Is it just me?

Re: Is it just me?

Simon Neuhoff — Fri, 10 Feb 2012 10:20:12 GMT

[quote user="Mark Rowland"]

Unfortunately in this real world we live in, an insured dog with a heart murmur detected at a routine exam needs to be properly counselled if only for the reason that at the next insurance renewal, you can bet your salary that the insurance company will exclude it and any related out of hand and so when it does become clinical the owner is left high and dry. Im not one for exploiting companies but I would also be willing to bet that they woudnt even accept a covering letter stating that the problem is non clinical. After all the company would be expected to fork out for the cardigard the dog was put on to?

[/quote]

This is an interesting conundrum - same goes for dogs with currently small, benign tumours etc. If on an annual policy they won't be covered when things DO become an issue. So how does the vet act - ethically, honestly and with the patient's best interests at heart? For the tumour perhaps its easy - if it seems likely to be an issue I recommend removal sooner rather than later - this puts the patients interests first too as the prceduroe is shorter and less painful etc. But for heart cases where there is a spectrum of grey and the exact time to start treatment is something not even specialists with specialist monitoring can agree on.......

Re: Is it just me?

Bob Russell — Wed, 08 Feb 2012 09:41:03 GMT

[quote user="Malcolm Ness"]

............ criticism perhaps, but VALID criticism, certainly not.

The prime role of the clinician is to guide effort and expenditure towards managing problems and not merely to accurately document abnormality.

[/quote]

This dog may live with the murmur for years or have catastrophic rupture of the chordae tendinae and die within half an hour but to determine this takes a crystal ball. Frightening the owner about something we cannot prevent but may not ever happen seems unproductive.

Thank you for the support Malcolm!

We are open to criticism every time we see a patient! I discussed investigation but suggested none at present. This was not to avoid accusations of over treatment but because I considered it would not benefit the patient at that stage. I stand by that recommendation.

Re: Is it just me?

An On MRCVS — Sun, 05 Feb 2012 14:12:30 GMT

(posted anon for fairly obvious reasons)

It's a two-edged sword. Saw a patient this morning for recheck, after a bit of a crisis during the week, in which the client may - and I say may - have cause to have a pretty good chat with the bosses at the OOH centre.

Client asked me what I thought of the treatment they'd had on the night in question - in an obviously leading manner - and I had to reiterate that I couldn't make comments on the treatment as I wasn't there, that they'd need to discuss the matter with the OOH centre, and I gave a quick explanation of why I couldn't indulge in any conjectural gossip on the case as I was bound by the GtoPC. I also made it clear that the client shouldn't try to read anything into that, and that as things were now OK, best to get on with life, and if they still felt a bit upset after a few days, get in contact with the OOH centre then. All in all, the tone of the consult was such that I was mightily (and somewhat guiltily) relieved to be the good guy on this one.

Problem is, I really, really do feel that an absolote b0ll0ck was dropped. If it had happened in the daytime, and in-house, we'd have been on to the VDS already. Rarely do I believe a word of what other vets are reputed to have said, but in this case I think the treatment was considerably lacking, and I couldn't in all good faith overtly back up the OOH vet and advise that their actions were correct. We're bound, if we can't say anything nice, not to say anything at all - and clients aren't daft, no matter how much we try to avoid miusunderstanding.

Tomorrow, I'll probably spay a cat which presents at the OOH centre for massive intra-abdominal haemorrhage. I might need to rely on that same vet to not fuel the client's anger - but there must come a point where we're not complicit in hiding stuff away.

Re: Is it just me?

Neil Wheadon — Sun, 05 Feb 2012 01:07:50 GMT

[quote user="Kate Richardson"]"by the time the antibiotics have gone through the stomach, there is very little left by the time it reaches the head" [/quote]

If I believed everything

All dogs go for a 10 mle walk twice a day

Nobody gives a fat dog titbits

He doesn't bite - really

However the chap who swore blind that his dog ate 7 frozen chickens a week, did bring a certain smile to my face.

Pinch of salt ,and think the best of your colleagues and defend them as we're not all mad you know

Re: Is it just me?

Mark Rowland — Sat, 04 Feb 2012 15:47:45 GMT

Re: Is it just me?

Malcolm Ness — Sat, 04 Feb 2012 15:25:16 GMT

............ criticism perhaps, but VALID criticism, certainly not.

The prime role of the clinician is to guide effort and expenditure towards managing problems and not merely to accurately document abnormality.

Re: Is it just me?

Vikki Halliday LLB — Sat, 04 Feb 2012 14:15:43 GMT

[quote user="Kate Richardson"]I just have a problem with people being misinformed[/quote]

As do I, however you must be careful that you do not place yourself in a position where we are seen to be openly criticising a colleague without a full history and perhaps all of the salient facts.

Clients have a happy knack of twisting things we tell them into ridiculous statements, and even within my own clinic I have clients who will come back and swear blind that my assistant told them we recommended letting a dog have a first season or a litter of pups prior to neutering, whereas I obviously know different because that's not our policy!

But no I agree it doesn't do our reputation any good, but I have also seen and heard some screaminly funny stories over the years of things vets have "told" clients as a way of explaining perhaps something that they felt was quite beyond the client's grasp.

