Direct Line

Re: Direct Line

Bob Russell — Thu, 09 Aug 2012 15:35:06 GMT

I consider JGW's comment far more unacceptable than Mr Laidlaw's!

Re: Direct Line

James Laidlaw — Thu, 09 Aug 2012 14:59:54 GMT

[quote user="Arlo Guthrie"]

[quote user="James Laidlaw"]Also, just because someone gets under your skin in another thread, that doesn't give you the right to adjectivise their surname for your silly posts. You really are a class A jerk sometimes.[/quote]

James, I agree with your point about adjectivising people's surnames.

JGW, please stop it.

That said, James, absolutely no need, under any circumstances, to stoop to your last remark.

[/quote] Fair enough. It's just ever so grating sometimes...

Re: Direct Line

Arlo Guthrie — Thu, 09 Aug 2012 12:58:19 GMT

James, I agree with your point about adjectivising people's surnames.

JGW, please stop it.

That said, James, absolutely no need, under any circumstances, to stoop to your last remark.

Re: Direct Line

Evelyn Barbour-Hill — Thu, 09 Aug 2012 11:53:03 GMT

[quote user="J G Wray"]PS Why the cant when trying to Bowdlerise?[/quote]

I know what "cant" is and I know what "Bowdlerise" means. I haven't a clue what you are on about.

Re: Direct Line

J G Wray — Thu, 09 Aug 2012 09:39:32 GMT

[quote user="Malcolm Ness"]Read what I wrote.[/quote]

I did. You brought up the subject of the PCA revision. What you did not say was whether you discussed the case with the owner in a manner which will lead them to take action for negligence. Once that action has been taken a "Mostyn" can go through with your name on it. What will you be doing?

JGW

PS Why the cant when trying to Bowdlerise?

Re: Direct Line

Malcolm Ness — Thu, 09 Aug 2012 08:30:02 GMT

[quote user="J G Wray"]If referral vets are asking about revisions (sic Mr Ness) in terms of negligence [/quote]

Read what I wrote.

Re: Direct Line

James Laidlaw — Thu, 09 Aug 2012 08:22:38 GMT

What they should do FIRST - is try to speak to the vet involved and maybe gently educate them as to why what they are doing is inappropriate, or just inform them of what has been done. If that doesn't work then they could contact the RCVS, IF any welfare compromise has occurred or lines of conduct crossed. Also, just because someone gets under your skin in another thread, that doesn't give you the right to adjectivise their surname for your silly posts. You really are a class A jerk sometimes.

Re: Direct Line

J G Wray — Thu, 09 Aug 2012 07:32:30 GMT

A few years ago the current Acting Registrar at RCVS Mr Hockey indiscreetly let it be known that he would be particularly focussing on "have a go" vets. At around the same time the nice people from Pet Protect "Mostyned" a RCVS Councillor for his fees.

Since then there have been few, if any, cases that have gone to DC for "having a go". There have been some for not "having a go" and RCVS have got involved in negligence issues as a dimension of a gross professional misconduct case.

If referral vets are asking about revisions (sic Mr Ness) in terms of negligence then, because there is an interest at RCVS and a precedent from Pet Protect to support them, perhaps these referral vets should be "Mostyning" these vets - after all, patients, animals, and not just egos, have suffered n'est-ce-pas?

JGW

PS Ref insurance payment ceilings, these days when discussing high grade MCT treatment with tyrosine kinase inhibitors, in reply to the question form the owner - "How long will Blu last" I reply "How much is left on the policy for this condition"? Then there is relief, to some degree, that my professional fees and drug charges are less than the referral centres.

Re: Direct Line

Rob Davis — Wed, 08 Aug 2012 20:03:19 GMT

[quote user="Alet Engelbrecht"]A week or so later, I got a request to send a referral letter to a nearby referral centre without any other communication - the owner self-referred.[/quote]

I wouldn't be happy with the referral centre accepting this self-referral. They should have redirected the owners back to you to discuss first.

Re: Direct Line

Alet Engelbrecht — Mon, 06 Aug 2012 18:05:55 GMT

Damned if you do, damned if you don't.

Had a young Yorkie (1yo) with persistent cystitis recently. Brought in by the owner's friend who was looking after her during their holiday. I discussed all the differentials and options with the agent - from bladder stones to congenital abnormalities, radiographs or referral for ultrasound (the practice did not have ultrasound). I could not palpate any stones (although I explained that I may not) and the agent did not want to chase costs before the owner was back. The history was sketchy at best, the agent thought the owner mentioned that the dog had cystitis before. I suggested that the owner either come for a consultation when back, or alternatively I would happily fax the history to their vet (the agent did not know who) to continue the workup.

A week or so later, I got a request to send a referral letter to a nearby referral centre without any other communication - the owner self-referred. Low and behold - it was bladder stones. I would likely have been able to diagnose it with a radiograph and my cystotomy would have cost a fraction of the cost. Granted, there were several factors in play here, but that's the price one pays for not doing the basics. I felt pretty silly when I got the referral report...

Re: Direct Line

Rob Loxley — Sat, 04 Aug 2012 00:15:41 GMT

[quote user="Mark Rowland"]Absolutely. It might not be broken, it might be much worse than that.[/quote]

My real point was more general regarding why first opinion vets might do some initial investigation before referring a case; hope your parrot is fixable though?

Re: Direct Line

Mark Rowland — Fri, 03 Aug 2012 15:53:12 GMT

Absolutely. It might not be broken, it might be much worse than that.

Re: Direct Line

Rob Loxley — Fri, 03 Aug 2012 13:43:44 GMT

[quote user="Mark Rowland"] if you see a parrot with a suspected broken wing and you are not going to repair it, why risk its life with a ga to radiograph prior to referral?[/quote]

Maybe it might not be broken and so not need referring (with the associated hassle and expense)?

