a lot of leaflets for, for practises as well, don't you? Well, I do, I do a client support pack, for, for people to offer to clients at the time of euthanasia because the, the, it's very clear the data from the human bereavement side, and this has been the standard recommended to human hospitals for the last 10 years, which is family members and carers should be offered information.

About local resources so they can find what's right for them because not everybody wants to talk and talking isn't necessarily the best thing. So my pack is one among others, which, lists many different kinds of resources. So, you and I are off the hook.

We don't have to figure out who needs what kind of support, but they have the information. And certainly offering people information about further resources is a big part of the whole euthanasia service that we can offer to our clients. Yeah.

I mean, interestingly, one of my big things is, as I've thought more about, more and more about webinar vets and had people come to me at conferences, is just to say, you know, you've helped to reduce our stress levels, you know, we're doing more CPD, we're falling back in love with the profession. And I think similarly with this, you know, these consultations are incredibly stressful times for, you know, the vets and the nurse, you know, we've had some comments coming in there, you know, we missed the vein. You know, I was talking to a young vet who'd had a horrendous euthanasia experience, which really can have a huge effect on that young vet's career, and that was, I think, partly because there wasn't supportive staff in that particular situation at that time.

So, you know, putting together a policy which is, this is what we do in. In the euthanasia sense, I mean, I'd be very interested to know, you know, those of you listening, we've had nearly 200 connections. I know there's vets and nurses sitting together, but how many of you feel that you've got a really well written, protocol to, to look at some of these areas?

Just before we go on to the questions, obviously all of those webinars will be recorded in the expertise series, so if you do miss one because an emergency comes in. You will be able to watch the recordings, and I'm just wondering again an idea that I'm just throwing out there. Do people feel happier that they can email or comment at the time, or would there be something to be said for putting a closed Facebook group together so that people could share experiences on that?

Obviously, on Facebook, you know, you won't have anonymity, and it may be that you prefer to have the kind of anonymity of being able to make comments on the webinar without, you know, as we usually do, we only say a first name. So that people can speak in confidence and ask questions without feeling that they may be asking a foolish question, which is, which is actually usually me, Caroline. I'm the one who asks the foolish questions, but I'm foolish enough to usually stand up and say it, so people, most people's questions are of course not foolish, are they?

No, and we need to honour our questions, you know, we ask questions and so on because we're concerned about this. If we didn't give a toss, a, we wouldn't be here, and B, we wouldn't be asking questions, so. You know, if we feel uneasy about this or that in our own practise or what we're hearing, that's, that's, there are valuable feelings and, and so, I certainly welcome any and all questions, and, it would be lovely to be for us to be a group who can just, really hear each other and, and help each other to learn and move forward, in our, in our work with, with grieving clients and support each other.

So, yes. I think those of you who are interested, if, if you do want to get involved in the Facebook, Facebook, you know, group, that's fine. Those who don't, of course, don't need to engage.

But if you feel that that would be useful, we would of course have to set it up. So, you know, do let us know via email or whatever. Sarah's saying thank you for a great webinar.

Could I ask, read the price of the pet loss of the pet team training support CD? I think, Sarah's just been on the website. Yes, it depends on how many you're ordering, and I don't want to, to take over this because that's my thing, if you will, separate from that.

But, Sarah, drop, drop me an email. It's CH@caroline Hewson.com, just there on the slide.

Drop me an email and, I'm on the road now, but I'm back in the office later tomorrow afternoon, early evening, and I'll get straight back to you then. And thank you very much for the question. You go into practises and help people with this, and I suppose the webinar series is almost a halfway house of not the same as having you in the practise for a day or two, but it.

It at least begins us to, to kind of just look at what we're doing and, you know, can we improve it or are we doing an absolutely fantastic job and, you know, that's of course. Exactly. I'm sure most of the time, you know, of course we can improve.

Yes, and then, you know, one of the lovely things is that they're always really pearls and lovely things that go on in different practises and tomorrow actually I'm giving a training, an open ticket training day in Newcastle and the nice thing about the open ticket days is that people come from different practises and it's very interactive, so we spend time brainstorming a practise policy and people learn from each other. Because we get to say, the extra mile touches that you might, might use, in euthanasia, which might be using special fabric to wrap the body. And then someone says, oh, and we do this, and you think, what a fantastic idea.

