Veterinary ECC and the out-of-hours service-member practice relationship

Re: Veterinary ECC and the out-of-hours service-member practice relationship

salome2001 — Thu, 10 Jun 2010 18:48:25 GMT

I am just going to comment on the OP so some of this may have been saif before, but just a c ouple of points from my humble opinion

- we are served locally by three separate OOH providers. Two are 24hr (one with referral and first opinion, not sure about the other one), one is only open OOH and transfers animals back first thing in the morning. I have real problems with the way the last works, not the least as the transfers are arranged by a separate pet ambulance and usually before contacting the day practice to let them know they are coming!!!

- My experience personally at the third clinic with my own pet (I locum so no acess to drugs etc at midnight on a bank holiday) was not impressive. The vet had obviously hjust woken up (nurse looked bright!) and p*ssed off with being called in. When she said she wanted to "keep the cat in for observation" and not give any treatment I uncloaked my veterinary self and told her what to give my cat.

- I do think that ECC should be considered and developed as a specialty in its own right and that OOH medicine- if truly "emergency"- deserves to be remunerated as such.

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Colin Cameron — Tue, 08 Jun 2010 10:54:53 GMT

[quote user="Vikki Halliday"]

Yes this service can be given equally in either an OOH provider or the member practice, but why should those of use who wish to have a life outside work, families who appreciate unbroken sleep patterns, and no desire to portray ourselves as "martyrs to the cause" , feel denigrated by your assertions that to be a vet is a "lifestyle" choice.

I think that is an outdated and frankly dangerous view, which if perpetuated will no doubt lead to more disillusionment and departure from the profession.

[/quote]

My opinion is no valid than anyone elses!!! How is my view, that if you choose to be in practice you should accept what that entails and just get on with it and stop complaining all the time, a dangerous or out dated one. A lot of young vets seem to have a dread of OOH instilled into them,well before they actually have to do any! All I was trying to say. however inelegantly, was that they would be better just to accept the situation, unless it isn really bad, and get on with leading a normal a life as possible. This actually make OOH much less onerous.I have always done this and therefore not been bothered too much by doing OOH cover. I still feel that in a number cases the perceived burden of OOH is somewhat at odds to the actual workload. In others of course the burden can be significant and in these circumstances a dedicated OOH provider would , I agree, be a Godsend. All opinions are valid and we must all judge our own circumstances and act appropriately. Two points that were raised by a "non vet" recently were 1. OOH providers have a vested interest in convincing practices that OOH cover within the practice is outdated and onerous. 2. If the EC working time directive is fully implemented with no opt-out allowed, vets will wll be in the ---- as they will be forced to employ lots of extra staff or to use one of these providers. For example a rural practice with no immediate neighbours would be compelled to either provide no OOH at all or to employ 3 other vets to cover the 120 remaining ours of the week. Then the complaints will really start ! In conclusion I would say that I was not intending to denigrate anyone so apologies if you felt this was the case. Please can people just stop complaining all the time, as I said in other replies, thats all. Learn to enjoy practice for what it is. I will give no more thoughts on this subject as they seem to be being taken out on context. You can all do just as you please and good luck!!!

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Julian Earl — Sat, 05 Jun 2010 20:03:49 GMT

[quote user="Vikki Halliday"]

Personally I think more recognition of the stress of being on call needs occur, particularly within the more senior ranks of the profession. The number of vets leaving the profession, and those with health issues or addiction, may well be on the increase because every time the "status quo" is questioned, those who query are made out to be pariahs by those who revel in their self-sacrifice and martyrdom to the profession.

[/quote]

Now I may or may not be playing Devil's Advocate here, but what makes you think that the more senior members of the profession (obviously not me, only having qualified in 1981) do not recognise this stress? And is there any suggestion that (a) this stress is greater now than it was x number of years ago; (b) people are less able to cope than x number of years ago, and (c) that night work is a more significant stressor than the stress of our responsibility (for example) or difficult clients (for another)?

To be quite honest, I think that it is not people who challenge the status quo who are now made to feel like pariahs, but those who suggest that in the real world it is not possible to employ extra vets simply to give everyone a cosy lifestyle. No-one, or certainly very few in my experience, enjoys OOH, but someone has to do it and rural practices cannot use VetsNow when they may be 30-plus miles away.

[quote user="Colin Cameron"]

[/quote]

I agree with just about everything you have said in this thread Colin, and regarding the bit in bold: I simply expect to be busy, so don't plan anything such as watching a film, finishing that book or going out, and if it is quiet and I do get some things done then it has been a good weekend. That is just my personal way of coping.

