Insurance minefield

Re: Insurance minefield

Anthony Todd — Sat, 29 Sep 2012 18:01:39 GMT

So what happened to the dog, not meaning to criticise, demean or abuse anyone, just would like to know....

Re: Insurance minefield

Mark Hedberg — Sat, 29 Sep 2012 17:55:31 GMT

This is true; my shorter female colleagues often got more abuse than I did; i'm not a rugby player but I'n 6'5 too :)

Re: Insurance minefield

Anthony Dennison — Sat, 29 Sep 2012 17:35:50 GMT

[quote user="Bob Russell"]

I would still like opinions from the new graduates to clarify if this is the case. Professional people still command a fair degree of respect but it is harder to gain that respect!

[/quote]

I'm a 2012 grad, and I don't have the fear. The head vet of my foster practice used to be on the DC so would always good hints and tips to keep myself covered. I'm of the opinion that I will try my best and hardest with every case - though I have been qualified all of 3 months so there are bound to be times where an owner feels I haven't done them right. At the end of the day, I'm fresh out of the box and have a huge amount to learn still, so I'll give myself a break most of the time.

I've had more smiles and thank you cards than I've had grumpy people yelling at me. And when they shout, smile and be as nice as pie back - not rising to it allows me to think clearly and they don't expect a kind and considerate response to their tirade, which often defuses the situation and allows normal conversation to resume. I worked in a bar for 4 years before and during uni, perhaps its my experience there that helped.

That said re. complaints to my face - I'm a 6'5" rugby player that often has some sort of bruise/damage on my face most Monday mornings, so my clients are just picking their fights!

Re: Insurance minefield

Gerry Henry — Mon, 03 Sep 2012 14:34:43 GMT

Don't you people have any work to do, blimey what a marathon.

K Burton, I sympathise, we've all been there, learn as much as you can that's not deleterious to your prefessional development and move on; steroids and NSAIDs together, OMG.

Re: Insurance minefield

Gillian Mostyn — Mon, 03 Sep 2012 13:02:49 GMT

[quote user="Arlo Guthrie"] I think I'm OK at judging whether someone is being an arse.[/quote]

Re: Insurance minefield

Arlo Guthrie — Mon, 03 Sep 2012 12:57:03 GMT

[quote user="Liz white"]Surely it depends how it's phrased? Open criticism is obviously not pleasant, but suggesting alternative approaches can be helpful in highlighting that there is not always only 1 way of doing anything, and may be reassuring to others who would approach things differently.[/quote]

[quote user="Bob Russell"]

It is good to see supportive posts, criticism can be done in a nice way and discussion is generally constructive.

I have to admit I did 'go off on one' some time ago when someone was talking in terms of operating on peoples kitchen tables which I have to admit horrified me and my posts were not particularly measured.

Discussions do get heated but it is very sad when they become personal. This is not discussion it is selfish and rude as it does put some off posting which is a shame - the other term for this is bullying!

[/quote]

[quote user="robloxley"]Shouldn't we constantly be questioning our clincal decisions and outcomes (unless we are all perfect ), albeit in a pleasant way?
That a internet forum thread will wander from the OP is nothing new...[/quote]

The whole point of this forum is to stimulate thinking about cases (and other stuff), as often as not by challenging what people have written. I certainly don't want to stifle that. However, there is a fine line between challenging people and scaring them off. Out of all the above, Liz has really hit the nail on the head:

[quote user="Liz white"]Surely it depends how it's phrased? [/quote]

That is my point. I ask that members always have it in mind that someone asking a question in this forum may be less experienced or confident than themselves, and make sure that any reply they post takes that into account (and also the fact that the written word is invariably interpreted more harshly than the spoken one).

[quote user="David Mills"]And, who, pray, would be the arbiter of this myriad of subjective opinion? Surely not yourself, as, with all due respect, you aren't qualified to do so. [/quote]

Oh God here we go again. . I am certainly not qualified to judge the merits of a clinical argument. I think I'm OK at judging whether someone is being an arse.

[quote user="David Mills"]This forum generally appears to be sliding inexorably to sterility[/quote]

Rubbish.

