Second opinions

Re: Second opinions

Mark Rowland — Sun, 15 Jan 2012 14:57:59 GMT

Not regular clients? want 2nd opinion? the cynic in me says make sure you get paid, usually these clients have some beef about paying twice and how they might feel that the other vets should pay...not your concern as you know.

Re: Second opinions

Kate Richardson — Sun, 15 Jan 2012 14:21:39 GMT

I think the thing to do Sarah, as Evelyn said, is to explain why you need to speak to the other vets and it is in their and their animals best interests to do so, and that it happens to all vets from time to time; sure we don't like it when someone wants to get another opinion, but we have to accept that we can't please all of the people all of the time. Anyway, sometimes, you end up backing up what the first vet has done, and everyone ends up happy- the owner feels happy that they have been given the right advice and the animal receives the right treatment.

Re: Second opinions

Sarah Wheeler — Sun, 15 Jan 2012 07:25:13 GMT

I don't think it was an emergency; they'd rung in the morning wanting a visit late in the day to see an animal that had been ill for a while. As it happened, I told them mulitple times on the phone that I was more than happy to come see it but only if I could speak to the other vet. They're not regular clients and in fact the only other time we've visited them was also for a second opinion. And you see, the problem is, last time the other vet went out and didn't ask any questions at all.

Re: Second opinions

Niall Taylor — Sat, 14 Jan 2012 17:11:35 GMT

[quote user="Mark Rowland"]What about non veterinary personel. Anyone ever had a history request from a rodentologist... I have [/quote]

I once took great delight in declining to send a set of radiographs to a chiropracter - jeez!

Niall

Re: Second opinions

Evelyn Barbour-Hill — Sat, 14 Jan 2012 17:04:12 GMT

[quote user="Judith Joyce"] but what happens when one of those GPs regards themselves as a specialist and happily takes on a case that a more knowledgeable, experienced and expert GP has had the sense to recognise as ,"a difficult case". [/quote]

Well, either:

1. The second GP actually is enough of a specialist , in that particular branch, or branch of a branch,to make progress with the case; or

2. The second GP has failed to perceive his limitations, in which case either:

a) after taking the case on and making initial moves, he will refer it to someone more expert, or

b) he will continue to thrash around with it badly, which might just possibly land him in big trouble.

It all comes down to proper professional behaviour, the spirit of it, not the letter of the GtoPC.

Re: Second opinions

Anthony Todd — Sat, 14 Jan 2012 15:37:04 GMT

Oh dear, oh dear, don't throw your rattle out of the pram, I was just giving my experiences with a dash of common sense. 99 out of 100 sounds to me like a generality rather than a statistic.

8 out of 10 cats prefer to feel better......but I haven't got the evidence for that either but you could ask Jimmy Carr.

Nothing personal, but the implication in the guides etc. is that all vets don't, hence the direct specific protocol, and as you say, in most cases, using wit and common sense works better.

What should night vets do when they can't get hold of the previous vet or any records?

[quote user="Utlendigur"]If the owner has been told the reason why a history is needed and continues to behave like an pr*t that is up to them - they aren't being refused a 2nd opinion full stop. You could say the same thing about an owner who has refused diagnostic tests and treatment. The ultimate responsibility for the pet's welfare is with the owner, as a vet I can't force an owner to accept advice. As I said "unless it's an emergency" - in which I'd count animals that are obviously suffering.[/quote]

Well, sod the owner, my responsibility was to help the animal, which in most, not all, I think I did.

[quote user="Utlendigur"] Perhaps calling people "witless" has something to do with it[/quote]

As I said above, FFS, nothing personal but, the blind adherence to a rigid protocol implies a lack of common sense and practicality and did nothing for the animal nor for my peace of mind, limited common sense and ability.

I humbly apologise, in advance, for any personal criticism of anybody. actual, hinted at, or implied.

Re: Second opinions

Utlendigur — Sat, 14 Jan 2012 14:39:02 GMT

[quote user="Anthony Todd"]99 times out of 100 the animal is getting worse, or at least not better ,and in 99 out of 100 cases the history won't make a blind bit of difference; [/quote]

Could you refer me to the evidence to back this up...

