What would you charge for clinical advise

Re: What would you charge for clinical advise

Martin Atkinson — Mon, 29 Jun 2015 11:12:55 GMT

[quote user="Clare Tapsfield-Wright"]The ones I would have loved to charge are the ones with a whelping bitch who don't want to bring her in but ring you every hour all through the night for advice and reassurance. Zero income for sleepless night and rarely a thank you

[/quote]Well this is one occasion I would charge them and tell them that there will be charged equivalent to the OOH fee as if the bitch is bad enough to require repeated phone calls it needs to be seen or if not it can be left alone for the night.

Re: What would you charge for clinical advise

Wren — Mon, 29 Jun 2015 09:12:12 GMT

[quote user="Braden Collins"]

My technique for these now is to set VERY firm times/occasions when they can call me (eg. if she hasn't had another puppy by 1am or if she's been straining for x time). If I'm in bed I then let calls go through to message bank. It lets them know I'm not sitting there waiting for their call and if they are calling outside the boundaries I've set down they don't get a call back. Not a perfect system but it's the best way I've found to get some sleep.

[/quote]

I do this with evening colics (ie. most of them!). I give them a firm time at which I will phone them to check on the horse (usually approx 2hrs after I leave). If the horse is better/no worse I them give them a time scale eg. 'check on the horse regularly until 11pm, if all looks well at 11pm, then leave it until tomorrow morning. I will ring you tomorrow morning by 8am for an update'. It's taken me a few years to work this out but it means you don't get willy nilly phone calls at times when it's inconvenient, or just simply too soon to know whether what you've done has made a difference. I am religious at ringing back when I say I will and it seems to impress clients. They do seem to like having a timescale to stick to too.

Re: What would you charge for clinical advise

Braden Collins — Sun, 28 Jun 2015 14:05:42 GMT

[/quote]

Re: What would you charge for clinical advise

Thomas Johnson — Sun, 28 Jun 2015 10:23:52 GMT

[quote user="Clare Tapsfield-Wright"]

I agree Wynne but it was usually on the lines of " she's been struggling but she's just had a puppy now " followed by another call 49 minutes later saying " I know you said to wait longer than this but we were a bit worried , ooh hang on , she's had another one " etc etc . You've got to love them haven't you !

[/quote]

I can well remember calls like that, usually people without much experience and a whelping that was going okay, but a bit slower than the average. There was nothing that needed doing clinically, and it really wasn't in the best interest of the bitch or pups to get them down to the surgery, but the clients needed handholding through it. And you didn't want to put them off calling again just in case things did start to go wrong.

Re: What would you charge for clinical advise

Clare Tapsfield-Wright — Sun, 28 Jun 2015 09:53:47 GMT

Re: What would you charge for clinical advise

Hannah Wynne Richards — Sat, 27 Jun 2015 16:27:34 GMT

Clare. I would have said, "Bring her in, I can't possibly comment without seeing her." If they persisted, I'd have repeated "Bring her in, I can't possibly comment without seeing her," Eventually they'd have got the mesage!

Wynne

Re: What would you charge for clinical advise

Robin Grimmer — Sat, 27 Jun 2015 14:58:14 GMT

[quote user="grumpyoldman"]

There are some "Blairs Children " , well that is my monica for them , 20-30 now ,know nothing in fact in a pub quiz they are as much use as a chocolate teapot, but google everything ,then try and catch you out with it except they cannot spell and understand the larger words, they also use go compare for everything and have also been courted by V4P because they have been in the shop on that Sunday and the history has been requested . They are always convinced its got FIP , the last one had actually swallowed a fish hook as I recall.

[/quote]

I had one of these in recently. Picked up a puppy from the motorway services, we gave first vac , then promptly came down with parvo. Of course blamed us even though checked with manufacturer and was too soon to be a vac reaction. Was already incubating parvo. Pup recovered, actually pretty quickly which we think was due to having had the first vac. Was he happy, no. Had a bill from ooh as was a weekend and then having done internet research decided it was the vaccine at fault, not the dodgy breeder! And kept wittering on about memory cells all the time! In the end I think he went somewhere else. Good riddance!

