Charging for whelping advice

Re: Charging for whelping advice

Clive Ansell — Tue, 24 Jan 2012 12:19:24 GMT

It is essential to have a weight. Advocate for example should not be used on puppies of <7 weeks and <1.0 kg (or based on a risk-benefit assessment).

Imagine the scenario; you prescribe Advocate without seeing someones prize £1500 heap of genetic mistakes puppy. It dies 24 hours later, which may or may not be related to the drug, and is only 6 weeks old and only weighs 0.9Kg. Any claim against you is going to be so much more difficult to defend if the puppy has never been seen and weighed.

The terms "thin ice" and "covering ones bottom" spring to mind.

Re: Charging for whelping advice

James Laidlaw — Tue, 24 Jan 2012 12:06:53 GMT

Also with milbemax and frontline combo/advocate/stronghold etc - it helps to have a weight, and best they come into the clinic to do that - then at least you can put that on the record with their free consult so you know what amount to dispense.

Re: Charging for whelping advice

Clive Ansell — Tue, 24 Jan 2012 11:39:50 GMT

[quote user="Michael Woodhouse"]

[quote user="Gillian Mostyn"]

I would never be able to consider a stray animal to be under my care.

Well I am referring to any POM.

[/quote]

So a new puppy can't have a Milbemax before you've seen it? Holidaymaker can't have some Frontline Combo for their dog?

By establishing they have a pet I can satisfy myself that I have sufficient information to prescribe the above.

[/quote]

I would not dispense a POM-V to an animal that has never been to the practice, I think common sense would dictate that a pet animal needs to have at least been seen and its existence verified, different for a sheep which one of 500 of course. It need not be a full veterinary consult and examination, just a quick check, or a check appt with a VN to at least say it is outwardly healthy and record its weight. As has been pointed out already, use it as an opportunity to discuss vaccines, neutering, diet, insurance etc etc.

Had a whining client yesterday that was unwilling to pay for a repeat prescription check for ongoing Felimazole claiming she "couldn't get to the surgery", but she was able to get there to collect the tablets though??? Same with the milbemax and frontline combo above, if client is coming to collect the drugs, they can bring their pet with them.

Re: Charging for whelping advice

Malcolm Ness — Tue, 24 Jan 2012 11:21:39 GMT

Two key facts here:

1. If push comes to shove, it is the individual vet who must prove, beyond reasonable doubt, that the patient was "under their care". Remeber that in England, the legal system is adversarial so "the benefit doubt" doesn't exist.

2. The care must be real and not just nominal is written into the legislation. It is difficult to see how a quick 'phone call giving exclusively reported and unsubstantiated information could ever be considered "real" rather than "nominal"

Re: Charging for whelping advice

Lorna McHardy — Tue, 24 Jan 2012 10:24:47 GMT

[quote user="argyro koukouseli"]

imagine that i tend to work with only resposible and reliable owners.....

[/quote]

<dream mode on> that'd be sooooooooo wonderful <dream mode off>

I'm a little jaundiced about owners this week, having just had a night where the 1.30 and the 4.30 both - being all worried and panicky, you see - turned up without their purses and, having left full of praise and thanks and promises, announced two days later that alas, they could not settle their bills just now.... and then one who phoned explaining that he needed his grazed dog seeing this rainy sunday, but had no money to pay for it now or ever. I was sufficiently annoyed by then to point out to him, politely, that is was his responsibility to finance his dog's care, whereupon he got very indignant that I should say such a hurtful thing to him, and slammed the phone down.

Although to be fair... the vast majority of owners are responsible and reliable; and polite and friendly as well. It's just that the others take up so much room in your head.

Re: Charging for whelping advice

argyro koukouseli — Tue, 24 Jan 2012 09:51:16 GMT

no you didnt....unfortunatelly....we do it.a lot.i know it sounds very bad but here in greece we deal with hundrets of stray animals or people with severe money probs so we do it only with antiotics or antiflamatory agents.hope that in ten years from now we will bacome a truly europian country with with owners and vets acting like you people.its not for the money.sometimes its also the only way to try and help the animal living in an island and we are as sure as possible that it the medication wont worsen the condition.i konw it sounds like malpractice and maybe it is but sometimes it gives the animal time until someone finally takes responsibility and bring the pet.things are quite unbelivable hare and imagine that i tend to work with only resposible and reliable owners.....

Re: Charging for whelping advice

Kate Richardson — Tue, 24 Jan 2012 09:24:10 GMT

Same here- free health check for all new animals to the practice if they just require anti-parasitics. After all you do need to weigh them- most owners have no idea how heavy their dog is.

Re: Charging for whelping advice

Hanna Bennett — Tue, 24 Jan 2012 09:11:20 GMT

I'm with Gillian on this one. We don't charge for a new pup flea or worm consult but they must have been examined by a vet before being prescribed POM. Most new puppies or kittens get by this by being vaccinated obviously but for the odd client whose pup has already been vaccinated before they register with us, we see it as an opportunity for our VNs to bond the client to the practice by offering free advice on pretty much everything, and if the vet sticks their nose round to do a quick health check then that covers the GtoPC issues too.

