What is going on here and what would you do?

Re: What is going on here and what would you do?

Bob Russell — Mon, 06 Jun 2011 09:23:20 GMT

I have never really considered this type of letter to be necessary or of much value other than as a weapon to 'bully' owners towards my own views and opinions and on reflection we probably will not produce such a letter. It was more a response to the frustration of the episode.

Re: What is going on here and what would you do?

Bob Russell — Mon, 06 Jun 2011 09:06:49 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Andrew Kent"]

I think in theory that is the kind of wording you would use but that boils down to signing something saying "I am breaking the law" in which case should they not then be reported?

I'd like a clause in it saying "By signing this I agree to waive my rights under the data protection act and give my permission for my details to be passed onto the appropriate agencies involved in enforcement of the above laws"

Andy

[/quote]

How exactly you gonna make 'em sign it?

[/quote]

Owner declined to sign would suffice. If an owner is unwilling to follow advice it is quite likely that they would refuse to sign. Not sure any of this would do anything but help to support clinical notes. I don't know (not sure I care that much) if these stand up in court but as someone has mentioned clinical notes are one-sided and do not prove they are a true representation of events.

Re: What is going on here and what would you do?

Andrew Kent — Sun, 05 Jun 2011 19:06:47 GMT

[quote user="Evelyn Barbour-Hill"]How exactly you gonna make 'em sign it?[/quote]

That's the point! It's really another way of getting the message across that what they are doing is not appropriate!

Re: What is going on here and what would you do?

Evelyn Barbour-Hill — Sun, 05 Jun 2011 18:08:39 GMT

[quote user="Andrew Kent"]

I think in theory that is the kind of wording you would use but that boils down to signing something saying "I am breaking the law" in which case should they not then be reported?

Andy

[/quote]

How exactly you gonna make 'em sign it?

Re: What is going on here and what would you do?

Andrew Kent — Sun, 05 Jun 2011 17:44:06 GMT

[quote user="robloxley"]However going back to the case that prompted this thought, if the foreign body had subsequently passed through uneventfully then no laws were broken, merely the client had gone against the vet's advice. Having this in writing to mitigate any potential claim when things didn't go to plan is a reasonable thought[/quote]

Fair point

Re: What is going on here and what would you do?

Rob Loxley — Sun, 05 Jun 2011 17:38:53 GMT

[quote user="Andrew Kent"]I think in theory that is the kind of wording you would use but that boils down to signing something saying "I am breaking the law" in which case should they not then be reported?[/quote]

However going back to the case that prompted this thought, if the foreign body had subsequently passed through uneventfully then no laws were broken, merely the client had gone against the vet's advice. Having this in writing to mitigate any potential claim when things didn't go to plan is a reasonable thought; maybe the VDS would have some advice on such matters?

Re: What is going on here and what would you do?

Andrew Kent — Sun, 05 Jun 2011 17:31:52 GMT

I think in theory that is the kind of wording you would use but that boils down to signing something saying "I am breaking the law" in which case should they not then be reported?

Andy

Re: What is going on here and what would you do?

Mark Hedberg — Sun, 05 Jun 2011 17:19:56 GMT

"I, the undersigned client, am the owner or authorized agent of the owner, for the patient detailed below. I confirm that I refuse treatment for the patient offered by (practice name). I further do not wish to have the patient euthanized.

I understand that this is contrary to the advice offered to me by the treating veterinary surgeon.

I further understand that under the 2006 Animal Welfare Act, I am solely responsible for any suffering endured by the patient listed below.

(Client Details)

(Patient Details)

Signature and Date"

I am not a solicitor, so I'm sure the legalese could use work, but would something like this be workable? (Note: this isn't something we use at our practice; hasn't really come up. So I can't say it works - haven't tried it.)

Re: What is going on here and what would you do?

Andrew Kent — Sun, 05 Jun 2011 17:09:30 GMT

But by offering them a letter to sign you are in some way endorsing their decision or at least facilitating it and therefore to some degree you are complicit in what is essentially breaking the law, unless you word the form in a very careful way but I think that would be difficult!

Andy

Re: What is going on here and what would you do?

Mark Hedberg — Sun, 05 Jun 2011 16:58:29 GMT

Is there a way I can "un suggest" my post?

Re: What is going on here and what would you do?

Mark Hedberg — Sun, 05 Jun 2011 16:56:14 GMT

[quote user="James Laidlaw"]

Do you need them to sign a letter if you have adequately recorded everything in the clinical records? Including the cancelled appointments?

[/quote]

Well, I would say yes - after all, that's why we request they sign euthanasia consent forms. The only one who can write in their clinical history is you; and it's easy for a client to potentially say "That's not what happened at all!" Whereas if they've signed a form that agrees they've decided not to take your advice, it's their signature on a legal document. The data on a clinical history is of necessity only one side of the story, as far as they're concerned.

(Whoops! I meant to hit "more options" - not "suggest".)

Re: What is going on here and what would you do?

