Jeremy Mantell, Chairman of the British Equine Veterinary Association’s working party on the review of the pre-purchase examination (PPE) of horses explains the current situation.

The veterinary examination of horses prior to purchase was first formalised in 1976 by the British Veterinary Association and the Royal College of Veterinary Surgeons who issued a joint memorandum, subsequently revised in 1985. This introduced the idea of the five stage clinical examination and subsequent report and laid down a protocol of minimum requirements for such an examination. By and large this technique has stood the test of time well but in 1999 BEVA, with the encouragement of the Royal College and of the Veterinary Defence Society, formed a small working party to review the procedure and to make recommendations for any changes, if required.

Veterinary surgeons have been advising on the suitability of horses for purchase for generations and it is to the credit of our forefathers and of the profession at large that the phrase “to vet” has entered common usage to indicate a thorough examination of a subject. One can only speculate how the phrase “to doctor” came about.

Since 1976 certain techniques involved in the clinical examination of horses have changed as have the availability of the various diagnostic aids. Perhaps as importantly the expectations of the horse owning public have also changed as have their level of experience and expertise.

Initially the working party invited comment from members of the profession both through BEVA’s own publications and through the Veterinary Record. Additionally, and perhaps uniquely, we also invited comment from the horse owning population by a letter to Horse & Hound. Sadly, this elicited very few responses (perhaps they are generally very satisfied with the system?) and the one that sticks in my mind is the letter from a dealer in Devon who complained that “it was insulting that vets should examine her horses as she only sold ex-racehorses which by definition are able to gallop soundly”. By and large the profession responded that the system still worked surprisingly well several decades on and, in general, “if it ain’t broke don’t try to fix it”. The working party agreed with those views but also felt that there is some scope for fine-tuning.

Most of the problems and claims associated with the pre-purchase examination of horses come down to communication, or lack of it. No article on the vetting procedure would be complete without reiterating the vital importance of discussing the purchaser’s requirements fully both before and after the examination. It is an essential theme of the examination that it is designed to advise the potential purchaser of the suitability of that particular horse for their chosen use as it stands on that day. We are not any longer advising about its general “soundness” for any role.

The aim of the pre-purchase examination was defined in BEVA’s Manual of The PPE in 1998 and it is reiterated here without apology. “The aim of the PPE is to carry out a thorough and complete veterinary examination of the chosen horse and to identify and attempt to assess those factors of a veterinary nature that may affect the horse’s suitability for its intended use, so that the prospective purchaser may make an informed decision as to whether or not to proceed with their chosen purchase”.

The manual is a particularly useful guide to the various aspects of the examination being made up of the series of chapters by experienced practitioners discussing everything from radiography to the respiratory system. In the U.K. the vetting procedure is still very much a full and thorough clinical examination upon which the attending vet bases his opinion. Unlike some other countries where a checklist format is used and the purchaser is encouraged to draw his own conclusions, the British approach has always been that the client deserves the considered opinion of the examining veterinary surgeon based on his knowledge, expertise and experience. This was one of the considerations in the review but we have come to the conclusion that the opinion remains a fundamental tenet of the vetting procedure in this country. Whilst there may be some benefit in a check list type format the opinion of the working party at the moment is that it is best used as an aide memoire to formulate the procedure rather than the report.

Other issues that have had to be considered in view of progress in their field are radiography and other ancillary aids, warranties and previous medical histories, blood and other laboratory tests, flexion tests and lunging on a hard surface in a small diameter circle.

At the present time warranties are a matter between the vendor and the purchaser and outwith the responsibility of the veterinary surgeon. However, an argument has been made that the examining vet should at least bring to the attention of the purchaser and encourage the vendor to provide certain warranties and we are currently looking at the viability of a standardised warranty form being available to run adjacent to the prepurchase examination. This could, for example, provide information about vices, allergies, and temperament, etc as well as previous medical and surgical history.

