furious!

Re: furious!

Hannah Wynne Richards — Fri, 07 Feb 2014 10:38:10 GMT

You would have offered to see all cases, so I'd be happy for you to do my OOH There's a lot here I wouldn't consider trusting - because they wouldn't even OFFER

Wynne

Re: furious!

Christopher Saul — Fri, 07 Feb 2014 10:14:58 GMT

I would agree with Wynne that we should always offer an appt out of hours if the owner is worried but the statement that telephone advice is miscondict is very sweeping

If an owner rings up out of hours and wants adcice, e.g. oh lets say a dog has had, I don't know, a soft poo. Dog otherwise very bouncy and fine. no other clinical signs. It's a sunady morning and client's own vets is open in, lets say, 4 hours for a short surgery. Owner wants to wait until then but wants reassurance that this is fine. OOH vet gives TELEPHONE ADVICE that this is fine. Is that OOH vet guilty of misconduct???

One could argue that to insist upon seeing the dog in person at the surgery is profiteering and, as such, misconduct.

Re: furious!

Hannah Wynne Richards — Fri, 07 Feb 2014 10:07:44 GMT

Bevs......as 1 South Walian to another.............. NSW is literally the other side of the planet

Wynne

Re: furious!

bevs2251 — Fri, 07 Feb 2014 02:22:07 GMT

Absolutely disagree - years ago, when I had to do after-hours calls, I would have advised clients after-hours re "minor" emergencies and appropriate treatment at home. No problems. If the client insisted on being seen , I would arrange to see them while also advising of the A/H fee to be paid at the time of consultation. A torn nail is no emergency - it was treated correctly by the mother except perhaps some lack of advice re NSAID pain relief (everyone has aspirin/paracetamol at home). To complain to the RCVS about this surely would be considered frivolous & a complete waste of time with added trauma to the vet involved having to deal with months of investigation. You should contact the clinic, if you have a complaint, and take it from there. The vet may have to alter his/her phone technique but a long drawn out legal complaint via the RCVS is completely unwarranted.

Telephone advice is NOT MISCONDUCT - certainly would not be considered so in NSW, Australia

Re: furious!

Michael Woodhouse — Wed, 22 Jan 2014 21:18:06 GMT

[quote user="Hanna Bennett"]or the folk who wanted to be at home at 7pm, would you offer to see the dog later at a more convenient time?[/quote]

No, because I don't know what I'll be doing at 8.30 etc. I could be driving in the opposite direction to do a cow caeser. Even the pet vets could be dealing with something else.

Two things I have done, firstly minor sick-ish things on a Sunday or B/H I will take details and arrange a lunchtime impromptu surgery. I tell them I will ring them back, but to ring me if animal worsens. Can condense a couple of jobs into a single trip out. The second thing if someone can't come straight away is to get them to ring when husband is back with car etc and only then commit to a time.

Re: furious!

Hanna Bennett — Wed, 22 Jan 2014 21:01:01 GMT

for the folk who wanted to be at home at 7pm, would you offer to see the dog later at a more convenient time? one thing I would say is that since we started running consults til 8pm our on call is extremely quiet. we work shifts so one or two lates every couple of weeks, makes for quiet on call and everyone likes it. there are ways round the OOH conundrum that don't involve OOH providers.

Re: furious!

Braden Collins — Wed, 22 Jan 2014 02:05:40 GMT

[quote user="Bob Russell"]

I pass the responsibility firmly back on the owner. If they feel it is an emergency then offer an appointment. Let them know what it will cost.

I like the idea of using flour, never seen or heard this! Suggest it then suggest they phone again in an hour if still worried. Sensible for VetsNow type places.

Personally I would prefer to see the animal, treat it and not have to worry further.

If I don't see an animal it always niggles me whether I should have done! Nothing to do with the RCVS, not sure I am that bothered what they think. I am more concerned about what my conscience has to say about it!

[/quote]

This is generally my approach. We charge $175 for an OOH consult (Approx 100 pounds) up to 10pm, then it goes up from there. We do give our vets permission to bump the cost up if appropriate - a torn nail would get a bit of a premium added if we feel it was not an appropriate use of our OOH resources. We never refuse a call out unless the owner can't/won't pay, or the vets feel it is unsafe, but we find many people with non-urgent "emergencies" are happy to wait until the next day when they are told the price.

We pay our vets half of the professional fees generated by OOH calls, so they may be happy to see a bit more OOH than they would otherwise.