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Rebecca MacMillan — Sat, 05 Jun 2010 19:50:19 GMT

[quote user="Colin Cameron"]

Now lets all just get on with it and actually learn to enjoy practice life!!!! Good luck to one and all

[/quote]

Well said!

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Colin Cameron — Sat, 05 Jun 2010 19:17:35 GMT

[quote user="james hunt"]Sorry, i must have misunderstood - I thought you were suggesting that unless people were prepared to do all their own out of hours work they shouldn't be working in practice?[/quote]

Not in the slightest. What I was really trying to convey was that if you choose to be in practice then instead of moaning all the time about being on call, learn to accept it and get on with a normal a life as you can. I would also say to employers to give as much on call support as possible to new and recent graduates to take some of the anxiety away. In my practice our less experienced vets always have the full back up from one of the partners. If you are in small animal practice and there is an OOH service provider in your area then use it and good luck to you. Now lets all just get on with it and actually learn to enjoy practice life!!!! Good luck to one and all

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Colin Cameron — Sat, 05 Jun 2010 19:09:43 GMT

[quote user="Michelle Tapp"]

I certainly think that the vets at my member practices do a good job with the emergencies they see in the daytime. I would never presume to say that I can do a better job than any other vet. But I know that all the staff in my clinic treat the patients and their owners just as our member practices would wish us to, that we do caring and conscientious work and have very few complaints from the few thousand grateful clients we see each year.

Michele

PS - so please spare a thought when debating for the hard working vets in this sector of the professio

[/quote] no-one is saying that you don't do an excellent job and I am sure that you work just as hard as the rest of us. my point is that there seems to be a growing resentment of on call withing the younger elements of this profession and an expectation that use of dedicated OOH providers is the norm. It does not work in every area or type of practice. Good luck to those who able to use centres like yours. I still like to look after my own patients OOH. We are a mixed practice and it would be difficult to do a rota as most of the other vets in this area are small animal only/. Anyway keep up the good work!!!!

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Colin Cameron — Sat, 05 Jun 2010 18:52:37 GMT

[quote user="Rebecca Benge"]

But it's not exactly the same as being able to switch off, have a relaxing bath, take the dog for a long walk, have a glass of wine, go out for dinner, go to the gym, climb into your pjs and watch TV - or whatever it is that most people enjoy doing in the evenings after work. You can't gurantee whether you'll even be able to eat your dinner uniterrupted or get a full nights sleep - so I don't call an evening on call as free time, even if it's a quiet one.

I personally do get an immense satisfaction out of the cases I successfully deal with alone and am glad I'm getting this experience. However I can't deny that I dread being on call, feel constantly on edge and only relax when the phone is handed back over. Maybe it's because I have only been out in practice for 10 months and am still building my confidence at dealing with emergency cases.

I agree that we don't go into this career blindly, we all know it's not a '9-5' job, but the actual reality of doing on call and working full time is somewhat difficult to prepare for (especially as a new grad when everything is still so new and the responsibility is nervewracking). Yes, it's a given that being a vet means you may have to sacrifice some things but can we please not berate people that are able to opt out, it's unprofessional and smacks of resentment.

[/quote]

Please do not call me unprofessional for stating my opinions. I am not berating anyone who is able to opt out of OOH work, good luck to them! Just please don't look down on those of us who either are unable to use these centres because of our type of practice ( eg. mixed) or choose to do our own because we feel it is our responsibility towards our patients and do not wish to pass that responsibility on to someone else.

As regards on call, I fully appreciate the daunting task it must seem to new graduates, having been through the mill myself and being an employer of a recent graduate. It does take time to become confident in emergencies and I would expect any employer to give full back up to young, less experienced vets. In my practice new and recent graduates always have the backing of one of the partners. I am sure that you will, with experience, hold on-call in less dread and will actually manage to have a fairly normal life. I made a conscious decision many years ago that I would just accept being on call and tried to do things as normally as possible. Not always easy in practices with busy OOH workloads but some mitigation is possible. If it is really too busy OOH perhaps a second vet on call is needed ( I once worked a 1st and 2nd on call rota which worked fairly well). Do not let being on call get you down, just learn to live with it and try to do all the normal things you mentioned. Remember mobile phones are mobile. I can remember the revelation when they first came along. Good luck

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Colin Cameron — Sat, 05 Jun 2010 18:03:53 GMT

[quote user="Aoife O'Sullivan"]

I totally agree with your views and also feel quite battered by the OOH debates that come up in these forums. I have worked for several different out-of-hours providers since 2006 and I hope that the work that is done OOH and the benefits that having OOH providers makes to the profession, are recognised, if not by everyone, at least by the people we are providing the service for.

