Just visits

Re: Just visits

Martin Atkinson — Wed, 23 Oct 2013 11:05:19 GMT

Having gone round in circles several times, and given that my posts have received as many 5 star approvals as the opposite point of view, it is probably fair to say we are divided on this topic and should accept that we just beg to differ in our opinion of how a vet should conduct his/her business. I stick to my point of view and will never compromise the way I think a practice should be run. When I no longer feel I can do that is the day I will retire.

Re: Just visits

Michael Woodhouse — Wed, 23 Oct 2013 01:06:29 GMT

[quote user="Martin Atkinson"]My practice is hardly state-of-the-art cutting edge technology, it is soundly equipped with what I believe is the basic minimum that is needed to treat 99.9% of what is thrown at me. You're right fair is not the word perhaps something a little stronger: it is irresponsible and unprofessional to set up a practice that does not even have (to quote mariette): inhalation anaesthesia, oxygen or x rays, or the ability to hospitalise patients. Yes maybe they can refer on to another branch/practice but there are occasions when this is not feasible and an animal will suffer/die - this is IMO disgraceful professional misconduct. How anyone could even contemplate working in a practice like that beggars belief.[/quote]

Firstly if the only equipment you have is a bottle of pentoject, a single syringe and a needle no animal needs to suffer.

I've never radiographed a cow. I've fixed many fractures.

Never used oxygen on anything bigger than a calf but done many operations.

On the small animal side I would grab the ultrasound machine far more often than I'd radiograph OOH. Checking to see if puppies have good strong heart beats, is this a pyo, free fluid in chest or abdomen. Do I remember you saying you don't have a scanner?

What about the dog with a bone stuck in the oesophagus? I don't have an endoscope. I can't measure clotting times. That could be useful, and even essential in some cases.

If someone calls with a sick animal and is registered locally I will always direct them back to their own practice in the first instance. Otherwise I will see, assess and then come up with a plan. I'd never suggest they started ringing different vets who may be better equipped to deal of their own back. To my mind it is for me to refer on as appropriate (bearing in mind owners wishes, budget, and limitations of the treatment any of us can offer).

[So having gone around in a circle I have no problem with vets offering a limited service or a different model if that is what they want to do, so long as provisions are in place for 24 hour cover]

Re: Just visits

Thomas Johnson — Tue, 22 Oct 2013 15:30:42 GMT

[quote user="mariette asselbergs"]

[/quote]

Another thought has come to mind, as far as I am aware no-one has any objections to solely ambulatory equine practices, or mixed practices that do basic equine work. Neither of them have any hospitalisation or operating facilities and refer on to their local equine hospital. How is this any different to a small animal vet who only does visits?

Re: Just visits

Rob Loxley — Tue, 22 Oct 2013 13:48:34 GMT

[quote user="mariette asselbergs"]If it is acceptable tyo limit your services to just equine, or large (or small, or exotic), then is it acceptable to limit your services in the way as described above?[/quote]

Why not - we have vaccination & neutering clinics, we have a couple of local specialists with practices that just do ophthalmology and reproduction respectively; if someone phoned us with a horse to see we'd put them in contact with someone suitable (in fact the gtpc tells you that "Veterinary surgeons must keep within their own area of competence").
What you can't abdicate in practice (and I'd argue that a visiting vet is "in practice") is your 24hr provision of emergency and first aid care, so you should make provision to deal with such eventualities, rather than just meeting them with a refusal.

Re: Just visits

mariette asselbergs — Tue, 22 Oct 2013 13:19:12 GMT

During the 5 years I worked in this practice we only once had a dog dead. This was an acute pyo in very bad condition and for the owner it was either us operating or PTS. Otherwise we had no deaths from surgery ever, but referred ill animals or non-routine ops elsewhere if owner wanted that. There were many cases where the owner would have opted for PTS for financial reasons but the animal was saved because we operated cheaply. Our practice manager/receptionist checked specifically that we did nor underprice for routine stuff in comparison to other practices. There were also cases of RTA trauma where the small animal practice we wanted to refer to only offered putting the animal on a drip and dealing with the stitch up or jaw wiring the next day. In these cases we and the owners said thank you very much and we did it there and then.

