Unprofessional or bitchy?

Re: Unprofessional or bitchy?

Martin Atkinson — Thu, 06 Jun 2013 16:10:15 GMT

[quote user="Malcolm Ness"]A quick peruse of veterinary web-sites suggests that everybody has the best facilities, everybody has state of the art equipment, everybody offers the best clinical care, everybody offers 24-7 care and hardly anybody uses a deputising service. Discuss.[/quote] On my website I do do tell them that I do some of my own out-of-hours but when necessary/or if its in the best interests of the animal they will be referred to a deputising service because seeing a dedicated vet and nursing staff they are likely to get a better service than from someone whose just put in a 12 hour day and has been dragged out of bed at 3 am.

Re: Unprofessional or bitchy?

Gillian Mostyn — Thu, 06 Jun 2013 13:27:02 GMT

Did you watch the show Anthony? Best entertainment I've had in ages!

For example:

client complains that food is taking too long to arrive

owner tells him to f*** off and eat somewhere else then.

Wouldn't we all love to say exactly what we want to? Priceless.

Re: Unprofessional or bitchy?

Anthony Dennison — Thu, 06 Jun 2013 12:21:59 GMT

Slightly off topic, but be careful what you put on facebook on behalf of your business....

http://www.heavy.com/social/2013/05/amys-baking-company-bakery-facebook-meltdown-most-hilarious-epic-meltdown-ever/

Re: Unprofessional or bitchy?

Malcolm Ness — Thu, 06 Jun 2013 11:21:49 GMT

Devil's advocate again:

Undoubtedly, patients given constant care by an appropriately experienced. expert and rested vet plus a similar VN at their home practice is better than any other arrangement. However, that would be cost-prohibitive in most cases and unnecessary in at least as many cases. This is another example of a very nasty slippery slope down which our profession has a tendency to fall - other examples would be the dental that can only be done after hundreds of pounds worth of blood work and imaging; the cruciate surgery that is preceded by a thousand pounds worth of imaging, involves several thousand pounds worth of surgery and is followed by many hundreds of pounds worth of "rehab" or the fifteen hundred pound hemilaminectomy that is inflated by a thousand pounds or more of pointless MRI then further by a fortnight of "hospitalisation" (and more "rehab"). Beware "Gold standard" becoming effectively obligatory - we price a lot of our clients out of the market. (see another recent thread where Evelyn was red-starred for implying that palpation was acceptable/better than ultrasound/radiography for dx of a pyo.

Nobody, I think can have a problem with different practices offering a range of service levels - both in terms of facilities and expertise. But, I am not sure that all practices are fully open and honest with this to their clients. For example, we have one small practice that uses our OOH service. They make no attempt to hide this fact from their clients and if one of their (very) low price neuters goes wrong, the arrangement we have is to deal with the case and bill the practice. Others practices seem less transparent/communicative. (interestingly, they also seem to have more "complications")

If it were possible to question the owners of all the dogs that were "hospitalised" last night, I strongly suspect that most would be under the impression that their pet had had at least one competent veterinary carer in constant attendance (ie in the same building and with responsibility for patient care). I similarly suspect that fewer than half had even that relatively basic standard. I am not saying that the level of care was necessarily inadequate, merely that some clients are not having things explained as well as they might.

Re: Unprofessional or bitchy?

Bob Russell — Thu, 06 Jun 2013 09:48:33 GMT

We have found that being proactive and explaining to clients (from day one) the reasons for using an emergency service is best. As a single vet practice the vast majority fully understand and accept this. It is not a secret and VetsNow posters, leaflets, price list are plastered over the waiting room.

VetsNow is 20-40 minutes away from us (traffic dependent). I recommend people divert on their way into town in advance to find out how to get there if they are worried!

My in-patients rarely go to VetsNow overnight as I have kennels at home and the family love keeping an eye on inmates! I also have a brilliant inflatable bed http://www.aerobed.co.uk/ for the few occasions I have had to stay with those unfit to travel. The golden rule is 'would I be happy for my pet to be treated this way?'.

Pot calling kettle black, for patients treated at their branch practices there is a 20-40 minute trip to get to their main practice out of hours!!

Now who is sounding bitchy?

As to JGW's point about clients not being that interested in equipment levels, I have to agree. However within the post was the suggestion that we are a 'lesser equipped practice'.