James Laidlaw — Sun, 05 Jun 2011 11:34:52 GMT

Do you need them to sign a letter if you have adequately recorded everything in the clinical records? Including the cancelled appointments?

Re: What is going on here and what would you do?

Andrew Kent — Sun, 05 Jun 2011 11:29:16 GMT

I think it is a difficult issue as to whether it is appropriate for us to have something along the lines of a discharge against medical advice form. People are entitled to decide about their own treatment and can decline this if they wish. However the obligation to provide veterinary treatment to a suffering animal is a legal obligation as well as an ethical one.

So how can we have a form that is similar?

Andy

Re: What is going on here and what would you do?

Rob Loxley — Sat, 04 Jun 2011 13:22:37 GMT

[quote user="Bob Russell"]Any ideas of phrasing?[/quote]

I guess you want something like a human self-discharge form.

I guess it should state the problem that has been explained, the treatment that has been advised, that the treatment was refused (and reasons if given), the potential problems that may occur have been explained, and that the owner takes responsibility for any such adverse outcome.

If they don't sign it then I'd just record all the above in the notes (and would do do even if they sign a bit of paper!)

Re: What is going on here and what would you do?

Mark Holmes — Sat, 04 Jun 2011 13:16:11 GMT

Shame about he outcome, interesting radiograph. I have always tended to operate on straight lines and this case would support that

Re: What is going on here and what would you do?

Bob Russell — Sat, 04 Jun 2011 11:37:43 GMT

Just as part of the learning process I will formulate a letter for clients to sign making it clear that they confirm they have declined my recommendations as to treatment. Any ideas of phrasing?

Re: What is going on here and what would you do?

Bob Russell — Sat, 04 Jun 2011 11:26:27 GMT

We can only be guided by the owners comments. Appointments were made because he was not right then cancelled when he ate the next meal. This tells me a lot more about the digestive tract of the Labrador Retriever.

My opinions on this are pretty unprintable but I genuinely believe it was only causing FB symptoms intermittently or the owner would have been forced to take action earlier. In the owners defence we did agree the compromise that the dog would be euthanased if he deteriorated and this option was nearly taken on Thursday evening.

No problem quoting this case but make sure it cannot be traced back to being one of my failures!

Re: What is going on here and what would you do?

Hannah Wynne Richards — Sat, 04 Jun 2011 11:15:02 GMT

I would say that this case justifies prosecuting the owner for causing unnecessary suffering by not following veterinary advice-and changing the Gto PC to allow us to report this type of owner without jumping through hoops with Royal College 1st In fact Bob may I quote this case in my response to the draft guide ? B****y owners-and my sympathies Bob

Wynne

Re: What is going on here and what would you do?

Andrew Kent — Sat, 04 Jun 2011 10:52:12 GMT

Sorry to hear that Bob, but some people just can't be told!

Andy

Re: What is going on here and what would you do?

Bob Russell — Sat, 04 Jun 2011 10:43:28 GMT

[quote user="mariette asselbergs"]

WOW, 2 WEEKS LATER,CONGRSATS AND THANKS FOR SUCH A CLASSIC GOOD CASE!!!

Mariette

[/quote]

Not such a good case - crashed and died last night. It seems the gut was not as viable as it looked. Thank goodness all the appointments made then cancelled by the owner are documented on our records.

Re: What is going on here and what would you do?

mariette asselbergs — Fri, 03 Jun 2011 20:44:44 GMT

WOW, 2 WEEKS LATER,CONGRSATS AND THANKS FOR SUCH A CLASSIC GOOD CASE!!!

Mariette

Re: What is going on here and what would you do?

Bob Russell — Fri, 03 Jun 2011 18:04:28 GMT

Tennis ball (chewed to a strip) removed by enterotomy today! Amazing!!

Re: What is going on here and what would you do?

Bob Russell — Wed, 18 May 2011 13:33:18 GMT

I genuinely felt that surgery was the correct option as the vomiting was on-going. The owners made the decision partly based on the comment 'you cannot spend a thousand pounds on a dog!'. I let them know roughly how much our referral practice would have charged!

Update from yesterday - all seems to be OK! I will get someone to phone tomorrow for another update and ask if they have got the dog insured yet!

Re: What is going on here and what would you do?

Rob Loxley — Mon, 16 May 2011 19:48:28 GMT

Brings to mind the recent disciplinary case where the expert witness was quite happy to suggest leaving fragments of glass to pass through. Unfortunately if you don't advise surgery and it goes on to perforate you can be sure a complaint is coming...

Re: What is going on here and what would you do?

Bob Russell — Mon, 16 May 2011 12:51:07 GMT

The owners have phoned this morning. The dog is absolutely fine!!

I agree with all of those recommending surgery and this is what I suggested! The dog and owners just got lucky me thinks!

I am not convinced they will do a poo check but I have asked! There was a previous thread discussing when we should operate and when not and I was interested in peoples views as to what they would do in a similar situation should surgery be an option! I would have knocked the dog out to confirm FB by palpation and gone ahead with a laparotomy.

Thank goodness Labs are built like tanks!