Clinical histories

Re: Clinical histories

Michael Woodhouse — Sun, 30 Jun 2013 23:27:43 GMT

[quote user="Martin Atkinson"]The nurse/receptionist told me she would have to check with her client first, I told her in no uncertain terms that it was no damned business of the client and that if there was an issue here I wanted to speak to the vet NOW! [/quote]

Our reception staff are told to hang up the phone if people are rude.

Re: Clinical histories

Glenn Hodgson — Sun, 30 Jun 2013 23:23:10 GMT

[quote user="Martin Atkinson"]

[quote user="Bob Russell"]The latest thing from a practice nearby is to get permission from the owner to send a history in addition to a vet authorising a history to be sent! Had one or two clients pretty unimpressed that their wishes were being questioned![/quote] I had one the other day when requesting a history for a new kitten brought in for a check with pretty obvious chlamydiosis possibly also FHV with a load of crap advice from the 'breeder' who was obviously well dodgy and would clearly been aware of its condition. The nurse/receptionist told me she would have to check with her client first, I told her in no uncertain terms that it was no damned business of the client and that if there was an issue here I wanted to speak to the vet NOW! The history arrived 5 minutes later. And low and behold there was no history of this condition even though the 'breeder' had been treating it with medication from a previous case.

[/quote][quote user="Martin Atkinson"]

[/quote]

At our practice we request consent from clients prior to forwarding their pets histories, by phone initially, then by letter if necessary. I am of the opinion that this is good client care and that there is generally ample time for this to be done prior to a client standing in front of their new vet.

The primary reason is,sadly, to ensure that the request is valid having heard of practices requesting histories against a clients wishes. Also, I write things like.--- "client suffering from AIDS/immunosuppressed, zoonitic risks discussed in depth." I now suspect that this should be reserved for "client notes" rather than the pets clinical history?

As with most aspects of my work animal welfare takes precedence. If a colleague tells me that they need a history to help with a clinical emergency they will get it, verbally there and then if required. If my client/ex client were to take umbrage, so be it.

"I told her in no uncertain terms that it was no damned business of the client and that if there was an issue here I wanted to speak to the vet NOW!" IF I interpret your tone correctly. Wow.... that is an interesting way to go about business. Here's hoping we never find ourselves sending each other histories!

Re: Clinical histories

Nicola Cole — Sun, 30 Jun 2013 20:43:48 GMT

Thanks for info. Sorry to repeat an old thread-didnt realise it had already been discussed.

Re: Clinical histories

Martin Atkinson — Sat, 29 Jun 2013 11:34:01 GMT

[quote user="Nicola M"] Just to check-does the history belong to the pet or the owner? Eg. as above-if kitten with new owner registers with a practice and the practice requests the breeder's history from previous practice should this be given (legally, not morally)?[/quote] This has been covered in depth on another thread: the history unequivocally belongs to the pet, the previous owner has no right of of ownership morally or legally, the only thing that they have claim to under the data protection act is their personal and financial details

Re: Clinical histories

Michael Woodhouse — Fri, 28 Jun 2013 23:16:47 GMT

We have a vet check each history faxed because sometimes stupid spelling mistakes slip in making you look a fool and we do sometimes put comments in that should maybe not sent "no more treatment until account settled" "Cheque returned by bank" etc.

As we are mixed there is not always even a vet at the surgery so sometimes it can be the next day before we can get a history sent out. Our receptionist leaves at 5pm so nothing will happen if you ring up during your evening surgery.

Re: Clinical histories

Nicola Cole — Fri, 28 Jun 2013 22:43:49 GMT

[quote user="Martin Atkinson"]I had one the other day when requesting a history for a new kitten brought in for a check with pretty obvious chlamydiosis possibly also FHV with a load of crap advice from the 'breeder' who was obviously well dodgy and would clearly been aware of its condition. The nurse/receptionist told me she would have to check with her client first, I told her in no uncertain terms that it was no damned business of the client and that if there was an issue here I wanted to speak to the vet NOW! The history arrived 5 minutes later. And low and behold there was no history of this condition even though the 'breeder' had been treating it with medication from a previous case.

[/quote] Just to check-does the history belong to the pet or the owner? Eg. as above-if kitten with new owner registers with a practice and the practice requests the breeder's history from previous practice should this be given (legally, not morally)?

Re: Clinical histories

Martin Atkinson — Fri, 28 Jun 2013 17:09:12 GMT

[quote user="Utlendigur"]we twigged what was going on when one client rang up to book an appointment with us just after we'd faxed her notes - she wasn't happy about the OTHER practice's behaviour! [/quote] I don't want to prolong the agony on this but at some point your client must have given the new practice her details, unless they're just going through the phone book, so she is not entirely innocent in this charade and I would still be suspicious of her motives unless she was a spy for your camp and came forth voluntarily with all the details. Or maybe I've just learned to be a cycnic.

Re: Clinical histories

Utlendigur — Fri, 28 Jun 2013 13:55:35 GMT

[quote user="Martin Atkinson"] 1) if they were offering POM products like Milbemax they were in effect guilty of treating animals not under their care[/quote]

Not sure of the exact tablets but that's one reason why they were "registering" clients

[quote user="Martin Atkinson"]2) If your clients were sniffing around a new practice it doesn't sound as though they're very loyal or overly happy with your services[/quote]

It was an open day with various entertainments, free offers and a chance to be nosey - we twigged what was going on when one client rang up to book an appointment with us just after we'd faxed her notes - she wasn't happy about the OTHER practice's behaviour!