[quote user="Anthony Todd"]most of us have the wit and resolve to ask for it and explain to the owner why.[/quote]

As I do - and in most cases it works. I find your implication that I don't (and am lacking in wit and resolve) very insulting

[quote user="Anthony Todd"]If you turn them away either the animal remains untreated, and suffering more, or, the 99 out of 100 owners go to another vet and make quite sure they don't mention anything previous at all.[/quote]

If the owner has been told the reason why a history is needed and continues to behave like an pr*t that is up to them - they aren't being refused a 2nd opinion full stop. You could say the same thing about an owner who has refused diagnostic tests and treatment. The ultimate responsibility for the pet's welfare is with the owner, as a vet I can't force an owner to accept advice. As I said "unless it's an emergency" - in which I'd count animals that are obviously suffering.

[quote user="Anthony Todd"]or getting something inappropriate.[/quote]

Which it is more likely to do without the history. Such as the idiots who didn't tell me their dog had been to a neighbouring practice the previous day and had a couple of "jabs" - one of which was a hefty dose of dexafort. Would have mixed well with nsaids I was about to prescribe

[quote user="Anthony Todd"]When one did the right thing and phoned the previous vet one often got an inadequate history, if any, an obviously very incorrect diagnosis [/quote]

If that's the case then you know to start again from scratch.

[quote user="Anthony Todd"]and an ice cold reception terminating in a description of the client which was always uncomplimentary.[/quote]

That may be your experience, it ain't generally mine. Perhaps calling people "witless" has something to do with it

Re: Second opinions

Judith Joyce — Sat, 14 Jan 2012 11:43:36 GMT

[quote user="Evelyn Barbour-Hill"]PS Where I wrote "specialist" above, I did of course mean "specialist", not necessarily "Specialist". Whoops, wrong thread! [/quote]

But surely, as others on that other thread have pointed out, there isn't any confusion so you didn't need to qualify your statement!!

Whilst I agree entirely with your sentiment about, "..... a difficult case it doesn't want toting around one general practitioner after another" but what happens when one of those GPs regards themselves as a specialist and happily takes on a case that a more knowledgeable, experienced and expert GP has had the sense to recognise as ,"a difficult case".

Malcolm N (aka Devil's advocate)

Re: Second opinions

Anthony Todd — Sat, 14 Jan 2012 11:05:24 GMT

[quote user="Utlendigur"] If they won't give us the first vet's details or allow us to contact them, they get shown the door. [/quote]

Yes, well, you've got the moral and ethical high ground but what about the animal.

99 times out of 100 the animal is getting worse, or at least not better ,and in 99 out of 100 cases the history won't make a blind bit of difference; if it would, or is vital or essential, then most of us have the wit and resolve to ask for it and explain to the owner why.

If you turn them away either the animal remains untreated, and suffering more, or, the 99 out of 100 owners go to another vet and make quite sure they don't mention anything previous at all.

So the next vet could end up either refusing treatment, and the animal trails off untreated again, or getting something inappropriate.

When one did the right thing and phoned the previous vet one often got an inadequate history, if any, an obviously very incorrect diagnosis and an ice cold reception terminating in a description of the client which was always uncomplimentary.

I just used common sense and discretion, sometimes even made the animal better, so at least someone was happy.

Re: Second opinions

Mark Rowland — Sat, 14 Jan 2012 08:58:54 GMT

What about non veterinary personel. Anyone ever had a history request from a rodentologist... I have

Re: Second opinions

Michael Woodhouse — Sat, 14 Jan 2012 01:20:36 GMT

[quote user="David Mills"]

I do think sometimes the animal welfare aspect of this is overplayed sometimes. I remember a job I had where the farm side had no capacity for clinical notes so effectively if a beast didn't get better and it was you visiting that day you'd effectively be treating blind unless previous colleague had left a bottle of something to inject.

Small animal wise it's easier if you get a clinical history but would it be essential to the consultation from an animal welfare perspective? Not sure at all.

[/quote]

I have thought exactly the same. The main thing in a more complex case would be repetition of tests that had already been run.

Re: Second opinions

David Mills — Sat, 14 Jan 2012 00:58:39 GMT

Small animal wise it's easier if you get a clinical history but would it be essential to the consultation from an animal welfare perspective? Not sure at all.

Re: Second opinions

Evelyn Barbour-Hill — Fri, 13 Jan 2012 23:58:28 GMT

Afterthought.

