24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Sarah Keir — Tue, 14 Jan 2014 17:19:57 GMT

[quote user="Jo Dyer"]

Thanks Gareth. I don't do politics or committees, but I did for a nanosecond consider running for RCVS council. Then I read the latest RCVS news, encouraging candidates to stand for nomination with the words 'The role of RCVS council is not to represent the veterinary profession…'

I therefore have absolutely no idea what their role is. Perhaps someone could enlighten me.

[/quote]

I was told when I was a student (in a RCVS talk I think), that the RCVS is not there to represent vets to but protect the public from vets doing bad things! Actually I think it might have been the BVA talk - their way of signing us up to have having 'representation'. What happened to that vet union thingy?

Sarah

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Evelyn Barbour-Hill — Mon, 13 Jan 2014 22:21:17 GMT

[quote user="Francisco Gomez"]

My point is that, in order to comply to the Code, you'd have to do things that don't make too much sense. It tries (the Code) to get things so explicit that in some situations it becomes unworkable.

Therefore, the Code shouldn't be Code, it should only be a Guidance. IMHO

Some had already said: Well, you should be able to interpret it. The problem is that we've seen some DC decisions where we aren't really allowed to interpret it.

[/quote]

Well done. You've spotted it. I warned you all when Belgravia House weaselled in that weaselly change from "Guide" to "Code" but nobody was bothered at the time.

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Francisco Gomez — Mon, 13 Jan 2014 20:10:25 GMT

[quote user="Anthony Todd"]

[quote user="Francisco Gomez"]So, in my opinion, you do have to offer a consultation every time.[/quote]

Oh, and with respect, Francisco, 'cos you speak sense all the time, FFS,

[/quote]

Made me laugh so hard I almost...

[quote]

What, would you "see", 'cos that's all you'd do

[/quote]

I'm sorry I'm so difficult to read. But I am in agreement with you tho you wouldn't think I'm.

My point is that, in order to comply to the Code, you'd have to do things that don't make too much sense. It tries (the Code) to get things so explicit that in some situations it becomes unworkable.

Therefore, the Code shouldn't be Code, it should only be a Guidance. IMHO

Some had already said: Well, you should be able to interpret it. The problem is that we've seen some DC decisions where we aren't really allowed to interpret it.

Would I like to prescribe some ACP to the Alsatian without proper examination? I would love to, and I do think it is the right thing to do. But ...

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Anthony Todd — Mon, 13 Jan 2014 18:44:39 GMT

[quote user="Jo Dyer"]I don't do politics or committees[/quote]

That's exactly the trouble, and this isn't personal, before someone uses that defence.

The very people that could inject reason, common sense and the real world into the RC won't, and we are left with committee men or women, climbing up the steps ['cos it's not a slippery pole] to higher self-esteem and office.

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Anthony Todd — Mon, 13 Jan 2014 18:38:51 GMT

[quote user="Mark Holmes"] It is easy to decide an animal needs to be seen.[/quote]

Sure, but you have to apply common sense which is a rare thing, not related to university degrees or IQ, and, appears to be somewhat absent in the powers that be and some posters.....

All your examples should be seen 'cos, as you say, clients either lay it on thick or lay it on too thin and you can't tell.

I remember a promoter of top-end motor racing ringing me on a Sunday saying his dog had diarrhoea for a few days and could I see it?

Sh11111t, did it need to be seen!! It was flat, dehydrated, couldn't raise it's head, and on the way out...

When admonished he lamely said "I thought it should be seen....!

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Jo Dyer — Mon, 13 Jan 2014 18:30:00 GMT

[quote user="Gareth C."]jo, I agree and think someone (you?) should run as a single issue candidate at the next RCVS election. [/quote]

I therefore have absolutely no idea what their role is. Perhaps someone could enlighten me.

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Anthony Todd — Mon, 13 Jan 2014 18:28:32 GMT

[quote user="Francisco Gomez"]So, in my opinion, you do have to offer a consultation every time.[/quote]

Oh, and with respect, Francisco, 'cos you speak sense all the time, FFS, common sense must prevail [not that the DC has any or shows any].

I'd want to see that example quoted too and find the dirty great cat-bite abscess.... It's common sense!

What, would you "see", 'cos that's all you'd do, you wouldn't examine the lethal alsatian and you wouldn't even find the hyperthyroid cat, and probably not even see it in my examples!!!

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Gareth C. — Mon, 13 Jan 2014 17:04:54 GMT

It is no great secret that the RCVS receives numerous complaints regarding failure to visit or failures of OOH services - only a very few (three in the last 6 years) reach the DC

That does give me some hope and should be something the RCVS should make more public. It may not be a secret but its not something that most vets will be aware of I would imagine, perhaps the RCVS would like to report that in their next newsletter?

