AFJ rebuttal

I thought Tom's response was appropriate.

Below is the letter I wrote to the American Farriers Journal.

I wrote it in response the a letter titled "Oops! There's a veterinarian in the room."

Ray, FYI, the AFJ cannot give you permission to publish the entire vet letter. Copyright remains with the author of the letter. If you get permission from Dr. Frederick, I will post his entire letter here in .PDF format. But I have already quoted the pertinent parts of what the doctor wrote in my letter, which is allowed in copyright law under "fair use."

As the author of the text that follows, I hereby give permission to anyone and everyone to share it on other forums or web sites as long as it is shared in it's complete form without editing.

“Oops! There's a critical thinker in the room . . .”

I felt compelled to write a rebuttal to some of the assertions made in a letter from Michael A. Frederick, DVM regarding vet/farrier relations in the April 2014 issue of the American Farriers Journal.

In a room full of farriers bashing unethical behavior from veterinarians, I can understand how the cognitive dissonance must have been unbearable for Dr. Frederick. So I am grateful that he wrote a letter which codifies the arrogance and common ignorance that is the root cause of the problem. I have often suspected that some veterinarians actually think this way, but were never willing to put it in writing where it could be challenged. Bravo! Now I have an example of the problem and a chance to publicly question the smoke screen of veterinary authority over farriers.

In that letter Dr. Frederick asserts, “Veterinary practice acts are specific; if a veterinarian is involved with a horse's care, he or she is the team leader and has the ultimate responsibility for the treatment plan.”

Actually the horse owner is the team leader and they decide who gets to work on their horses. Is Dr Fredrick suggesting that the veterinarian's malpractice and liability insurance covers the farrier? Usually a veterinarian's insurance only covers the veterinarian and his or her direct employees. Most farriers are self employed, independent professionals who contract directly with horse owners. Veterinary practice acts do nothing to protect farriers from being held accountable for their work product when a veterinarian is involved. It is more likely that the farrier will be held accountable for his or her work as well as the medical diagnosis upon which the work is predicated.

When the horse owner is the plaintiff in a law suit over the outcome of the “treatment plan,” will the court hold the veterinarian liable for negligence or malpractice and dismiss all claims against the farrier who executed the treatment plan? What if the veterinarian should testify that the farrier erred in executing the treatment plan? Will the court take the word of a farrier over the word of a “doctor?”

Dr Fredrick's letter continues with, “If you are presented with a “shoeing prescription,” your options are to follow the prescription or not shoe the horse.”

Actually there is another option. The idea that a horse owner should pay a non-farrier to tell a farrier how to do his or her job is patently absurd. Although the horse owner may not see this epistemological conundrum at first blush, the farrier should approach the owner calmly and rationally and lead them to see the truth. Simply explaining where the lines of authority, accountability, and liability are drawn is usually all it takes to get the horse owner to authorize the farrier to use his or her own judgment.

A farrier has a duty of care to use his or her professional judgment and the ethical obligation to disregard anything prescribed by a veterinarian that may be harmful to the horse. The prescription is the veterinarians opinion and it creates no accountability unless the veterinarian shoes the horse.

The owner has the final authority to choose who shoes their horse. If they feel the veterinarian is better qualified to make the all of the shoeing decisions, then they should have the veterinarian shoe the horse.

A shoeing prescription does not absolve a farrier from liability. On the contrary, it diverts liability away from the veterinarian and forces the farrier to assume all of the risk.

And then Dr. Frederick prescribes, “Never put the client in a tug of war between the veterinarian and farrier. Let's make this a team effort.”

As I have outlined above, the owner can make an informed, rational choice without being placed in a “tug of war.” But a shoeing prescription has nothing whatsoever to do with team work.

When a veterinarian is called upon to diagnose a lameness problem, the first principle of medical diagnosis is “get a history.” Considering the fact that the attending farrier may work on a given horse anywhere from 6 to 10 times a year, it ought to be obvious that it is the farrier who has to most intimate knowledge of the animal's baseline of comfort and performance. Yet many veterinarians short change the diagnostic protocol by performing a diagnosis and prescribing treatment without ever consulting with the attending farrier. And yet farriers are expected to respect a veterinarians who violate the precepts of diagnosis in this way? If a veterinarian does not do their own job correctly, what business do they have telling farriers how to shoe horses? Why should farriers tolerate such hypocrisy?

Dialog must flow freely between veterinarians and farriers in order for each professional to take advantage of the experience and expertise of the other. Dialogue begins when a veterinarian engages a farrier in a discussion about the animal's history.

The responsibility and the risk is shared equally between the veterinarian and the farrier. Each depends on the other for critical decision support information. The best outcomes result from working relationships where mutual trust and respect develops as the result of professionals supporting each other in collaboration.

