The Mystery Customer .

RE: The Mystery Customer .

Thomas Johnson — Tue, 15 Mar 2016 08:38:28 GMT

[quote user="Anthony Todd"]The discussion is not the definition of the "second opinion" which is irrefutable, as a previous opinion has been given, but whether giving the "second opinion" is ethical if the vet does not know his or her opinion is not the first.[/quote]

From the Code of Professional Conduct:

5.6 When an animal is initially presented, a veterinary surgeon should ask whether the animal is already receiving veterinary attention or treatment and, if so, when it was last seen; then, contact the original veterinary surgeon for a case history. It should be made clear to the client that this is necessary in the interests of the patient. If the client refuses to provide information, the case should be declined.

5.7 In an emergency, it is acceptable to make an initial assessment and administer any essential treatment before contacting the original veterinary surgeon.

RE: The Mystery Customer .

Gillian Mostyn — Mon, 14 Mar 2016 21:46:16 GMT

I started replying.... then I lost the will to live.

Hope the dog continues to do well, GOM.

RE: The Mystery Customer .

Anthony Todd — Mon, 14 Mar 2016 21:13:18 GMT

[quote user="Gillian Mostyn"]No it isn't. A second opinion is requested by the client. (It is what it says on the tin). If it is requested by the original vet, it would be a referral![/quote]

Except that a "referral", by definition means that no opinion has been given by the referrer.

[ A parrot not eating is referred without an opinion?]

I now see what you're saying. Strictly and logically if a vet gives another opinion concerning an animal that is, by definition, the second opinion.

The discussion is not the definition of the "second opinion" which is irrefutable, as a previous opinion has been given, but whether giving the "second opinion" is ethical if the vet does not know his or her opinion is not the first.

What to do in this case is the discussion.

RE: The Mystery Customer .

Gillian Mostyn — Mon, 14 Mar 2016 19:13:09 GMT

[quote user="Hannah Wynne Richards"]A second opinion is when the original veterinary surgeon calls in a coleague for help.[/quote]

No it isn't. A second opinion is requested by the client. (It is what it says on the tin). If it is requested by the original vet, it would be a referral!

RE: The Mystery Customer .

Gillian Mostyn — Mon, 14 Mar 2016 19:09:39 GMT

Duplicated

RE: The Mystery Customer .

Gerry Henry — Mon, 14 Mar 2016 19:00:56 GMT

Not 'sly' or 'sneaky', probably just worried to distraction, be more forgiving

RE: The Mystery Customer .

Anthony Todd — Mon, 14 Mar 2016 18:33:41 GMT

[quote user="Hannah Wynne Richards"]

A second opinion is when the original veterinary surgeon calls in a coleague for help.

Wynne

Done that often too, but you usually need an animal... You mean advice, done that often too....

[/quote]

RE: The Mystery Customer .

Anthony Todd — Mon, 14 Mar 2016 18:31:55 GMT

[quote user="Gillian Mostyn"]There is only one type of second opinion consultation, isn't there?[/quote]

Oh dear, that was the point! Read the relevant post again [I quoted from it]

The post was about when you are giving a second opinion but don't know you are.....

RE: The Mystery Customer .

Hannah Wynne Richards — Mon, 14 Mar 2016 18:29:42 GMT

A second opinion is when the original veterinary surgeon calls in a coleague for help.

Wynne

RE: The Mystery Customer .

Gillian Mostyn — Mon, 14 Mar 2016 17:42:18 GMT

[quote user="Thomas Johnson"]It didn't read as moving the goalposts to me. It's still a second opinion, whether they've told you or not[/quote]

Thanks- I agree, but wasn't sure why Anthony meant. There is only one type of second opinion consultation, isn't there?

RE: The Mystery Customer .

Julie Innes — Mon, 14 Mar 2016 14:19:22 GMT

I always phone for history- both because I don't want to treat an animal that is already taking medication that I know nothing about , and as a courtesy to my colleagues, the previous (or concurrent!) vet.

I've had referral reports sent to me which make no sense...till you discover that the client moved house and practice, and the new vet didn't have the courtesy to let us know. I just feel it leaves you wide open to all kinds of mistakes/ allegations. It really doesn't take long to request a history- with fax and e-mail it can be across in minutes.

RE: The Mystery Customer .

Thomas Johnson — Mon, 14 Mar 2016 10:07:31 GMT

[quote user="Anthony Todd"]

[quote user="Gillian Mostyn"]OK. We'll agree to differ. I'll continue to insist on a clinical history before giving a second opinion.[/quote]

You've moved the goalposts!