Re: Is it just me?

Kate Richardson — Sat, 04 Feb 2012 14:04:47 GMT

That is exactly what I did do Vicky! No, your right, it's not my problem, I just have a problem with people being misinformed. Actually, the owner said he thought it was BS! But it doesn't do our reputation any good.

Re: Is it just me?

Vikki Halliday LLB — Sat, 04 Feb 2012 14:00:36 GMT

[quote user="Kate Richardson"]That's all fine and I take your point. But in the situation I described I wasn't treating the animal and I wasn't being asked to treat the animal, the owner wasn't asking for my advice, and he wasn't complaining about the treatment he had been given.[/quote]

I usually find in these cases that a raised eyebrow at the appropriate point in the conversation provokes the client to ask for more information. If they don't then unfortunately it is not your problem!

Re: Is it just me?

patrick murphy — Sat, 04 Feb 2012 13:58:07 GMT

I had liquid panacur up the rectum as that is where the parasites lurk.

Re: Is it just me?

Kate Richardson — Sat, 04 Feb 2012 13:53:57 GMT

[quote user="Robin Grimmer"]

[quote user="Kate Richardson"]

Now there may be an element of what the vet actually said and what the client heard in this story, but I do scratch my head sometimes and think, did you really do 5 years at uni.

Apparently, and obviously this is as told by the client, "by the time the antibiotics have gone through the stomach, there is very little left by the time it reaches the head"

Eh?

Sorry, but it's been bugging me all week, so had to share it!

[/quote]

I completely disagree. I think the moral of this story is never believe what a client says - however nice he or she may seem - especially when running down another vet. I'm not saying all vets are wonderful, but you should back up your colleague until proven otherwise.

You might find that next time the client has gone to a different vet and you are on the receiving end.

[/quote]

That's all fine and I take your point. But in the situation I described I wasn't treating the animal and I wasn't being asked to treat the animal, the owner wasn't asking for my advice, and he wasn't complaining about the treatment he had been given.

Re: Is it just me?

Bob Russell — Sat, 04 Feb 2012 11:33:23 GMT

[quote user="Martin Atkinson"]

[quote user="Bob Russell"]

I saw a small dog with grade IV-V HM in early December. No clinical signs of congestive heart failure so I suggested we did not put the dog on medication at that stage. Seen over the weekend elsewhere by which time this had become 'he said it was nothing to worry about!'.

[/quote]

Not wishing to be too hard on you Bob, but if you didn't suggest some investigations: X-ray, ECG, NTproBNP, even echo, you may have left yourself open to valid criticism of the way you handled the case. A grade IV murmur may indeed be nothing to worry about but if nothing else those investigations would give you baseline to compare with later. If you did offer some investigation, criticism withdrawn.

[/quote]

I discussed X-rays, echo etc but without clinical signs it is unlikely I would have started treatment. I also warned them of the signs to look out for especially a cough and breathlessness. I do wonder if I should routinely give out a handout in these situations!

"No action needs to be taken at the moment" becomes "he told me there was nothing to worry about"!! All murmurs warrant some worrying about!

Re: Is it just me?

Hannah Wynne Richards — Sat, 04 Feb 2012 10:20:13 GMT

That's the prob Whilst if a doctor did the same he/she would be considered a good thorough doctor-and never mind the cost to the poor taxpayer

Wynne

Re: Is it just me?

Lucy K — Sat, 04 Feb 2012 10:16:35 GMT

[quote user="Martin Atkinson"]Not wishing to be too hard on you Bob, but if you didn't suggest some investigations: X-ray, ECG, NTproBNP, even echo, you may have left yourself open to valid criticism of the way you handled the case. A grade IV murmur may indeed be nothing to worry about but if nothing else those investigations would give you baseline to compare with later. If you did offer some investigation, criticism withdrawn[/quote]

Ah yes, but then wouldn't he be accused of ordering "meaningless, expensive tests", just to drive up the cost of the vet visit, especially if he knew that the dog was insured?!! Damned if you do and damned if you don't!

Re: Is it just me?

Martin Atkinson — Sat, 04 Feb 2012 09:56:29 GMT

[quote user="Bob Russell"]

[/quote]

Re: Is it just me?

Hannah Wynne Richards — Sat, 04 Feb 2012 09:46:51 GMT

I would say it's 100% the difference between what the veterinary surgeon said, and what the client heard-especially if a different spouse/partner saw the 1st veterinary surgeon to the one who saw you-so there may have been some "Chinese whispering " involved as well

Wynne

Re: Is it just me?

Thomas Johnson — Sat, 04 Feb 2012 09:34:17 GMT

[quote user="Claire Fisher"]

[quote user="Clive Ansell"]

I recently had a client that gave ProKolin per rectum for her dogs diarrhoea.

[/quote]

I've had a couple of clients try to do that so now I put "Give 2mls twice daily by mouth" on the label just to be sure there's no confusion!

[/quote]

I will usually give the first dose in the consulting room to make sure they know what they're doing, same with topical eye and ear treatments!

Re: Is it just me?

