Disciplinary Committee - much better!

Re: Disciplinary Committee - much better!

Bob Russell — Mon, 23 Dec 2013 12:10:13 GMT

I doubt there will be a shortage of vets. I bet there will be a shortage of experienced vets!

However much CPD you do there is nothing that beats a degree of experience. Ideally you need a balance of both!

The main reason for the shortage of locums is likely to be the lack of experienced locums.

I worry about the lack of fairly basic clinical competence and the owners without a clue that not all vets are equal!

I am sure the Romanian vets will happily flock to the UK to fill the budget end of the market for a pittance. The profession has gone down the slippery slide, perhaps one reason why many vets give up and leave. As long as there is a constant supply of people with veterinary qualifications there will be someone to see each patient. What they end up doing with the patient is the real worry!

The 'meat inspector' vets at some of the pet shops are an all time low IMO. Cheap way to get the population vaccinated but pretty clueless clinically! Owners seem to be blissfully ignorant!

You get what you pay for in most instances.

Re: Disciplinary Committee - much better!

Rob Loxley — Sun, 22 Dec 2013 19:48:27 GMT

[quote user="Robin Grimmer"]Yes there are a more vets qualifying these days but aren't a lot more vets leaving the profession?[/quote]

Why are they leaving? Not just to have families; see the various posts on these forums, for instance.

[quote user="Malcolm Ness"]Why do you think it says "should" and not "must"?[/quote]

OK then, maybe it should say must. I feel it is something we should be clear about, and it is certainly something our clients ask about.

Re: Disciplinary Committee - much better!

Robin Grimmer — Sun, 22 Dec 2013 14:37:47 GMT

Re Maclolm's point: are there really too many vets? Yes there are a more vets qualifying these days but aren't a lot more vets leaving the profession? There certainly seems to be no shortage of locum work.

Re: Disciplinary Committee - much better!

Robin Grimmer — Sun, 22 Dec 2013 14:37:07 GMT

Re: Disciplinary Committee - much better!

Neil Wheadon — Sun, 22 Dec 2013 14:30:47 GMT

[quote user="Anthony Todd"]Sorry I don't understand what you mean, unless all vets, or most, now see every OOH caller??[/quote]

In our household, I do dedicated OOH calls whilst my wife works for a 'traditional practice' offering their own OOH service.

Sarah ( a paid assistant, no financial OOH inducements) will offer to see the vast majority of clients if they are concerned. Her reasoning is that if the owner is concerned enough to call then something may be amiss and it's very difficult in some cases to diagnose over the phone.

With respect, you said in your experience and you have retired, and yes when I first qualified 20 years ago there was a reticence to not see things. However life moves on and expectations have increased, so modern vet practice is more inclined to see things regardless of financial stake in the organisation, it's also part of our oath of being a vet.

Neil

Re: Disciplinary Committee - much better!

Robin Grimmer — Sun, 22 Dec 2013 14:22:11 GMT

Re: Disciplinary Committee - much better!

Robin Grimmer — Sun, 22 Dec 2013 14:21:05 GMT

Re: Disciplinary Committee - much better!

Robin Grimmer — Sun, 22 Dec 2013 14:16:14 GMT

Re: Disciplinary Committee - much better!

Robin Grimmer — Sun, 22 Dec 2013 14:15:20 GMT

Re: Disciplinary Committee - much better!

Robin Grimmer — Sun, 22 Dec 2013 14:13:22 GMT

Re: Disciplinary Committee - much better!

Virginia Campbell — Sun, 22 Dec 2013 13:36:16 GMT

You said that you have never met an employed vet who didn't ALWAYS encourage non attendance.

I have never met anyone like this. I always offer a consult - even if I think the owner is probably fussing over nothing- and actively encourage all but the most trivial sounding things (eg animal has pulled stitches out 2 days before they were due to come out anyway)

Re: Disciplinary Committee - much better!

Malcolm Ness — Sun, 22 Dec 2013 12:51:06 GMT

[quote user="robloxley"]GtoPC: "3.4 Clients should be provided with information on the emergency service, including relevant telephone numbers, location details and the likely initial costs of a consultation. Such information should enable clients to consider whether they are able to access the service outside normal working hours."
We include such details in our 'Welcome' leaflet and have a notice in reception (obviously all don't). How would you like the GtoPC advice updated?[/quote]

I said no REAL obligation. I chose the words carefully. Why do you think it says "should" and not "must"?

[quote user="robloxley"]Pay peanuts...[/quote]

And therein lies the problem - too many vets chasing too little work. There is currently an unpleasant race to the bottom in terms of prices (inevitably, standards follow) and given that the cost of the vet is the major cost of providing veterinary services then the downward pressure on vet incomes will continue. A business analyst friend has taken an overview of the veterinary market and her perception is that though most vets think that the previous levels of veterinary income/wealth will continue, the indicators suggest otherwise. As over-production of vets across Europe continues (and the UK is jumping on that bandwagon with commitment) we can expect to see more and more vets entering the UK job market to service fewer and fewer pets. The evolution of vet business in UK s leading to a relatively small number of corporate practices competing ever more fiercely for a shrinking market and attention to "controlling" the major cost (the vets) will become intense. In those circumstances, any company employing a £25k vet when they can get the job done by a vet who will do it for £20k, or 15, or 12 will go out of business. The unfeasibly cheap bitch spey or the "free" booster isn't the start of that slippery slope, it is already a good way down the hill.