Of course if an animal comes in as a "second opinion" then you get the history, which the owner gladly and completely complies with!

We were talking about an animal that comes in and you think it may have been treated somewhere else for the same thing, but the owner stays stumn, totally different.........viz:

Friday evening the client rings for progress report and says "did not want to tell you on wednesday but we had been going to Another vets Ltd with dysuria for 7 months ,had lots of treatment

[/quote]

It didn't read as moving the goalposts to me. It's still a second opinion, whether they've told you or not!

RE: The Mystery Customer .

grumpyoldman — Sat, 12 Mar 2016 18:40:26 GMT

Dog is fine doing well , histopath said margins narrow , client very grateful and shook hands this morning which was a bit weird TBH ,its coming back for monthly checks (ultrasound) , and staying on the cox-2 meds . We shall see .

RE: The Mystery Customer .

Anthony Dennison — Sat, 12 Mar 2016 11:22:39 GMT

[quote user="Gillian Mostyn"]

[quote user="Anna Battek-Kosiorowska"]I can not imagine registering a new client without requesting previous history unless it is an emergency on Sunday. On Monday the receptionist will be on the phone to the previous vets.[/quote]

Ditto.

Most local vets are really prompt. One (not for profit practice) takes between 1 week and 4 months. Never less than a week though.

[/quote]

But they get shirty if they don't get histories within an hour of the request...

RE: The Mystery Customer .

Anthony Todd — Fri, 04 Mar 2016 17:14:20 GMT

[quote user="Gillian Mostyn"]OK. We'll agree to differ. I'll continue to insist on a clinical history before giving a second opinion.[/quote]

You've moved the goalposts!

Of course if an animal comes in as a "second opinion" then you get the history, which the owner gladly and completely complies with!

We were talking about an animal that comes in and you think it may have been treated somewhere else for the same thing, but the owner stays stumn, totally different.........viz:

Friday evening the client rings for progress report and says "did not want to tell you on wednesday but we had been going to Another vets Ltd with dysuria for 7 months ,had lots of treatment

RE: The Mystery Customer .

Kate Richardson — Fri, 04 Mar 2016 17:02:54 GMT

[quote user="Anthony Todd"]Yeah, and how many Cushings have an itchy skin....??[/quote]

Certainly possible if they have secondary bacterial infection, or demodex as a results of chronic hypercortisolaemia and immuniosuppression....

RE: The Mystery Customer .

Gillian Mostyn — Fri, 04 Mar 2016 16:58:43 GMT

OK. We'll agree to differ. I'll continue to insist on a clinical history before giving a second opinion. And in doing so, abide by the GtoPC.

You can continue to.....be retired!

RE: The Mystery Customer .

Anthony Todd — Fri, 04 Mar 2016 16:36:01 GMT

[quote user="Gillian Mostyn"]But I guess this conversation is pointless, because Anthony would have known not to go near this dog with steroids anyway....[/quote]

You are quite right, I wouldn't, 'cos, even from your written description, it was pretty obvious that it needed a good look at, and it sounds as if you had the back up of a history as well as the appearance, but, even without the history, all of us would recognise a "complicated" skin, for want of a better word.

This is my whole point; a first glance at most skins will give all of us a good idea of what is going on; when to give something and when to do biopsies, with or without a history, and deal it with accordingly.

All I can say is that by being sympathetically proactive, even to the extent of treating the animal, if sensible, you can usually get the owner to tell you why it is a "second opinion" and enhance the other vet., or at least not damage reputations and usually help the animal immediately.

RE: The Mystery Customer .

Emily Rainbow — Thu, 03 Mar 2016 20:45:04 GMT

Sounds like my second opinion that had had 6m of antibiotics and steroids.... It had ringworm!

RE: The Mystery Customer .

Gillian Mostyn — Thu, 03 Mar 2016 19:27:57 GMT

[quote user="Anthony Todd"]

Yeah, and how many Cushings have an itchy skin....?? I did have some veterinary common-sense, which may surprise most of you! [Didn't want to embarrass West Drayton's finest.]

Gosh, you modvets, I thought you'd know that, after all those blood tests too....[sarcasm]

[/quote]

That comment is, frankly, ridiculous.