Where do, where do you, where is it you say you get the special envelopes for the pets fur, and then bit by bit, you know, we put together, just a really detailed, a really detailed client care policy. So yes, I certainly sharing ideas with other practises is, is fantastic. Once you get a group together, that dynamic is so powerful, isn't it?

It is. It really is. Now, let me just see.

Julie's saying we have no written policy protocol for PTS, . Let me just see if we've got some of the, we've got plenty of statements and comments here. Catherine's saying thank you, very interesting.

Is it OK to use your own experience of loss to open up dialogue with a client, or is that too personal or awkward for a client? They may not realise in that time of grief that the staff in a practise have their own pet loss experiences and can emphasise on that level. Gosh, that's such a good question, Katherine.

And I would say, in principle, we need to be careful that, we don't, we don't find that we're taking over the conversation to tell our story. And that's so easily done, I think, for us as human beings generally, that often when someone's talking to us, we're thinking about connections and how we've experienced it, and then Rather than simply listening to them and being with them where they are, we, then come back with our story about us. So it's a balance there, but certainly it, it's sharing our experience and our feelings is an important part of professional communication.

And so saying, you know, I lost my own cat to cancer just like this 3 years ago, and I still remember how difficult I found it. So, you know, I really feel for you at this time or something like that. So just to touch on it so they know.

But normally, I think often when people are in the throes of it, their own emotion, having just heard some bad news, that it's hard for them to take in anything else and it's important we don't block them and their feelings by coming in with our story and if you will distracting them from where they are. So it's a balance. But no, I think it's, it's, there's nothing wrong with, with, indicating that we truly do, not that we know how they feel because you never do.

You can't know how somebody else feels, but you know how you felt and how awful, how difficult you found it. So you can certainly relate to the idea that, to them experiencing real difficulty, definitely. As you said with the example, you know, as scientists, we're often trying to find solutions for people, whereas actually all we need to be sometimes is a listening ear, isn't it?

That's right. And that's something that that I work on with people with the whole business of reflective practise, which is something that we do in life anyway, but it's, anyone who's come through that college more recently, will know about it. And it's just the whole idea that we reflect on cases or consultations, and we think about what went well and what didn't go so well, how we felt, what happened, and then, based on that, what we would do differently.

So certainly, you know, reflecting on, on how these cases go for us and then thinking, oh, you know, maybe I did talk a bit too much. That's my thing. I talk too much.

Yes, talk too much. That's, that's my particular, weakness in any consultation. So, you know, all of us will have our, our third leg and the reflective practise is a great, great way to learn from our experience.

Meryl has a question. She says, a lovely name, by the way, Meryl, like that. At what stage you?

All right. I thought you knew each other, but I'm just trying to keep the confidentiality if they want to do that. At what stage would you advise a professional team in a practise to refer people to a counselling because you cannot meet their needs?

I often call people who are dealing with their grief weeks after PTS, and I Feel felt and qualified to continue to help them. Even after creating the expertise series, are there signs where you would advise referral and to whom would you refer? Mhm.

Gosh, that's such a good question, Meryl. And certainly, I, I don't have particular expertise in counselling. So none of what I cover here is, is counselling.

It's about how we can bring in current knowledge of grief to inform our professional practise as vets, communicating with grieving owners. So in terms of follow up with people, I think the first thing is having offered them, a res a, a support resource that lists all the different kinds of resources. So they already are empowered to look further if they wish to.

That would be the first thing. The second thing, and I'll, I'll find at the end, come to when would you refer and how, to whom I would refer. I would say strictly speaking, as professionals ourselves, we should only be referring on our clients to those who are qualified counsellors.

Now, cancer is not a protected term, and for example, I saw at one college you can pay £99 to do an online self-study course, and at the end of it, you have a certificate and you can call yourself a coor if you want. Now, normally with, with formal counselling training, it's a much longer process of study that's supervised and you engage in supervised practise, so you're seen in interaction with, with clients, and you're also asked to undergo counselling yourself for the duration of your training, so that you're, you're aware of your stuff, and so that you don't project that onto whoever it is you're supporting. So that would be, an optimal counselling service would be someone who had that standard of care.

And those people would normally be registered members of the British Association of counselling Psychologists. And there's a list of those counsellors on the RAF site. Which is www.the Ralph site, RAP.com.