Re: Clinical histories

Martin Atkinson — Fri, 28 Jun 2013 13:44:59 GMT

[quote user="Utlendigur"]We've started doing this for requests from one practice because we've had a very aggressive new practice open up down the road who are requesting histories for clients on the slimmest basis eg they had an open day recently and requested histories for clients who had only gone to have a look round and collect the free worming tablet they were offering - some were a bit annoyed that the practice had then requested their notes![/quote] Thoughts here: 1) if they were offering POM products like Milbemax they were in effect guilty of treating animals not under their care - may be worth looking into; and 2) If your clients were sniffing around a new practice it doesn't sound as though they're very loyal or overly happy with your services - sorry.

Re: Clinical histories

Utlendigur — Fri, 28 Jun 2013 13:24:26 GMT

[quote user="Bob Russell"]The latest thing from a practice nearby is to get permission from the owner to send a history in addition to a vet authorising a history to be sent! [/quote]

We've started doing this for requests from one practice because we've had a very aggressive new practice open up down the road who are requesting histories for clients on the slimmest basis eg they had an open day recently and requested histories for clients who had only gone to have a look round and collect the free worming tablet they were offering - some were a bit annoyed that the practice had then requested their notes!

We have a "non-clinical notes" client file on our PMS where we can write up things that aren't strictly clinical eg disputes, info on family circumstances that might be better kept private, disagreements between family members over what they want done, financial info, or just have a rant, and put the number of the file in the notes to indicate that there is extra info elsewhere.

Re: Clinical histories

Martin Atkinson — Fri, 28 Jun 2013 10:46:36 GMT

Re: Clinical histories

Dagmar Steele — Fri, 28 Jun 2013 10:30:31 GMT

I am guilty of not always being completely clinical in my clinical notes. Sometimes the odd personal comment slips in and I like to remove it before sending it anywhere else. I always send them within an hour though.

Re: Clinical histories

Clive Ansell — Fri, 28 Jun 2013 10:21:13 GMT

Most practice computer systems have separate areas to write notes and reminders in addition to clinical notes, which if used should mean there is no reason to edit clinical notes.

In my area, local RSPCA and PDSA clinics seem the slowest, and can often take days to send through notes despite several phone calls. I saw a second opinion on Monday, previously seen at a cheap jack, and still waiting for a history! with second opinions I prefer the history so I can read through it before seeing and accepting the case.

Re: Clinical histories

Wren — Fri, 28 Jun 2013 09:59:27 GMT

[quote user="Bob Russell"]

The latest thing from a practice nearby is to get permission from the owner to send a history in addition to a vet authorising a history to be sent! Had one or two clients pretty unimpressed that their wishes were being questioned!

[/quote]

My old practice always did this as a lead into a question about why they wanted to go elsewhere. Obviously we didn't bother if the the surgery was 150 miles away as that one's obvious. It lets the clients air their grievances and on several occasions it was a minor misunderstanding that was easily rectified and the client chose to stay with us instead of going to the other practice. The call had to be handled sensitively but for us it was a worthwhile exercise as a) we got feedback, however unwelcome and b) we often got the feedback AND got to keep the client.

Re: Clinical histories

James Laidlaw — Fri, 28 Jun 2013 09:55:13 GMT

I've been just as guilty as anyone else of writing things in notes about difficult clients - fortunately not had any lately!

In reality though, shouldn't clinical notes be just that - clinical notes, not notes about the owner? Then the job of transferring notes would be fine, and as Bob mentioned - owners are entitled to request their histories, and there shouldn't be anything derogatory or defamatory or similar within. I endeavor to improve on my own notes, and hopefully this fad of redaction can go away...!

Re: Clinical histories

Bob Russell — Fri, 28 Jun 2013 09:46:38 GMT

I make a point of assuming the owner will see the history at some stage. They are entitled to see it (I believe!).

The worst comments I would use would be along the lines of 'head v's brick wall' particularly with owners of grossly obese pets! If there are any client or pet behavioural issues we would put a concise, factual summary of events.

Re: Clinical histories

Martin Atkinson — Fri, 28 Jun 2013 09:33:52 GMT

I always check histories before they're sent for the above reasons but also because the fax machine is in my office and the nurses are usually busier than I am and to make sure there isn't something that is not completely clear or may have not been updated since the last client visit. I always endeavor to get them sent within an hour. I have to say though, that unless there is something completely libelous, if the notes are that critical of the client I probably won't be wanting them back anyway and it may do them some good to see some home truths!

Re: Clinical histories

Chris Barker — Fri, 28 Jun 2013 09:14:23 GMT

On two occasions when the full warts and all histories have been sent from our clinic the client has got to read them - either by direct access to the fax or by reading the computer screen while the vet was out of the room. With consequences. Henceforth practices will receive salient details only....

Re: Clinical histories

Mark Hedberg — Fri, 28 Jun 2013 09:05:08 GMT

[quote user="James Laidlaw"]

Short notice new client today and trying to get a history has me frustrated...!

Why is it that some clinics seem to have a policy of having a vet check the history before it is sent? Sure the clinical records shouldn't need redacting (without then removing parts of the history) prior to sending. Some cases seem to take weeks for us to get the histories though or I just give up trying, but I thought GtoPC advises histories to be transferred if requested...

Any opinions?

[/quote]

The main reason we did at my last employer was to catch the occasional comment on client history. Apparently, so the story goes, if there's something on the client history that causes the next clinic to decline the client, we get in trouble about that. So little bits about 'client screamed at staff' or 'client is a ******' or 'wouldn't pay the bill if he was on fire' got redacted.

One amusing case was a nightmare client from hell, there was actually more redaction than actual clinical history. I don't really know how blacking it out helped in anyway, had i seen a case history like that I would have run a mile!