Complaints

Re: Complaints

mariette asselbergs — Wed, 05 Feb 2014 22:19:11 GMT

" Normally accompanied by requests for wormers or nail clips or flea treatment. " (David Mills) And anal glands.

Mariette

Re: Complaints

Virginia Campbell — Wed, 05 Feb 2014 16:53:13 GMT

David - how true!

Re: Complaints

Evelyn Barbour-Hill — Tue, 04 Feb 2014 23:43:54 GMT

[quote user="Jenny Smith"]

Wasted teenage years on tinterweb and three years as a receptionist... I can touch type like a demon! :D

[/quote]

Anyone else seen a French film called "Populaire"? Highly recommended for entertainment.

Re: Complaints

sandpiper — Tue, 04 Feb 2014 22:54:43 GMT

Spot on. Completely agree with David's summary.

Re: Complaints

David Mills — Tue, 04 Feb 2014 22:11:24 GMT

Agree with the above. I do quite a lot of OOH, both for daytime practice and locum, and find complaining clients/patients fall into a few categories:

1. culmination of chronic disease: these are GUILT patients e.g. dog vomiting for a week and come in on a Sunday afternoon. These want to blame someone because they want to transfer from themselves - they know the animal should have been sooner - so as above, they pick the vet or pratice 'cos you're the other person there. Cue blowing of cheeks when quoting for fluids, rads etc, wanting a diagnosis now. Most likely to complain is animal does not get better, quickly, and cheaply (or what they perceive as cheaply, which is <£50)

2. acute disease that was their fault: e.g. running into the road, trapping leg in door. Less bothered about costs at the time, but become very concerned about them if you cannot make them feel better about their carelessness with diagnosis and treatment. A variant is having fed the dog a load of chocolate or grapes and ring wanting you to say it will be OK, and complain when you refuse and insist on seeing and making sick - retrosepctively will complain about cost with the justification 'dog will be fine'.

3. disagreeing couples. Usu an extension of 1, and wife has managed to persuade hubby after a weekend of nagging, that cat needs seeing on a Sunday afternoon One wants admitting (wife, usu), one wants light (i.e. cheap) but 100% effective treatment (hubby). If admitted and landed with bill, animal fixed, wife is retrospectively talked into the fact admission wasn't necessary and animal needed a jab or two and would have been fine - resulting in complaints about over-treatment (see Chikosi).

4. Over-worriers. Will present if vomits once. If not fixed instantly will complain that vet didn't investigate fully, exam fully, etc etc. Wants tests done, bloods etc, usually insured, but complete overkill.

5. Over-expectants. Think because they're paying higher prices they should be getting gold-standard, as opposed to what they would get in a normal daytime situation. Expect 'more for their money' Usually a variant of 1).

6. (charity one, mainly) Queue-jumpers. Know usually seen quicker at a weekend. Usually will get through the door by over-exaggerating e.g. 'off its legs' 'screaming in pain' 'hasn't eaten for a week'. Normally accompanied by requests for wormers or nail clips or flea treatment.

Re: Complaints

Utlendigur — Tue, 04 Feb 2014 19:43:24 GMT

[quote user="GrooveJet"]Does anyone have any thoughts as to why complaints seem to be more common in the OOH setting? [/quote]

Some thoughts...

Often emotionally charged eg the pts that's been on the cards for days and the owners have now decided at 4am that they want it done on a visit NOW

Costs

Often clients who have delayed bringing the pet in during normal hours because they don't want/can't afford bill and are now faced with even bigger bill for sicker pet OOH - and no way is it their fault so it must be yours because you are the only other person there

Not their usual/favourite/tame vet

Panic

Lot of clients seem to think that we can cure everything, especially if they are paying money, and become deaf to any talk of poor prognosis

Re: Complaints

Andy Elliott — Tue, 04 Feb 2014 19:41:49 GMT

[quote user="GrooveJet"]Does anyone have any thoughts as to why complaints seem to be more common in the OOH setting? Is it always caused by poor communication on our part? Or is it because things are more serious to begin with (otherwise it can wait until morning)? Or perhaps sometimes owners are panicked and not thinking straight at the time of making the decision, then regret it in the cold light of day?