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Jo Dyer — Mon, 13 Jan 2014 16:37:55 GMT

[quote user="Francisco Gomez"]

I'm sorry if you're a bit late. Not sure if you have missed the >1000 posts about the case. But this is what you might be looking for?

http://www.vetsurgeon.org/forums/t/15627.aspx

[/quote]

Yes, I am very late to this forum, and I have indeed missed many hundreds of posts on the topic. Sorry if I'm covering old ground.

Thank you for the link to the poll, I've learned something else new and I can now feel a poll coming on…...

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Hannah Wynne Richards — Mon, 13 Jan 2014 15:46:35 GMT

I'm with Francisco.

Wynne

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Mark Holmes — Mon, 13 Jan 2014 14:36:01 GMT

[quote user="Anthony Todd"]

[quote user="Michael Woodhouse"]I massively disagree with you that an animal needs seeing before you can make any sort of clinical decision[/quote]

+1 see mine above, but we should have the discretion to do or not, using common sense and veterinary input.

[/quote] I think it depends what clinical decision you are trying to make. It is easy to decide an animal needs to be seen. If a client is laying it on thick, it's very difficult to say it doesn't. They lie and are completely unreliable. They also have completely different perception of emergency. Loads if blood to a client means a few mls, loads if blood to me means redecorating. How often does a dog get described as in agony and not moving only to knock you over at the door? Or "not eaten anything for months" only to have gained weight and then swallow a bowl of food in the clinic?

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Francisco Gomez — Mon, 13 Jan 2014 13:03:20 GMT

[quote user="Anthony Todd"]

[quote user="Francisco Gomez"]'Under his care[/quote]

We've been here before!

[/quote]

I know we have.

But still you failing the Code if you're not compliant with it.

If an owner that you've never seen rings telling you (at a OOH centre) that they 'think' their cat is in pain and wants to use their bottle of meloxicam from their own practice and you say yes... but then the cat dies that same night for a unrelated issue. They might want to seek compensation or your registration removal because:

a) You are authorising the use a POM-V without examining the patient

b) The datasheet clearly states that 'These side effects .. in very rare cases may be serious or fatal'

How is this different from any other breach of the Code?. (I.e. Unnecessarily delaying a visit)

So, in my opinion, you do have to offer a consultation every time.

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Anthony Todd — Mon, 13 Jan 2014 12:21:39 GMT

[quote user="Michael Woodhouse"]I massively disagree with you that an animal needs seeing before you can make any sort of clinical decision[/quote]

+1 see mine above, but we should have the discretion to do or not, using common sense and veterinary input.

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Anthony Todd — Mon, 13 Jan 2014 12:18:41 GMT

[quote user="Francisco Gomez"]'Under his care[/quote]

We've been here before!

What about the owner who has never been near the practice before who's got a lethal alsation with a bad ear?

Of course you give him a load of Acp and hope he can give them and no one gets hurt in the process?

Or the old cranky hyperthyroid cat who freaks out for days if it is presented, and can't be caught at home? [I gave this example last time!]

We initially refused to repeat it's prescription 'cos it "was the law" that it had to be seen; fortunately the irate owner [who had common sense] rang me and I risked being struck off for prescribing for it......

As usual, the addition of a common-sense clause with a proviso of responsibility would cover all situations and should be added but then the RS doesn't read or take regard of forums and everyone is happy with the status quo so you'll just get torn up by the alsation and the cat will remain hyper.....

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Francisco Gomez — Mon, 13 Jan 2014 11:49:10 GMT

[quote user="Michael Woodhouse"]

I massively disagree with you that an animal needs seeing before you can make any sort of clinical decision

[/quote]

I know, but the Code...

'4.4 POM-V medicines must be prescribed by a veterinary surgeon, who must first carry out a clinical assessment of the animal under his or her care. (See below for RCVS interpretations)'

... and ...

'Under his care

4.9 The Veterinary Medicines Regulations do not define the phrase 'under his care' and the RCVS has interpreted it as meaning that:

the veterinary surgeon must have been given the responsibility for the health of the animal or herd by the owner or the owner's agent
that responsibility must be real and not nominal
the animal or herd must have been seen immediately before prescription or,
recently enough or often enough for the veterinary surgeon to have personal knowledge of the condition of the animal or current health status of the herd or flock to make a diagnosis and prescribe
the veterinary surgeon must maintain clinical records of that herd/flock/individual

4.10 What amounts to 'recent enough' must be a matter for the professional judgement of the veterinary surgeon in the individual case.'

