Client complaint.....am I unreasonable?

Re: Client complaint.....am I unreasonable?

Melanie Illingworth — Sat, 15 Jun 2013 21:26:10 GMT

Seizures rings a bell for me too. I checked the formulary recently after seeing a Pug with a hx of seizures which had a suspected sting reaction - it did say to avoid in cases with a history of seizures.

Re: Client complaint.....am I unreasonable?

Bibs — Fri, 14 Jun 2013 23:23:15 GMT

If chlorphenamine is so innocuous then why do I have it in my head that I need to be checking there is no history of seizures or glaucoma before I dispense it? Must have read something in a formulary at some point.

Re: Client complaint.....am I unreasonable?

Marie Kubiak — Fri, 14 Jun 2013 15:06:34 GMT

[quote user="Thomas Johnson"]

Definitely, and I did start my post by saying I agreed with you, I would have done the same as you in your situation. It was this part of Marie's post that I was questioning:

[quote user="Marie Kubiak"]

If I haven't seen a patient for a particular problem then I'm not prepared to prescribe to treat it ..... This goes for any prescription meds regardless of how innoccuous they may appear to be.

[/quote]

I would be happy to dispense prescription medication on behalf of another vet following written or verbal request but that's another completely different situation to the one in the OP! I still would not prescribe for an animal who is not under my care in any way.

Marie

Re: Client complaint.....am I unreasonable?

Martin Atkinson — Fri, 14 Jun 2013 14:30:56 GMT

+ another 5

Re: Client complaint.....am I unreasonable?

Hannah Wynne Richards — Fri, 14 Jun 2013 12:38:05 GMT

Thanks

Wynne

Re: Client complaint.....am I unreasonable?

Dagmar Steele — Fri, 14 Jun 2013 11:50:42 GMT

Five stars Wynne!

Re: Client complaint.....am I unreasonable?

Hannah Wynne Richards — Fri, 14 Jun 2013 11:46:59 GMT

What I really can't understand from some of these postings,is why on earth should anyone ever want to break the law, in order to REDUCE their income

Wynne

Re: Client complaint.....am I unreasonable?

Thomas Johnson — Fri, 14 Jun 2013 10:59:58 GMT

[quote user="Martin Atkinson"]

[quote user="Thomas Johnson"]I would agree with you in this situation, but there has to be some flexibility. I was contacted earlier this week by someone who was looking after a dog for a family member, the dog has heart disease and they had run out of furosemide. I contacted the vet who normally sees the dog, who wasn't local to us, and received a comprehensive history including cardiac measurements from its last echocardiogram 2 months ago. On the basis of this history I was happy to dispense them some furosemide, technically I suppose I should have asked for a written prescription from the dog's normal vet.[/quote] This is a totally different scenario, unless the client had asked for a consultation and/or there was change in it's condition, this animal was still under the care of the other veterinary surgeon, technically you required a prescription but if we can't work together like this with a bit of common sense then there is no hope, but what you couldn't do was just hand out some medication to someone who walked through the door on their say so alone.

[/quote]

Definitely, and I did start my post by saying I agreed with you, I would have done the same as you in your situation. It was this part of Marie's post that I was questioning:

[quote user="Marie Kubiak"]

If I haven't seen a patient for a particular problem then I'm not prepared to prescribe to treat it ..... This goes for any prescription meds regardless of how innoccuous they may appear to be.

[/quote]

Re: Client complaint.....am I unreasonable?

Martin Atkinson — Fri, 14 Jun 2013 09:22:13 GMT

Re: Client complaint.....am I unreasonable?

Thomas Johnson — Fri, 14 Jun 2013 09:12:13 GMT

[quote user="Marie Kubiak"]

I'm with you on this. If I haven't seen a patient for a particular problem then I'm not prepared to prescribe to treat it. If another vet elsewhere has seen it, diagnosed a condition and started treatment then they can go back to them for ongoing refills if they aren't prepared to let me assess the animal so that it comes under my care. This goes for any prescription meds regardless of how innoccuous they may appear to be.

