Locums, steroids and snake oil........

Re: Locums, steroids and snake oil........

Francisco Gomez — Sat, 24 Aug 2013 23:03:39 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]Which is...... why, I wonder?[/quote]

Because the locums usually don't want to do them.

Dentals per 100 contacts[ vaccinations and consults] can vary between 8.18% and less than 1.5% in full time vets and locums are way below that.

The 8.18% vet did this as an average over about two years; the less than 1.5% said "I hate dentals" but was an excellent orthopod.

[/quote]

Interesting. They don't want to do them, so they just ignore the patient's mouth?

Or do they say "Binky really needs some dental attention, I'd like to book him in for the boss to see" ?

I would prefer the latter in any case, but I'd certainly prefer that to the lady who decided to do some extractions (despite my instructions to leave anything dental for me) and made a complete and utter cock-up of it.

[/quote] ... And there you can see how tricky the Locum business can become: the boss who complaints because you don't and the boss who complaints because you do (and in some cases, it doesnt matter if you did it right, because unless you do it in the exact/impossible same way, it'd be a 'cock-up'). [not trying to say yours specifically wasn't a cock-up, just raising a point: you both are principals and can't agree in what you want the Locum to do...]

Re: Locums, steroids and snake oil........

Evelyn Barbour-Hill — Sat, 24 Aug 2013 21:29:57 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]Which is...... why, I wonder?[/quote]

Because the locums usually don't want to do them.

Dentals per 100 contacts[ vaccinations and consults] can vary between 8.18% and less than 1.5% in full time vets and locums are way below that.

The 8.18% vet did this as an average over about two years; the less than 1.5% said "I hate dentals" but was an excellent orthopod.

[/quote]

Interesting. They don't want to do them, so they just ignore the patient's mouth?

Or do they say "Binky really needs some dental attention, I'd like to book him in for the boss to see" ?

Re: Locums, steroids and snake oil........

Anthony Todd — Sat, 24 Aug 2013 18:52:18 GMT

[quote user="Evelyn Barbour-Hill"]Which is...... why, I wonder?[/quote]

Because the locums usually don't want to do them.

Dentals per 100 contacts[ vaccinations and consults] can vary between 8.18% and less than 1.5% in full time vets and locums are way below that.

The 8.18% vet did this as an average over about two years; the less than 1.5% said "I hate dentals" but was an excellent orthopod.

Re: Locums, steroids and snake oil........

Evelyn Barbour-Hill — Sat, 24 Aug 2013 16:46:39 GMT

[quote user="Anthony Todd"]Dentals fall through the floor with most locums, for instance.[/quote]

Which is...... why, I wonder?

Re: Locums, steroids and snake oil........

Anthony Todd — Sat, 24 Aug 2013 16:43:55 GMT

[quote user="Iain McAllister"]As far as turnover is concerned - usual reason it goes down as has been mentioned before is clients putting off things til their regular vet comes back [/quote]

No sorry, not only are the numbers of consults down but the "services" and therefore fees per consult are often 50% of the usual.

Dentals fall through the floor with most locums, for instance.

Re: Locums, steroids and snake oil........

Iain McAllister — Sat, 24 Aug 2013 13:16:07 GMT

I'm a locum too - if an animal is on a long term non-helpful or even contra-indicated treatment then I will try to subtly steer the pet away from the therapy - not so difficult as it may seem as often then original therapy is not really effective and the owners are open to change - Not had any negative feedback from practices I work for over this

If the treatment is effective and not contra-indicated but not really my personal choice then I'll make the appropriate noises and continue with it!

As far as turnover is concerned - usual reason it goes down as has been mentioned before is clients putting off things til their regular vet comes back or clients preferring to see one of the other vets - altho some practice receptionists don't help by referring to the locum as some sort of last resort!

...but that's down to the practice owners not training their support staff properly - so when they moan perhaps they should be more introspective - - do I have a locum pack detailing protocols, billing methods, use of the PMS etc , have I trained my staff in helping a locum do his job efficiently etc - if you do you are in a minority!

Just be more philosophical about things Anon!

Re: Locums, steroids and snake oil........

Robin Grimmer — Sat, 24 Aug 2013 11:49:22 GMT

Back to the OP, I don't know why you've got such a bee in your bonnet about this anon. You said yourself it was a very short term locum. I've been locuming for 4 years and thankfully I mostly do regular ones where I know the practice and clients well and vice versa. However, I have worked in similar practices to the one you describe, I just put my head down and get on with it. Also, I don't know why you feel the need to post as anon - you haven't named the practice or even the area you work in.

Re: Locums, steroids and snake oil........