A shoeing prescription:

1. Is a reprehensible scam used by unethical veterinarians to swindle money from low information horse owners.
2. Fraudulently represents the veterinarian as having expert knowledge of horseshoeing when in fact very few veterinarians can proficiently demonstrate such knowledge by getting under a horse and executing their own prescription.
3. Creates the false pretense that the farrier is incompetent to decide how to do what they do for a living.
4. Makes the farrier accountable for the outcome of the prescribed treatment regardless of the accuracy of the medical diagnosis.
5. Eliminates the tactical advantage that a farrier would normally have to make changes and adjustments during the shoeing process based on feedback from the horse.
6. Erects a facade between the veterinarian's accountability for a good diagnosis and the validity of the treatment decisions whereby the farrier becomes the fall guy for a bad result and the veterinarian becomes the hero for a good result.

Many horse owners are credulous enough to fall for this scam and impose the shoeing prescription on the farrier as a condition of the service contract.

Communication between professionals stops when a veterinarian commits the “assault” of the “shoeing prescription.” A veterinarian that is so arrogant to dismiss the farrier's prerogatives and invoke this fraudulent pretense of authority over a farrier deserves no respect. If the veterinarian refuses to be cooperative in regards to communication and resorts to dictating instead of dialog, the farrier has a civic duty to call out the veterinarian on the grounds of unethical conduct and to inform the owner of the breech in writing. The only way this kind of repugnant, adversarial, unethical behavior is going to stop is if farriers and veterinarians stop enabling it. While I can agree that things need to improve in how veterinarians and farriers interact, I put the burden of improvement on the unethical veterinarians.

If Dr. Frederick wishes to discuss this topic further, I will be happy to engage him in a public debate in front of the attendees at next year's International Hoof Care Summit.

Tom Bloomer, CF, RJF

Very well written Tom.

Tom I have read this a couple of times , once in the magazine and then on this forum.
I wonder how many farriers would be able to follow your lead...

Unless the Veterinarian has a bad reputation already.
For many farriers the opportunity to work with a Veterinarian can mean better stature in the public's eye and more work in the local horse community.

Also how many farriers have the knowledge and ability you have to present such a case to the horse owner or defend his/her actions to others who question what he/she did.

As with anything there needs to be leaders who set the path and I believe your letter is or can build such a path.

You touch on many aspects in your letter of importance.

Your offer to debate/discuss at the IHC could present a good forum due to the large amount of attending farriers from all over the country .

Information of this type, will start at the top and will gradually feed down to the less educated farriers working in the trenches.

Education in this trade isn't only about working on horses....The adage that farriers wear a lot of hats should also make farriers realize they need to be just as educated in all the fields these hats represent.

Thanks Tom

my 2 cents worth

Bruce, I've run across some vets who seem to have "pet farriers" who will do whatever the vet says without question. They see lots of lame horses over and over again - the horses never get sound. And their customers think they are lameness experts because of it.

I sent Dr. Frederick a copy via email. Never got a response.

I wouldn't have expected you to since we are all just supposed to bow down to the "team leader". This guy was talking out both sides of his face while he was attempting to make point #5 in his afj letter.

P.S. Tom, you are a genius with the written word

I find that most of the time if I am working on a horse with a vet, there is followup work that the owner will be taking care of. This requires the owner to be part of the "team". Also it is the professional thing to do to keep the client as an integral part of the treatment plan. Any case is really a puzzle where the owner, the vet and the farrier are the pieces. If one piece is left out the puzzle will not come together. I don't think any one of the three is more or less important than the other two.

I got the email address from this web page.

http://www.bbb.org/cincinnati/busin...itown-pet-hospital-inc-in-cleves-oh-36003121/

Well said Tom. Power to ya. I would also like to mention that it was a farrier that told me about pergolide, which provided effective medical treatment for the condition that caused my older mare to founder 3 times. NOT any of the 3 vets who threw up their hands and suggested euthanasia. Thanks to all the farriers who accept the responsibility to learn the whole Big Picture, because they are in this to help horses, regardless of whose ego gets bruised. There are still places in the USA where large animal vets still spend most of their time with their arms inside a cow.
Katy

Very well written Tom. I commend you for your way with words and the ability to set the record straight. I've been lucky over here in the aspect I have vet with whom I work, and not being told how to do my job. Those I've worked with many times will come up with plan A, sometimes I will come with plan B, sometimes we come up with plan C. I've also been presented once with a vet that told the owner I knew more about the hoof, so my call was best.

As Tom stated, the Team Leader has to be the owner as they are the ones paying the bills and have the last word!

I haven't seen anything, Mr. Steele.