I really enjoy OOH work and feel it is a rewarding and worthy job to do, for clients, their pets and for member practices. In some instances, i think the comments on this thread insinuate that everyone that works in OOH is financially motivated, however in my experience, we just have a job to do like everyone else and we should be paid for this.

Why cant we all just get along? At the end of the day, we are all hoping to achieve the same thing, aren't we?

[/quote]

[quote user="Aoife O'Sullivan"]

Why cant we all just get along? At the end of the day, we are all hoping to achieve the same thing, aren't we?

[/quote]Of course we are all trying to do the best for all our patients. How we achieve that OOH is up to the individual practices bearing in mind factors such as distance to travel etc. I just don't like the creeping feeling that practices doing their own OOH cover are way behind the times. Just like those who choose to use dedicated OOH service providers, we choose not to. And anyway, as mixed practice it would not achieve much as we would still need to be on call for the large animal work. But Hey, each to there own. You will also have noticed that posts on these forums really do stir things up a bit with steam from the ears etc.

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Colin Cameron — Sat, 05 Jun 2010 17:49:44 GMT

What I was trying to convey was that by all means use these OOH service providers if you so choose but please do not look upon those of us who would rather cover our own clients OOH as strange not in the modern world. We are all trying to do our very best for our patients after all. I my practice we simply prefer to look after our own patients.

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Vikki Halliday LLB — Fri, 04 Jun 2010 23:56:11 GMT

[quote user="Colin Cameron"]

Point 1. of course if the animal is in significant pain it should be attended to as soon as practicable. I have always done so and will continue so to do. It should not need to travel miles to dedicated centre to be seen. I have nothing against OOH centres per se but do not accept the arguments that only they cangive a satisfactory service and that it cannot be provided with ones own practice.

[/quote]

Agreed that acute and significant pain should be attended to, but when the RCVS cannot seem to agree on what is a "reasonable distance" for clients to travel to OOH providers, why is your opinion any more valid than the G to PC?

I think that is an outdated and frankly dangerous view, which if perpetuated will no doubt lead to more disillusionment and departure from the profession.

[quote user="Colin Cameron"] A non emergency would most probably be dealt on the phone or if the client insisted on being seen a suitable convenient appointment could be made[/quote]

No client has the right to "insist" to be seen. It is purely a veterinary decision based on the available clinical information. Unfortunately the litigious society we are now in makes vets terrified of refusing client "insistence" in case they are misconstrued as refusals to see genuine emergency cases.

[quote user="Colin Cameron"] I do accept that there is a huge difference between big city setups and more rural ones and perhaps the city vets do need more time off,[/quote]

Why? I have worked in both and found the OOH calls to be greater in the country! It also takes longer to deal with, travel to and from, and therefore recover from such late night excursions to the surgery.

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Michelle Tapp — Fri, 04 Jun 2010 21:08:41 GMT

[quote user="Colin Cameron"]I am satisfied that my seemingly controversial statements have acheived their objective in stimulating debate on OOH provision.[/quote]

I'm afraid I'm breaking my rule of not getting involved in this type of debate but I just had to ask....why does the subject need this debate? My brain (which to be fair is usually at least moderately sleep-deprived so may just not be getting what its all about!) is screaming at me that surely it's all very simple; if a practice wants to contract out its OOH care and there is a company in the area providing that service then they use it. If a practice wants to do their own OOHs then they do it!

[quote user="Colin Cameron"]I am just getting a bit fed up with seemingly being constantly told that unless we have specialist status or are in a referral centre we should not be doing anything beyond vaccinations and cat speys! [/quote]

Michelle

PS - so please spare a thought when debating for the hard working vets in this sector of the profession!

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Rebecca MacMillan — Fri, 04 Jun 2010 18:01:49 GMT

[quote user="Colin Cameron"]

Being on the end of a phone with not many calls isn't exactly " working without a break"

[/quote]

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Shailen Jasani — Fri, 04 Jun 2010 17:35:31 GMT

Just to veer a bit away from the lifestyle aspects and more towards the clinical aspects, in the few days before I made my original post I encountered a couple of different scenarios that I feel are relevant to the OOH provision conversation.