Martin I have worked for decades without inhalation, oxygen, x rays or hospital facilities in the majority world (or Holland many years ago) and although I am grateful and happy to now use all the facilities which are available, I feel that you can certainly do quality work without them. Experience helps to judge and make choices, and I feel for young vets who do not build up this experience. But I feel sure I could work ethically sound under those conditions.

And it is NOT a case of just burdening other practices with difficult cases at night. It is offering proper 1st line work, day and night, and referring when it is appropriate, day and night, not out of laziness but in line with the case as it presents itself.

Mariette

Re: Just visits

Gareth Dowdeswell — Tue, 22 Oct 2013 09:49:36 GMT

[quote user="Martin Atkinson"]

[quote user="Colin Thomson"] But you can't expect all vets to run at the same level of investment as yourself just because you think its not fair that they don't, IMO.[/quote] My practice is hardly state-of-the-art cutting edge technology, it is soundly equipped with what I believe is the basic minimum that is needed to treat 99.9% of what is thrown at me. You're right fair is not the word perhaps something a little stronger: it is irresponsible and unprofessional to set up a practice that does not even have (to quote mariette): inhalation anaesthesia, oxygen or x rays, or the ability to hospitalise patients. Yes maybe they can refer on to another branch/practice but there are occasions when this is not feasible and an animal will suffer/die - this is IMO disgraceful professional misconduct. How anyone could even contemplate working in a practice like that beggars belief.

[/quote]

I think there was a DC case where the vet was required to restrict himself to consulting and vaccination only and to refer anything else on to another vet, so from that I'd guess the RCVS is happy with sort of set up, as long as there's no deception to owners. I think you'd be expected to have some sort of established relationship with another practice for referring on animals that you couldn't deal with.

Re: Just visits

Gareth Dowdeswell — Tue, 22 Oct 2013 09:25:05 GMT

[quote user="bob lehner"]

[quote user="Thomas Johnson"]why would you choose to take the job where you hade to do OOH co[/quote]

My impression is that most newer grads do try and avoid jobs which require OOH work - but equally I have met some keener ones who have taken a job specifically because they will have to do OOH - and appreciate that they will gain more experience in emergency work by doing so.

I feel everyone should do it at least for a while - although personally, having been on the OOH rota for 30- plus years I was very happy to stop.

(Of course a big difference between purely SA practices and mixed/farm/equine who still have to do their own OOH).

[/quote]

I'm not sure its a case of new grads avoiding jobs with OOH - in small animal at least I think the majority of jobs now don't do their own OOH, so its actually quite hard to find a job still doing its own OOH.

Re: Just visits

Martin Atkinson — Tue, 22 Oct 2013 09:24:07 GMT

Re: Just visits

Thomas Johnson — Tue, 22 Oct 2013 08:48:09 GMT

[quote user="mariette asselbergs"]

I never felt uncomfortable working in a simple rural practice without inhalation anaesthesia, oxygen or x rays, or the ability to hospitalise patients. We worked to the very best of our abilities, had a lot more time to spend on and with our clients, and we had a good understanding with a proper small animal practice that we could refer patients to them if owners wanted to follow our advise to do so. Several owners still preferred us to do their dog caesars. But it must be acceptable to tell an owner that yes you are a vet, but you cannot offer what they see on TV, because you either don't have the skills and experience, or you don't have the equipment or environment.

[/quote]

My experience in my first job was on the other side of this. I worked in a mixed practice with all of the small animal eqipment you would expect: inhalation anaesthesia, xrays, etc. Another practice set up in the town without such facilities. They were significantly cheaper than us for routine surgical procedures, I always wondered how much the clients going to them understood the increased risk, or if they just saw the price and assumed we must be overcharging. And I had several calls out of hours from people who had called the other practice, but were told that they were unable to deal with the problem and that they should call us, there was no agreement in placebetween the two practices, but of course we did see the animals. It very much felt like they were taking the easy work.