Re: What would you charge for clinical advise

Nhombokisheni — Sat, 27 Jun 2015 14:30:57 GMT

[quote user="Neil Wheadon"]

I've never had this before, but will be an increasing issue in the internet age?

Thoughts?

Neil

[/quote]

The internet has unfortunately created "overnight medical wise men/women". Given that almost every owner I have come across does not take kindly to being blamed for the ills of their pet, this "wisdom" has become a fashionable weapon to prove level of concern and apptitude. And so, yes, each time someone says they want to talk, you just have to know and accept that you are being tested against "a pool of knowledge titbits".

To charge or not to charge........yes, the vet has a right to charge for their professional time and expertise. Unfortunately the "internet obese" type will always go away agrieved because they belieive you merely affirmed "what they knew already". I guess the solution lies in what they do in the corperate world....use the reception for all its worth to filter calls and get them to book such appointments separately.

I also feel that the vet-client relationship, once established, progresses from "lets see" attitude, to trust and ultimately to full blown dependence. And the fact that its almost second nature to reassure every client that you are just a phone call away (By the way its now a mobile call away", clients go away feeling they can call you anytime....."Oh, our vets are so nice, I can call anytime of day if I am worried".

I acknowledge there are some clients who will milk the system, but by and large I want to believe most clients are genuinely trusting and dependent on our services. A solution could lie in coming up with some flexible system where they get one/two free telephone follow up calls as standard, then they get charged for all others.

Just a thought....

Re: What would you charge for clinical advise

Sarah Wheadon — Sat, 27 Jun 2015 12:27:25 GMT

And the extra sting about the whelping bitch is that the owners are usually doing it for their own profit....

Re: What would you charge for clinical advise

Laurence Webb — Fri, 26 Jun 2015 22:47:38 GMT

Sounds like a good result.

I don't think there is a hard and fast rule. You shouldn't be afraid of charging for your time but sometimes it oils the wheels not to do so rigorously.

We (and clients) sometimes get hung up on confusing a consultation with an examination. Not brought an animal with you? Then it doesn't count! But they are taking your time and seeking a professional opinion from you and I assume you don't feel that your time is worthless!

I recall a conversation I had with a client with a diabetic animal. They were doing glucose curves at home then booking a telephone appointment to tell me them and discuss how treatment should be altered. I was charging a reduced (possibly 50%, but I can't remember) consult fee for this and she was getting the insulin off the internet. The phone calls normally took 10-15 mins. One day she phoned me up to complain about the charges. The gist of the conversation * was

"Why are you charging me for this service"?

"Because it takes time and requires my professional expertise"

"I'm a professional too, but with all your experience it only takes a minute or two for you to decide what to do" (these were almost her exact words and I think she was trying to butter me up. I think her actual exact words were 'considerable experience and skill')

"But you are paying for my experience. Just because it takes less time for someone experienced to decide what to do doesn't mean I shouldn't charge. What do you do?"

"I'm a lawyer"

"How much do you charge for phone calls?"

"Oh, err. I didn't mean to offend you. Um. So, what should I do with Tiddles' insulin?"

* names and exact details have been changed for reasons of confidentiality and making me sound better.

In this case I would probably have chosen not to charge a consult fee, but I would have made that decision during the 'chat'/consultation. As a general rule I prefer receptionists to book clients in for a consultation (inferring that a fee will be charged) then if I choose not to charge then I am being generous. If they are booked in for a 'chat' then the client is not expecting to pay and any fee puts their back up.

In practice I don't charge for most of these as they are hand holding exercises and helps to bond the client. The extra support they will be repaid in other ways. If you are locumming then you need to find out what is the norm for the practice you are working in.