We don't have all the toys but my point was that for its size the practice is extremely well equipped (I like 'useful' toys and will happily spend money to get them!) and we have easy access to all the facilities we lack.

Re: Unprofessional or bitchy?

Gillian Mostyn — Thu, 06 Jun 2013 09:10:12 GMT

Can anyone really disagree that an animal is always best served by being attended to all night?

Michael- would you leave a cat alone on a drip from 8am until 6pm without a single check up and still be 'happy' with the situation?

I'm not criticising you for doing this - we sometimes do it too. But the owner has the situation explained to them and they make the choice - our OOH provider with 24hr care, or stay with us for occasional checks (although ours aren't left for 10 hours!) The cost difference is pretty significant though - which I am also happy to defend. A big part of why we had to stop doing our own OOH was because we'd have to employ more staff as people cannot be expected to work night and day.

My recommendation? Well if it was my pet and it was very sick, I wouldn't want it left alone for 10 hours at your practice. But as long as your owners are fully aware of what you can provide, then you are doing nothing wrong.

But back to the OP........ unprofessional and makes them look very silly. Likely to gain you more clients than you lose.

Re: Unprofessional or bitchy?

Dagmar Steele — Thu, 06 Jun 2013 09:03:03 GMT

To come back to Malcolm's post. I don't do my own OOH service but send clients to the local clinic. I tell them so it's no secret and the clinic does a good job whilst charging reasonable fees. They are not cheap but neither would I be at 3am. I am a single vet with one employee (part time) and one nurse. A lot of procedures would not be done to a good standard if we tried at night and we refer at daytimes too (ie cruciates and the lot). Whilst this might not be ideal all customers know about it and I would rather refer than do a botch job. And yes, we spay bitches (but not for 100.-) and so far none of them had to go to the OOH service in 16 years. We don't hand them out still sleeping at 6pm and slam the door after them. Spays go home at 1pm, plenty of time to call or come back if problems occur.

Re: Unprofessional or bitchy?

Phil Hyde — Thu, 06 Jun 2013 08:37:45 GMT

[quote user="Michael Woodhouse"]

I sometimes think we can be out of touch with what our clients want. Take a blocked cat on at 6pm Saturday evening. Examination, GA, unblock and start fluids. Done, cleaned up at cat awake by 7pm. Go home for tea with drip running. Go back 10pm to check everything ok. If all is well I would happily leave overnight and reassess next morning. If cat sick and flat then go back sooner. With me it might cost you a couple of hundred pounds. With VetsNow I don't know - change from a thousand?

[/quote]

Leaving a cat on its own on a drip overnight? Interesting...

Let me put a word in from the emergency clinic perspective.

We charge 45 quid for overnight care (including kennelling, nursing, frequent monitoring and a full examination by a vet).

Granted any extra work necessary would add to these costs, (as they would with you) as would ambulance transfers if required (could add another 50 quid).

Are you saying you charge a lot less than this to go back into the practice once, twice or more?

Phil

Re: Unprofessional or bitchy?

J G Wray — Thu, 06 Jun 2013 07:47:08 GMT

[quote user="Michael Woodhouse"]I hate the way on call rules my life. But I love the work and the challenge of it. I'd be a worse vet now without that OOH experience.[/quote]

After 25 years of doing OOH one in two or three I decided this was horseshit.

[quote user="Michael Woodhouse"]I sometimes think we can be out of touch with what our clients want. [/quote]

There is pleanty of evidence, now theree's a word, of what clients want. Mellanby's paper is one.

[quote user="Michael Woodhouse"]What does the owner want? Cat fixing[/quote]

Something comes before this. Clients want to know prognosis - " Is my pet (member of my family) going to be all right?" Then they want to know what's required to "fix it" and reasonably in my vew, also want to know the cost. The clients who say money no object ( fewer these days)can be slowed down in a sentence by telling them what initial treatment will cost. That estimate can be carried on a piece of paper in a drawer in the consulting room for use there and then. More detailed costs can be discussed and should be as son as poss.

As for the OP, the "complaining" practice is missing a point. Kit is not interesting or importan to clients . Something altogether different is.

JGW

Re: Unprofessional or bitchy?

Michael Woodhouse — Wed, 05 Jun 2013 23:29:11 GMT

[quote user="Aisling McGrath"]Their prices are VERY high, and obviously this is very frustrating and can pose a huge problem for clients, but ultimately IMHO, clients want the best for their animals, and the fact that I don't do OOH AND day work means that I am a better day vet, and during the night, they can see an excellent "night vet".[/quote]

I'm not convinced everyone wants the best for their animals - how often do you recommend something to be told that is too much money or the classic that he's old and they really don't fancy giving the cat a tablet once per day for its over-active thyroid. HOW much for radioactive iodine etc.