[/quote]

I would agree with you in this situation, but there has to be some flexibility. I was contacted earlier this week by someone who was looking after a dog for a family member, the dog has heart disease and they had run out of furosemide. I contacted the vet who normally sees the dog, who wasn't local to us, and received a comprehensive history including cardiac measurements from its last echocardiogram 2 months ago. On the basis of this history I was happy to dispense them some furosemide, technically I suppose I should have asked for a written prescription from the dog's normal vet.

Re: Client complaint.....am I unreasonable?

Christina Smith — Thu, 13 Jun 2013 17:14:45 GMT

Allergic rhinitis - probably commoner than we think. Well disguised by the adrenaline doses brought about by visit to the vet!

Re: Client complaint.....am I unreasonable?

Marie Kubiak — Thu, 13 Jun 2013 13:59:56 GMT

.[quote user="Martin Atkinson"]

[quote user="John Flynn"]My thoughts exactly. I cannot imagine what I would have been able to tell from examining the dog that would have changed a discussion that I could otherwise have had with the owner over the phone[/quote] All I can say is that there are those amongst us who have a different interpretation of their duty of care!

[/quote]

Whole different situation if it's an animal that is seen regularly, had a condition diagnosed by our practice and is truly under our care requiring a repeat prescription but that's not the case here.

Marie

Re: Client complaint.....am I unreasonable?

Mark Hedberg — Thu, 13 Jun 2013 09:56:24 GMT

[quote user="Martin Atkinson"]

I had Zimbabwean client who complained about my charges and qualified this by stating how much less his vet in Harare would have charged. There is no answer to this that would be worthwhile and taken on board by the client. I used to feel like this , then I resorted to this , went through and now I am more likely to feel .

[/quote]

Not at all - you charge a mere £30 or so for a consult, a Zimbabwean vet would charge millions of Zimbabwean dollars! NOW who's cheaper?

Re: Client complaint.....am I unreasonable?

Martin Atkinson — Thu, 13 Jun 2013 09:44:42 GMT

[quote user="Tim Browning"]

If you had a death wish and were willing to be sexist for dramatic effect you could have retorted 'You can get a woman in Latvia for a few pounds!'

[/quote] I was going to reply rather more succinctly to Catherine's post but I feel that this sums up it up rather more simply. I had Zimbabwean client who complained about my charges and qualified this by stating how much less his vet in Harare would have charged. There is no answer to this that would be worthwhile and taken on board by the client. I used to feel like this , then I resorted to this , went through and now I am more likely to feel .

Re: Client complaint.....am I unreasonable?

Martin Atkinson — Thu, 13 Jun 2013 09:35:47 GMT

Re: Client complaint.....am I unreasonable?

Tim Browning — Thu, 13 Jun 2013 09:28:41 GMT

If youy had a death wish and were willing to be sexist for dramatic effect you could have retorted 'You can get a woman in Latvia for a few pounds!'

Re: Client complaint.....am I unreasonable?

CatherineThomas — Thu, 13 Jun 2013 07:27:55 GMT

I do sometimes tell people that they can get piriton from the chemists but I would only do that after seeing the animal and discussing the problem properly.

A while ago we had a client get aggressive because we wouldn't give him fucithalmic. The dog was a mastiff with severe bilateral entropion. He'd been to see an ophthalmologist 2 years previously who had recommended surgery. There was no mention of using fucithalmic in the letter we had on file but the owner insists that they had told him he could keep getting fucithalmic without being seen as an alternative to surgery. He told us he knew the eye had an ulcer and he needed the fucithalmic. We were not happy to do anything without seeing the dog. So he started getting aggressive and making sexist comments. The receptionist had to call the police to get him off the premises. He then threatened to contact trading standards, RCVS, the local press etc etc. Several months down the line we haven't heard anything from him. I don't know if we've recieved a request for history but I really hope the dog has been seen and treated. He had also complained about the cost of boosters when he'd been in 5 months before, because his girlfriend came from Latvia and didn't understand how we could charge so much for it when you can get a booster in Latvia for a few pounds.

Re: Client complaint.....am I unreasonable?