Re: What would you charge for clinical advise

Clare Tapsfield-Wright — Fri, 26 Jun 2015 22:04:55 GMT

The ones I would have loved to charge are the ones with a whelping bitch who don't want to bring her in but ring you every hour all through the night for advice and reassurance. Zero income for sleepless night and rarely a thank you

Re: What would you charge for clinical advise

Neil Wheadon — Fri, 26 Jun 2015 11:27:37 GMT

As an update, I saw her yesterday

Her concern was that at 16 years old she was concerned that giving Felimazole (which she hadn't collected) would unmask renal disease. However her primary concern was that her cohort of friends all had 17 year old cats that they had bought for the children and all were going through some degree of chronic medication, with one thing leading to another, so she was concerned.

Result was she took the Felimazole and will book a blood test in a few weeks to look at the T4 and renal parameters, so all good and no I didn't charge her a consult.

I quite liked this. I maintained control on a very busy day, she had time to express her concerns at a time that I wasn't trying to do something else, so all good

I've locummed in 2 practices where a diary is opened for appointments to be made for telephone advise with a vet much like our local GP practice does. Food for thought?

Neil

Re: What would you charge for clinical advise

Sorrel Proctor — Fri, 26 Jun 2015 11:14:03 GMT

I'd book her an appointment (clients are more likely to think appointment slot = charge) and expect to charge her. And if she's a relatively new client inform her of the appointment length. If it turns out it's a 3 minute job then give her a pleasant surprise by not charging. Job done.

Re: What would you charge for clinical advise

Nicola Cole — Thu, 25 Jun 2015 21:09:35 GMT

Bit of a tangent but I had a lovely but very upset lady call me one Sunday on call to say her dog had passed away overnight. It became apparent during our conversation that the poor lady thought that if she called to speak to a vet overnight she would be charged a large amount for it and she wasn't sure how poorly the dog was so thought she would wait till morning.....very sad.

Re: What would you charge for clinical advise

Michael Woodhouse — Thu, 25 Jun 2015 21:06:18 GMT

We would charge a consult unless the questions were very simple. I've had people wait 30 minutes in open surgery to come into the consulting room and ask for some flea treatment.

We have two dispensing fees one is +£5 and one is +£10 as 'advise and dispense' and 'advise and dispense - extensive' that we use occasionally for someone who talks for an age about a problem. I use them to cover the time taken to ring vets check meds and dispense on holiday. It's hidden by the PMS so they generally think their own vet is cheaper for drugs than us.....

Re: What would you charge for clinical advise

Evelyn Barbour-Hill — Thu, 25 Jun 2015 19:27:13 GMT

[quote user="Neil Wheadon"]

Cat seen twice in the past 10 days (never seen before), diagnosed hyperT4 and on Felimazole (I haven't seen her )

Owner has been on the internet and wants to discuss this, and apparently has lots of questions, but doesn't want to bring the cat and wants to do this face to face.

My inclination is to charge her a consultation as after all she's using my clinical expertise.

[/quote]

I do lots and lots of stuff without charge, but in that particular situation I'd expect to be paid a standard consultation fee. Consultation is consultation.

Many many people hover at the desk expecting to pay, and express pleasant surprise when I wave them away... "no, no charge for that". Conversely, there's a few that say " Do I owe you anything?" as they head for the door.... usually people who most definitely do owe me something.

Re: What would you charge for clinical advise

Martin Atkinson — Thu, 25 Jun 2015 16:50:09 GMT

[quote user="Clive Ansell"]

if it is just a few generally questions directly related to what she has been seen for in the last 10 days, I wouldn't charge, but if it is prolonged (say >5 min) or involves another problem or condition then I would charge a consultation fee.

As I rule I am happy to discuss ongoing already diagnosed conditions or treatments over the telephone, but will not agree to telephone consultations other than that.

[/quote]I still wouldn't charge for a telephone consultation - it is impractical, inflammatory and unprofessional unless you really want to get rid of the client. Of course It does make a difference if it is a core client rather than if its a freeloader. I will give 5 minutes of my time after that, as said, it is make an appointment.

