148: Is the Veterinary Business Model Failing Our Patients? A Frontline Perspective From a Top UK Charity. With Dr Paul Manktelow
“If you can’t afford a pet, you shouldn’t own one.” Ever said this line?Once you’ve been on the receiving of someone’s anger about the cost of their vet bill, it’s an easy thought to have. But it’s not the whole story, is it?In this episode, I sit down with Dr. Paul Manktelow - a veterinary surgeon with 20+ years in UK animal charities and current Director of Veterinary Services at Blue Cross. Dr Paul shares lessons learned in not-for-profit vet care to help us untangle that tension between care, compassion, and commercial reality.We cover:Trends from the front lines in the charity sector How “affordability” is shifting under rising cost of livingDecision-making tools that balance optimal vs achievable careBusiness models that either enable or block access to careHow vets can approach financial conversations with clarity, dignity, and trustYou’ll learn about:💡 “Pragmatic care” as the antidote to chasing the mythical ‘gold standard’💡 Cost-based vs value-based pricing models 💡How to think in tiers of care—and where the limits lieBecause behind every clinical decision is a human one.Find out how we can help you build you in your vet career at thevetvault.com.Check out our Advanced Surgery Podcast at cutabove.supercast.com. Get case support from our team of specialists in our Specialist Support Space.Subscribe to our weekly newsletter here for Hubert's favourite clinical and non-clinical learnings from the week.Join us in person for our epic adventure CE events at Vets On Tour. (Next up: Japan snow conference!) Topics and Time Stamps03:11 Balancing Costs and Care in Veterinary Practice06:45 Challenges and Changes in the Veterinary Profession11:41 Client Expectations vs Financial Realities16:32 The Impact of Economic Hardships on Pet Care32:16 Blue Cross's Model39:10 Individual Responsibility in Veterinary Practice42:54 Getting Clear on Quality of Life and Prognosis47:23 Cost-Based vs Value-Based Pricing Models01:10:05 Pragmatic Care and Clinical Guidelines01:16:54 The One Question
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147: What I Got Wrong (And Right!) About AI in VetMed: A Software Engineer Sets Me Straight. With Rohan Relan
In episode 141, I shared my take on where AI fits into veterinary medicine - and where it might take us next. But I’m no expert.So I brought one in.In this episode, I sit down with Rohan Relan , Silicon Valley software engineer and founder of ScribbleVet ,an AI tool built for vets. We unpack the promise and pitfalls of AI in clinical practice and try to figure out how you can use it without losing sleep (or your license).What we cover:Why AI is not just a "smarter Google”- and why that mattersThe risky shortcuts vets are already taking (and how to avoid them)How to increase trust and accuracy when using AIWhere innovation collides with privacy, data, and consentDIY AI vs purpose-built tools If you're curious about AI but not sure what’s hype and what’s helpful, this one’s for you.Come find out what W(asabi)TF Wednesday is all about at our Japan Snow ConferenceCheck out our podcast for business owners, and Dr Sam’s ‘How To Make A Hell Of a Profit And Still Go To Heaven’ workshop.Join our community of Vet Vault Nerds to lift your clinical game and get your groove back with our up-to-date, easy-to-consume clinical episodes at vvn.supercast.com.Get help with your tricky cases in our Specialist Support Space.Visit thevetvault.com for show notes and resources related to this episode.Subscribe to our weekly newsletter here for Hubert's favourite clinical and non-clinical learnings from the week.Topics and Timestamps04:39 What I got wrong about AI08:19 How models “know” things — next‐word prediction & reasoning15:00 Grounding AI responses using external tools / search19:19 Scribble Vet features38:12 Privacy, ownership, and AI liability51:00 Rohan’s podcast and AI tool recommendations54:00 Key misconceptions & Caveats
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PIMA: The Anaemia That You Didn’t Know About, But Really Should. With Dr Cynthia Lucidi and Dr Claire Sharp. Bonus - Live at IVECCS
Today’s bonus IVECCS live session wasn’t your average ‘clinical 101’. I had the absolute privilege of getting two brilliant minds on the yellow couch, and … wow. Apparently 1 + 1 = 🤯 !!Clinical pathogist Dr Cynthia Lucidi joined me to unpack her talk on Diagnosing Ineffective Hematopoiesis. If you’re a bit lost with that title - don’t worry, so was I! So I brought backup: ECC legend Dr Claire Sharp joined me to ask the smart questions, and together, they cracked open a topic every GP and ECC vet needs to understand: PIMA – Precursor-Targeted Immune-Mediated Anaemia. (If you’ve ever managed an anaemia case that almost looked like IMHA but just didn’t quite fit, or just an anaemia that didn’t want to fit into ANY of the boxes, it was probably this!) This one started out GP-friendly, but with two minds like these-it escalated fast. Expect specialist-level gold. You’ll want to give this one your full attention. But I promise - it’s worth it!What we cover:Defining ineffective haematopoiesis and how it differs from hypoplasiaDiagnostic criteria and differentials for PIMA vs. IMHAImportance of timing and interpretation in persistent non-regenerative anaemiaWhy bone marrow aspiration is underused and how to perform it effectivelyPathologist tips on identifying spherocytes and phagocytosis artefactsChallenges of diagnosing IMHA and PIMA in catsRole of transfusions and crossmatching in long-term PIMA managementTimeframes for response and remission in PIMA treatmentWhen to consider splenectomy for refractory casesClinical significance of myelofibrosis in dogs with PIMAEducating clients and general practitioners on prognosis and referral timingClick here to access all of our clinical content at IVECCS special rates.