Re: furious!

Anthony Todd — Tue, 21 Jan 2014 17:40:14 GMT

[quote user="Bob Russell"]I like the idea of using flour, never seen or heard this![/quote]

It's really starch or potatoes you need viz;

http://onlinelibrary.wiley.com/doi/10.1002/star.201200259/abstract

We advised potatoes in Pakistan as a healing material for terrible open saddle sores and abused tissue in place of some horrible tissue destroying preparations currently in use. The idea being to promote and allow healing with something that is readily available.

Re: furious!

Anthony Todd — Tue, 21 Jan 2014 17:34:33 GMT

Withdrawn due to improvement in starring....

Re: furious!

Anthony Todd — Tue, 21 Jan 2014 17:25:04 GMT

[quote user="Anthony Todd"]

[quote user="Malcolm Ness"] its fine to advise against seeing such cases promptly PROVIDED you have absolute confidence in the owners' diagnosis.[/quote]

Should be surgically implanted into the Code, Guide, Legal Precursor or whatever the RCVS will want to call it.

This thread gives many examples of animals which, if MN's advice was followed, would be seen at an appropriate time.

[/quote]

Sorry, I wasn't thinking properly.

MN should be slightly misquoted, or the "Guide/Code etc", which would, and should, make this apply to visits because of the conflicts of being a OOH centre and available to visit.

So the guide should read:

"If a member is confident that the owner's description, following a telephone discussion of the animal's condition, can be relied on then it is permissible to refuse to visit such a case but give such further advice as is appropriate"

MN and others please improve on the wording or syntax.

In the end we'll lead the donkey to water so it may drink.....

Re: furious!

Bob Russell — Tue, 21 Jan 2014 17:18:02 GMT

I pass the responsibility firmly back on the owner. If they feel it is an emergency then offer an appointment. Let them know what it will cost.

I like the idea of using flour, never seen or heard this! Suggest it then suggest they phone again in an hour if still worried. Sensible for VetsNow type places.

Personally I would prefer to see the animal, treat it and not have to worry further.

Re: furious!

Tom Ward — Tue, 21 Jan 2014 16:15:34 GMT

Telephone advice is notoriously difficult - I've had people describe everything from a slightly stressed cat to one with 250ml fluid in its chest identically. You just don't know until you see it for yourself, but does that mean we're going to end up in a situation where the only advice we can give is 'come to the vets' because we're so scared of complaints/litigation? If the owner is concerned, see the animal. If they're not, make a judgement - record the details of the call and advise accordingly. Surely you can only act on the information you're given?

Re: furious!

Anthony Todd — Tue, 21 Jan 2014 10:51:34 GMT

[quote user="Malcolm Ness"] its fine to advise against seeing such cases promptly PROVIDED you have absolute confidence in the owners' diagnosis.[/quote]

Should be surgically implanted into the Code, Guide, Legal Precursor or whatever the RCVS will want to call it.

This thread gives many examples of animals which, if MN's advice was followed, would be seen at an appropriate time.

Re: furious!

Louise Buckley — Tue, 21 Jan 2014 10:46:51 GMT

[quote user="Martin Atkinson"]There is no way this is a disciplinary case, however if Catherine's mum doesn't like the way the vet dealt with her she has the option of voting with her feet.[/quote]

Not strictly true when OOHs. So many areas are now in the situation that clients have no choice but to use a given practice - when all vets subscribe to a OOH provider, for more hours of the week than not, clients have no choice other than to leave their animal to suffer or use the only practice available. However, I am not bashing the OOH provider here - I don't have a problem with the advice given. I am more concerned about how quick other vet professionals are to slam a vet/vet team for advice given in the absence of their ability to defend themselves. Re: the forum critiques of the flour use advice - does this not smack slightly of the RCVS DC ruling re: the use of blankets?

Re: furious!

Louise Buckley — Tue, 21 Jan 2014 10:37:19 GMT

[quote user="Clive Ansell"]

[quote user="Hannah Wynne Richards"]

An appointment should have been offered............ end of. You all know my opinions on telephone advice. This shows what it's like from the other side of the fence........ not nice!

Catherine, all I can say is my sympathies. To be honest, if I was in your place, a letter to Royal College would already be in the post!

Wynne

[/quote]

Why would you write to the RCVS? there is no issue of professional misconduct here. It is a matter of debate as to whether this patient needed seeing immediately or not.