If its about a condition its not been seen for previously or asking for quotes for anything other than routine which the nurses can't give out, beyond the odd grunted fact, it is 'I'm sorry I can't help until I've seen the pet', - make an appointment.

Not a dig at you in any way Clive more at the whole thread, but surely this is all common sense.

Re: What would you charge for clinical advise

grumpyoldman — Thu, 25 Jun 2015 15:43:22 GMT

They do shop around a lot ,I would not charge them anything for just a few minutes ,better to invite them in for a weight and BP monitor plus t4 if its due with the nurse check its stable discuss the options then.

Re: What would you charge for clinical advise

Bob Russell — Thu, 25 Jun 2015 15:42:58 GMT

My nightmare diabetic clients are buying everything off the internet so I was spending quite a lot of time with the owners. Having spent at least an hour talking to them over a ten day period I stopped taking the calls and they had to make an appointment. I did mention that I had staff to pay and that without making a profit would be putting the closed sign up on the door!

We have a compromise now. Major issues they make an appointment but the rest of the discussions are via email. They send me curve details and I look at it when I can/feel like it and send a reply when it is convenient. Much less time wasted! I make sure my email address is not available to them but they have to go through the normal practice one!

We give estimates for scale and polish but ranges for other dental work!

Re: What would you charge for clinical advise

Clive Ansell — Thu, 25 Jun 2015 15:07:54 GMT

As I rule I am happy to discuss ongoing already diagnosed conditions or treatments over the telephone, but will not agree to telephone consultations other than that.

Someone telephoned this morning wanting to speak to a vet about the ins and outs of pyometra, way beyond that given by reception staff; the only advice I would offer is "you need to make an appointment"

Another thing I am not happy to do is give estimates or quotes for work for patients that have not been seen, such as for dental work.

Re: What would you charge for clinical advise

Hannah Wynne Richards — Thu, 25 Jun 2015 14:53:17 GMT

Standard consult fee.

Wynne

Re: What would you charge for clinical advise

Martin Atkinson — Thu, 25 Jun 2015 13:54:05 GMT

[quote user="Neil Wheadon"]

[quote user="Martin Atkinson"]better to make an appointment [/quote]

I've actually done this as there are a few spare spots this afternoon, in an effort to retain some control over the amount of time that she spends on this.

[/quote]Don't take that comment out of context Neil it is not what I was suggesting unless it really is out of control.

Re: What would you charge for clinical advise

Neil Wheadon — Thu, 25 Jun 2015 13:46:12 GMT

[quote user="Martin Atkinson"]better to make an appointment [/quote]

I've actually done this as there are a few spare spots this afternoon, in an effort to retain some control over the amount of time that she spends on this.

It was a hypothetical question as have always phoned clients /talked to them when they pop in and in reality it's often much shorter than you think.

There's a simultaneous thread here on overdemanding clients and consider if every client wanted a chat over everything we did, we'd have no time for anything, so a line in the sand is somewhere, just wandered where it was?

Neil

Re: What would you charge for clinical advise

Martin Atkinson — Thu, 25 Jun 2015 13:24:43 GMT

You've already got at least one consultation out of her, some lab fees and dispensed some medication. What do you want - a pound of flesh as well? I don't think it is unreasonable at all to discuss things for free within reason on the phone, or even if she pops in outside consultations is you're not busy, after all this patient will be back a lot of times for monitoring in the future. Being helpful on the phone will only engender goodwill, being off-hand may send her somewhere else and you've lost all that future income (and thus speaks the king of off-hand)!

Of course this has to be within reason and after 5 minutes I may be inclined to say that I have to go and attend to another patient and if she is still concerned it would then be better to make an appointment and discuss matters at the next check-up. If she is a high maintenance client you'd rather be rid of anyway than maybe you should charge her then its a win-win situation - you either get rid of her or make more money!!