Referral concerns

Re: Referral concerns

Alice Courtney — Fri, 07 Sep 2012 08:32:01 GMT

It's all settled for now, I had the most enjoyable phone call with the 'referral vet', a bit like being in a debating team and whopping the other team's a**e. Very much appreciate everyone's support & advice, thanks!

Re: Referral concerns

Rob Reid — Fri, 07 Sep 2012 07:57:55 GMT

Just picked up this thread - so much to get annoyed about.

The simple answer to me would be to bin this client off, then you have nothing to worry about. Client has already proven on several occasions and in several ways (lack of prompt paymentm failure to follow advice etc etc) that there is no no client/vet trust so, as others have suggested I would wash your hands.

I'm not a subscriber to this hang on to clients at all costs theory. Life's too short, if a client is a pain in the backside then let them know the lie of the land - they'll either buck up their ideas and you'll end up with a good bonded client or they'll go somewhere else, in which case you don't have to worry about them.

As for the 'referral vet' - I use the term loosely in this case as they are not worthy of it - an assertive phone call would do the job in my case reminding of them of their responsibilities once they start treating a case and also perhaps directing them to read the ethical codes in the GtPC.

Frustrating case!!

Re: Referral concerns

Michael Woodhouse — Fri, 07 Sep 2012 01:29:41 GMT

[quote user="Alice Courtney"]"To be honest, they just turn up and we get on with it."[/quote]

WOW

[quote user="Alice Courtney"]Ah, so THAT'S how you do it. And this dog must have been in that 1% of cases where your girls forget to get the history...twice, for the same dog...what are chances of that? (I'm rubbish at stats, but maybe it's 0.01%?)[/quote]

I can help with this

1/100 odds of it happening once, multiply the numbers together

1/5000 odds of a 1 in a 100 even happening twice assuming each time independent (2/10000)

=0.02%

Re: Referral concerns

Evelyn Barbour-Hill — Thu, 06 Sep 2012 19:28:02 GMT

[quote user="Alice Courtney"]

It seems we're all making a big fuss over nothing:

"To be honest, they just turn up and we get on with it."

Ah, so THAT'S how you do it. And this dog must have been in that 1% of cases where your girls forget to get the history...twice, for the same dog...what are chances of that? (I'm rubbish at stats, but maybe it's 0.01%?)

[/quote]

SO 'tain't a referral! It's a supercession! Never mind the not bothering to get a history, they should not have sent the client back to you. It's up to them now to do post-op checks, follow-up Xrays, "empty his glands while I'm here" , etc. etc.

Re: Referral concerns

Alice Courtney — Thu, 06 Sep 2012 18:03:05 GMT

It seems we're all making a big fuss over nothing:

"To be honest, they just turn up and we get on with it."

Re: Referral concerns

Alice Courtney — Thu, 06 Sep 2012 11:52:36 GMT

I didn't mean there was any problem with my practice manager! Don't get me in trouble She's brilliant, and I think it's only right that she looks after our clients as well as us employees. Where we have differing opinions, we discuss them openly and maturely, as is sensible. Amen

Re: Referral concerns

Mark Hedberg — Thu, 06 Sep 2012 06:54:29 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Alice Courtney"].I don't think my practice manager would look too kindly on me sending him straight back out the door.[/quote]

There's your problem. Practice manager.

[/quote]Odd, ours was brilliant, an unsung hero who kept the pitchforks of the HMRC away, a gentleman of the old school, honest as the day is long, backed you to the hilt and able to talk stroppy client out of the tallest trees. I've never met another guy like him and we worked together very well. (true, he never tried to tell me how to treat a patient!) not all practice managers are bad!

Re: Referral concerns

Evelyn Barbour-Hill — Wed, 05 Sep 2012 23:01:40 GMT

[quote user="Alice Courtney"].I don't think my practice manager would look too kindly on me sending him straight back out the door.[/quote]

There's your problem. Practice manager.

Re: Referral concerns

Alice Courtney — Wed, 05 Sep 2012 12:26:35 GMT

I'm not that annoyed with the situation, so my blood pressure remains its normal level I think, I just think it's low and un-professional of a practice to behave like this consistently, which they seem to do. A one-off is just that, but this isn't. I will phone him and be my usual chirpy self, and resolve the matter in a traditional English non-confrontational but ever-so-slightly-not-impressed way...Thanks all!