But I can illustrate this with a completely true anecdote. Little bichon, second opinion, been treated for months with steroids and antibiotics for intensely itchy, ulcerated skin which had continued to get worse despite treatment. It had been assumed that it had an allergy. Biopsy and blood tests by me confirmed calcinosis cutis, which had unfortunately now progressed to neoplastic changes. The extensive and long term steroid use meant I immediately got on with diagnostics. I don't blame the first vet - but their 'treatment failure' in the clinical history did mean that I progressed to aggressive diagnostics straight away. Without it, I probably would have given antibiotics and steroids because it did look typical for allergies...

But I guess this conversation is pointless, because Anthony would have known not to go near this dog with steroids anyway....

RE: The Mystery Customer .

Anthony Todd — Thu, 03 Mar 2016 19:17:54 GMT

[quote user="Gillian Mostyn"]Similarly, putting a pet through further invasive tests or multiple GAs to confirm a diagnosis which, with a history to hand, can already be confirmed, is unethical.[/quote]

Of course, but you are choosing an extreme example, and the clipped cephalic might give, even me, the prompt to make further enquiries.....

Unethical, but better, rather dumb.......

RE: The Mystery Customer .

Anthony Todd — Thu, 03 Mar 2016 18:54:43 GMT

[quote user="Martin Atkinson"]You may feel that giving that pet it's shot of dexafort to improve its itchy skin is for the best[/quote]

Yeah, and how many Cushings have an itchy skin....?? I did have some veterinary common-sense, which may surprise most of you! [Didn't want to embarrass West Drayton's finest.]

Gosh, you modvets, I thought you'd know that, after all those blood tests too....[sarcasm]

You knockers should really pick better examples! [Martin, you surprise me; I make loads of better knockdowns]

Scoring points aside, surely you guys will realise that, with a bit of intuition, rather than slavishly following the RVC directives, you should be able to suss out the cases that really need the history and the cases that would benefit from urgent relief, and a bit of a chat so you can determine why the owner is**ssed off with the previous vet.

I tried to support the previous vet [which was so easy, cos usually they were right!!] and it enhances everyone if you say that he other vet was spot on.

It must happen so often now 'cos the fees are so high and there re so so many vets so it is worth while thinking this scenario through.

I don't think you ever enhance your reputation by slagging off another, however justified you think it may be.

PS: What goes round comes around, so slag he other vet off today and beware of what bites you tomorrow.

RE: The Mystery Customer .

Martin Atkinson — Thu, 03 Mar 2016 18:35:57 GMT

[quote user="Gillian Mostyn"]

[quote user="Anthony Todd"]I always considered the pet first and it may have a rather different feeling.[/quote]

Anthony - in doing this, I am considering the pet first and foremost. An owner 'shopping around' for an opinion without being honest isn't in the pet's best interests.

[/quote]So very true. The dog doesn't know that it has an illness that vet 2 is about to make worse because he hasn't got the previous history. You cannot apply anthropomorphism to this argument.

[quote user="Gillian Mostyn"]

[quote user="Anthony Todd"]I had the owner of a foxy sweep the dog off the table when I asked for the previous vet, and the dog was very very itchy so needed relief pronto!![/quote]

You may feel that giving that pet it's shot of dexafort to improve its itchy skin is for the best. The previous vet, who has just diagnosed cushings/DM and refused to use steroids, preferring to use a different drug such as apoquel (which the owner then doesn't want to pay for) may not agree. Similarly, putting a pet through further invasive tests or multiple GAs to confirm a diagnosis which, with a history to hand, can already be confirmed, is unethical.

[/quote]I don't think even Anthony can counter that one it is a trump hand and perfectly illustrates why we have a rule on succession. It 'aint going to die from an itchy skin in the time it takes to get a history!

RE: The Mystery Customer .

Gillian Mostyn — Thu, 03 Mar 2016 17:07:36 GMT

[quote user="Martin Atkinson"][quote user="Anthony Todd"]What happens to the pet in the meantime?[/quote]If its not urgent it waits. If it is, as we've already said, it gets emergency treatment. [/quote]

Ditto

[quote user="Anthony Todd"]I always considered the pet first and it may have a rather different feeling.[/quote]

Anthony - in doing this, I am considering the pet first and foremost. An owner 'shopping around' for an opinion without being honest isn't in the pet's best interests.

[quote user="Anthony Todd"]I had the owner of a foxy sweep the dog off the table when I asked for the previous vet, and the dog was very very itchy so needed relief pronto!![/quote]

RE: The Mystery Customer .

Anthony Todd — Thu, 03 Mar 2016 16:22:29 GMT

[quote user="Martin Atkinson"] A client who doesn't understand this is not welcome.[/quote]

I always considered the pet first and it may have a rather different feeling.