It was only a torn nail, and once any haemorrhage had stopped the crisis would be over, and it would not be an emergency. When I used to work on call, I would have given telephone advice for this but would have offered or agreed to an appointment if the client was worried or if they requested one.

I cut my thumb badly last week while chopping wood with a hand axe; I just cleaned it and applied a good dressing to stop the bleeding, but didn't need to go to A&E or take any analgesia other than a good shot of a single malt. I can't see a torn nail would be any more of an issue?

[/quote]

Agreed! Most clients would be pleased to get free first aid advice (unless part of the insured brigade!) and not have to pay the £100 - 150 it would have taken to see and treat the dog. I am surprised at the number of comments regarding flour. I thought this was pretty standard first aid advice for a cut nail - I was taught flour or drag the nail through a soap bar to form a plug (the latter I tend to avoid as more invasive / could cause further pain & distress / owner could get bitten). I use and advise the former myself and find it works really well

Re: furious!

Robin Grimmer — Tue, 21 Jan 2014 09:31:03 GMT

[quote user="Vet2Vet"]

[quote user="Michael Woodhouse"]

There's a happy medium to be struck. I see OOH to deal with accidents, emergencies and to relieve suffering. I'm not there to express anal glands at mid-day on Sunday for your convenience. Equally (I'm 10 minutes away from the surgery) if someone desperately wants something seeing I have never refused.

7pm to me is about the worst time. We close at 6. Sometimes it can be half past by I leave. 7pm I am sitting down, having a coffee and waiting for my tea to cook. I'd rather go out at 9pm after a relax and a feed.

[/quote] 5 stars

[/quote]

Surely this thread just shows what a burden doing your own OOH is and how necessary VN and other OOH providers are for our sanity. You're not disturbing anyone's meal/sleep/time off work and not calling anyone back to the clinic. If someone wants to pay a premium for something that's not a true emergency, so what?

Re: furious!

Hannah Wynne Richards — Tue, 21 Jan 2014 09:11:59 GMT

Clive If I watched Benefit St, I'd probably chuck the TV through the window - I'd be so angry about my money being stolen to support these wastes of space.

Wynne

Re: furious!

Vet2Vet — Tue, 21 Jan 2014 07:01:49 GMT

[quote user="Michael Woodhouse"]

[/quote] 5 stars

Re: furious!

Alet Engelbrecht — Tue, 21 Jan 2014 05:24:21 GMT

[quote user="Hanna Bennett"]not sure I get the folk worrying about charging the ooh to see these cases- if the owner wants the dog seeing and is happy with the cost then why are you worrying about it?[/quote]

In theory, I completely agree. However, I have unfortunately put many animals to sleep because of costs (seemingly) spiraling out of control and when you look back, money were needlessly spent on OOH surcharges, when it would be much more wisely spent on relieving the animal's discomfort.

We have a half hour consulting hour session on Saturday PM, Sunday AM and PM - I speak to clients on the phone, offer to see them immediately if they so require, but I do make the suggestion of coming in during consulting hours once I have ascertain that the dog with diarrhoea is still running around and playing with a ball.

Re: furious!

Michael Woodhouse — Mon, 20 Jan 2014 23:15:14 GMT

Re: furious!

Mark Holmes — Mon, 20 Jan 2014 22:31:13 GMT

[quote user="grumpyoldman"]It's easier to see it and deal with it than spend an evening fretting about it.

[/quote] It does depend on how often you get these calls and how far you are from the clinic. I have a 90 minute round trip. If you don't sort them you never stop

Re: furious!

grumpyoldman — Mon, 20 Jan 2014 22:03:17 GMT

It's easier to see it and deal with it than spend an evening fretting about it.

Re: furious!

Clive Ansell — Mon, 20 Jan 2014 21:22:04 GMT

Wynne,

Are you watching benefits street, Mondays channel 4 9pm? I've worked in a practice just round the corner from there, great clients (not)

Re: furious!

Hannah Wynne Richards — Mon, 20 Jan 2014 19:46:39 GMT

Total agreement with Hanna. It's very very wrong of a veterinary surgeon to even attempt to dictate to clients how they are allowed to spend theirmoney.

Wynne

Re: furious!

Hanna Bennett — Mon, 20 Jan 2014 19:06:03 GMT

not sure I get the folk worrying about charging the ooh to see these cases- if the owner wants the dog seeing and is happy with the cost then why are you worrying about it?