And that, that they're located at different places around the country. Now that's not to put down the services of people who might not be registered with them, but I would certainly want to know if I was referring somebody on, I would want to know that the person concerned was more than a very well-meaning and perhaps experienced individual with all the right qualities who may not, however, have undertaken the same level of training as someone who'd be a member of the British Association. Now, that's in the end down to you, but I'd certainly, wouldn't just want to refer somebody on to anybody who said, oh, well, I'm a counsellor.

And part of the reason for that is because grief for pets can be linked to many other things and deeper human traumas, and, you really, as I understand it, you need a better understanding of that and a professional understanding of that to make sure you wouldn't make a mess. Now, to listen, as in the trained listeners and support service through the pet bereavement support service, that's absolutely fine, and that's a super service, but for counselling per se, I certainly want to research the people concerned quite carefully. As to exactly when you would refer, that's a tough one because every case is different.

And also, we can perhaps tend to medicalize grief. You know, we live in a sanitised world where we're all meant to be on the journey and going places and we're meant to be positive and for every young and de da di da. And the reality of life is different.

The reality of life is different. And if you look back to the Greek legends, they're full of the ups and downs of life, and they're gods and goddesses and all the stories that unfold are stories about the ups and downs of life. So in that culture, there wasn't the same expectation that we're all just these thinking, people who feel happy and solve problems and for whom grief is a problem, which is all to say someone may still seem very distressed, but that may be normal for them.

And it maybe it's not a problem, and maybe they don't need any further help. They need just to work through that process. And that's not to say don't refer to people, don't refer people or don't care, but just, it's important for us as problem solvers that we don't see grief as yet another clinical problem that we help solve.

So where does that leave us then? And I would say it's, probably just by, by self-disclosure and, and some, some open conversations saying, Mr. Smith, I'm, I'm very concerned by, by, what you're telling me and you, you said to me, so you can explore, if they say, I don't think I can go on, you can say, tell me more about that.

What, what, what do you mean by that? . And they, and so if people say something vague, which concerns you, to say, tell me more about that and try and find out more specifically what they mean.

And then say, you know, Mrs. Smith, from what you're telling me, you're really finding life very difficult without Rover, and I understand why that, that might be, . How would it feel to you, if I were to, to look up, or I'm wondering if, I'm wondering if it would be helpful to you if I was to look up some further support that might be useful.

Would you like me to do that or, you know, would you like me to contact John Smith, who's, So we work closely with, who supports people at this stage. So I'm, it's awkward in the wording I'm using because I'm not talking to Mrs. Smith and it's sounding kind of stilted, but I would suggest, Meryl, that kind of approach, but empowering people with a wide range of information about resources from the outset, having a particular counsellor in mind, such as even the list on the Ralph site, which are qualified counsellors, and then just an honest conversation with Mrs.

Jones, which says, you know, I'm, I'm concerned for you. You know, would it make sense to you? So again, not saying, let me refer you, but saying, you know, would you like me to do that?

So to empower them, and if they say no, then so be it. That sounds great, Caroline. Somebody's just said BACP is the British Association of counselling and Psychotherapy, not psychologists.

Oh, thank you. I beg your pardon. That's it.

Thank you so much. And you know, when I said it, I thought that's not right and I don't have it written down in front of me. So thank you very much for that, that, that correction.

Thank you. Sharon is just saying that she missed some of the webinar. I'm wondering whether she can get to see it again.

We will be putting this up on the site, Carol, Sharon, so. We, we'll send an email out to everybody to say, go and have a look, cause, Caroline, I think just, you know, as a resource standing on its own for practises. It will certainly help people just to kind of reflect on what they're doing and, and maybe even, you know, as people are now sitting around as, you know, two vets and a nurse and a receptionist to actually just reflect on what they do and say, are there ways we can improve it and or have we done that thing where we just give a price to somebody with the jolly music in the background, those little changes can make substantial differences, can't they?

Absolutely, yes, yes, because everyone wants to do the best they can and they are already doing the best they know how. So, but life intervenes and that's where the policy helps. So again, when the front desk is really busy, if you've got a policy in place, so everyone in the ward area knows that they might the odd time have to pick up a call and have that conversation instead of front desk or whatever it is.

But absolutely, you know, it would be great if this just our time together today. Really, gives you some direction and tips and maybe it's highlighted some gaps and you think, oh, I can plug that gap right here, right now. Fantastic.

That's great. That's great. And I think, you know, this, the, the webinar will be on the site, certainly for quite a while.

