Is this 'poaching'

Re: Is this 'poaching'

Anthony Todd — Mon, 25 Jun 2012 16:53:05 GMT

[quote user="Colin Cameron"]So just where do you stand on ethic and professional courtesy, given that you appear to somewhat selective in this depending on the case? And should it not be either "palavra" or "palaver"?[/quote]

Sorry about the spelling.

I'm very clear on ethics and professional courtesy, make the animal comfortable, which may involve a varying amount of diagnosis and or treatment, then, and only then, extend ethics and professional courtesy.

I would never allow either ethics or professional courtesy to come before, delay or obfuscate the welfare of the animal.

And ,sure, I would be selective, depending on the case; obviously.

Re: Is this 'poaching'

Colin Cameron — Mon, 25 Jun 2012 13:41:47 GMT

[quote user="Anthony Todd"] some supercilious, in his eyes and mine, palarva about ethics, [/quote]

So just where do you stand on ethic and professional courtesy, given that you appear to somewhat selective in this depending on the case? And should it not be either "palavra" or "palaver"?

Re: Is this 'poaching'

Hannah Wynne Richards — Mon, 25 Jun 2012 12:52:36 GMT

Actually I don't see that as a dilemma at all All that's necessary is to say (with a smile ) "I can't possibly comment on a case I have'nt seen " If the neighbour takes offence-they were the ones out of order in asking in the first place-if unsatisfied with the other veterinary surgeon's advice-the correct course would be to request a referral

Wynne

Re: Is this 'poaching'

plantagenet — Sat, 23 Jun 2012 17:39:28 GMT

The current In Practice ethical dilemma is a very relevant one. If I get in to a conversation with an owner away from the practice, I would do everything I could to guide them back to their practice and discuss any misgivings they have with their own vet, including asking them to direct them towards a 2nd opinion. I have also phoned the vet in question to alert them to a possibly disgruntled client. Anything else is definitely poaching.

Re: Is this 'poaching'

Julian Earl — Sat, 23 Jun 2012 15:21:43 GMT

[quote user="Alet Engelbrecht"]

...The baloney about an ongoing skin case needing urgent treatment - it is either a second opinion or supersession if the primary vet is not involved. End of. It only needs urgent treatment because the owner allowed the condition to become urgent. Yes, treat the patient and the condition, but do not fool yourself for one moment to think that you have gained a good loyal client that respect/trust the veterinary profession.

[/quote]

Why baloney? It is irrelevant to the dog whether the skin is so bad because of the owners's neglect, but a skin lesion can clearly and obviously be bad enough to require urgent treatment. If further treatment is required for on-going care does it become a second opinion and the region between second-opinion and supercession is rather grey.

Re.the lameness in the OP: poaching would indeed be if the OP had actively pursued the work even when it could wait. Merely attending to immediate first-line pain relief is fine; however, if the practice is open for normal clinics when the other is on emergency service only, it does rather open up the former practice to this sort of occurrence on a regular basis I would have thought. Knowing that, is that a deliberate policy to attract in clients of the other place?

Re: Is this 'poaching'

Anthony Todd — Sat, 23 Jun 2012 14:26:07 GMT

[quote user="James Laidlaw"]

I found Filipino Task Force on AIDS. Didn't think that was what you meant...!

[/quote]

ROFL, serves me right for mixing genres or whatever the TLA for that now is.....

Re: Is this 'poaching'

James Laidlaw — Sat, 23 Jun 2012 12:36:30 GMT

I found Filipino Task Force on AIDS. Didn't think that was what you meant...!

Re: Is this 'poaching'

Anthony Todd — Sat, 23 Jun 2012 11:58:10 GMT

[quote user="James Laidlaw"]Yeah... I wasn't talking about the individual case mentioned in the OOH times when no one is available. But I you can get a history you should. That's all I meant. Would you care to explain FTFA? For the record I think having external emergency providers without access to history isn't ideal. Where possible I try I give clients printed history and current treatment if I think there's a possibility they may require OOH treatment. Or I'll contact the emergency clinic directly.

[/quote]

Sure, agree with all of that, and "FTFA" means Fly The Flipping Aircraft or the common vernacular which means the same, but might offend those who live by the GtoPC....

Re: Is this 'poaching'

James Laidlaw — Sat, 23 Jun 2012 11:13:24 GMT

Yeah... I wasn't talking about the individual case mentioned in the OOH times when no one is available. But I you can get a history you should. That's all I meant. Would you care to explain FTFA? For the record I think having external emergency providers without access to history isn't ideal. Where possible I try I give clients printed history and current treatment if I think there's a possibility they may require OOH treatment. Or I'll contact the emergency clinic directly.