The first was about a dog that had had a splenectomy at the member practice and then transported to the OOH provider. The dog developed clinically significant ventricular tachycardia over the evening and required treatment with a lidocaine infusion. The following morning, the member practice did not feel in a position to continue the lidocaine infusion which therefore posed a conundrum which ended up with the dog being referred essentially for continued post-op care.

The second scenario was when a friend rang for some advice. She works in a small animal-only general practice and was presented with a collapsed blocked cat when on-call. She did not have the facility to measure blood potassium concentration or to perform an ECG, and wanted some advice with the facilities she had available on how to go about addressing the cat's hyperkalaemia that was almost certainly present and of cardiovascular significance. This was in the backdrop of her also doing some shifts for an OOH provider where she did have these facilities available.

I encounter these types of scenarios quite a lot in advice calls, discussions at CPD and so on, and they are partly what prompted my original post.

Re: Veterinary ECC and the out-of-hours service-member practice relationship

james hunt — Fri, 04 Jun 2010 16:36:34 GMT

[quote user="Colin Cameron"]

If you don't want the whole package, do something else!

[/quote]

Sorry, i must have misunderstood - I thought you were suggesting that unless people were prepared to do all their own out of hours work they shouldn't be working in practice?

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Colin Cameron — Fri, 04 Jun 2010 14:21:01 GMT

I am satisfied that my seemingly controversial statements have acheived their objective in stimulating debate on OOH provision. Some replies have not really fully appreciated the points raised. I am just getting a bit fed up with seemingly being constantly told that unless we have specialist status or are in a referral centre we should not be doing anything beyond vaccinations and cat speys!

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Colin Cameron — Fri, 04 Jun 2010 14:01:09 GMT

[quote user="james hunt"]

I may not have understood these asertions correctly, however I would have thought that having a fully staffed all night surgery available to see those out of hours calls which aren't going to die if left overnight, but may endure significant pain or discomfort, is providing a service which animal owners may avail themselves of if they find it convenient.

As an aside it prevents VS's who have worked the previous day and will work the following one having to disrupt their evening meal/kids sports/domestic argument/whatever to deal with a non emergency. I think there's plenty to occupy our professional minds during the day without having to endure (and to some people that's what it is) the additional anxiety of being on call. Yes, out of hours work presents interesting challenges and learning experiences and some individuals will relish these. Others may find the acute nature of cases and lack of support and back up extremely intimidating. Personally I don't feel that such people should be told that they have no place in our profession! end of rant!!

[/quote]

Point 2. I did not say that they should not be in the profession if they found OOH intimidating. it is up to their employer to provide the necessary back up etc. in order to alleviate anxiety. I have found that my young vets cope remarkably well with back up from senior, more experienced vets. In have never had a problem with vets accepting OOH rotas. A non emergency would most probably be dealt on the phone or if the client insisted on being seen a suitable convenient appointment could be made, minimising the disruption. And anyway it is not every night. I do accept that there is a huge difference between big city setups and more rural ones and perhaps the city vets do need more time off, but having worked in both I am not totally convinced of the arguments.

Lets have some common sense in this discussion please.

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Colin Cameron — Fri, 04 Jun 2010 13:38:25 GMT

[quote user="Ian Ross"]

I have previously spent spent 8 years working in practices that ran their own out of hours - the first a mixed practice where I sometimes worked (being at the end of a phone, rather than at the practice) 120 hours without a break (admitted not called a lot of this time but had to remain in the area), and the second where we did a 1 in 7 rota, but could work a 36 hour non-stop period.

[/quote]

Being on the end of a phone with not many calls isn't exactly " working without a break"

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Rudolph — Fri, 04 Jun 2010 09:32:43 GMT

[quote user="Julian Earl"]Are you suggesting that 999 cases out of 1,000 can be reasonably diagnosed or even assessed over the phone? [/quote]

No. Sophia picked me up properly on this one. I was just suggesting that by careful questioning on the phone you can make a reasonable assessment of what is and isn't urgent. And, may I reiterate, I NEVER prescribe based on a telephone conversation. Usually the result is that I ask that the animal is seen; the variable is when.

As for the lifestyle issue, why is perceived to be lazy or uncaring to want a 9-6.30 (no-one is working 9-5!) job? I've made my case for this before. I work hard when I am at work, I enjoy my time off. I agree with the sentiment of "why can't we all just get along?" - I don't berate others for their lifestyle choices.

I didn't choose veterinary as a lifestyle, I chose it as an interesting job! Work should not define who you are. I like to think that I have a lot more to offer to the world than simply "I'm a vet". Letting a stranger look after my clients' OOH needs allows me to be a person for a while each day and I'm okay with that.