Re: Direct Line

Mark Rowland — Fri, 03 Aug 2012 09:27:27 GMT

No but if you see a parrot with a suspected broken wing and you are not going to repair it, why risk its life with a ga to radiograph prior to referral? I dont make the ceiling, It is there because of the low financial value of the patients. I dont bother xraying daschunds off their hind legs as I know Im going to refer them so why delay things. I suspect the problem here may rest with the referral centres who insist on repeating rafts of tests (the colleges are most to blame for this). I will happily use referred radiographs if they are of sufficient quality. I work cases up as far as I can prior to referral but If I suspect that referral may be what Im going to do I just get on with it.

Re: Direct Line

CatherineThomas — Fri, 03 Aug 2012 06:27:41 GMT

[quote user="Mark Rowland"]

On the other hand, insurance companies probably dont appreciate paying twice when referral centres repeat xrays/tests as this does little but waste money in many cases and Im sure they would prefer early referral of cases such as this. One of the exotic insurance companies has a ceiling of £1000, Im not that chuffed (and neither is the client) if half of that is spent on a case that is probably going to be referred anyway

[/quote]

Surely the problem there is the low ceiling set by the insurance company. With a limit of £1000 you wouldn't expect to be able to cover referral of most problems in a dog or cat. Why should it be any different for an exotic animal? You can't always tell if something is going to need referral without doing some tests or treatment first. I wouldn't send a PU/PD dog off for referral without doing at least initial investigations, or a lame dog without first doing radiographs or possibly a short course of anti-inflammatories. Should I have different standards before referring an exotic animal?

Re: Direct Line

Mark Rowland — Thu, 02 Aug 2012 23:23:20 GMT

Re: Direct Line

Alex Gough — Thu, 02 Aug 2012 21:01:12 GMT

Of course one of the things that annoys insurance companies is the "deskilling" of GP vets because of the trend to refer cases that in the past may have been dealt with more cheaply in house (not necessarily better, nor necessarily worse, just more cheaply). I think they would be unlikely to pursue a vet to recover costs for a cock up on a case they were trying to avoid referring, as it would likely increase the pressure to refer, and increase insurance costs overall. I agree that we should all be striving to do better than the legal minimum. However, when you are talking about who bears the costs for mistakes, it is only reasonable to expect the one who has made the mistake to only bear the cost if it is negligence. The VDS has a clear definition of what they consider negligence to be.

Re: Direct Line

Hannah Wynne Richards — Thu, 02 Aug 2012 11:16:54 GMT

Total agreement with Sarah

Wynne

Re: Direct Line

Sarah Keir — Thu, 02 Aug 2012 10:27:40 GMT

[quote user="Martin Atkinson"]

I think this could set a very dangerous precedent: who is to judge the competence of the physician?

[/quote]

Seeing as how Malcom is a RCVS Recognised Specialist, and we are assuming the previous vet in this case was not, I know who I'd plump for as being correct. No vet should be beyond holding up their hands and saying 'this is beyond my knowledge/experience/help' and do something about it - even if it is talking to someone who has done the procedure for advice and still doing the procedure with informed consent, if the owner cannot afford referral up the tree.

Sarah

Re: Direct Line

Hannah Wynne Richards — Thu, 02 Aug 2012 09:35:19 GMT

Obviously if negligence was involved the original veterinary surgeon should pay I would say that the obviously incorrect technique Malcolm referred to is definitely negligence

Another factor that should be considered is why the case wasn't referred in the 1st place If it's on contemporaneous records that a referral was offered but declined, then I think the owner should pay, if referral wasn't offered then the veterinary surgeon should-note I said veterinary surgeon,not practice-some assistants will x-ray clients wallets (or attempt to) and not offer optimum treatment because of cost-which bothers them,but not the owner

Wynne

Re: Direct Line

PATRICK MARSHALL — Wed, 01 Aug 2012 07:16:35 GMT

[quote user="Gerry Henry"]

... is it me?

[/quote]

It's just you Gerry..... RBS and Direct Line are specifically targeting you in a cynical attempt to curry favour with public opinion in an attempt ro redress the balance for years of PPI mis-selling, the deeds of Fred Goodwin and the latest revelations about LIBOR rate manipulation.

Please do not to take it personally; but try to bear this onorous burden with the good grace, rancour and parsimony that is inherent to all Scots.

Re: Direct Line

James Laidlaw — Tue, 31 Jul 2012 19:19:13 GMT

If the client was as misled as you described did you discuss it with the vet involved?

Re: Direct Line

Malcolm Ness — Tue, 31 Jul 2012 18:36:34 GMT

[quote user="alex gough"]If it is negligence, they shouldn't, if it isn't they should.[/quote]

Negligence is a matter for the courts to decide and if they do then the culprit might be made to pay rather more than just the cost of revision.

I suspect that I am not alone in believing that as a profession we should aspire to a standard higher than not quite illegal.

Re: Direct Line

Bob Russell — Tue, 31 Jul 2012 17:56:06 GMT

[quote user="alex gough"]

I think it's fairly simple as to whether insurance should foot the bill or not for complications. If it is negligence, they shouldn't, if it isn't they should.

[/quote]

If it is negligence Vet Defence should (in theory) pay but I dread to think what our premiums would be if they paid out every time something goes wrong.

It is not inappropriate for pet insurance to pay out if there are complications. The vet involved and/or Vet Defence should be responsible for negligence.

Re: Direct Line

Alex Gough — Tue, 31 Jul 2012 17:16:56 GMT

I think it's fairly simple as to whether insurance should foot the bill or not for complications. If it is negligence, they shouldn't, if it isn't they should.