Re: Just visits

Colin Thomson — Mon, 21 Oct 2013 22:34:53 GMT

[quote user="Martin Atkinson"]Why should someone be allowed to do this - they wouldn't get away with it if they set up an ill-equipped practice that couldn't do half the work presented safely and effectively. If you can't afford to do the job properly you shouldn't be doing it. Once again this stinks of cherry picking, don't tell me this 'somebody' is on a philanthropic mission to help 'people who do desperately need it at home' they are doing to make a living and finding a cheap easy way to do it, they may be desperate but it is still not fair on those of use who have invested a considerable amount of resources, financially and at the expense of their family/social life, to set up a decent practice, doing a decent job!![/quote]

I think you'll find they largely will get away with this. And do, much to the RCVS's chagrin. Whether they should or not is a different matter. But you can't expect all vets to run at the same level of investment as yourself just because you think its not fair that they don't, IMO.

Colin.

Re: Just visits

mariette asselbergs — Mon, 21 Oct 2013 21:46:39 GMT

Yes Mark, that is exactly as I think it could work nicely. Plenty of vets who would be bored out of their minds and neglecting their talents going around doing boosters, nail clips, ears, flea allergies when they could be doing cruciates or complicated work ups of IBDs or what have you. But there are others who have the talent to brighten upv the day of a 90 year old, somebody in a wheelchair or with learning disabilities or mental health issues who want to talk and talk while the cat is being checked over. I bet for some people this would be hell, for others it is a meaningful way of spending (part of) their professional life. You would never be rich but you could make a living. And there are people doing it.

For the practice I happen to work in now, night visits are an absolute nightmare not out of lazy- or sloppiness but because it is logistically a nightmare. Being able to call an independent vet with a van, who will go out to do PTS or bring an animal to the hospital is a godsent.

Surgical skills do not belong to the day 1 skills of young graduates. A vet who went into farm practice or equine practice and never spayed a bitch would be vulnerable if his/her first bitchspay, undertaken on their own, ended in disaster. Or if they undertook a gastrotomy or intussusception operation, never having done one before. But if they say, straight out of school: I don't want to become a surgeon, I do not choose to develop these skills, is that unacceptable?

Do all farm or equine practices a formal understanding with small animal practices that these do the emergency small animal work that happens to come their way? Or do they simply have a sign up saying they only do farm animals or equines?

Mariette

Re: Just visits

Mark Hedberg — Mon, 21 Oct 2013 20:42:32 GMT

Deep breath, Martin, deep breath. Just as a devil's advocate, I can think of vets who may not particularly like doing visits, and after recent DC decisions, might be nervous about them!

Imagine a vet who wants to work with your practice and take all the headache of visits off you - in exchange for, say a percent of the fee, you send them the case, they triage, and if simple, treat the case, and no need for you to worry about 'how long is too long' and all that. Complicated cases referred to you for further workup!

It's not cherry picking if they're taking cherries you don't particularly want! :)

Re: Just visits

Martin Atkinson — Mon, 21 Oct 2013 19:36:37 GMT

[quote user="mariette asselbergs"]I was already afraid that somebody would misunderstand my question.[/quote] OK apologies if I have misunderstood you but you should have made this clearer.

[quote user="mariette asselbergs"]I have worked in practices which for example do not have inhalation anaesthesia, or oxygen, or x rays [/quote] I think that you should not be working with practices like this as by default if you've referred you clients to them you are also partly at fault if they can't do the job - it indeed begs the question how they can work properly but that is another issue.