Re: Is this 'poaching'

Anthony Todd — Sat, 23 Jun 2012 11:10:10 GMT

[quote user="Alet Engelbrecht"]Yes, treat the patient and the condition[/quote]

Hooray, hooray, at least the animal is relieved; so

End of! [as the client would have said, if he was turned away] and I say now

Martin can keep living, and I can watch Black Caviar as everyone in Australia will be doing at, I believe 1.30am......

Re: Is this 'poaching'

Alet Engelbrecht — Sat, 23 Jun 2012 10:48:10 GMT

FACT: OOH providers do not have access to daytime history.No one is disputing this.Nor the fact that the animal will be treated before being redirected to the primary practice.

The OP's questions, as I understand, were -

(1) Did he/she do enough for this patient (i.e. provided adequate emergency care) or should more have been done?

(2) When does it become poaching?

As I have said before, I have worked for corporates, I have also worked for private OOH providers (with on site vet and nurse). The private OOH providers have had their own day time clinic, so poaching clients were a big no-no as they were dependant on the other clinics to use their OOH service too. All clients from other practices seen OOH had to sign an agreement that they were not going to use the day time services of the OOH practice for a specified minimum time period. I don't know how binding this legally was, but it was the intention of the private practice to discourage any thoughts about poaching that the home practice or client may have. Animals were treated OOH, but anything that could wait until the next day, did.

In answer to the first question - I do not think that you need to take non-essential radiographs on a Sunday (for reasons I have stated previously). I am not doing elective lameness workups for my own clients either on a Sunday (not even when I was working for the corporates). Yes, treat the dog (as was done). The history was not important for this. Enquire from the client, whether they want to change vets - i.e. do you need to fax your history of the treatment to the primary vet, or request their history from them.

The second question - No, I don't think it is poaching. It is only the way many corporates need to grow - remember - they start from zero and every new client is important. Therefore there is a massive focus on New Client deals. Like it or not, it is reality.

The baloney about an ongoing skin case needing urgent treatment - it is either a second opinion or supersession if the primary vet is not involved. End of. It only needs urgent treatment because the owner allowed the condition to become urgent. Yes, treat the patient and the condition, but do not fool yourself for one moment to think that you have gained a good loyal client that respect/trust the veterinary profession.

Re: Is this 'poaching'

Martin Atkinson — Sat, 23 Jun 2012 10:45:29 GMT

[quote user="Anthony Todd"]Hey, Martin, you'll never guess, the legendary Peter Knapp worked for uncle Clive too!![/quote] I know I worked with him for 3 years, but not sure at what point he became a legend!

PS I given up arguing the case re. succession, this does not mean you've won for I've never knowingly lost an argument, I'll just give up the will to live if it carries on.

Re: Is this 'poaching'

Anthony Todd — Sat, 23 Jun 2012 10:01:30 GMT

[quote user="James Laidlaw"]Surely the answer to that has to be - it's only important the one time something does go very wrong. Better to always cover one's behind, isn't it?[/quote]

Er,um, in the meantime, although my rear is chromium plated, the dog's is getting worse by the minute......!

These sort of owners are smart enough to give a "suitable" answer which could be:

"Never been to a vet down here, we come from Scotland yesterday" or

"Dunno" or

"You're just down the road and the dog's tearing itself apart and my wife and 5 children under 6 are all crying louder than the dog"

And I'm certain that if you refuse treatment he'll go to the next nearest vet and modify his responses to suit.....

I'm happy to take the risk that a single shot of Bets and a collar [if you insist] will cause complications.

Why don't all you knockers just FTFA as pilots say?

Re: Is this 'poaching'

Julian Earl — Sat, 23 Jun 2012 09:53:48 GMT

[quote user="James Laidlaw"]

[quote user="Anthony Todd"]Oh, come on, let's be sensible here, how often is the previous history vital in an animal that just comes in?[/quote]

Surely the answer to that has to be - it's only important the one time something does go very wrong. Better to always cover one's behind, isn't it?

[/quote]

I'm with Anthony on this, more or less. Sometimes it is better to treat in this situation because the animal needs the treatment now, not 24 or 48 hours later, this being the lesser of two evils. It is possible to talk to the owner and clearly indicate that there are risks if the dog/cat is on other treatment already, just to emphasise that they should tell you of previous treatment - it is not as though we are talking about a pet with a deaf, dumb and blind owner here. You can cover your behind in more ways than one and one of those ways is better for the animal today.

