15/06/2023
Saved from an un-necessary syringe of euthatal – how Chat GPT did a better job than the APHA and a Veterinary Surgeon.
**BEFORE READING FURTHER PLEASE BE ADVISED THAT I WILL REMOVE/HIDE ANY OFFENSIVE COMMENTS ABOUT THE VETERINARY PRACTICE - WE ALL NEED TO LEARN FROM THIS ERROR AS IT COULD HAVE HAPPENED TO ANY VETERINARY PRACTICE DRIVEN BY A EUTHANASIA ONLY BASED APROACH. LETS FOCUS ENERGIES ON MOVING FORWARD INTO THE NEW ERA OF COMPASSIONATE, EBVM-BASED CARE AND WORK WITH THE VET PROFESSION TO DELIVER THIS**
Three weeks ago owner X got the news from her vet that one of her two healthy Romanian rescue dogs had tested posted for Brucella canis (positive on the iELISA test), despite being in the country for several years. She was informed that all the veterinary practice would now offer was euthanasia and she was warned about the dangers to public and canine health.
The owner was devastated. She ran a canine business from home with dogs and humans visiting daily, and had an elderly relative in the home. While she decided what to do she moved her elderly relative out of the house and cancelled her many clients. Over this period we had several conversations and she reached out to both myself and others trying desperately to search for answers, explanations, and possibilities for false positives.
Finally, she accepted that she had no choice but to euthanase her dog in the light of her personal circumstances and now lack of ongoing veterinary care for her dog. She booked her dog in to be euthanased on Monday 23rd May.
Two days before she sent me the lab test results and when I looked at them I realised that there was an unusual anomaly between the quantitative result and the qualitative result. The qualitative result said ‘positive’ but the quantitative result implied not only a negative result, but also that the dog had absolutely no evidence of Brucella canis antibodies whatsoever in the blood sample. In fact, it was a minus figure (- 0.08)!
I flagged immediately to the owner that these results were problematic, told them what the boundaries of an iELISA range are (0 – infinity), and what the cut off for a positive result was (1.47 and higher).
I advised them to cancel the euthanasia and discuss with their vet but if they had any issues I would call the vet or source them an alternative vet. The owner then asked Chat GPT (an artificial intelligence tool) which also confirmed that this result was an anomaly!
Yesterday they contacted their vet who agreed to contact APHA. APHA looked at the results and confirmed this was a manual error mistake by their laboratories, and have now re-issued the results showing a negative result. The owner is still waiting for an apology from APHA, receiving only a matter of fact ‘lab correction’ email.
So….
What can we learn from this?
• Fear based medicine can cost lives and reduces the likelihood of vets showing due diligence. Anomalous results can and do occur. In fact, one laboratory (not APHA) got an estimated 39,000 potentially life threatening results wrong (https://www.gov.uk/government/news/ukhsa-publishes-investigation-findings-following-errors-at-the-private-immensa-lab?fbclid=IwAR1cnKC2J6nmBpiEPM3Ad3C2_riTOYFiafwLe9pefnvPOal-R0NVurH30iQ)
• That the APHA need to immediately improve their quality assurance processes at their laboratory.
• It is critical that (as I have been calling for since the start of this campaign!!!) that APHA publish publicly and on their lab result forms:
1. The parameters of the iELISA test (0 – infinity)
2. The threshold for a positive result (1.47 and above is considered positive)
3. The parameters of the control group used to validate their test (roughly ends about about 1.60).
4. That they do similarly for their other tests.
• That middlemen laboratories being used (e.g. IDEXX, FINN, Veterinary Pathology Group, etc) are supplied with this additional information and that they also REPORT this on their lab result forms.
• That a lack of critical control points to check and recheck for errors at multiple points of the process could have cost this family their family member’s life, and this owner her business.
I will not be naming the veterinary surgeon or the veterinary practice involved in this situation (before anyone asks). Errors happen, and I understand that the practice is reviewing their processes as a consequence. The important thing now is that a significant event audit is undertaken and the practice learns from this situation.
I only hope this also includes a review of the necessity of recommending euthanasia and withdrawal of veterinary care, and a recognition that their callous (‘positive means positive’) approach to client and patient care nearly had a catastrophic outcome.
And just to flag further : by flagging this to the owner and interpreting their lab test result I would have also been in violation of my veterinary nurse professional code of conduct. Had I still been a registered veterinary nurse! It’s not my role as a vet nurse to interpret a patient’s results. I should just smile sweetly and give it to the vet to do their vetty thing 🙈
It’s ludicrous, and the veterinary nurse professional code of conduct is not fit for purpose. In reality, vets and vet nurses absolutely work together on things like this to ensure that this kind of thing does not happen! RVNs are often involved behind the scenes in discussing and interpreting clinical information to help the vet reach a diagnosis- we often have already reached the diagnosis/have a pretty good idea what that diagnosis will be in our heads which is why we have alerted the vet that there is an issue or prioritised one patient’s examination over another. The boundaries between clinical sign spotting and diagnosis are often pretty murky.
It is exceptionally unlikely I would have faced a disciplinary, but the reality is that I would have been in violation of my professional code of conduct 🙈😬
Please note: ChatGPT is not a regulated professional and free to say what it likes so long as it isn’t rude or offensive 😂