Re: Disciplinary Committee - much better!

Malcolm Ness — Sun, 22 Dec 2013 12:50:20 GMT

I said no REAL obligation. I chose the words carefully. Why do you think it says "should" and not "must"?

[quote user="robloxley"]Pay peanuts...[/quote]

Re: Disciplinary Committee - much better!

Michael Woodhouse — Sun, 22 Dec 2013 02:37:36 GMT

[quote user="Malcolm Ness"]Immediate post-surgical after-care cannot in my opinion be adequately delivered some 25 miles distant from the original practice [/quote]

Where I live there is a token OOH GP service ~20 miles away. If genuinely ill then a district hospital with an A&E is 30 miles away and if it was something worse then I'm nearly 50 miles from James Cook.

I agree that these need to be explicitly brought to the owners attention - there is a reason they can be cheap!

Re: Disciplinary Committee - much better!

Anthony Todd — Sun, 22 Dec 2013 00:02:35 GMT

[quote user="Neil Wheadon"][quote user="Virginia Campbell"]

Arriving very late to the thread but...

.[quote user="Anthony Todd"]I have yet to meet an employed vet [unless he/she had a financial incentive to attend] that didn't always try to talk the owner out of an attendance, [/quote]

Say what?

I take it you're trying to get a rise out of us. It worked.

[/quote] Absolute rubbish Anthony, come to to Somerset, Wednesday nights and listen to my wife in action. Crikey I almost sound cross. Neil

[/quote]

Sorry I don't understand what you mean, unless all vets, or most, now see every OOH caller??

If that's the case, great, but in my experience it was never thus.

Perhaps OOH clinics and dedicated staff have made the difference?

Re: Disciplinary Committee - much better!

Rob Loxley — Sat, 21 Dec 2013 22:58:49 GMT

[quote user="Malcolm Ness"]the owner discovered that the practice uses a deputising service only when she gets to hear their answering machine message[/quote]

[quote user="Malcolm Ness"] it is disgraceful that we as a profession are under no real obligation to discuss the features, limitations and potential costs of the care offered[/quote]

GtoPC: "3.4 Clients should be provided with information on the emergency service, including relevant telephone numbers, location details and the likely initial costs of a consultation. Such information should enable clients to consider whether they are able to access the service outside normal working hours."
We include such details in our 'Welcome' leaflet and have a notice in reception (obviously all don't). How would you like the GtoPC advice updated?

[quote user="Malcolm Ness"]Owner was as astounded to discover that the deputising vet wants paid nearly twice the cost of her bitch spey just for a consultation.[/quote]

Pay peanuts...

Re: Disciplinary Committee - much better!

Neil Wheadon — Sat, 21 Dec 2013 22:11:57 GMT

[quote user="Virginia Campbell"]

Arriving very late to the thread but...

.[quote user="Anthony Todd"]I have yet to meet an employed vet [unless he/she had a financial incentive to attend] that didn't always try to talk the owner out of an attendance, [/quote]

Say what?

I take it you're trying to get a rise out of us. It worked.

[/quote] Absolute rubbish Anthony, come to to Somerset, Wednesday nights and listen to my wife in action. Crikey I almost sound cross. Neil

Re: Disciplinary Committee - much better!

Virginia Campbell — Sat, 21 Dec 2013 21:16:53 GMT

Arriving very late to the thread but...

.[quote user="Anthony Todd"]I have yet to meet an employed vet [unless he/she had a financial incentive to attend] that didn't always try to talk the owner out of an attendance, [/quote]

Say what?

I take it you're trying to get a rise out of us. It worked.

Re: Disciplinary Committee - much better!

Anthony Todd — Sat, 21 Dec 2013 17:32:01 GMT

[quote user="Malcolm Ness"]we as a profession are under no real obligation to discuss the features, limitations and potential costs of the care offered especially in the case of elective surgical procedures.[/quote]

And it won't change until the "referring" or "delegating" practice are deemed responsible and obliged to smooth the aftercare, if needed.

Back in the day, [and it's fair to acknowledge that Tony Self, the head vet at the Harmsworth in North London suggested we have a sort of rota for night work, which didn't get too far] the practices on "our" rota used to treat post-op problems for free, and I would have thought that this should, and could, be arranged now, or, at least, at cost.

After all the OOH providers do quite well out of the normal emergency calls they depend on from the referring practices.

We didn't have a problem but it was a sort of mates club with no corporate involvement.

Not another red star please, unless there's a reason given, and I know it "was back in the day" but we didn't have the current problems, so perhaps sometimes, the old ways weren't catastrophic....

Re: Disciplinary Committee - much better!

Malcolm Ness — Sat, 21 Dec 2013 16:49:08 GMT

[quote user="Bob Russell"]Surely this is what VetsNow are offering.[/quote]

Not just VetsNOW but any reliance on a deputising service for a very sick patient is fragmented aftercare - at the very least it means moving the patient twice a day.