If the animal is currently being treated by an RSPCA clinic, you'll have a job getting a history anyway!

Re: Second opinions

Evelyn Barbour-Hill — Fri, 13 Jan 2012 23:52:38 GMT

[quote user="Sarah Wheeler"]The owner didn't want to tell me who had seen it, for fear of upsetting the other vet. [/quote]

I've had that only once, from a horse owner (what a surprise ). I told her that the other veterinary surgeon would be even more upset when he did find out.

If it turns out halfway through a consultation that this is a second opinion or a supercession (I usually have to explain the difference to the owner) then what I do depends upon circumstances. There are situations where it clearly doesn't matter if you leave it till later to contact the other veterinary surgeon, and situations where it matters very much. Moreover, I have excellent and understanding relations with neighbouring practices (I understand that some of you may not) and we are all happy with our own level of communication.

You are never obliged to do a second opinion. (You are not obliged to supercede either, unless it is emergency.) You can always decline: "I'm sorry, I don't do second opinions on this sort of case". (There speaks the self-employed! I can see it might be more tricky for the assistant in certain practices). Examples from me would be a skin or an eye or a mysterious internal medicine ailment. If it's that difficult a case it doesn't want toting round one general practitioner after another, it needs referral to a specialist. Many a time I have told people, in a friendly and polite manner "if I take Binky on, all I shall do is arrange for him to see a specialist, and Mr. X can do that for you. " Generally people take that in the same manner; sometimes quite relieved I think; and sometimes they even offer to pay for the consultation.

PS Where I wrote "specialist" above, I did of course mean "specialist", not necessarily "Specialist". Whoops, wrong thread!

Re: Second opinions

Utlendigur — Fri, 13 Jan 2012 22:18:40 GMT

[quote user="Michael Woodhouse"]Every now and again we get someone turn up having made an appointment who once you begin the consult lets on it's a second opinion, in these cases I contact the vet afterwards.[/quote]

Unless it's an emergency we try to contact the practice there and then, if we can't they get offered an appointment another day giving us time to get the history. If they won't give us the first vet's details or allow us to contact them, they get shown the door.

This is from the RCVS client info

"There are no restrictions on seeking a second opinion without the consent of your vet, but the second vet will need to contact your normal vet to obtain treatment information. This is so that conflicting treatments are avoided, and is in the interest of your animal. It is also a professional obligation for veterinary surgeons."

And this is from the GTPC

"Although both veterinary surgeon and client have freedom of choice, as a matter of professional courtesy and in the interests of the welfare of the animals involved a veterinary surgeon should not knowingly take over a colleague's case without informing the colleague in question and obtaining a clinical history.

When an animal is initially presented a veterinary surgeon must ask whether it is already receiving treatment, and if so, when it was last seen, and 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 this information the case should be declined."

My feeling is that you aren't obliged to see the animal (except emergencies obviously). Ok some people might withold the info because they don't want to upset their existing vet, but that shouldn't be a problem in a grown up professional world, but the other likely scenarios might be a bad debtor, or a client that's been sacked, or one that is simply looking to play one vet off against another - all more aggro than they're worth. I also don't think you can do an acceptable job if you don't have all the information, especially in a case that's been going on a while where how it has changed (+/- changes in diagnostic tests) will be as important as what it looks like on one day. Don't know anything about the large animal side though..

Re: Second opinions

Hanna Bennett — Fri, 13 Jan 2012 22:17:04 GMT

see the RCVS guide under 'Supersession' - you are obliged to contect the preceding vet to inform them you are seeing the case and request the history. admittedly never had it happen while in farm animal practice!

Re: Second opinions

Michael Woodhouse — Fri, 13 Jan 2012 21:27:32 GMT

You can only do so much. Every now and again we get someone turn up having made an appointment who once you begin the consult lets on it's a second opinion, in these cases I contact the vet afterwards. If they let us know in advance would do things properly.

Had the odd case where they won't give other vets details, so what can you do? Get them to bring any medication the animal is on and do the best you can. I'll do things properly to a point but I find usually in these cases the trust in the old vet has been lost and they are looking for somewhere new.

Re: Second opinions

Mark Hedberg — Fri, 13 Jan 2012 21:19:29 GMT

I wa under the impression that getting a history should always be done before seeing a case - if an owner declines then it usually signals a sticky situation that will blow up in someone's face. ;)