So if you feel that that would be useful to have as a lunch and learn to people who haven't been present today, then please feel free to, to, to use that. Mhm. Claire is, is asking a question.

I think we'll make it the last one because we're getting very close to 2 and I'm very keen for people to be able to get to their 2 o'clock surgery on time. And when an, when an animal is emaciated, very dehydrated, flea ridden at the point of elective euthanasia, and has not been brought in regularly, is it appropriate to make a comment when you feel the animal has suffered significantly? I feel clients need to know that this is wrong and the animal has been left too long.

Mhm. I agree with you, Sarah, and I think it's very challenging for us because I don't know about you, but I feel outraged when I see that the condition of the animal, and at the same time, I recognise that the owner is upset and has probably put off for who knows what reasons, and that's the thing. Maybe they've lost their jobs, they're caring for a terminally ill partner, you know, there can be a whole story, which doesn't excuse the condition of the animal, but it's certainly, Explains the human context.

So I, I like you, sir. I feel very challenged by them and I feel it is important for us to speak out, not to read the right Act at the time, but, first of all, to, to applaud the person for coming in, and we can indicate one way or another, we can say, I'm, I'm concerned that Rover may have been suffering for some time, and I'm so glad you brought him in, da da da da, that kind of thing. I get into more of that when I'm working with vets on the handling difficult euthanasia consults, but I think finding the right words, and that's a learning journey for all of us to keep looking for and exploring words that are authentic for us to express whatever it is that needs to be expressed.

But I think definitely naming it because really, for whatever reason, that person is in breach of the Animal Welfare Act by having neglected their animal. It doesn't matter the reasons. I mean, those are understandable and this and that.

Do we need to report them to the RSPCA? Sometimes perhaps we might, especially if there might be other animals, and there's a concern they may not be in good health either. And there may be people who may be suffering as well because perhaps this person has, has totally broken down really and, and can't be exactly.

So, so, . Definitely, those are things and again, a practise policy and, an approach collectively where we've sat down together as a group within my practise, your practise, and worked out together what we say and revisit it periodically to share our stories. That all helps us in these difficult situations to do the best we can by our clients, our pets, and ourselves.

Caroline, we've had some cracking questions. I know you're very much going to look at these in formulating the, the course that you're going to put out at the end of May and beginning of June. So there's, there's a lot of questions, comments that have come through.

I think if we tried to answer them all now, we'd be here till about midnight and then of course, we probably would need to do an expertise course because we'd all be experts, so. I, I think, we should call it to, to an end, but what I will do is I will obviously pass those questions over to you. Those of you who are interested, obviously the, the web address is in the chat box, so click on that and, you know, by all means do sign up.

And the idea with the additional price for extra people is that if people need to have it at home, they can reflect on it, they can spend more time. Because you can watch it of an evening. So, although we're doing it 1 till 2, those of you who don't manage to get to see it live will be able to watch the recordings, you know, at your leisure.

So, if, if there are any questions on how, kind of how the series is going to run, then I would suggest just email office at the webinar vet.com. Any more sort of questions where you want to go into a bit more detail with Caroline, then I know Caroline's email address is up there, so feel free to, feel free to email her.

We're very busy today, Caroline, at 8 o'clock we've got a webinar all about how to, how to do the whole thing of, Hector parasite control better in the practise as well. So we're, we're doing a lot of kind of practise, practise stuff today. It's not clinical, but I think nevertheless, you know, it's, it, it, they're both just such important topics.

So I'm sure many of you have already signed up for the Bravecto series, but if you haven't, go onto the website. Webinar vet.com and you'll find a banner there as you will with Carolines and click on that and you can sign up.

But I hope to see many of you tonight at 8 o'clock. Caroline, again, thank you so much, and I think so many fantastic questions show how much interest you've peaked there with, with the comments and, and just the way that we can go away and reflect. You know, about the ideas with pre-euthanasia consults and all of the things that we can just go away and think about.

Perhaps those of you in a staff room have already been doing that. So really enjoyed the webinar. I hope everybody else has.

I think from the comments that so far we've had, it shows many people have, and looking forward to the series, which will start on, I think we said the 26th. That's right Tuesday. Tuesday, May 26th, 1 o'clock.

Looking forward to those as well. Thanks so much, Caroline, for your time. Thank you.

Thank you, everyone, cheer you. Thank you, bye bye.