Which means that if you work in an OOH center and have never seen the patient, there is very little of what you can do unless a consultation and a real physical examination takes place. Can you really make a clinical decision under this restrictions and without seeing the patient?

- Before you say anything, I know that a clinical decision doesn't necessarily imply that you have to prescribe, but in most cases, it does -

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Bob Russell — Mon, 13 Jan 2014 11:27:54 GMT

As I have said on many occasions I believe the whole Chikosi case is so flawed throughout that it should not be used as a guide for the profession. It was an embarrassment. The comments regarding perceived weaknesses with VetsNow policy should have been addressed to VetsNow and not used to pad out a written decision to strike a vet off. Mr C had no control over policy other than refusing to work for the company.

It worries me that a DC can be comprised of people so poorly equipped to decide how a reasonably competent vet would behave under particular circumstances. Richard has pretty much said it all when he says that there are numerous complaints about failure to visit and these get kicked to the sideline at a very early stage.

Reading between the lines there may be evidence that Chikosi may not have been sympathetic or behaved well but to accept this at face value is not justice.

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Francisco Gomez — Mon, 13 Jan 2014 10:41:21 GMT

[quote user="Richard Stephenson"]

But to suggest that professionals can do what they want and never have to 'defend their decisions'

[/quote]

That's a bit harsh Richard. I don't think anybody is suggesting that in here.

What it is being suggested is that

a) There are limited options for vets in certain situations. As the Code progresses, it constraints more our actions because we fear it.

b) By the above progression, the Code seems to be favouring more and more the public and larger businesses, while us the vets are the ones paying for it.

I agree that the Chikosi case had a poor defense. But the punishment for 'grave concerns about the completeness of the advice given in Vets Now protocol in relation to road traffic accidents, which does not envisage circumstances in which the condition of the animal is such that it requires urgent euthanasia at the scene of the accident.' in paragraph 32 of this particular case wasn't even met with a withdraw of the Practice Standards Scheme status of the practice. However, the individual did pay with his registration: This would mean livehood for some of us.

*edited to put the actual written in italics

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Richard Stephenson — Mon, 13 Jan 2014 10:34:27 GMT

[quote user="Gareth C."]but to live in fear of being struck off because the client refuses to call a taxi etc is no way to carry on.[/quote]

Gareth,

You shouldn't be living in fear - if you have a good reason why a visit is inappropriate on genuine (not hypothetical) grounds such as already dealing with an emergency, personal safety, client unreasonable, totally inappropriate request for a visit - simply record that in your clinical records and be prepared to politely and thoughtfully defend your decision IF challenged. Many OOH clinics now RECORD all telephone conversations - which I strongly recommend - and that proves invaluable back up in such cases.

It is no great secret that the RCVS receives numerous complaints regarding failure to visit or failures of OOH services - only a very few (three in the last 6 years) reach the DC - most are closed BECAUSE the vets have behaved reasonably and responsibly and given a sensible reasoned explanation of their actions. That's all that is required. So don't live in fear - simply follow the Guidance and carefully consider requests for visits - if one isn't appropriate record why.

Yours,

Richard S.

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Richard Stephenson — Mon, 13 Jan 2014 10:28:07 GMT

[quote user="Michael Woodhouse"]The crux of the matter is; why should we have to defend our decisions in such cases?[/quote]

Because you are a professional person and therefore accountable for your decisions. I'm afraid the 'doctor knows best' approach doesn't wash with the public anymore.

Perhaps if we said that you should be prepared to explain your decision that might be more to the point. But to suggest that professionals can do what they want and never have to 'defend their decisions' is I'm afraid not something that society will generally tolerate anymore (we have Dr Shipman to thank for that).

Yours,

Richard S.

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Michael Woodhouse — Mon, 13 Jan 2014 10:23:35 GMT

[quote user="Jo Dyer"]The crux of the matter is; why should we have to defend our decisions in such cases? A clinical decision cannot be made until a physical examination has taken place. Therefore all the comments saying 'his clinical judgment was that the dog needed seeing and since the owner said he couldn't move it, then he had to visit' are rubbish. I imagine he decided to visit because of all the emotional pressure that was being applied in all directions, and for no other reason. [/quote]

I massively disagree with you that an animal needs seeing before you can make any sort of clinical decision. Do you not get people ringing up to speak to a vet and asking if something is worth seeing? People ringing up about ongoing cases and tweeks of medication? A dog with otitis at 1am that your clinical decision is to wait until 9am surgery? Joining in with the threads on here 'what's wrong with my dog' is just the same.