I'd say the majority of clients who ring OOH just want reassurance. Especially when people are on their own and have no one else's opinion on the dog with the minor ailment. I will put well over 50% of people off until the next day if appropriate.

A lot of weird and wonderful things come in OOH that make you a better vet. I do think that everyone should have to do a stint of OOH for the experience. I am also a little dubious over the 'quality' of some of the vets doing night work. I have heard many tales from colleagues of anyone with MRCVS after their name being thrown in at the deep end, recent grads, immigrants with a less than ideal grasp of the language etc.

What does the owner want? Cat fixing. What do they get in both cases - fixed cat. Do they want to pay for 24 hour monitoring? Multiple blood tests? etc etc?

Our consent forms state something along the lines of "hospitalised animals do not receive constant supervision - they will be checked as often as deemed clinically necessary by the veterinary surgeon in charge of the case". I draw it to people's attention and no-one has ever made an issue of it. Thinking very hard I'm not sure I've had a case surprise me and die overnight, other than things you occasionally end up with that are clearly on the way out but owner won't consent to PTS.

I hate the way on call rules my life. But I love the work and the challenge of it. I'd be a worse vet now without that OOH experience.

Re: Unprofessional or bitchy?

Aisling McGrath — Wed, 05 Jun 2013 23:06:16 GMT

I have to say Elizabeth sums it up very well:

"Doing your own OOH is not automatically the best service. Not unless you have a well rested vet and nurse on site all night who are able to monitor patients (all night) of needed."

I previously worked in a practice where we provided our own OOH, and often I was so busy (or so exhausted) that I definitely couldn't provide gold standard care to my patients, it was just me, no nurse (I understand this isn't always the case), and I had to do whatever xrays/IV lines/bloods/surgeres etc by myself or with the client!!! (not ideal trying to deflate a GDV at 3am with a super stressed client watching me fail!)

"should also be made well aware (if a practice does it's own OOH) if their pet will be put in a kennel and left alone overnight"

I'm sure that in certain practices that provide their own OOH, this is not the case, but I unfortunately I had to do that in my case, especially on weekends, because not only had I lots of work to do during the day (so did quick diagnositics and started treatment, then move onto next emergency!), but I needed whatever sleep I could get at nighttime, in order to be ready for next day's work! so patients nearly always went unmonitored overnight! Not ideal!

I also feel that in my current job, where VetsNow provide our OOH, that I quite simply do much better at my day job! Rest is fantastic!

I have found the staff at VetsNow to be very helpful regarding cases that I have had to transfer to them, and they are very helpful when sending us back our clients that they have seen for us.

Their prices are VERY high, and obviously this is very frustrating and can pose a huge problem for clients, but ultimately IMHO, clients want the best for their animals, and the fact that I don't do OOH AND day work means that I am a better day vet, and during the night, they can see an excellent "night vet".

Just my two cents.

Re: Unprofessional or bitchy?

Bibs — Wed, 05 Jun 2013 21:41:58 GMT

Doing your own OOH is not automatically the best service. Not unless you have a well rested vet and nurse on site all night who are able to monitor patients (all night) of needed.

I don't think clients think of this aspect though (or are told). They just think cost and convenience because they don't know any better.

Clients should be made well aware if OOH is "farmed out" but they should also be made well aware (if a practice does it's own OOH) if their pet will be put in a kennel and left alone overnight. Then they can decide what they would rather happen in the event and what they think is worth the cost.

Re: Unprofessional or bitchy?

Arlo Guthrie — Wed, 05 Jun 2013 18:45:22 GMT

[quote user="Bob Russell"]Fortunately a number of clients have jumped to our defence so they are doing the job for us![/quote]

And SO much more effectively than you could possibly hope to do! (i.e. a zillion times more powerful from the pen of a client than the owner of the practice)

I know teaching granny to suck eggs, but if you DO pile in, the victor is the one who responds with the best grace and good humour. That's the one the audience will warm to, not Mr S. Grapes. Whatever you do, don't rise to the bait.

Re: Unprofessional or bitchy?

Bob Russell — Wed, 05 Jun 2013 18:30:11 GMT

It is on a local open facebook page.