[quote user="mariette asselbergs"]f somebody would want to set up a mobile clinic with relatively low starting cost, is that in breach of the GoPC? It does not have to be at all because they are too lazy to offer more advanced services, they may not (yet) be in the financial position to make all the investments immediately and might want to start out "feeling the waters" with a mobile clinic offering basic stuff to people who do desperately need it at home. [/quote] Why should someone be allowed to do this - they wouldn't get away with it if they set up an ill-equipped practice that couldn't do half the work presented safely and effectively. If you can't afford to do the job properly you shouldn't be doing it. Once again this stinks of cherry picking, don't tell me this 'somebody' is on a philanthropic mission to help 'people who do desperately need it at home' they are doing to make a living and finding a cheap easy way to do it, they may be desperate but it is still not fair on those of use who have invested a considerable amount of resources, financially and at the expense of their family/social life, to set up a decent practice, doing a decent job!!

Re: Just visits

mariette asselbergs — Mon, 21 Oct 2013 18:02:07 GMT

I was already afraid that somebody would misunderstand my question. Your accusing tone is misspent on me because I will always assist any animal or people, paid or not, as well as I can. BUT, I have worked in practices which for example do not have inhalation anaesthesia, or oxygen, or x rays and when called about an emergency of a cat or dog I have always made clear that I can only give limited emergency help and they might be better off to go to a more specialised and better equipped small animal practice. Is that particular practice then in breach of the GoPC when it does offer small animal services? I never thought so, but was curious to how far this would go. Of course an equine vet can put a dog RTA to sleep with domosedan and somnulose, but should he/she not tell the panicked people on the phone that they should phone another vet who might be able to save the dog's life?

If somebody would want to set up a mobile clinic with relatively low starting cost, is that in breach of the GoPC? It does not have to be at all because they are too lazy to offer more advanced services, they may not (yet) be in the financial position to make all the investments immediately and might want to start out "feeling the waters" with a mobile clinic offering basic stuff to people who do desperately need it at home. Of course there should be good collaboration with other practices but if the others immediately condemn it as lazy and irresponsible then it becomes difficult not so?

Mariette

Re: Just visits

Thomas Johnson — Mon, 21 Oct 2013 17:57:19 GMT

[quote user="bob lehner"]

[quote user="Thomas Johnson"]why would you choose to take the job where you hade to do OOH co[/quote]

I feel everyone should do it at least for a while - although personally, having been on the OOH rota for 30- plus years I was very happy to stop.

[/quote]

I agree, I started off in mixed practice and did on-call over three jobs for about 8 years, I think it helped me to think for myself and to develop as a vet.

Re: Just visits

Martin Atkinson — Mon, 21 Oct 2013 15:15:50 GMT

[quote user="mariette asselbergs"]We are supposed to not work outside out competencies. Is it acceptable under the GoPC to run a practice on the basis of only very basic first line stuff, e.g. no surgery? Can you refuse certain day or night emergencies on the basis that you do not or cannot do surgery and they would only have the option of painkilling, first aid and PTS? In other words, if people want more they have to go elsewhere? This is e.g. the position of large animal vets if confronted with a call about an RTA dog. If it is acceptable tyo limit your services to just equine, or large (or small, or exotic), then is it acceptable to limit your services in the way as described above?[/quote] Like my answer to the OP Mariette, you are displaying a worrying lack of understanding of your responsibilities to your patients and colleagues as well as the GTPC. You cannot refuse any emergency at any time of night or day, if you are unwilling to deal with it you should not be practicing. Whilst it is reasonable in general practice when faced with a case that you do not feel competent to deal with, or there is no money to pay for treatment or it is totally impractical to give that treatment, to offer just pain relief or PTS or a referral but to actually set out with the intention of probably being in this position is unacceptable. If a horse got knocked down outside my surgery I would be expected to deal with it I cannot refuse but I would do what I could until experienced help arrived but I did not put myself in the position voluntarily then decide I couldn't deal with it. This is different from a vet who deals only with specific species being called to an unfamiliar species, you are a small animal vet who should be competent to deal with all SA cases especially as you have set up on your own without back-up. This not only unprofessional it stinks of cherry picking.