Re: Charging for whelping advice

Mark Hedberg — Tue, 24 Jan 2012 07:36:25 GMT

[quote user="Gillian Mostyn"]

[quote user="argyro koukouseli"]save time by asking directly who is going to pay for him.Most of the time the answer is because its a stray they cant spend a lot of money or bring the dog.You tell them to come by,and give them medication to help him.Do not try to solve this on the phone.Make them come so increase chances of selling drugs or your prescription.[/quote]

From your post it sounds like you are prescribing prescription medications without seeing the animal. That is illegal in the UK so we cannot make money this way.

I'm sorry if I have misunderstood you though.

[/quote]

Maybe it's a bottle of kaolin - who knows?

Re: Charging for whelping advice

Gillian Mostyn — Mon, 23 Jan 2012 23:59:37 GMT

[quote user="Michael Woodhouse"]So a new puppy can't have a Milbemax before you've seen it? Holidaymaker can't have some Frontline Combo for their dog?[/quote]

erm...nope. Not from my practice.

Puppies and kittens get panacur - they need to come in (for a free puppy check if necc) to get a POM.

Re: Charging for whelping advice

Michael Woodhouse — Mon, 23 Jan 2012 23:58:18 GMT

[quote user="Gillian Mostyn"]

I would never be able to consider a stray animal to be under my care.

Well I am referring to any POM.

[/quote]

So a new puppy can't have a Milbemax before you've seen it? Holidaymaker can't have some Frontline Combo for their dog?

By establishing they have a pet I can satisfy myself that I have sufficient information to prescribe the above.

Re: Charging for whelping advice

Gillian Mostyn — Mon, 23 Jan 2012 23:52:47 GMT

[quote user="Michael Woodhouse"]The animal just needs to be under our care. There is no requirement in law for us to have physically examined it.[/quote]

'Under our care' is open to translation but I disagree in your assertion that an animal doesn't have to have been physically examined. The exact wording of the GtoPC is:

2H. The use of veterinary medicinal products

1. This guidance is based on current EU and UK law and published guidelines & Codes of Practice (see below)

2. The responsible use of veterinary medicines for therapeutic and prophylactic purposes is one of the major skills of a veterinary surgeon and crucial to animal welfare and to the maintenance of public health.

3. Under the Veterinary Medicines Regulations, veterinary surgeons may prescribe POM-V veterinary medicinal products only following a clinical assessment of animals under their care.

4. Failure by the profession to observe these requirements could result in the removal of the exemption for the supply of medicines by veterinary surgeons.

*************

Under his care

5. The Veterinary Medicines Regulations do not define the phrase 'under his care' and the RCVS has interpreted it as meaning that:

a. the veterinary surgeon must have been given the responsibility for the health of the animal or herd by the owner or the owner's agent

b. that responsibility must be real and not nominal

c. the animal or herd must have been seen immediately before prescription or,

d. recently enough or often enough for the veterinary surgeon to have personal knowledge of the condition of the animal or current health status of the herd or flock to make a diagnosis and prescribe.

e. the veterinary surgeon must maintain clinical records of that herd/flock/individual

What amounts to 'recent enough' must be a matter for the professional judgement of the veterinary surgeon in the individual case.

**************

I would never be able to consider a stray animal to be under my care. And it is not in a herd that may have been seen recently.

[quote user="Michael Woodhouse"]Obviously that would depend on what was being prescribed.[/quote]

Well I am referring to any POM.

Re: Charging for whelping advice

Michael Woodhouse — Mon, 23 Jan 2012 23:36:34 GMT

[quote user="Hannah Wynne Richards"]1 piece of telephone advice only-bring it in[/quote]

Or the opposite, leave it alone, stop fussing and let nature take its course.

[quote user="Gillian Mostyn"]From your post it sounds like you are prescribing prescription medications without seeing the animal. That is illegal in the UK so we cannot make money this way.[/quote]

The animal just needs to be under our care. There is no requirement in law for us to have physically examined it. Obviously that would depend on what was being prescribed.

Re: Charging for whelping advice

Gillian Mostyn — Mon, 23 Jan 2012 23:26:14 GMT

From your post it sounds like you are prescribing prescription medications without seeing the animal. That is illegal in the UK so we cannot make money this way.

I'm sorry if I have misunderstood you though.

Re: Charging for whelping advice

argyro koukouseli — Mon, 23 Jan 2012 22:37:00 GMT

my previous post had to do with giving advice generally.When it comes to whelping advice i could agree more with gillian.....