Re: Is this 'poaching'

KathW — Sat, 23 Jun 2012 09:46:52 GMT

[quote user="James Laidlaw"]

[quote user="Anthony Todd"]Oh, come on, let's be sensible here, how often is the previous history vital in an animal that just comes in?[/quote]

Surely the answer to that has to be - it's only important the one time something does go very wrong. Better to always cover one's behind, isn't it?

[/quote]

How many out of hours providers have full access to the clinical histories of patients that they see on behalf of other practices. Not many I would think yet they are prviding the OOH cover by arrangement with the clients (daytime) practice.

If the owners can't remember what drugs their animal is on or they are family members that happen to be looking after the dog/cat for the weekend they often don't know. Is there a difference?

Re: Is this 'poaching'

Hannah Wynne Richards — Sat, 23 Jun 2012 09:44:02 GMT

The animal would still have been treated, and treated ethically if the owner was sent back to the original practice-or it's OOH provider

Wynne

Re: Is this 'poaching'

James Laidlaw — Sat, 23 Jun 2012 09:03:42 GMT

[quote user="Anthony Todd"]Oh, come on, let's be sensible here, how often is the previous history vital in an animal that just comes in?[/quote]

Surely the answer to that has to be - it's only important the one time something does go very wrong. Better to always cover one's behind, isn't it?

Re: Is this 'poaching'

Julian Earl — Sat, 23 Jun 2012 07:04:24 GMT

[quote user="Martin Atkinson"]

[quote user="Anthony Todd"]So you'd refuse to treat it quoting the Guide to Professional Conduct, neatly reversing my animal,client,vet priority......??[/quote]

I would ask why this client has come to me and not to the other vet's 24 hours service. Weeping dermatitis is not an emergency, what are you going to give it - corticosteroids? How do you know that this dog doesn't have HAC or is already on some little white pills the the client just conveniently happened to forget to tell you about? The only circumstance under which you should flout the rules on supercession are in a true emergency where delaying the treatment could result in an irreversible worsening of the animals condition or death. Providing this dog with an E collar to prevent further self-trauma may have been a reasonable choice until such time the client could have got it to his own vet [/quote]

A weeping dermatitis could well be an emergency in the ense that we are to protect animal welfare and are not dedicated per se to saving lives. Weeping dermatitis can of course be extremely painful and hence require "emergency" treatment.

[quote user="Hannah Wynne Richards"]

What if as well as advising anal gland removal the original veterinary surgeon had prescribed nsaids and you then gave steroids? VDS would just love trying to defend you if things had gone wrong-I don't think

Wynne

[/quote]

They wouldn't have to, not necessarily. Find me a paper showing the frequency, severity and likelihood of this adverse reaction. Everyone quotes it but no-one seems to be able to find a source - not the drug companies, not PubMed, not specialists - believe me, I've asked them all. It is frequently cited in PubMed human papers but never is a source given. I am not necessarily saying that there is no risk, nor that the evidence is not there but for such an oft-quoted "fact", the evidence is hard to find and for all I know may be a veterinary urban myth based on some human or veterinary anecdotal experience. Just saying, like...

Re: Is this 'poaching'

Anthony Todd — Fri, 22 Jun 2012 19:50:48 GMT

[quote user="Hannah Wynne Richards"]

In the best interest of the animal -yes-but giving 2nd opinions without the knowledge of the original veterinary surgeon is definitely not in the animals best interest-you only know as much (little) of the history as the owner firstly knows, secondly has remembered correctly,and thirdly chooses to tell you The ethical thing to do-towards both animal and original veterinary surgeon, is politely inform the owner that the correct way to arrange a second opinion is to ask their original veterinary surgeon to refer

Wynne

[/quote]

Oh, come on, let's be sensible here, how often is the previous history vital in an animal that just comes in?

Surely we have the wit [and before someone confuses "wit" for sense of humour, it means intelligence] to work out which case needs a history prior ro diagnosis and/or treatment and which case, by it's overt presentation, can be treated on that basis.

Of course what you say is theoretically and pedantically ,true but then you introduce "ethical things" and common humanity,[the animal that's still tearing itself to bits], remember, and sense gets overridden.

And before someone trumps me with "supercession" most of those sort of walk-ins, IMHO, go back to their usual vet on Monday or whenever anyway but at least the dog and the owner have a better weekend.

I remember seeing many animals when I was with Uncle Clive [Martin, for it was he] that went back to Mr. S, who turned his bloody phone off at the weekend and told them to ring us!!

Hey, Martin, you'll never guess, the legendary Peter Knapp worked for uncle Clive too!!