[/quote]

We have thought about this many times! We think it is because of the nature of the case-load (very sick, injured animals requiring lots of work) in combination with higher than normal fees. It therefore requires double the communication effort right from the outset with the client.

Re: Complaints

Miriam Lodewyks — Tue, 04 Feb 2014 19:28:50 GMT

Does anyone have any thoughts as to why complaints seem to be more common in the OOH setting? Is it always caused by poor communication on our part? Or is it because things are more serious to begin with (otherwise it can wait until morning)? Or perhaps sometimes owners are panicked and not thinking straight at the time of making the decision, then regret it in the cold light of day?

Re: Complaints

Mark Hedberg — Tue, 04 Feb 2014 19:24:31 GMT

[quote user="Tom Ward"]

[quote user="Mark Hedberg"]

Do I *want* to know where your last finger is? :D

[/quote]

hehe - it's where it should be. Little finger of left hand has decided it's above typing. Just sits there looking pretty.

[/quote]

Fair point. I've just seen enough weird veterinary injuries I thought I'd just clarify - you'd not be the only vet with nonstandard digit counts!

Re: Complaints

Andy Elliott — Tue, 04 Feb 2014 18:58:17 GMT

I agree that we can use technology to help us and my opinion is that CCTV should be in all consult rooms. It would give us protection from spurious claims and accusations. The difficulty is to convince other members of staff that it is for their benefit and not for checking up on them!

We do all our own OOH and unfortunately most of the complaints we receive and most of the bad debt arises from OOH work. I have come to the conclusion that we really need to absolutely explicit about what things cost and that we still have to charge if the animal dies.

Re: Complaints

Tom Ward — Tue, 04 Feb 2014 16:49:39 GMT

[quote user="Mark Hedberg"]

Do I *want* to know where your last finger is? :D

[/quote]

hehe - it's where it should be. Little finger of left hand has decided it's above typing. Just sits there looking pretty.

Re: Complaints

ruths — Tue, 04 Feb 2014 16:30:44 GMT

I think that even in normal animals there's a benefit to knowing the baseline values for hr and rr and even temperature ( if poss) Every now and then you meet an animal that is one end or the other of a normal distribution curve- eg the 5 yr old femal collie who has a natural hr of 60 - If you knew this was the case when the dog is well and healthy, you wouldn't be suspicious when it comes in with vomitjng and diarrhoea and a pulse of 58 I hink writing down the numbers is really important and doesn't take up much space at all. And can be so helpful in characterising the problems next time you or somebody else sees that patient

Re: Complaints

Mark Hedberg — Tue, 04 Feb 2014 16:14:57 GMT

[quote user="Tom Ward"]

[quote user="Mark Hedberg"]

I paid for vet school by working in a logistics company; touch typing beats hunt-and-peck hands down; you wouldn't use 2 fingers when you operate on a patient, why would you use 2 fingers to type?

[/quote]

does a clumsy, self taught, seven finger typing technique count?

[/quote]

Do I *want* to know where your last finger is? :D

Re: Complaints

Tom Ward — Tue, 04 Feb 2014 15:20:15 GMT

[quote user="Mark Hedberg"]

I paid for vet school by working in a logistics company; touch typing beats hunt-and-peck hands down; you wouldn't use 2 fingers when you operate on a patient, why would you use 2 fingers to type?

[/quote]

does a clumsy, self taught, seven finger typing technique count?

Re: Complaints

Mark Hedberg — Mon, 03 Feb 2014 20:40:05 GMT

I paid for vet school by working in a logistics company; touch typing beats hunt-and-peck hands down; you wouldn't use 2 fingers when you operate on a patient, why would you use 2 fingers to type?

