What would you do?

Re: What would you do?

James Laidlaw — Thu, 18 Apr 2013 13:15:28 GMT

[quote user="J G Wray"]

[quote user="Laurence Webb"]Did you ever get to the bottom of what was so dangerous about the vaccine brand they used and why yours is so much safer[/quote]

The other vet painted a picture related to a change over to a new vaccine, no names no pack drill, adminstering the product and the cat becoming dull and breaking out in mulltiple crusting exudative erythematous skin lesions within a day.

Who knows why a novel product might do this, or whether there's something more mundane here?

JGW

[/quote] What product?

Re: What would you do?

Bob Russell — Thu, 18 Apr 2013 13:12:44 GMT

Not that bad a sign for a member of staff to get really hot under the collar in this way. It shows loyalty to the practice and that she cares.

We get quite a lot of reactions like this and there have been occasions where I have felt the same. The problem is, you cannot please Mr & Mrs Joe Public all the time and a proportion of said public are completely all knowing whist being pig-ignorant!

We had someone come in yesterday looking for a calcium supplement for a bitch with puppies. When good dietary advice was offered the response was 'don't try to convert me I am not interested'. I suspect her normal practice had given similar advice to us and it was not what she wanted!

Re: What would you do?

Anthony Todd — Thu, 18 Apr 2013 11:13:58 GMT

[quote user="J G Wray"]The client in our present case is quite adamanet she doesn't want to join the practice and I think examining the patient as per usual might not add clarity to the owner and her vet's choice of care. So should we be syringe mechanics and say nothing?[/quote]

Geez, what a storm in a styrofoam container!! Far canal, just ring the other vet and see if the story is kosher, check if said cat has had an exam, and jab the thing. If the story is suspect decline with grace and reason.

Client happy, other vet happier than he/she would be hearing the client's paraphrased and twisted version of the visit, cat just pissed off at being manhandled again.

All this argybargy doesn't reflect well on the profession, and has no bearing on the animal or it's health.

If the two vets go on about it the client will just go to another practice, keep stum, and never darken the door of either of you again.

Never heard of an generalised urticarial reaction to a cat vaccine, I must say.

Does it happen??

Re: What would you do?

J G Wray — Thu, 18 Apr 2013 10:54:48 GMT

[quote user="Laurence Webb"]Did you ever get to the bottom of what was so dangerous about the vaccine brand they used and why yours is so much safer[/quote]

Who knows why a novel product might do this, or whether there's something more mundane here?

JGW

Re: What would you do?

J G Wray — Thu, 18 Apr 2013 10:51:29 GMT

[quote user="Mark Hedberg"]Does your Head Nurse know the client, by any chance? It does seem a bit OTT to go off over something like this...[/quote]

No, HN does not know client. She takes some stuff v seriously. She is fiercely loyal and hard working. She has a huge amount of credit in the practice and is waspish only occasionally. Her compromise solution is sensible. her apoplexy is as yet unexplained. Because she provided a solution I shall let her tell me in her own time.

JGW

Re: What would you do?

Laurence Webb — Thu, 18 Apr 2013 10:08:30 GMT

Did you ever get to the bottom of what was so dangerous about the vaccine brand they used and why yours is so much safer? Was this initiative vet directed or client (or client's breeder friend) directed? I hope yellow forms have been filled in so we can all be warned off this dangerous stuff in the future!

Re: What would you do?

Mark Hedberg — Thu, 18 Apr 2013 08:47:21 GMT

Does your Head Nurse know the client, by any chance? It does seem a bit OTT to go off over something like this...

Re: What would you do?

J G Wray — Thu, 18 Apr 2013 08:40:20 GMT

[quote user="Julie Innes"]I always insist on getting a history faxed from the previous/ existing vet, and I now have a "client" and a "non-client" price- ie our regular clients are rewarded for their loyalty, and the dearer price (hopefully! deters people who might register just to get a cheap vaccine.[/quote]

Heading towards a resolution which keeps apoplectic members of my staff on side. I phoned the practice for a second time, the vet came to the phone this time and suggested what my HN suggested, though somewhat less flamboyently:

"Oh, would you really do that?" was the vet's reply. I pointed out that this case is a poisoned chalice if 'owt went awry. We talked about cold chain and she seemed happy. If the client turns up we'll know she followed through.

I was a bit taken aback by the vehemence of my HN in all this. She pointed out that in the past we have always done the legwork for clients, picking up meds or kit from the other practices and she didn't think it was on to get us and the client to work out a problem for the other vet. I was a bit surprised that the other vet was so cynical that she prepped the owner toexplain that if we vaccinated there would be no supersession, without contacting me first to explain.