The use of radiography, ultrasound, endoscopy or other ancillary aids will, of course, depend on the specific circumstances of the individual horse. As a general rule these should be used only as an aid to diagnosis rather than as a screening procedure and it is the opinion of the working party that these are more suitable as “add ons” rather than as a standard part of the procedure. Purchasers and indeed insurance companies should be aware that radiography, in particular, may result in more questions being asked than answered.

The value of a pre-exercise blood sample tested for routine haematology and biochemistry as a screening technique is, we believe, best left to the judgement of the attending vet. However, the working party believes strongly that the taking of a blood sample for subsequent medication analysis is to be encouraged; this acts both as a deterrent and as a fail safe mechanism should things go wrong. The scheme currently organised by the Veterinary Defence Society is commended.

The questions of flexion tests and of small diameter lunging on the hard elicit strong responses on both sides of the debate. After much consultation the working party have come to the conclusion that the best way forward is to encourage these techniques but certainly not to make them mandatory. There will be many occasions due to, e.g. the age of the horse, the competence of the handler, or the suitability of environment where these techniques are inappropriate and indeed could even be dangerous. However, we believe that they should be considered and specifically rejected in the circumstances rather than being mandatory. The over-riding principle when using these techniques should be more to exacerbate or confirm a suspicion of abnormality that has already been detected rather than solely to act as a screening technique in an otherwise normal horse. That said there will inevitably be variations in the degree of acceptable normality with these techniques depending on the age and type of horse involved and it will be up to the attending vet to make a balanced judgement on their acceptability rather than to take an all or nothing view. Again, as a general rule an asymmetric response on either side of the body is likely to be more significant than minor variations which are symmetrical.

There is now a body of opinion that says that the PPE should provide the purchaser with an opinion on three aspects of the horse. Whilst the primary role of the pre-purchase examination is to advise the potential purchaser as to the suitability of their chosen horse, the examining veterinary surgeon should also be aware of two other aspects on which they should base their advice. These are the horse’s suitability for insurance, bearing in mind that horses that may be suitable for a specific purpose may not necessarily be suitable for insurance purposes and the affect that any abnormality that is noted may have on subsequent resale. We would urge colleagues to be aware of the increasingly conservative approach of equine insurance underwriters and would advise that the purchaser be told, if any abnormality has been noted, to agree to buy the horse subject to obtaining satisfactory insurance cover before they purchase the horse.

The working party has also considered the limited examination, also known as the two stage vetting. Although these have been around in various formats for many years it is only recently that the VDS have approved of them, provided that the potential purchaser is made aware of the limitations in advance and signs a disclaimer. These limited pre-purchase examinations do have a place but we advise caution in their use, more especially if the criteria for commissioning such a limited examination are mainly financial. There is an argument that says these are more suitable for the experienced and professional type horse owners rather than the inexperienced. An inexperienced owner on a tight budget, buying a “cheap” horse is almost invariably better advised to spend their money on a full veterinary examination to determine all the factors that may or may not affect their choice. So often such “cheap” horses carry a multitude of conditions and injuries, hence their financial value and it is just those horses that benefit more from a complete and thorough check. Similarly, young and inexperienced veterinary surgeons may be best advised to approach such “cheap” horses with caution as the balanced opinion of the relative merits of their problems may require a greater level of understanding, experience and expertise.

The working party also considered whether or not any restriction should be placed on who actually carries out such an examination. Although accepting there was an argument for this we felt that such decisions were best left to the individual circumstances and the practices involved. It goes without saying though that any veterinary surgeon embarking on such a pre-purchase examination should feel reasonably confident and competent with regards to equine experience and their ability to make a balanced judgement on any abnormalities found. Those with as yet limited experience are advised to continue gaining experience, to read the BEVA manual and to enrol on the BEVA/Fort Dodge pre-purchase examination training day.

It is anticipated that the formal review of the pre-purchase examination will be completed soon and they will be published before BEVA’s annual Congress which is to be held this year in Birmingham from 10-13 September 2003. Further details are available from BEVA at 5 Finlay Street, London SW6 6HE, (www.beva.org.uk)

Reproduced by kind permission of The Editor of The Veterinary Review