[quote user="Bob Russell"]Many practices offering 'continuous' care are doing nothing of the sort[/quote]

But some do and that is PRECISELY why I think an honest and open approach to obtaining fully informed consent should be considered an essential part of our dealings with clients.

Smarting a little about this one as I have had to deal with [another] cheap bitch spey complication. Yes, I know complications happen to everybody and the details of this technical error aren't important here. Enough to know that the original op was done for considerably less than £100.00, and that the owner discovered that the practice uses a deputising service only when she gets to hear their answering machine message three hours after she collected her pet and "she still hasn't been able to lift her head up". Owner was as astounded to discover that the deputising vet wants paid nearly twice the cost of her bitch spey just for a consultation. Immediate post-surgical after-care cannot in my opinion be adequately delivered some 25 miles distant from the original practice and, again in my opinion, and given that there is a widespread belief amongst the public that vets provide 24 hour care for their patients it is disgraceful that we as a profession are under no real obligation to discuss the features, limitations and potential costs of the care offered especially in the case of elective surgical procedures.

Re: Disciplinary Committee - much better!

Bob Russell — Sat, 21 Dec 2013 10:45:24 GMT

I have avoided too much comment regarding the original vets decision to release a desperately sick animal to the owners in the first place and the apparent failure to forewarn the OOH vet. I don't know the clinical details.

None of my patients go home without a careful assessment of the risk of doing so,

Re: Disciplinary Committee - much better!

Bob Russell — Sat, 21 Dec 2013 10:38:00 GMT

[quote user="Malcolm Ness"]

[quote user="Bob Russell"]I would have no objection to some wording added to the GtoPC strongly recommending sending histories to OOH services where there is a reasonable expectation there might be issues. [/quote]

Therein lies the issue. If there is a reasonable expectation of post-op problems then the original clinician should be advising that the case is passed as soon as practical to a practice offering continuous care. Whether or not the client does so is their choice but there should be properly informed consent surrounding the issue of major medical or surgical treatments being left reliant on fragmented aftercare.

[/quote]

Surely this is what VetsNow are offering. Many practices offering 'continuous' care are doing nothing of the sort. With a dedicated OOH''s service you know there will be a vet on site 24 hrs a day which is more than can be said of the majority of practices.

If a patient comes to me in the evening with symptoms that could deteriorate (yes I know it is unpredictable) then I would send a history and explain the process to the owner. An example a vomiting puppy that you cannot quite rule out a FB or just might be the start of Parvo! Educating the client is key. I will take patients home or stay with them if it is appropriate.

A really ill and unstable patient clearly should be discharged back to the owner under really limited circumstances. These I would want to discuss with the OOH's vet. Having said that our referral centre is really good at offering support if I am really concerned about a patient and on occasions I have been able to recommend owners contact them directly. These are usually cases where advanced imaging is likely to be the next step.

Overall I consider my patients have access to really good care out of hours. They don't get fragmented aftercare, I tailor it to what I feel is the best needs of client and patient sometimes cost v's quality where budgets are limited.

Re: Disciplinary Committee - much better!

Anthony Todd — Sat, 21 Dec 2013 09:26:59 GMT

[quote user="Malcolm Ness"]

[/quote]

+1, ie the surgical history, as I've been trying to get across.

And this, from an eminent vet. far away:

In my imagination, you may have just hinted that our clinicians tend to no longer keep what you consider to be the proper balance between the art and the science of veterinary clinical medicine.
Even worse, you may have suggested that this drift may have two great drivers, the first being the margins on unnecessary 'tests' which delight bank managers, and the second being the business of protection of the backs of the marginally competent.

If so, you must learn that times have indeed changed. You will recall that we were taught - and were shown by example, that ours was a profession. We earned our living through the practice of our skills. We were taught to wear a coat and tie. Any suggestion of merchandising was abhorrent, and any veterinarian forced by circumstances to provide general animal requirements for sale to the public was required by regulation to conduct that business in separate premises.

Signage was tightly restricted to size and content, and advertising was only permitted (and only in small column print in the newspaper) to notify of the commencement of a practice in a new area.

Come to think of it, that does smack a little of James Herriot.

I recall being strongly criticised for my Presidential oration in the late seventies when I suggested that there was possibly a discernable tendency for companion animal practitioners to opt for the expensive treatment alternative every time, without explaining the cheaper and possibly less reliable alternatives to the owner. A good example of this is the pinning of broken metacarpal/metatarsal bones in preference to a cast or even a well applied bandage.

Shock.... Horror! "We wouldn't do that!"

Re: Disciplinary Committee - much better!

Malcolm Ness — Sat, 21 Dec 2013 08:44:42 GMT

Re: Disciplinary Committee - much better!

Anthony Todd — Fri, 20 Dec 2013 08:18:15 GMT

[quote user="David Mills"]They are littered with contradiction, backtracking and illogicality[/quote]

Just one example please to ram home your dogmatic .... but then the sentence sort of goes round itself.

I'll try and explain it again if you do. Use this case as the example.