[quote user="David Mills"]note the hysterical reaction when one person - that's one out of 7000 - says they're too scared to post.[/quote]

No David, my reaction is rarely if ever based on the reaction of one person. It's based on reading thousands of posts and hundreds of conversations. Something you might not know is that I have so far been on the receiving end of two telephone calls from people in tears about the way they have been treated on here. It was a while ago now, but yes, it affects how I moderate things.

Re: Insurance minefield

David Mills — Mon, 03 Sep 2012 12:10:49 GMT

[quote user="Bob Russell"]

[quote user="Hannah Wynne Richards"]

I would say the origin is the claims culture Where once someone tripped on the pavement merely said something rude, and got on with life, now they're off work for 3 weeks and claiming compensation-alsothe old -fashioned respect for professionalpeople has evaporated

Wynne

[/quote]

Not sure I agree about the claims culture being the culprit. I suspect it is the VMD bogeyman being paraded in front of a group without the experience to give them confidence to say 'that is nonsense'.

I would still like opinions from the new graduates to clarify if this is the case. Professional people still command a fair degree of respect but it is harder to gain that respect!

[/quote]

I just wonder whether it is more the malaise of the precautionary principle, and that the profession is becoming more conservative. I doubt the 'claims culture' is to blame, but moreover the seeming obsession that pervades veterinary teaching with 'contraindications and possible side effects' - perhaps we are seeing the dawn of the age where non-maleficence is king. The blame must partly lie within the incorrect application of EBM where students are imbued with doctrine about much of what we do being based on weak evidence (true), alongside usually lists - with no indication of incidence rates - of side effects, some very serious. There is a distinct mismatch in emphasis where possible side effects or complications (possibly one in 100,000) are given undue influence, and indeed the EBM around these may be even more suspect than that pertaining to efficacy. I have seen it over the last two years in clinical discussions with students wherein the first question is not what beneficence is possible, but the more pernicious 'but doesn't that cause/isn't that associated with...' This, of course, whilst much of what pours down from university teaching is anecdotal (alebit expert). If one was conspiracy-minded it could be construed as playing into the referral centres' hands...

Re: Insurance minefield

Bob Russell — Mon, 03 Sep 2012 11:24:42 GMT

[quote user="Hannah Wynne Richards"]

Wynne

[/quote]

I would still like opinions from the new graduates to clarify if this is the case. Professional people still command a fair degree of respect but it is harder to gain that respect!

Re: Insurance minefield

Hannah Wynne Richards — Mon, 03 Sep 2012 11:02:44 GMT

Wynne

Re: Insurance minefield

Rob Loxley — Sun, 02 Sep 2012 23:31:58 GMT

[quote user="K Burton"]we spend everyday living in fear of being struck off[/quote]

Serious question: where does this stem from? University teaching, RCVS contact, VDS, clients, colleagues, generally growing "claims culture"?

Re: Insurance minefield

Joyce Whitehead — Sun, 02 Sep 2012 21:58:12 GMT

My first boss - too many years ago - had a similar secret, but in those days before many canine NSAIDs being around (I am THAT old), his answer was "One of each" - ie penicillin and betsolan mixed in the same syringe. Surprisingly many of them got better anyway...

I still think of antibiotic and NSAID as the sophisticated version of one of each, good for PUO at least!

Re: Insurance minefield

Mark Hedberg — Sun, 02 Sep 2012 21:01:07 GMT

[quote user="K Burton"]

to those asking where the senior vet was, he recommended high dose dex plus rimadyl (discovered this is his answer to everything)

[/quote]

So THAT'S the secret, then!!

Re: Insurance minefield

Rajat — Sun, 02 Sep 2012 20:11:18 GMT

[quote user="K Burton"]please remember how terrifying practice is when you're a recent grad! [/quote]

So true..I remember it clearly..!