Re: Complaints

Francisco Gomez — Mon, 03 Feb 2014 20:00:47 GMT

It requires a few classes, but once you've learnt, it becomes second nature. I do this everyday like if I was driving or riding a bike, never think about it. What I'm writing now is touch typing. The best thing is that it gives you the benefit of looking at the screen while you're typing.

[quote user="tess"]

Perhaps it's not too late to learn...

[/quote]

Re: Complaints

Jenny Smith — Mon, 03 Feb 2014 19:16:36 GMT

Wasted teenage years on tinterweb and three years as a receptionist... I can touch type like a demon! :D

Re: Complaints

Glenn Hodgson — Mon, 03 Feb 2014 15:38:55 GMT

COuld write a 500 word detailed NAD on PE and keep in in clipboard...

CTRL-V (paste) all day!

Re: Complaints

tess — Mon, 03 Feb 2014 14:20:23 GMT

[quote user="James Laidlaw"]Depends how fast you can type! ;)

[/quote]

Yes! Those of us who still remember hand written record cards will testify to that. I type with 2 fingers and have a reasonable speed but I really wish I could touch type. Perhaps it's not too late to learn...

Re: Complaints

James Laidlaw — Mon, 03 Feb 2014 13:46:44 GMT

Depends how fast you can type! ;)

Re: Complaints

Glenn Hodgson — Mon, 03 Feb 2014 12:10:55 GMT

There has to be a balance though.

e.g. Normal coat noted on examination during a booster consultation. You could describe this in several ways.

1. Assume a reader/lawyer would assume this as included in "NAD in P.E."

2. Add a line "Coat NAD."

3. Add "Examined coat, no hairless areas noted. Normal luster. O reports after questioning that not pruritic. Coat colour brown and hair length 2cm over trunk....... ..."

There is a balance to be struck.

I'll happily write into the hundreds of words when documenting a critically ill case being passed to a colleague

I'll happily write NAD on P.E. for a healthy 2 YO booster dog, thus managing time time for situations/patients that could better use it.

If you write everything normal down you're onto >20 minute consults and >fees.

Re: Complaints

James Laidlaw — Mon, 03 Feb 2014 09:23:16 GMT

Absence of information in clinical notes is not equivalent to information in notes. I am pretty over thorough with my notes and with reading previous notes on history for new patients, or when working in new clinics etc. If you don't write things down, you're only guessing at remembering what you did.

Re: Complaints

Jenny Smith — Mon, 03 Feb 2014 04:07:17 GMT

I work exclusively OOH, so I write a LOT of notes. The main reason being that the vets who are following me aren't able to grab me in the staff room/in prep/on the phone to double check what I meant, so I try and cover all bases.

All my patients get a cardio/resp/neuro status recorded as part of a major body systems assessment. The rest of my PE I then break down into the systems I check, so if it's an acute vomiting dog I focus on abdo palp etc so don't put in a section for ortho other than not observed lame or similar. It helps if there are a few of us handing over cases over a weekend, you can easily see what has or hasn't been checked each time with longer term hospitalised patients.

As I'm aware I do tend to write lots, I usually either use headings or tend to separate out my PE findings from the rest of the clinical notes. I hope the read logically... sometimes you just have to write lots, had a recent severe head trauma RTA and my injuries list was massive. Poor doggie was smashed, but made a really good recovery despite the skull fractures :)

Jenny

Re: Complaints

Jenny Smith — Mon, 03 Feb 2014 04:07:16 GMT

Jenny

Re: Complaints

Glenn Hodgson — Sun, 02 Feb 2014 21:45:20 GMT

[quote user="David Mills"]

[quote user="Glenn Hodgson"] if I wrote NAD ON P.E. that means I have checked the heart so would expect not to be sailing in s*#t canyon.[/quote]

It may do to you. Would it to a PIC member, or a lawyer?

[/quote]

Here's hoping!