Evelyn Barbour-Hill — Fri, 23 Aug 2013 23:30:02 GMT

[quote user="An On MRCVS"] Rather just a bit manipulative;[/quote]

All practising veterinary surgeons who deal face-to-face with the public are a bit manipulative. In fact, as with being "assertive" (another word which to me is pejoric) it's supposed to be a good thing. You have to get "compliance", you have to persuade the owners to have this and that done and not to do the other. There's no end of management articles for both veterinary surgeons and nurses on how to do it.

Re: Locums, steroids and snake oil........

Anthony Todd — Fri, 23 Aug 2013 20:36:37 GMT

[quote user="An On MRCVS"]The contrast between 1/ the handling of animals on years of steroids, with no diagnosis, and poorly educated owners, that think only one 'God-like' vet can possibly treat their pet,. [/quote]

Trouble is [yes, it's me again, the snake oil protagonist,] the drug is branded because of the bad vet. Applying your logic you could argue the propofol is a dangerous and abused drug and should be avoided by any right minded doctor because of one publicised misuse.

Sure there are vets who do just that [and 45 years ago I worked for one] but also that is the fault of the nurses who allow repeats without question, [and affix a label "As directed"]

Are there any vets or practices where the boss or head vet is less than 30 years graduated where this sort of practice occurs and steroids are so grossly misused?

If so it's the vet not the drug that should be condemned.

Similarly I've seen dogs on phenobarb [and obese] for literally years 'cos they had one single fit when a puppy but phenobarb isn't condemned.

I still don't get it!

I would add that I wish I could ever have created such an aura and had enough charisma, or even a just a bit, so that clients believed me when I tried to insist that if they got the fleas controlled they wouldn't have to use anything at all to treat the recurrent allergic dermatitis.

Nah, it's hormonal Mr.Boss Vet said, all those years ago, and the "Ovarid" works just fine thank you, young man.

My first boss in the UK had clients coming just so he could lay his hands on the animal to ensure recovery...

Truly the Jose Mourinho of the veterinary profession.

Re: Locums, steroids and snake oil........

An On MRCVS — Fri, 23 Aug 2013 20:04:20 GMT

[quote user="Evelyn Barbour-Hill"]I love the idea of snail oil! [/quote]

Imagine snail Oil? Yuk. I meant to say snake oil!

OK, I don't mean to suggest absolutely fraudulent. Rather just a bit manipulative; not doing anything absolutely wrong, but not doing anything remotely right, for some client management reason or other.

Sorry for the Anon, but I suppose the original thing that spurred me on was this.

The contrast between 1/ the handling of animals on years of steroids, with no diagnosis, and poorly educated owners, that think only one 'God-like' vet can possibly treat their pet,. The owners then refuse essential treatment when that vet is away for 2 weeks. These owners have been poorly managed/educated by their own practice and this has led to animal suffering. And we all know practices like these.

And 2/ the over-reaction of the RCVS to the Chikosi case and the enormous burden and punishment put on that particular vet in that particular situation.

I am not suggesting for a minute that the RCVS should or could address the vets, it is just a philosophical point really.

Re: Locums, steroids and snake oil........

Hannah Wynne Richards — Fri, 23 Aug 2013 14:17:56 GMT

Is homeopathy snake oil? Discuss

Wynne (colander on head again!!!!!!!!!!)

Re: Locums, steroids and snake oil........

Evelyn Barbour-Hill — Fri, 23 Aug 2013 12:17:32 GMT

I love the idea of snail oil!

To be serious just for a second, though, (I promise it won't last!), "snake oil" is generally taken to mean a truly fraudulent medicine, not a bedside manner however oleaginous that might be.

Re: Locums, steroids and snake oil........

An On MRCVS — Fri, 23 Aug 2013 10:50:32 GMT

[quote user="Evelyn Barbour-Hill"]Hey! Where's the snake oil?[/quote]

The snail oil is in the 'bedside manner' referred to by others on this thread.

Re: Locums, steroids and snake oil........

Evelyn Barbour-Hill — Fri, 23 Aug 2013 00:31:03 GMT

[quote user="An On MRCVS"]

[quote user="robloxley"]I refer you to your title of your thread... [/quote]

And skin disease.......

[/quote]

Hey! Where's the snake oil?

Re: Locums, steroids and snake oil........

An On MRCVS — Thu, 22 Aug 2013 21:57:53 GMT

[quote user="robloxley"]I refer you to your title of your thread... [/quote]

And skin disease.......

Re: Locums, steroids and snake oil........

Rob Loxley — Thu, 22 Aug 2013 21:25:42 GMT

[quote user="An On MRCVS"]Secondly, I did not expect to start a discussion about steroids[/quote]

I refer you to your title of your thread...

Re: Locums, steroids and snake oil........

Mark Hedberg — Thu, 22 Aug 2013 20:34:48 GMT

No worries, Anon! Around here, it always becomes about steroids sooner or later - it's like the Godwin's Law of vetsurgeon.org.

Re: Locums, steroids and snake oil........