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Aoife O'Sullivan — Fri, 04 Jun 2010 05:33:04 GMT

[quote user="Michelle Tapp"]like I say I really don't enjoy reading the OOH debate threads that pop up occasionally and tend to feel quite battered by them personally but don't get involved. The veterinary profession as a whole is really under attack from public opinion in general these days so I would like to think that people within the profession could communicate and understand each other better to support each other in times like these. What can I say - I like everyone to be happy![/quote]

Michelle,

Why cant we all just get along? At the end of the day, we are all hoping to achieve the same thing, aren't we?

Re: Veterinary ECC and the out-of-hours service-member practice relationship

james hunt — Thu, 03 Jun 2010 23:46:15 GMT

I also think spouses of vets could do without having disturbed nights for the sake of their other half's profession, as more than likely they need to be alert for their own job come the morning!

Re: Veterinary ECC and the out-of-hours service-member practice relationship

james hunt — Thu, 03 Jun 2010 23:33:02 GMT

[quote user="Colin Cameron"]

We must not forget that we are a service provider and why we chose this path.

[/quote]

[quote user="Colin Cameron"]

A bit OTT don't you think? A good proportion of OOH calls will wait until normal surgery hours, if the correct enquiries are made

[/quote]

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Colin Cameron — Thu, 03 Jun 2010 23:01:18 GMT

[quote user="Evelyn Barbour-Hill"]

Nicely put.

[/quote]

Thank you

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Colin Cameron — Thu, 03 Jun 2010 22:49:34 GMT

Being a vet used to be a calling and " what you did " and was more or less a way of life. It now seems that it is being denegrated to just another job with a lifestyle for the convenience of certain types of practitioners. We must not forget that we are a service provider and why we chose this path. In the words of a poem I read some time ago about being a vet, " Think hard before you choose my friend, then stick it to the bitter end". Anyway what actually is "a lifestyle". I agree that vets have chosen their profession but an increasing number appear not to want the bits that might be a tiny bit inconvenient. If you don't want the whole package, do something else! End of rant!!!

Re: Veterinary ECC and the out-of-hours service-member practice relationship

sophia guymer — Thu, 03 Jun 2010 22:45:38 GMT

[quote user="Julian Earl"]Are you suggesting that 999 cases out of 1,000 can be reasonably diagnosed or even assessed over the phone? Owners are notoriously inaccurate about assessing pain even with a hobbling old dog, and other examples of misinterpretation are aplenty. A "runny eye" with a deep corneal ulcer, bitches "slightly off colour" for several weeks due to a pyo about to rupture etc., etc., etc. [/quote]

Tried to stay out of this one as don't do any OOH anymore due to being part time so don't really feel entitled to an opinion but felt had to comment on this.

I don't know which one of you is right here so am not trying to take sides but I don't think Rudolph is suggesting that he thinks the OWNERS can make the diagnosis over the phone! What he is saying is that HE can make an educated descision when speaking to an owner on the phone,so just as much as you would worry that a runny eye might be a deep corneal ulcer, a quiet castrated male might be a blocked bladder, etc and so get them seen to soon that day/night HE would too!!

I really don't think he would just take an owners word for it!!!!! His percentages would be way out!!!

Feel free to correct me if I am wrong, Rudolph

Re: Veterinary ECC and the out-of-hours service-member practice relationship

Colin Cameron — Thu, 03 Jun 2010 22:28:37 GMT

[quote user="Hannah Wynne Richards"]

I cannot emphasise too strongly that EVERY owner who phones OOH should be offered an appointment, especially by an OOH provider whose veterinary surgeons and nurses are already at work, so don't have to get out of bed !!!!!!!!!!!!!!!!!!!!!!!!!!! Also if a veterinary surgeon does not examine and treat an animal who is in pain (even though that pain is not life-threatening ), then IMHO that failure justifies both a criminal prosecution, and a Royal College disciplinary action

Wynne

[/quote]A bit OTT don't you think? A good proportion of OOH calls will wait until normal surgery hours, if the correct enquiries are made. I do agree though that if in any doubt it is better to see the animal. Experience will help to make these decisions easier. A not uncommon phone call is for a 5-6 month old entire female cat " rolling about the floor in agony" . Does this really need to be seen as we are told the cat is otherwise eating and drinking normally. I suppose it is the "season" for it!! But always the proviso of "if in doubt" or if the client insists on being seen. As mentioned in other replies, common sense should prevail.