Re: Referral concerns

Alex Gough — Wed, 05 Sep 2012 11:15:33 GMT

[quote user="Alice Courtney"]It is only when the dog walks through the door with a shaved leg and opsite bandage on that something smells fishy[/quote]

In my limited knowledge of orthopaedics, if it smells fishy, you may have a problem...

Re: Referral concerns

Bob Russell — Wed, 05 Sep 2012 09:54:03 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Alice Courtney"]not a diplomate?[/quote]

If it's a diplomate that makes it far worse.

[quote user="Alice Courtney"]I have never reported another vet. Should I be doing so, and if so how?[/quote]

No. Phone him up and have a blazing row. Or write him a very correct, icy cool, stiff, very polite, extremely rude letter.

[/quote]

This is the advice that I really agree with!!

It is clearly festering so let it all go in a well thought out and phrased letter (no threats to do anything though). Keep copies!

The other end may take it on board, apologise and change their ways (just had to duck as a pig flew over my head) or they might not but at least your blood pressure will return to normal. Sack the client - you will never be able to work constructively together.

Re: Referral concerns

Dagmar Steele — Wed, 05 Sep 2012 09:05:36 GMT

In Germany we don't have the same rules as you have in the UK, no need to have the records before treating. (it would be preferable if you had them, but it's not necessary) This means this would be a very common situation over here and although annoying I have learned to live with it. I always request the records from the previous vets and send records to the next, and my referral centre is very good at sending stuff, too. But that's it, people shop around a lot, I have loads of clients with animals with conditions diagnosed elsewhere. I sometimes don't manage to get my hands on the records, some clients won't even tell me where they were, but I'll have to treat them anyway. Not very nice and sometimes more than dangerous...

Re: Referral concerns

Alice Courtney — Wed, 05 Sep 2012 08:30:18 GMT

[quote user="Utlendigur"]

[quote user="Rajat"]Most sensible people want to keep their first opinion referring practices happy- sounds like these might be one of the few that aren't![/quote]

Probably because they seem to have decided to dispense with them and accept "referrals" direct from the clients - therefore no need to keep the middleman happy..

[/quote]

Exactly my problem! The referral practice doesn't give two hoots about p***ing me off, because they get the business direct from the client when they self-refer.

The point about refusing to see the client after the operation is a tricky one. What would have happened is the client phones & asks reception for a recheck examination, who sees that he has recently been seen for lameness and books him an appointment. It is only when the dog walks through the door with a shaved leg and opsite bandage on that something smells fishy...I don't think my practice manager would look too kindly on me sending him straight back out the door.

Re: Referral concerns

Utlendigur — Tue, 04 Sep 2012 20:58:46 GMT

[quote user="Rajat"]Most sensible people want to keep their first opinion referring practices happy- sounds like these might be one of the few that aren't![/quote]

Probably because they seem to have decided to dispense with them and accept "referrals" direct from the clients - therefore no need to keep the middleman happy..

Re: Referral concerns

Rajat — Tue, 04 Sep 2012 20:31:53 GMT

[quote user="Evelyn Barbour-Hill"] Or write him a very correct, icy cool, stiff, very polite, extremely rude letter.[/quote]

Funny, only the English (or British islanders whatever is PC) have mastered this art. I remember one of Omad Djalili's shows where he was talking about how polite English people were...he said he had an argument once, and was halfway home before he even realized he had been insulted!

Me personally, I'd have a frank chat with the referral clinician and let them know you'll never refer anything to them ever again and dissuade all clients from coming to them in the future because of their apalling professionalism (of course in the nicest, calmest, most proper tones). Try speaking to a partner if he/she is not one. Most sensible people want to keep their first opinion referring practices happy- sounds like these might be one of the few that aren't!

Re: Referral concerns

Evelyn Barbour-Hill — Tue, 04 Sep 2012 20:12:30 GMT

[quote user="Alice Courtney"]not a diplomate?[/quote]

If it's a diplomate that makes it far worse.

[quote user="Alice Courtney"]I have never reported another vet. Should I be doing so, and if so how?[/quote]

No. Phone him up and have a blazing row. Or write him a very correct, icy cool, stiff, very polite, extremely rude letter.