Anne Pietersma — Sat, 04 Feb 2012 09:05:58 GMT

We did get sidetracked there didn't we... I agree with the last posts, so homeopathy aside, we must remember that no matter how 'believable', we don't always hear the other version, so it's best not to judge a colleague based on what the client says... They may well have their own issues (non compliance with meds, not taking heed of previous advice, resulting guilt, etc) which brings them to construct a seamlessly woven story...that they themselves might well believe!!

Re: Is it just me?

Mark Rowland — Sat, 04 Feb 2012 08:37:24 GMT

[quote user="Robin Grimmer"]

[quote user="Kate Richardson"]

Now there may be an element of what the vet actually said and what the client heard in this story, but I do scratch my head sometimes and think, did you really do 5 years at uni.

Apparently, and obviously this is as told by the client, "by the time the antibiotics have gone through the stomach, there is very little left by the time it reaches the head"

Eh?

Sorry, but it's been bugging me all week, so had to share it!

[/quote]

You might find that next time the client has gone to a different vet and you are on the receiving end.

[/quote]

yep

Anyone who has had an RCVS complaint will see what utter C**p some people are prepared to write to try to get their point across. In my first, I apparently in my first job took a run up to a colicking horse that was down and kicked it in the guts. Just for the record I never touched it with my feet. That though was the clients reason it had ruptured its stomach (something that had happened before I even arrived).

Le sigh

Re: Is it just me?

Robin Grimmer — Fri, 03 Feb 2012 23:42:43 GMT

[quote user="Kate Richardson"]

Now there may be an element of what the vet actually said and what the client heard in this story, but I do scratch my head sometimes and think, did you really do 5 years at uni.

Apparently, and obviously this is as told by the client, "by the time the antibiotics have gone through the stomach, there is very little left by the time it reaches the head"

Eh?

Sorry, but it's been bugging me all week, so had to share it!

[/quote]

You might find that next time the client has gone to a different vet and you are on the receiving end.

Re: Is it just me?

Claire Fisher — Fri, 03 Feb 2012 23:06:12 GMT

[quote user="Clive Ansell"]

I recently had a client that gave ProKolin per rectum for her dogs diarrhoea.

[quote user="Rob Davis"]

Presumably for pyoderma around the tail base we should be sticking tablets in the other end....

[/quote]

I've had a couple of clients try to do that so now I put "Give 2mls twice daily by mouth" on the label just to be sure there's no confusion!

[/quote]

Re: Is it just me?

Laurence Webb — Fri, 03 Feb 2012 22:42:11 GMT

[quote user="Anne Pietersma"]some natural remedies (subjected to rigorous scientific, double-blind trials ideally!!) may hold some water [/quote] Well if you want to be accurate, a bottle of homeopathic treatment does hold some water. Just doesn't hold anything else.

Re: Is it just me?

Anne Pietersma — Fri, 03 Feb 2012 22:04:06 GMT

Sigh, you're so right. I actually worked one summer for a few weeks with a homeopathic vet after my first yr vet school and he had me read this tome - I recall finding it very perplexing after all I had learnt the previous year. I never really dug it since, though believe that some natural remedies (subjected to rigorous scientific, double-blind trials ideally!!) may hold some water (but don't dig the so-called 'memory of water' per se homeopathy is known for...hope I don't offend anyone...)

Re: Is it just me?

Niall Taylor — Fri, 03 Feb 2012 21:56:44 GMT

[quote user="Anne Pietersma"]it was a 10 yr Golden and had been treated with homeopathy by a vet, was getting worse.[/quote]

I think you'll find that the homeopath would have said this was an 'aggravation', a sure sign that the homeopathy was working. Just the same as if it had got better, this is what the homeopaths would call an 'improvement', a sure sign that the homeopathy was working.

[quote user="Anne Pietersma"]Usually I've been open to alternative treatments, trying to keep an open mind, but it should at least be in the context of a proper (even basic!) diagnostic work-up[/quote]

I'm afraid homeopaths don't 'believe' in conventional diagnoses, any more than they 'believe' in conventional treatments.

Niall

Re: Is it just me?

Anne Pietersma — Fri, 03 Feb 2012 21:29:51 GMT

Last Sunday I had a case that made me wonder too: a blood smear referred (via internet) to me from across the pond from an emergency vet friend who works in Texas who saw an OOH case treated by another vet- likely Ehrlichia platys organisms (it's a rickettsial organism, responds to tetracyclines - doxycycline) clearly visible in platelets on the blood smear, even the vet nurse picked up on something strange in the platelets and alerted the emergency vet after they analysed the blood in house- it was a 10 yr Golden and had been treated with homeopathy by a vet, was getting worse. Usually I've been open to alternative treatments, trying to keep an open mind, but it should at least be in the context of a proper (even basic!) diagnostic work-up, and when there are no effective alternative treatments available...I actually posted the blood smear pic as a first 'mystery' case on our new Facebook page - we'll do these weekly with responses to the cases on our twitter - to see the photo, go to www.facebook.com/televetdx (answer on twitter: @televetdx). I quickly browsed the literature and saw that some rickettsial cases have been reported in Europe... so we've got to brush up on these critters...