Re: Just visits

Thomas Johnson — Mon, 21 Oct 2013 14:59:30 GMT

[quote user="mariette asselbergs"]

We are supposed to not work outside out competencies. Is it acceptable under the GoPC to run a practice on the basis of only very basic first line stuff, e.g. no surgery? Can you refuse certain day or night emergencies on the basis that you do not or cannot do surgery and they would only have the option of painkilling, first aid and PTS? In other words, if people want more they have to go elsewhere? This is e.g. the position of large animal vets if confronted with a call about an RTA dog. If it is acceptable tyo limit your services to just equine, or large (or small, or exotic), then is it acceptable to limit your services in the way as described above?

[/quote]

I don't see why not, but I imagine that if they required treatment beyond what you could offer due to treatment you had given, for example a severe reaction to a vaccination requiring hospitalisation, you would be expected to have arrangements in place for another veterinary surgeon to see them.

Re: Just visits

bob lehner — Mon, 21 Oct 2013 14:58:02 GMT

[quote user="Thomas Johnson"]why would you choose to take the job where you hade to do OOH co[/quote]

I feel everyone should do it at least for a while - although personally, having been on the OOH rota for 30- plus years I was very happy to stop.

(Of course a big difference between purely SA practices and mixed/farm/equine who still have to do their own OOH).

Re: Just visits

mariette asselbergs — Mon, 21 Oct 2013 13:48:34 GMT

I regularly do mobile vet work. It is lovely and there is a great need for this type of service: most of the time over half of our clients are either very old, or disabled or have very stressed cats which would not like to travel to a practice, or have small children and cannot take the whole bunch to a practice. It is also a great service in complement to a vet clinic if you can provide ambulance type work for animals that need to be picked up or taken somewhere. For some people it is even an important social check up to have meds and animal food delivered once a week en route, so we can check up that they are allright. If you can also offer the option to do night home visits or pick ups for extrreme cases then an existing practivce will probably be happy to collaborate with you.

And this brings me to a related question to the forum:

Just curious of opinions!

Mariette

Re: Just visits

Thomas Johnson — Mon, 21 Oct 2013 10:33:37 GMT

[quote user="Francisco Gomez"]

One of my ex-bosses once told me that part of the decision of using dedicated OOH service was the difficulty of getting job applicants (vet assistants) willing to share the OOH rota...

[/quote]

If as a vet you have the choice of working for a practice where you have to do out of hours, or one that doesn't, and the reality is that your pay and daytime working hours are likely to be similar in both, why would you choose to take the job where you hade to do OOH cover?

I think there are going to be a big problems for practices in areas where OOH providers aren't available.

Re: Just visits

Gillian Mostyn — Mon, 21 Oct 2013 09:04:48 GMT

[quote user="Francisco Gomez"]One of my ex-bosses once told me that part of the decision of using dedicated OOH service was the difficulty of getting job applicants (vet assistants) willing to share the OOH rota...[/quote]

Absolutely- it was a very big part of why we moved to a dedicated OOH provider. I don't think I'd have any of my current assistants (who are all excellent, dedicated vets) if we did our own OOH.

Re: Just visits

Francisco Gomez — Sun, 20 Oct 2013 21:57:39 GMT

One of my ex-bosses once told me that part of the decision of using dedicated OOH service was the difficulty of getting job applicants (vet assistants) willing to share the OOH rota...

Re: Just visits

Liz w — Sun, 20 Oct 2013 21:42:36 GMT

I suspect that these jobs are more of a result of the high percentage of women in the profession, and trying to combine career and children.

Re: Just visits

Francisco Gomez — Sat, 19 Oct 2013 18:05:46 GMT

There are A LOT of jobs out there, enough for some to earn in excess of £600 in a night. The problem is that we all want too much comfort...

Re: Just visits

Roger Meacock — Sat, 19 Oct 2013 16:49:08 GMT

I wonder if this post is just a prequel to what we might expect in future if we are producing more vets than there are jobs for? In other circumstances if someone cannot find the job they are looking for and they are strapped for set-up funds we may see more similar ideas/ventures emerge.

Cheers

Roger