Mark Holmes — Wed, 12 Jun 2013 21:19:29 GMT

I am with Martin on this one - I think. If a client rang, whom I bearly new demanding a prescription for something - even piriton. For a condition - allergic respiratory disease which to be honest is unlikely. Based on a (second hand) diagnosis of an unknown vet ( who may not even exist) my answer would be being it down. I could spend 10 minutes discussing it over the phone and get a pretty good idea about the case but then that's a consultation and needs paying for. If I knew the patient, the case and perhaps even the owners enough to trust their judgement it MIGHT be different but in the circumstances above - no way. Pay for the consultation that won't happen over the phone so come down.

Re: Client complaint.....am I unreasonable?

John Flynn — Wed, 12 Jun 2013 20:48:18 GMT

[quote user="David Mills"]

[quote user="Martin Atkinson"]I was just following a protocol which I believe was in the best interests of the animal: [/quote]

Was it? I'd like to know the contraindications that you considered for chlorphenamine - side effects, interactions, possible dangers, that sort of thing, or what you may find (or think you may find) on clinical exam that, specifically, in this case, would disclude you (or a receptionist) from directing the client to the hayfever aisle?

Strongly arguable, of course, is that the welfare of the animal was, and could have been predicted to have been, far greater breached by being taken to the vets and subjected to an examination and injection, than being given generic chlorphenamine off the shelf. Welfare risk assessment in this case - taking into account the vast safety profile of chlorphenamine - would firmly come down on the side of telling the client to source the tabs himself.

[/quote]

My thoughts exactly. I cannot imagine what I would have been able to tell from examining the dog that would have changed a discussion that I could otherwise have had with the owner over the phone.

Re: Client complaint.....am I unreasonable?

David Mills — Wed, 12 Jun 2013 19:28:56 GMT

[quote user="Arlo Guthrie"][quote user="David Mills"]

[quote user="Martin Atkinson"]because after a clinical examination and a discussion of the symptoms and apparent response to treatment it seems this was indeed the the first one in 38 years.[/quote]

Fair enough.

[quote user="Martin Atkinson"]PS its not me giving you the red stars![/quote]

They are music to my eyes. Personally, I think its Mr G.

[/quote]

Ironic, given I was just catching up with this thread and had been liberally sprinkling your posts with stars, David, on the basis that they were thought-provoking, and I empathise with your view on rules

Only then did I read this post

Yours-leaning-to-starboard

[/quote]

Is it hay fever making everyone so grouchy recently?

Re: Client complaint.....am I unreasonable?

Arlo Guthrie — Wed, 12 Jun 2013 18:46:59 GMT

[quote user="David Mills"]

[quote user="Martin Atkinson"]because after a clinical examination and a discussion of the symptoms and apparent response to treatment it seems this was indeed the the first one in 38 years.[/quote]

Fair enough.

[quote user="Martin Atkinson"]PS its not me giving you the red stars![/quote]

They are music to my eyes. Personally, I think its Mr G.

[/quote]

Only then did I read this post

Yours-leaning-to-starboard

Re: Client complaint.....am I unreasonable?

Martin Atkinson — Wed, 12 Jun 2013 16:38:33 GMT

[quote user="James Laidlaw"]Did you suggest he try taking it off piriton?

[/quote] Of course, has been on it all year but the symptoms worsen as soon as the summer arrives and the dog wheezes and coughs. I guess if it works it is better than corticosteroids, I doubt very much we'd have got it onto inhaled medication and at least it is cheap (even with Atkinson tax and a dispensing fee)!

Re: Client complaint.....am I unreasonable?

James Laidlaw — Wed, 12 Jun 2013 13:23:05 GMT

Did you suggest he try taking it off piriton?

Re: Client complaint.....am I unreasonable?

David Mills — Wed, 12 Jun 2013 12:41:32 GMT

[quote user="Bob Russell"]

For profit? Yes of course but dispensed from a 500 tablet pot Piriton are cheaper than the blister packed ones at Boots! Everyones a winner!

[/quote]

Even with the Atkinson tax??

[quote user="Hannah Wynne Richards"]

David I didn't realise we had a poet amongst us!!!!!!!!!!!!!!!

[/quote]

Watch out for my coming anthology...

Re: Client complaint.....am I unreasonable?

Hannah Wynne Richards — Wed, 12 Jun 2013 12:39:08 GMT

David I didn't realise we had a poet amongst us!!!!!!!!!!!!!!!

Wynne