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Antibiotic CRI’s: Better Than Bolus? With Prof Steve Epstein. Bonus - Live At IVECCS
If you caught my conversation with Prof. Steve Epstein from IVECCS 2024, you already know this:When it comes to septic patients, timing of antibiotics is everything. Ok, maybe not EVERYTHING, because in our follow-up discussion 1 year later at IVECCS 25, Prof Steve explored an idea that might just shift your ICU protocols: duration of administration matters. That’s the idea behind the concept is prolonged infusion - giving time-dependent antibiotics over extended periods for more sustained bacterial kill time. (Spoiler alert: it works. BUT...with a few caveats.)Jump in to this one for a straight-forward data backed action you can take with your critical patients that will save more lives.Topics We Unpacked:Time-dependent vs. concentration-dependent antibioticsProlonged infusion vs. continuous rate infusion (CRI)Human evidence: findings from the BLING III trialApplicability of human data to veterinary patientsDosing challenges and pharmacokinetics in septic animalsPractical recommendations for veterinary ICU settingsClick here to access all of our clinical content at IVECCS special rates.
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Why Are We Still Euthanising Blocked Cats? (And What You Can Do About Tt — Even On a Budget). With Dr Corey Fisher. Bonus - Live at IVECCS
We’re live at IVECCS! For the next few days we’ll be sharing some highlights from our favourite recordings with the fabulous speakers, where we get to the best bits from their talks at IVECCS, the premier conference for emergency and critical care veterinarians, technicians, practice managers, and students. If you’ve worked in vet practice for more than a minute, you’ve seen it:A cat comes in, blocked and in pain.You know the treatment.The owner hears the estimate.And just like that — a treatable case turns into a heartbreaking goodbye.But what if there’s a better way?In this eye-opening talk, Dr. Corey Fisher breaks down practical, evidence-based protocols for managing feline urethral obstruction (iUO) without breaking the bank.He draws on peer-reviewed research and ongoing clinical trials to bust some myths about fluids, catheters, and cost.Most importantly?He’ll show you how to tailor treatment to the client’s budget while still delivering acceptable clinical outcomes.What You'll Learn:Recurrence rates and euthanasia risk in feline urethral obstructionThe surprising data behind 8-hour catheter protocolsTo flush or not to flushHyperkalemia management: hold the insulin!Should you perform decompressive cystocentesis? The evidence says...The most cost-effective pain relief Fluid therapy without the fluff: shorter staysThe meds we use that we shouldn’tThe truth about urinalysis and prescription diets: essential or optional?This isn’t just theory — it’s a mindset shift.Whether you're in a high-end clinic or resource-limited practice, you’ll walk away with real tools you can use today to improve care and protect your patients from unnecessary euthanasia.Click here to access all of our clinical content at IVECCS special rates.
About The Vet Vault: Fall In Love With Veterinary Science
Vet life can be tough—but it’s also good. So, how do we make it even better? Join inspiring conversations with veterinary trailblazers who share real stories, fresh ideas, and strategies to help the talented, passionate humans (like you!) who make up the veterinary profession thrive—in work and in life.
Hosted by Dr. Hubert Hiemstra, a veterinarian with over 20 years of experience and a passion for helping vets build happier, more fulfilling careers. Hubert brings warmth, curiosity, and a knack for asking the right questions, creating a space where the best ideas in vet med come to life.
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