Anyway I shall sell vaccine against a prescription, to the client, for £X, to be administered by the vet. The other vet can explain why she is charging for a script and administering vaccine I've sold for £X to the client. If the vet had got off their sorry something I would have sold it to the other practice for £Y, £Y being less than £X.

Funny old world

JGW

Re: What would you do?

Julie Innes — Wed, 17 Apr 2013 22:27:17 GMT

As a relatively new practice in the area, we get this a fair bit. I think our vaccine price is a little cheaper than our neighbours, but although I don't really want people just coming for a cheaper vaccine, I didn't want to suddenly hike the price for our existing clients.

I always insist on getting a history faxed from the previous/ existing vet, and I now have a "client" and a "non-client" price- ie our regular clients are rewarded for their loyalty, and the dearer price (hopefully! deters people who might register just to get a cheap vaccine. Also means their regular/ previous vet knows they are coming to me, and I can check their clinical record (and any other comments the other vet has- sometimes they call and warn me about debtors/ loonies!).

I thought a full clinical exam was par for the course at vaccination? I wouldn't be happy just to jab and grab.

Re: What would you do?

Gillian Mostyn — Wed, 17 Apr 2013 19:36:18 GMT

Personally, I wouldn't assume the client is telling the truth. If something the client says seems odd, and you wouldn't expect a vet to say it, then they usually haven't.

Re: What would you do?

Evelyn Barbour-Hill — Wed, 17 Apr 2013 17:38:35 GMT

[quote user="J G Wray"]

[quote user="Gillian Mostyn"]Is there a problem with speaking to the client's vet?[/quote]

Nope, not in theory. The fly in the ointment is my Head Nurse. She has got wind of all this and is wondering, loudly and with expletives which would make a navvy blush, why the other practice don't "Get off their something somethings, get round here with a prescription and get us to dispense against the something script.".. Apparently they could "Use a something Starbucks something insulated something coffee mug suitably something chilled, to keep the something cold chain intact." and , and "We won't get mixed up in any stupid something problems that way", "What a bunch of somethings..."

So anyway, I thought I'd ask for someother opinion, and ring them myself.

JGW

[/quote]

Your Head Nurse is entitled to her opinion, I'm sure, and to express it I suppose if you tolerate that sort of thing, but what business is it of hers?

Re: What would you do?

J G Wray — Wed, 17 Apr 2013 17:35:01 GMT

[quote user="Gillian Mostyn"]Is there a problem with speaking to the client's vet?[/quote]

So anyway, I thought I'd ask for someother opinion, and ring them myself.

JGW

Re: What would you do?

Gillian Mostyn — Wed, 17 Apr 2013 17:22:44 GMT

Is there a problem with speaking to the client's vet?

Re: What would you do?

James Laidlaw — Wed, 17 Apr 2013 16:49:54 GMT

[quote user="J G Wray"]

[quote user="Evelyn Barbour-Hill"]Well, if it was me (if it were I), I'd "perform" a full clinical examination[/quote]

Not sure you're using the subjunctive correctly here. In the past I have referred patients to specialists and on two occasions the clients have returned distressed that the referral vet pointed out the patient's other major problem and seemed to dwell upon it. Case one, a Boxer with paraprostatic cyst and a stifle lameness. The soft tissue surgeon was keen to send the dog on to his orthopod colleague. In this case I phoned him up and asked him to stay on condition. In the second, a lung problem, the physician pointed out the prutitus could be worked up by her dermatology colleague. In this case I told her that as a dermatologist she made a fine physician.

The client in our present case is quite adamanet she doesn't want to join the practice and I think examining the patient as per usual might not add clarity to the owner and her vet's choice of care. So should we be syringe mechanics and say nothing?

JGW

[/quote]

If you want to take the risk, go ahead.

If you're seeing the patient to administer a POM, I think it's prudent to perform a full clinical exam, make the client aware of any findings and leave them and their vet to deal with anything you find if they don't want you to deal with it. If you just jab and run, and something does go wrong, or there's something you missed because you didn't perform an exam, what then?

Re: What would you do?

J G Wray — Wed, 17 Apr 2013 16:04:28 GMT

[quote user="Evelyn Barbour-Hill"]Well, if it was me (if it were I), I'd "perform" a full clinical examination[/quote]

JGW

Re: What would you do?

Anthony Dennison — Wed, 17 Apr 2013 15:54:28 GMT

We have a similar problem at a couple of our branches, where we bought out the practice that owned them previously. Just before selling up, the previous owner embarked on a 'vaccine for life' promotion, meaning if people paid a lump sum at their animal's primary course they'd get free vaccines for life. A lot of people come for vaccines to us, and see other vets in the area for other things. I have seen a cat that has regular depo medrone injections for skin problems, and a dog that had stifle surgery in the previous year. A lot of owners are quite open about it - I ask if there is anything that might make the vaccine ineffective/dangerous, they usually spill.