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Gareth C. — Mon, 13 Jan 2014 10:08:20 GMT

jo, I agree and think someone (you?) should run as a single issue candidate at the next RCVS election. we can all do home visits if we want to for genuine cases (fitting dogs, elderly owners etc), but to live in fear of being struck off because the client refuses to call a taxi etc is no way to carry on.

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Francisco Gomez — Mon, 13 Jan 2014 09:49:22 GMT

[quote user="Jo Dyer"]

The crux of the matter is; why should we have to defend our decisions in such cases?

[/quote]

Exactly my point. Do we need to have a Code where every possible scenario is explicitly described and the vet has no say, just being struck off if you vary your interpretation slightly?

[quote]

you were only guilty if none of your peers would do, or would admit to doing, the same themselves.

[/quote]

I'm sorry if you're a bit late. Not sure if you have missed the >1000 posts about the case. But this is what you might be looking for?

http://www.vetsurgeon.org/forums/t/15627.aspx

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Jo Dyer — Mon, 13 Jan 2014 09:14:46 GMT

[quote user="Michael Woodhouse"]All we have learnt is if you make absolutely no defence as to why you delayed seeing an animal then you will (rightly) get into bother.[/quote]

Sorry Michael, quoting you is not personal but yours just happened to be the first (of many) such statements that I found when wanting to write this.

The crux of the matter is; why should we have to defend our decisions in such cases? A clinical decision cannot be made until a physical examination has taken place. Therefore all the comments saying 'his clinical judgment was that the dog needed seeing and since the owner said he couldn't move it, then he had to visit' are rubbish. I imagine he decided to visit because of all the emotional pressure that was being applied in all directions, and for no other reason.

The RCVS's own legal assessor says words to the effect of: 'it has to be shown that NO reasonably competent veterinary surgeon in practice, working in the same field (large animal, small animal, equine, OOH etc), would have done what the respondent is alleged to have done'. Indeed that is how I understood 'disgraceful professional conduct' worked; you were only guilty if none of your peers would do, or would admit to doing, the same themselves.

Surely this very sensible definition should be applied early in the investigative procedure so that all concerned can have their stress minimised. Send out a question to a statistically significant sample in a totally neutral manner, and pay attention to the answers. RCVS need to have access to a database of competent veterinary surgeons working in all the various fields in order to do this. Oh wait, they already have…...

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Jo Dyer — Mon, 13 Jan 2014 08:44:39 GMT

[quote user="Alet Engelbrecht"] I believe that if we do not look after ourselves, our mental well-being and support structures (family, social interactions etc), we will not be able to continue to be the caring individuals that will want to put the welfare of animals first. Lets not botch a chance to have a say in the guidelines. [/quote]

I could not agree more, and I think it is something we vets are really bad at, in contrast to the medics who are taught to build support structures from the beginning of their careers so that they minimise the risk of burnout.

To quote from an American vetty blog I read recently: 'To be mandated to serve all at the expense of ourselves is a clear path to self destruction'

Re: 24/7 cover – should mandatory house visits be removed from the Code of professional conduct?

Mark Holmes — Mon, 13 Jan 2014 03:14:22 GMT

[quote user="Richard Stephenson"]

[quote user="John Flynn"]if i'm going on maternity leave and am advised that i will not be replaced for that time and, in my opinion, that will leave the clinic understaffed to be able to deal with emergencies, I would have to resign. I should have thought of this in advance and had a clause in my contract stating that my employer must make adequate provisions, but i did not write the contract. If i did have such a clause then i better lawyer up for constructive dismissal i guess.[/quote]

John - in the unlikely event that you were pregnant or going on maternity leave I'm sure that if your employers required you to resign due to a failure to enable compliance with things required by your regulator then the compensation awarded by the employment tribunal would be so large you wouldn't have to worry about working again!

As a professional you have a responsibility to ensure that any employment is compliant with the Code of conduct in the same way as you would check out pay, hours worked and holiday entitlement. No one would work in a practice that didn't pay you, and you shouldn't work in practices that don't comply with the Code (or let you comply with) to a level with which you feel is reasonable and comfortable.

Its that simple really!!

Yours,

Richard s.

[/quote] Sorry Richard, I find this a pretty weasely way of getting Vets to do the RCVS's job. It doesn't take into account the pressure to find a job or the limited employment options available to many Vets. Whilst you can take lower pay than you would like, or fewer holidays than you would like - what about standards? Lower than you would like? Extreme example I know but there is only one vet practice on Shetland. Where do you work if you don't like it? There are also huge areas where you have effectively one employer given how many practices are now corporate owned and there are few practices which have 24/7 cover with which I am completely comfortable. I don't mean to shoot the messenger but if it is the RCVS's intention that members effectively regulate practices with their own livelihood then it leaves many in an impossible situation