[quote user="K Burton"]Having spent so long training to do the job we spend everyday living in fear of being struck off, and the clients are perputually disappointed that they're seeing us rather than 'Dr Bob' who's just retired - the clients loved the previous vet because the were older and didn't believe in blood tests and didn't charge anything up properly, and when we try to do a proper job the clients often think we're just out to make money![/quote]

A tough gig for a new grad if that is/was till recently the pervading culture

Re: Insurance minefield

Utlendigur — Sun, 02 Sep 2012 19:16:18 GMT

[quote user="K Burton"]- but for those further on in their careers than myself, please remember how terrifying practice is when you're a recent grad! Having spent so long training to do the job we spend everyday living in fear of being struck off, and the clients are perputually disappointed that they're seeing us rather than 'Dr Bob' who's just retired - the clients loved the previous vet because the were older and didn't believe in blood tests and didn't charge anything up properly, and when we try to do a proper job the clients often think we're just out to make money![/quote]

Hate to tell you but looking from 20yrs further on, it doesn't change much

Re: Insurance minefield

Kathryn Burton — Sun, 02 Sep 2012 18:21:54 GMT

Thank you everyone for your input - I wasn't expecting to spark quite such a debate! In answer to a few of the points raised:

- my colleage did take ab x-ray, and also digitally explored the oral cavity to look for injuries

- at the practice there's myself (a number of years qualified but only went into practice six months ago), a 3 yr qualified vet, and a senior vet - to those asking where the senior vet was, he recommended high dose dex plus rimadyl (discovered this is his answer to everything)

- we had a similar case a couple of weeks ago which our senior vet did surgically explore, then the lump came back and the dog ended up being referred, and the client kicked off because they hadn't been referred straight away

- getting lots of opinions on any clinical case is always helpful

- but for those further on in their careers than myself, please remember how terrifying practice is when you're a recent grad! Having spent so long training to do the job we spend everyday living in fear of being struck off, and the clients are perputually disappointed that they're seeing us rather than 'Dr Bob' who's just retired - the clients loved the previous vet because the were older and didn't believe in blood tests and didn't charge anything up properly, and when we try to do a proper job the clients often think we're just out to make money!

Re: Insurance minefield

David Mills — Sun, 02 Sep 2012 17:25:37 GMT

[quote user="Arlo Guthrie"]

[quote user="Hannah Wynne Richards"]Arlo will have to stop playing with his new plane, and start moderating I'm with Gillian on this We have none of us seen the case This is a new grad who decided to refer , is now being pressurised by owners to commit a criminal offence,and is having a lot of people who've not seen the case criticising I can't say whether or not I would have referred-I haven't seen the case [/quote]

Wish I had been (playing with my plane). In fact, I was away at a thanksgiving service for my grandmother yesterday.

It's a really difficult area, this thing of questioning other people's clinical decisions. For example, some people actually enjoy being made to question their own actions. Plus I think it can be useful for someone happening on this thread perhaps 6 months down the line, looking for information about something, to see the diversity of opinion.

That said, I think it also depends on how one questions another's clinical opinion. For me, this:

[quote user="Gerry Henry"]Is it an age thing or don't first opinion practices do anything these days apart from vaccinate and refer?[/quote]

reads as slightly sarcastic (whether or not that was the intention).

So on balance, I am with you, Gillian and Wynne.

I think perhaps we should have a new rule that members are not allowed to question another member's clinical decisions UNLESS either:

the OP specifically invited others to comment on what they have done

any post that questions another's clinical opinion must show respect for the OP and recognise things like being unaware of all the facts / benefit of hindsight / possibility of the questioner being wrong themselves. A post that recognises some or all of these things should (I would hope) invite further discussion with the OP, and not cause them to retreat into their shell (and discourage others and from asking questions)
the questioner is posting information which they really believe is going to help the OP or the case in question.

[/quote]

And, who, pray, would be the arbiter of this myriad of subjective opinion? Surely not yourself, as, with all due respect, you aren't qualified to do so.

This forum generally appears to be sliding inexorably to sterility, tit for tat anecdote and dogma in its reach for the elusive and undefinable 'inclusivity' - note the hysterical reaction when one person - that's one out of 7000 - says they're too scared to post. As such, it will become poorer for it.

As it goes, all the criticisms of the clinical care, however written, appear in the general case to have been justified. It ain't K Burton's fault - I think rather its a pernicious university-led educational problem where even things such as demodecosis are referred these days. All the more justification for clinical teaching beyond lectures to be removed from universities (which are also profit-led referral centres who rely on their charges referring in the future) as much as practical in the coming years.