But maybe thats because my clients have no shame that they are bargain hunting.

Re: What would you do?

Thomas Johnson — Wed, 17 Apr 2013 15:03:02 GMT

I would ask the client for permission to contact their normal vet to discuss the previous vaccine reaction, if they won't give permission then I would refuse to see the cat. If they do I would then contact their normal vet to make them aware of the situation and request the history.

The vaccine data sheets state that only healthy animals should be vaccinated, so you would have to carry out a clinical examination, how I would then discuss anything I found might depend on what their normal vet had found previously and recorded in the history.

Re: What would you do?

Rob Loxley — Wed, 17 Apr 2013 13:39:46 GMT

[quote user="J G Wray"]Since I'm canvassing opinion, what would you do?[/quote]

In your current position, I'd give a courtesy call to their vet to confirm (particularly as the history suggests a SAR), then vaccinate the cat as normal.

Here, we have a good working relationship with local practices (not saying you don't) so will source individual vaccine doses of an alternative brand if needed.

Re: What would you do?

Michael Woodhouse — Wed, 17 Apr 2013 13:29:14 GMT

[quote user="Gareth Dowdeswell"]I thought we were supposed to obtain a history prior to seeing any animal if it has been seen by another vet? [/quote]

GTPC states that if we are taking over a case (or words to that extent). Allows a bit of freedom to do a vaccination or see a sick animal that just turns up when on holiday.

I agree it is useful, but for a booster fairly unnecessary.

Re: What would you do?

James Laidlaw — Wed, 17 Apr 2013 13:16:52 GMT

If it were me, I would have tried to buy a dose from a neighbouring vet, rather than send the client there... Maybe they don't get on so well? What are the vaccines involved?

Re: What would you do?

Gareth Dowdeswell — Wed, 17 Apr 2013 12:29:16 GMT

[quote user="J G Wray"]

[quote user="Michael Woodhouse"]I'd speak to their own vet.[/quote]

Quite, but this isn't a supersession. If we vaccinate how much opinion do we express? How much of a physical exam do we perform?

JGW

[/quote]

I thought we were supposed to obtain a history prior to seeing any animal if it has been seen by another vet? Have I misunderstood the Professional Conduct Guide? Obviously its essential for an animal already on treatment, but we should get it for vaccs too. If the client's story is true, I'd expect it to be supported in the cats clincal notes.

Re: What would you do?

Evelyn Barbour-Hill — Wed, 17 Apr 2013 12:18:54 GMT

[quote user="J G Wray"]

[quote user="Michael Woodhouse"]I'd speak to their own vet.[/quote]

Quite, but this isn't a supersession. If we vaccinate how much opinion do we express? How much of a physical exam do we perform?

JGW

[/quote]

Well, if it was me (if it were I), I'd "perform" a full clinical examination. And then it might be difficult, without seeming rude, to avoid expressing some opinions. But that is not the point. It's not a supersession, but it still seems a reasonably good idea to speak to their own vet. If you have a couple of minutes to make the phone call, why not check it out?

Re: What would you do?

J G Wray — Wed, 17 Apr 2013 12:05:27 GMT

[quote user="Michael Woodhouse"]I'd speak to their own vet.[/quote]

Quite, but this isn't a supersession. If we vaccinate how much opinion do we express? How much of a physical exam do we perform?

JGW

Re: What would you do?

Michael Woodhouse — Wed, 17 Apr 2013 10:04:58 GMT

I'd speak to their own vet. If they were happy me vaccinating the cat then I would. If the vet was local and wanted me to supply them with a dose of our cat vaccine then I'd do that too.

We have open surgeries, we get people just turning up for vaccinations that we have never seen before. If there are no ongoing health problems then I will sometimes vaccinate and ask for a history afterwards. I would not vaccinate a cat that had [supposedly] had a vaccine reaction without history in front of me.

Re: What would you do?

Martin Atkinson — Wed, 17 Apr 2013 10:02:45 GMT

[quote user="Mark Rowland"]Tbh they're not sort of client I would want anyway. Something's bound to go wrong and this client sounds like they would have no issue slating you to someone else. My clients come because they like the service and trust my judgement. I probably wouldn't entertain them.

[/quote] Have 5 gold stars Mark. 5 years ago I would have agreed 100% with that but even I am starting to weaken my principles to get bums on seats.But TBH you're in a different situation to us you're a specialist so clients come to you for a specific service or are referred so you're not competing quite so much in the cut-throat environment but that's not to say I don't agree with the sentiments.