With over 15 years’ experience in general practice, a diploma in veterinary dermatology, numerous publications to her name and as one of only a handful of veterinary dermatologists recognised as specialists by the Royal College, Anita Patel has run her own dermatology referral practice for the last 10 years, seeing cases from all over the South East of England.
In this exclusive interview, Anita gives her opinion on everything from how vets in practice could improve their approach to dermatological dilemmas to the challenges of being a referral vet.
Why did you decide to specialise in dermatology?
When I was an undergraduate – which seems like a lifetime ago – we didn’t really get much teaching on skin conditions at all. So when we qualified, and were faced with at least 30 % of all consults being skin cases, all we knew how to do was to use steroids to control the symptoms. The over-dependence on, and inappropriate use of, steroids was something I wanted to change. Dermatology is also one of the most rewarding disciplines as you can make such a huge difference to both the animal’s and the owner’s quality of life.
How has dermatology changed since you’ve been practicing?
We’ve made huge leaps forward in the last ten to 15 years, with advances in research, the variety of medical products on the market and a general improvement in education and awareness. There’s a much greater emphasis now on proper diagnosis rather than symptomatic treatment. The types of cases that we see have changed a lot too – whereas I used to see a lot of parasitic diseases when I was first in practice, nowadays we see a fraction in comparison. For example, serious cases of sarcoptic mange are few and far between now.
What do you think has been the catalyst in the progression?
I think client education and the advent of new, easy to use anti-parasite products have played a key role. You can imagine how tough achieving compliance with the topical sprays (which were all we had available to us) was – especially for cats! The fact that one product now can tackle a whole range of issues is also really to our advantage as clinicians. For example, clients that use Advocate to treat regularly for lungworm will also be addressing a number of common endo- and ectoparasites at the same time. Thankfully, nowadays products are aimed at being user-friendly as well as effective.
New research is also obviously a key driving factor and it’s easy to forget how recently some key pieces of knowledge have come to light. For example, we never really used to treat pyoderma effectively and it’s only really been within the last 15 years or so that Malassezia dermatitis came on the radar.
Why did you decide to set up your own referrals business?
I love the independence and as I am used to working alone, that aspect didn’t scare me. I began seeing referrals while I was still in practice and realised there was a huge demand so it was a natural progression. While for some conditions you might refer for a specific diagnostic test, such as an MRI scan for a suspected neurological problem; but in dermatology, it’s all about experience and expertise, which I find really rewarding.
How does it compare to working in general practice?
There are pros and cons, just like any job. I miss the variety of general practice and having that case continuity with regular clients but I love the challenge of the extreme cases that referral work offers. Skin cases require a lot of time and attention which, as a referral vet, I can give. However, often by the time a client comes to me, there may not be much financial budget left which can be frustrating.
Having my own business also throws up its own challenges – it would be great to have someone to cover for me during the holidays, instead of taking my own calls, although luckily there aren’t usually many
What’s the most common condition that is referred to you? Definitely allergies!
….and which conditions do you find the most challenging to treat?
Autoimmune and neoplastic conditions are often tricky and many ultimately have a poor prognosis. A big challenge generally is financial constraints. However, even if you can’t do everything you’d like to, you can generally improve the condition by managing it conservatively. If you’re savvy with how you manage the condition, you can usually spare the level of steroids needed.
Is there a common mistake that you see vets make in practice?
Many vets forget to do the simple things first – the big one being not skin scraping before performing serum allergy tests. This can waste an awful lot of the client’s money. Vets should also always look at the scrapes themselves as once samples reach the lab the parasite may have wandered off. There is also still too much reliance on certain medications – by focussing on solving the primary problem vets can reduce the use of antibiotics as well as steroids, which is becoming increasingly important.
If you had to give vets three pieces of advice about approaching dermatological cases in general practice, what would they be?
- Do the simple things first – there’s an awful lot you can do with some tape, a scrape and a microscope! In fact, the latter is by far the dermatologists’ most important secret weapon and I believe it’s the most underused piece of equipment in practice.
- It’s all about the history – even signalment alone can tell you a lot so if you’ve got a new skin patient, get clued up before the animal enters your consult room. It’ll really help you narrow down your differentials.
- Don’t do the diagnostic test if you’re not confident in how to interpret it – if you’re unsure, it’s always worth seeking help before embarking on potentially costly diagnostics. Skin disease often requires long-term financial commitment and clients really appreciate prudent use of their funds. Early referral is always preferable as it means that the underlying condition isn’t complicated by secondary disease which can be really hard to get on top of.
What do you find most satisfying about treating dermatological cases?
There’s nothing better than getting clients to understand how to manage their animal’s condition correctly. If you can achieve this then the quality of life for the animal can be improved beyond all recognition.
Do you have any tips for vets struggling to overcome compliance issues with their clients?
Give them more time – at least 30 minutes for a new client. If you talk to them and explain, clients will almost always comply. It’s all about communication. Many of my clients tell me that they were dissatisfied with the fact that every time they visited their veterinary practice, they saw a different vet – so case continuity is clearly key.
Tell us a little more about your telemedicine service..
If a client can’t afford the full referral fee or vets just need a little advice, the latter can get in touch with me for some support. They can send me pictures, the case history and the clinical notes and I will put together a tailored report and some action steps for them.
Are there any advances in veterinary dermatology that you are particularly excited about? There are some really great new ectoparaciticide products which have come to market recently and a new cost-effective ciclosporin which I think will make a huge difference to the profession. Who knows where we will be in 20 years’ time though – just look at how far we’ve come in the last decade.
To find out more about Anita, her business or for referral information, visit http://www.dermatologyreferrals.co.uk/index.htm