Re: Charging for whelping advice

argyro koukouseli — Mon, 23 Jan 2012 22:24:16 GMT

i became really good at handling phonecalls by watching my mentors do it!actually one of them-there is 3 of them-actually charged clients when giving advice over the phone.but most of us cant do it,so....

first of all you dont let them talk..that mutch.after letting them tell you what its all about you get to ask the questions.eg "i took goofy for a walk.you remember goufy?the white one with the two ears four legs that you vaccinated four months ago.and now he is vomitting.he did it again three years ago and my mother says its the full moon etc"

no.

i took goofy for a walk ... stop!you stop them with your most polite kind voiceand you ask the questions.age intact or not vaccinated indoor or not nutricion. and if client youact like you remember the dog even though you dont.

then you ask what happend to goofy. vomiting .then you ask the questions to decide emergency or not.if not and you are in your office working ours you tell them to bring the patient immediatly.if its 2a.m to bring him first thing in the morning bacause if they do now' they will be overcharged although its not an emergency and you dont want to do that over nothing!and then comes the key question:"cant i try doing something at home ?trying some medication?" your initial answer should be no.because even though its not an emergency,it could be a complicated condition and you wouldnt like to give goofy any medication that would hide symptoms or ever make it worse.that way you are telling them that their dog isnt going to die over night.you also worry them more so you increase chances of bringing the dog in ,you look like you are trying to save them money and you look like taking goofys situation seriously and you dont want to harm him by assuming a diagnosis.

the people who reply that they cant bring the dog,or cant afford even just a clinical examination or just want to give the dog something and if they can they ll bring him in are NOT the people you want to be your clients.And they will not call you again and its fine.

trust me on this.This way you save time and bad reputation as a doctor.You seem like a responsible good doctor.And you rule out owners that are broke.

Of course you dont do that to the owner who is a regullar or recently spend 500euros on a facture or has recommended you to all his friends.

here in greece we get a lot of "there is a dog ,a stray,i feed him sometimes and he is ....goughing anorexic whatever"

save time by asking directly who is going to pay for him.Most of the time the answer is because its a stray they cant spend a lot of money or bring the dog.You tell them to come by,and give them medication to help him.Do not try to solve this on the phone.Make them come so increase chances of selling drugs or your prescription.

Of course its not all about the money!But we earn our living by doing this job,which is often bloody smelly and scratcy!We have to be choosy on our clients.We have to push them to bring their pets for examination.We have to respect the years of hard studing, so our clients do so.We get to choose if and when your knowledge is free of charge.

sorry my spelling and english are not that good.......

Re: Charging for whelping advice

Robin Grimmer — Mon, 23 Jan 2012 17:54:19 GMT

My advice - use an OOH provider, problem solved.

Re: Charging for whelping advice

Martin Atkinson — Mon, 23 Jan 2012 17:38:35 GMT

If it was one of my regular clients I would give advice up to a point but I do tell them before we start that I'm not going to talk them through a normal whelping. If they aren't registered clients then they probably are registered somewhere else and have just been told its going to cost them a lot to be seen and are trying me, so I quote the rules on supercession and tell them to call their own vet again, if they're not registered anywhere then they probably don't have any money anyway so they will get packed off to the RSPCA hospital. I pick and choose these days whether to be on call or not and have the option of being able to tell them to call my out of hours provider who would almost certainly tell them it needs to be seen and charge them a lot but I would probably give one overall piece of advice before doing that. When I did all my own OOH I found it a hard balance between giving some advice and then trying to get back to sleep and realising I can't so I might as well have seen them and just getting up and getting on with it. 90% of bitches in dystocia out of hours are going to need a C section anyway.

Re: Charging for whelping advice

Gillian Mostyn — Mon, 23 Jan 2012 16:11:57 GMT

I ask if the dog has just started being restless and panting and, if so, tell them to leave it alone and stop fussing... unless this goes on for more than 24hrs in which case I need to see it....

I ask them if there is any green discharge or if it has been pushing for >1 hour with no pup produced... in which case I need to see it.

No other advice is given apart from 'if you want me to tell you if your dog is OK or not, I would have to examine it!' Still working on my psychic powers - they would come in handy.....

Re: Charging for whelping advice

Hannah Wynne Richards — Mon, 23 Jan 2012 10:38:50 GMT

1 piece of telephone advice only-bring it in

Wynne

Re: Charging for whelping advice

Clive Ansell — Sun, 22 Jan 2012 21:27:52 GMT

[quote user="claire godfrey"]

But I think we should, the problem would be how.

[/quote]

Premium rate telephone lines are the obvious answer.

If you telephone your ISP, lawyer or accountant you are almost certainly going to be charged for their professional time. Why, as a profession, we continue to provide a free telephone advice service at all hours is beyond comprehension. I recently had a 15-20 minute telephone conversation with an accountant about the best way of buying a car and received a £40 +VAT bill for his professional time.

I don't know about others, but I do not conduct telephone consultations. In all but the most simply of queries my advice tends to be "you need to make an appointment to be seen". I am more than happy to discuss ongoing cases or lab results over the telephone of course.

Re: Charging for whelping advice

Alan Tevendale — Sun, 22 Jan 2012 18:24:17 GMT

I've always look at this one from the point of view that if we don't give advice we are far more likely to see more significant problems. If we don't give the advice they'll just phone their expert breeder friend who probably knows more in the first place.

Re: Charging for whelping advice

Claire Godfrey — Sun, 22 Jan 2012 18:04:20 GMT

But I think we should, the problem would be how.

Once spoke to an owner several times through the night, starting about 2am. By 6.30am it sounded like we really should be seeing the dog. At which point she told me she had no money or transport!

It was a chihuahua!