Re: Insurance minefield

Rob Loxley — Sat, 01 Sep 2012 18:16:22 GMT

[quote user="Arlo Guthrie"]

[quote user="Gerry Henry"]Is it an age thing or don't first opinion practices do anything these days apart from vaccinate and refer?[/quote]

reads as slightly sarcastic

[/quote]

I agree with you as far as the part of Gerry's post you have quoted; but the earlier part of his comment seemed to me to be a good expansion of the discussion (it is a discussion forum?).

Would agree about being too critical of the OP having not seen the case: from the OP's description I was reading 'oro/pharyngeal stick injury/abscess' whereas from Gerry's replies he seemed to be reading more 'jaw bone swelling' and the approach to each is different?

My 2p would be that the crux of the OP ref the incitement to commit insurance fraud was soon pretty clear cut, and so the talk moving to a wider discussion of the clinical case seemed likely?

[quote user="Arlo Guthrie"]I think perhaps we should have a new rule that members are not allowed to question another member's clinical decisions[/quote]

Shouldn't we constantly be questioning our clincal decisions and outcomes (unless we are all perfect ), albeit in a pleasant way?
That a internet forum thread will wander from the OP is nothing new...

Re: Insurance minefield

tess — Sat, 01 Sep 2012 12:47:45 GMT

[/quote]

Couldn't agree more.

Re: Insurance minefield

Bob Russell — Sat, 01 Sep 2012 10:26:13 GMT

It is good to see supportive posts, criticism can be done in a nice way and discussion is generally constructive.

The wider the range of contributors the more interesting the threads.

Re: Insurance minefield

Mark Rowland — Fri, 31 Aug 2012 18:08:31 GMT

Or if someone is going to do something stupid like worm a tortoise with ivermectin, I would think they would need telling if they were to ask why it died?

Re: Insurance minefield

Liz w — Fri, 31 Aug 2012 17:28:03 GMT

Surely it depends how it's phrased? Open criticism is obviously not pleasant, but suggesting alternative approaches can be helpful in highlighting that there is not always only 1 way of doing anything, and may be reassuring to others who would approach things differently.

Re: Insurance minefield

Arlo Guthrie — Fri, 31 Aug 2012 10:21:13 GMT

Wish I had been (playing with my plane). In fact, I was away at a thanksgiving service for my grandmother yesterday.

That said, I think it also depends on how one questions another's clinical opinion. For me, this:

[quote user="Gerry Henry"]Is it an age thing or don't first opinion practices do anything these days apart from vaccinate and refer?[/quote]

reads as slightly sarcastic (whether or not that was the intention).

So on balance, I am with you, Gillian and Wynne.

I think perhaps we should have a new rule that members are not allowed to question another member's clinical decisions UNLESS either:

the OP specifically invited others to comment on what they have done

any post that questions another's clinical opinion must show respect for the OP and recognise things like being unaware of all the facts / benefit of hindsight / possibility of the questioner being wrong themselves. A post that recognises some or all of these things should (I would hope) invite further discussion with the OP, and not cause them to retreat into their shell (and discourage others and from asking questions)
the questioner is posting information which they really believe is going to help the OP or the case in question.

Re: Insurance minefield

Martin Atkinson — Fri, 31 Aug 2012 09:55:24 GMT

[quote user="tess"]

I'm afraid this is why I tend to "lurk" on here and don't post very much. I have witnessed some spectacular situations where a poor person has asked an innocent question only to have their professional capabilties questioned over something unrelated. It does put people off and I do wonder if we were standing in a room together would people still make the same comments...

[/quote] In response to your final few words Tess, I feel the answer is I'm afraid there are some who are so arrogant they would - probably more so. The way forward is not to post less but more and criticise the perpetrators, however lacking in self belief or experience you may feel you may be, your opinion is still as valid as anyone else's, sometimes some people need to be knocked off their high horses. Once again I'm not entirely innocent here but I'm far more likely to post to wind up the know-alls and trolls than criticise someone who is less experienced than myself and I'm happy to take criticism in return - indeed I relish it.

Re: Insurance minefield

Virginia Campbell — Thu, 30 Aug 2012 19:19:48 GMT

[quote user="Gerry Henry"]Zzzzzzzzzzzzzzzzzzz

[/quote]

Is there a bee in your office, did you accidentally tissue glue your finger to the bottom left hand side of the keyboard, or are you just being rude?

Re: Insurance minefield

tess — Thu, 30 Aug 2012 19:18:53 GMT