I am not going to respond to it unless there are further comments. I suspect any action I take will be unhelpful. Fortunately a number of clients have jumped to our defence so they are doing the job for us!

Re: Unprofessional or bitchy?

Mark Hedberg — Wed, 05 Jun 2013 17:47:04 GMT

[quote user="James Laidlaw"]Can you not just delete the post if it's on your own practice Facebook page?

[/quote]

You could, but I suspect the post is doing far more damage to the author of the post than the recipient. ;)

Re: Unprofessional or bitchy?

James Laidlaw — Wed, 05 Jun 2013 17:20:37 GMT

Can you not just delete the post if it's on your own practice Facebook page?

Re: Unprofessional or bitchy?

Bob Russell — Wed, 05 Jun 2013 17:10:13 GMT

I accept that VetsNow is not what a lot of clients want or are used to but the idea that this is a practice 'farming off' out of hours and that it is second rate is misleading to say the least.

VetsNow have my phone number and permission to call it 24/7 if they have any queries (and have done). They have acted professionally and thoroughly and my patients have received very good treatment where necessary.

I have had cause to grumble about customer service this weekend and the issues will be followed through until resolved to my satisfaction.

I know the limitations of my type of practice and work closely with a local referral centre. I don't try to do more than I am capable or can provide proper aftercare!

I have an arrangement with VetsNow that complications following surgery are billed to me if considered the practice may be 'at fault' in any way!

Starting to sound like a teenager screaming 'It's not fair!' but we have put a lot of time into considerations regarding patient care.

I can criticize many aspects of other practices just as I am sure they feel they can my practice but making such comments (actually not making it clear that the poster is a partner at the practice to boot!) seems rather unprofessional.

We should all view facebook/twitter etc with a degree of caution and make sure all comments are 'suitably' measured!

Re: Unprofessional or bitchy?

Malcolm Ness — Wed, 05 Jun 2013 16:34:25 GMT

The protagonist is talking mainly about out of hours cover and Bob is talking about imaging etc. It is not clear to me whether Bob does provide an in-house out of hours service or whether he uses a deputising service.

Being devil's advocate and stirring a pot that probably doesn't need stirring:-

Whilst I can see that many will resent the forthright nature of this chaps remarks, there are two sides to every tale.

We provide a genuine 24 hours availability (and we don't set off-puttingly large fees). Every week we get calls from clients of other practices whose first inkling that their practice uses a deputising service is when they have followed the telephone answering machine trail to the deputising service to be told that they will be seen provided they enter the building just behind one hundred or more pounds sterling. Whilst I am not critical of anyone charging high fees, I think that it is sharp practice to cultivate clients without telling them that when the sun goes down, so does the service level. Examples: laryngeal tie-back surgery done as a day-patient case. Big bill. Had to be carried to the car. Deteriorated. Directed to deputising service who did an emergency tracheostomy. Good job. Better bill. Tracheostomy tube removed. Tracheostomy tube promptly replaced. Seen by us as a second opinion. Tie back revised (?? completed) successfully. Dog hospitalised with constant nursing and vet care for 48 hours. Big bill - but not as big as either of the other two. Had the original vet been open and honest about the limitations that their facility imposed then this client would have gone elsewhere. On another day, or with a less persistent and wealthy owner, the dog might have died.

Something that I find "teeth-grindingly unprofessional" to quote Arlo, is the increasingly widespread practice of "lock-up-shop" practices doing bitch speys for around a hundred pounds sound in the knowledge that come 6 o clock, they are off home with the lights out and if anything goes wrong then their unsuspecting client (unsuspecting because the vet has not informed them) will be charged more, much more, than the spay price to be seen at the deputising service.

A quick peruse of veterinary web-sites suggests that everybody has the best facilities, everybody has state of the art equipment, everybody offers the best clinical care, everybody offers 24-7 care and hardly anybody uses a deputising service. Discuss.

Re: Unprofessional or bitchy?

Robin Grimmer — Wed, 05 Jun 2013 16:16:21 GMT

In response to the title - both!

Re: Unprofessional or bitchy?

Arlo Guthrie — Wed, 05 Jun 2013 16:02:25 GMT

Teeth-grindingly unprofessional.

Makes the author sound like he/she has a face full of sour grapes.

Usually cleverer to identify competitor's weaknesses, and shout the positives about how your own services address those weaknesses.