Re: Referral concerns

Alice Courtney — Tue, 04 Sep 2012 20:07:37 GMT

darn, another typo slipped in...! advice, advise, whatever...

Re: Referral concerns

Alice Courtney — Tue, 04 Sep 2012 20:02:41 GMT

Thank you all so much for your thoughts. For the most part, I do just let things like this lie, and put it down as a blip/human error/lost post, but this case worries me more for a number of reasons 1) the fact that the referral centre has done the same thing twice, even after our calling them after the first incident, to explain we weren't happy with what had happened 2) the fact that, when my colleague called for advice after the dog became lame after surgery, the referral vet was hardly interested and seemed to want to wash his hands of the dog, and 3) I have just recently had another client with a dog with CCL rupture tell me that a friend of his had a dog treated for much cheaper at the same vets and could his dog go there...

Finally, would any of you advise anything different if the referral vet was a certificate holder, not a diplomate?

I have never reported another vet. Should I be doing so, and if so how?

Re: Referral concerns

Martin Atkinson — Tue, 04 Sep 2012 19:19:23 GMT

[quote user="Evelyn Barbour-Hill"]Now then, at that point I would have told the client that he had to go to A.N.Other for his post-op check, as it was nothing to do with you and you knew nothing about it. Seriously I would. [/quote] I didn't take that bit on board too much but agreed, in fact by seeing it you would become as guilty as the other vet was, and that was the time to give them their marching orders.

Re: Referral concerns

Evelyn Barbour-Hill — Tue, 04 Sep 2012 18:55:13 GMT

[quote user="Alice Courtney"]but am I right to be annoyed by this situation?[/quote]

Yes, but........... just go and pour it all out to the wife – well, husband – take the dog for a walk, put some loud music on.

[quote user="Alice Courtney"]We did then get a letter from the 'referral centre', but don't start me on the errors/typo's[/quote]

That would really really annoy me.

[quote user="Alice Courtney"]2w later, client comes in for a post-op check. Dog had CCL surgery (TPLO) at A.N.Other vets [/quote]

Now then, at that point I would have told the client that he had to go to A.N.Other for his post-op check, as it was nothing to do with you and you knew nothing about it. Seriously I would.

Re: Referral concerns

James Laidlaw — Tue, 04 Sep 2012 18:24:45 GMT

The other side of this is if the client has denied any previous consults or exams and taken it somewhere to be treated - you can't be certain what information the "referral" centre has or hasn't been given.

Like others I think it's crappy, but doubt there's a great deal that can be done beyond reporting. Doesn't sound like a great client, so maybe best to give them marching orders, if they want to shop around and make their own decisions, let them do it somewhere else and get them off your books.

I guess if the client wants things done cheap and doesn't follow your instructions and doesn't want to see the referral specialist you suggested then on the very tiny bright side, at least it's been treated...!

Re: Referral concerns

Hannah Wynne Richards — Tue, 04 Sep 2012 18:19:19 GMT

Like Martin-all of it Appalling behaviour from the referralcentre

Wynne

Re: Referral concerns

Rob Loxley — Tue, 04 Sep 2012 18:18:48 GMT

[quote user="Alice Courtney"] am I right to be annoyed by this situation?[/quote]

I think you are ref the referral/communication/succession, but agree with Martin's comment as far as letting it go. We've on occasion not had a referral letter through as it's got lost in the post/fax/ether, but generally where we refer the letters back are pretty prompt.

[quote user="Alice Courtney"]O cancels & fails to pay for work done to date[/quote]

Always get them to pay at the time...

[quote user="Alice Courtney"]No followup required at referral centre other than a phone call, so dog had no post-op rads.[/quote]

I guess that's their call (though I agree sounds odd not to check bone healing).

[quote user="Alice Courtney"]errors/typo's...[/quote]

I think you have an errant apostrophe

Re: Referral concerns

Martin Atkinson — Tue, 04 Sep 2012 18:01:45 GMT

All of it but the older I get the less bothered I am by these situations, if I was to report every instance of what I consider unprofessional conduct by other vets I would be writing a letter a day to the RCVS and the number of no-shows increases every day. Sadly courtesy, professional and personal, is becoming a thing of the past as everyone just thinks of themselves and what they can get for nowt. One question though: has the client ever settled his original bill?