An On MRCVS — Thu, 22 Aug 2013 20:30:17 GMT

I made the original post. Thank you all for your comments.

Firstly, on the issue of being a locum; Bob Lehner's post says it all, and very well too. It is a skill being a locum, balancing the issue of being of a filler-in and not compromising the care of the animals. I almost always get asked back to do more at a practice, and I have learnt over the years the need to balance filling-in while maintaining some clinical standards. I do get tired of people making negative asides about locums, but know that the industry would be in a bit of a pickle without them.

Secondly, I did not expect to start a discussion about steroids and skin disease. My point about the dog on steroids that died was this. It had obviously developed a new condition, that urgently needed alteration of treatment, but the practice had created these needy, 'suspicious' owners. I have seen that occur to a spectacular extent in certain individual practices. I personally don't like theose practices. They usually usually cause the owners to make bad decisions for the animal, that are contrary to animal welfare and also contrary to good clinical and business practice.

Thanks again for all your comments.

Re: Locums, steroids and snake oil........

Evelyn Barbour-Hill — Thu, 22 Aug 2013 19:15:50 GMT

[quote user="Anthony Todd"]

Have the writers ever actually seen a dog with an acute allergic skin?

Gimmee a break.

[/quote]

Trying to give you ten stars, Anthony.

Re: Locums, steroids and snake oil........

Martin Atkinson — Thu, 22 Aug 2013 15:08:29 GMT

[quote user="Anthony Todd"]

[quote user="Linda Filshie"]Oops I've managed to red star myself scrolling on iPad!

[/quote]

Join the club!

[/quote]Saves me doing it then eh Anthony if you're advocating corticosteroid usage. I actually have kept out of that argument on this thread, could turn to RMB or homoeopathy or evoke Godwin's Law yet!

Re: Locums, steroids and snake oil........

Anthony Todd — Wed, 21 Aug 2013 20:41:13 GMT

[quote user="Linda Filshie"]Oops I've managed to red star myself scrolling on iPad!

[/quote]

Join the club!

Re: Locums, steroids and snake oil........

bob lehner — Wed, 21 Aug 2013 20:30:28 GMT

Going back to the original post, I feel that being a locum is actually quite a tricky business (and I've had plenty of experience on both sides).

By definition the locum is there to fill a temporary gap. I don't think it is therefore your remit to try and change the practice protocols which have been established by the principals for their own particular reasons (be they good, bad or indifferent). Equally however you should not compromise your own clinical standards. Sometimes balancing these two, possibly rather opposing standpoints is not easy. You may certainly have to bite your tongue on occasions. When I started doing locums (having formerly been the senior partner in a busy Hospital practice) it was quite an eye opener.

Bottom line is if it is truly awful you can vote with your feet either immediately, or by declining any invitation to re-visit. I suppose if the clinical deficiencies were truly extreme you could follow the RCVS 'Whistleblowing' guidelines and report them.

However I suppose that the only way you can really ensure that you consistently practice to whatever high level you have set your self is by having your own business and not working for somebody else.

These days I only go back to places I like.

Re: Locums, steroids and snake oil........

Francisco Gomez — Wed, 21 Aug 2013 20:23:53 GMT

Not to worry, i just gave u 5 :-)

Re: Locums, steroids and snake oil........

Linda Filshie — Wed, 21 Aug 2013 20:21:23 GMT

Oops I've managed to red star myself scrolling on iPad!

Re: Locums, steroids and snake oil........

Anthony Todd — Wed, 21 Aug 2013 20:09:17 GMT

[quote user="robloxley"]Well, you know, I just looked at the guidelines for treatment of atopic dermatitis in dogs which say "Acute flares should be treated with a combination of nonirritating baths and topical glucocorticoids, once an attempt has been made to identify and remove the suspected causes of the flare. Oral glucocorticoids and antimicrobial therapy must be added when needed.[/quote]

Frankly this shows just how far out of touch with reality some vets are. [can't believe you'd do this Rob,,,] We all know that topical preps, whilst theoretically effective, indeed very effective in humans, are a waste of time in an itchy dog unless you put it in a buster collar and apply the skin prep frequently. Even then results are not worth the effort compared with a shot of steroids [demodex excepted, before you all jump on me] but we all should be able to tell the difference.

If you use enough steroid topically you'll get the same uptake systemically so you might as well just inject it or give it tablets.

How many owners can or want to bath their dog often enough to make any difference; it's hard enough with mange!

So you've got this dog or cat tearing itself to bits in minutes and you have to give it nonirritating baths and topical glucocorticoids.

And then go on with oral glucocorticoids and antimicrobials, why; there's usually no infection at all with a pure allergy. Belt and braces methinks.....

There would be a case for oral corticisteroids initially and topical for the bits not resolving but not the other way round.

Have the writers ever actually seen a dog with an acute allergic skin?

Gimmee a break.