Re: Is this 'poaching'

Charlotte Marshall — Fri, 22 Jun 2012 19:43:08 GMT

Heading back a bit towards the OP we had a case recently where a client of ours rang a local out of hours provider on a Sunday and they saw her, charged her an extra fee on top of their usual as she was not from one of their client practices and after treatment advised the dog should be taken to the usual vet on Monday. Now apparently at no time was it suggested that she should ring our out of hours service.

We do get clients occasionally saying 'oh I didn't think you were open on Sunday' (or at night) as they have not read our sign properly ,stating 24 hr cover. They may ring the out of hours provider as they are advertised as as open nights and Sundays but surely they should advise our clients to try ringing us. Especially if they are going to charge them an extra non client fee! If I get a client from one of their practices ringing me I always direct them there first. Of course I am not at the surgery all night and would have to leave home to see them which does rather put me off

Re: Is this 'poaching'

Anthony Todd — Fri, 22 Jun 2012 19:37:47 GMT

[quote user="Hannah Wynne Richards"]

Wynne

[/quote]

Oh dear oh dear, my way, I took a terrible risk to my legal insurance and my professional integrity but at least, not that it was of any significance in the scheme of things, the dog was greatly relieved in a matter of hours, thereby relieving the owner, who was also impressed that I didn't slag of the other vet or try to load the case with loads of tests, hospitalise it. or turn him away with some supercilious, in his eyes and mine, palarva about ethics, with a dog that obviously needed something done urgently on purely humane grounds.

And I took the terrible risk that something would go wrong with a shot a Bets [before NSAIDs were invented] too.

I'd do exactly the same again, even today; it was just common compassion.

Re: Is this 'poaching'

Hannah Wynne Richards — Fri, 22 Jun 2012 18:45:11 GMT

Wynne

Re: Is this 'poaching'

Martin Atkinson — Fri, 22 Jun 2012 18:20:35 GMT

[quote user="Anthony Todd"]So you'd refuse to treat it quoting the Guide to Professional Conduct, neatly reversing my animal,client,vet priority......??[/quote] I would ask why this client has come to me and not to the other vet's 24 hours service. Weeping dermatitis is not an emergency, what are you going to give it - corticosteroids? How do you know that this dog doesn't have HAC or is already on some little white pills the the client just conveniently happened to forget to tell you about? The only circumstance under which you should flout the rules on supercession are in a true emergency where delaying the treatment could result in an irreversible worsening of the animals condition or death. Providing this dog with an E collar to prevent further self-trauma may have been a reasonable choice until such time the client could have got it to his own vet. You were not prioritising this patients welfare if you saw it you were offering a convenience for the owner who, for whatever reason, chose to come to you rather than his own vet which seems somewhat hypocritical. You are in no position to question the other vet's reasons for suggesting removal of the anal glands until you've had his side of the story and certainly should absolutely not be contradicting that advice without a request from the client for a second opinion and having obtained a full history. I cannot help feel that you have a strange way of thinking if you could honestly say you couldn't give a toss whether your clients went to random vets with their pets when it suited them obtaining advice without that vet requesting a history first, it is hardly in the animals interest which you allege to hold in such high regard above that of the vet and the owner.

Re: Is this 'poaching'

Hannah Wynne Richards — Fri, 22 Jun 2012 17:54:21 GMT

It's a supercession A 2nd opinion is when the original veterinary surgeon contacts another veterinary surgeon on behalf of the client-and supplies full history

Wynne

Re: Is this 'poaching'

Alet Engelbrecht — Fri, 22 Jun 2012 17:45:32 GMT

[quote user="Anthony Todd"]Ok I'll have to make my point by example, and it's an actual one.[/quote]

Now the way I understand this example is that it is a second opinion, which the College actually encourage (as informed by a previous thread). Had you explained to the client this right, there would be no conflict about him providing the other vet's details. If, like you say, the other vet advised removal of the anal glands for a flea allergy, it may be in the animal's best interest to change vets. BUT, if the client is telling you one thing and the vet's recommendations were completely different??? Like James said - clients' recall are not perfect and the anal gland excision may have been either years ago or the FAD a totally new problem. In your example, you may be completely disrespectful to a colleague or completely entitled. That's why there should be 2 sides to the story.

Theoretically, the receptionist should have ascertained that it was a second opinion when the appointment was booked and a request for a history could have been made in a delicate way, but even so, if the client did not divulge the details on the phone, you had a duty to discuss this with the client and, sure, treat the dog, but try to get the other side of the story first thing Monday morning.

Perhaps I have skimmed through some of the comments, but I really do not see your argument.

Apart from this - there are many insured pets and not at least attempting to get a history or recording that the client refused to disclose the previous vets' details may lead us unknowingly open to insurance fraud.