Truth or fiction?

Re: Truth or fiction?

Bob Russell — Wed, 02 Apr 2014 13:48:20 GMT

Today!

Client with dog and aural haematoma. Outstanding bad debt going back to 2010. Account locked so appointment could not be made except by an administrator. Client more than a little upset and vocal when I declined to see the animal full stop.

PIC/DC can 'swivel' if they consider an aural haematoma to be an emergency or life threatening!!

Re: Truth or fiction?

patrick murphy — Wed, 02 Apr 2014 13:22:06 GMT

I had one last week, that is no money, no transport,no friends or whatever, so for the cat's sake I saw it, inj ab's and said that I was not prepared to dispense med's for free, but if they came back with the money, no probs, and they did! every once in a while we get fooled.

Re: Truth or fiction?

Gillian Mostyn — Wed, 02 Apr 2014 08:08:28 GMT

Sandpiper- you are absolutely right- assistants need to feel that their welfare is more important to the boss than anything else. It must be awful to work for someone like you described. But I genuinely don't see how any change in our code would make their life easier?

Re: Truth or fiction?

grumpyoldman — Tue, 01 Apr 2014 23:50:57 GMT

I sacked a client today ,for trying to arm twist one of the assistants into signing a export cert for a malamute travelling to the USA confirming that the dog had two testicles in its scrotum ,it did not and she graciously apologised ,but refused to sign ,the client went mental and downloaded a torrent of abuse on both vet and nurse . Even more irritatingly he was a nice as pie with me and grovelled , but then he would do because I am 6ft 4in and 110kg .I hate that sort of thing its really shite ,No one wants people frightened to come to work crying ,terrified about the next time the waiting room door opens in case its one of those people ,so get rid they are not worth it . Sooner or later he will have a real problem possibly with a negative outcome ,then you will have RCVS garbage on your doorstep as well ,

Re: Truth or fiction?

Jo Dyer — Tue, 01 Apr 2014 21:41:18 GMT

[quote user="sandpiper"]As one of the very many holding a fundamentally different view, who have been repeatedly insulted by the many choice remarks offered by a partially sighted few, these are some of my thoughts -[/quote]

I'm not going to quote your whole post because it is long, and I'm not going to quote any parts because it is (IMHO, obviously) consistently excellent. To echo Francisco;

Wow

Re: Truth or fiction?

sandpiper — Tue, 01 Apr 2014 21:24:19 GMT

It doesn't cause me that much stress any more, not for the past couple of years. Partly since locum work allows more control over my diary, more regular proper down time and choice over the practices in which I work. I've become much more detached than in the past and accept that I do my best as far as is possible and some people are just going to be difficult for the sake of it and my stress is much reduced.

But it's worth being mindful that assistants have less control over many of these things than practice owners. Some practice owners are reasonable and supportive and I've been lucky enough to meet some wonderful practice owners, but after locuming widely across the country for some time, I've seen many practices which are not reasonable, where the assistants are really caught between a rock and a hard place. That includes one where a colleague faced clear, open, irrefutable racism from an obnoxious client and the practice owner refused to sack the client. The colleague was advised by the VDS (personal communication) that (s)he was entitled to refuse to provide vet care to that clients' pets, even in emergency circumstances. Yours truly got saddled seeing that client and it was extremely uncomfortable seeing him. Of course one will argue, that is an isolated extreme example etc etc. Except I've come across so many instances myself and more through colleagues, to the point where they border on commonplace (not racism as such, just unreasonable ill-considered stuff)

Re: Truth or fiction?

Nicola Cole — Tue, 01 Apr 2014 21:20:21 GMT

[quote user="Hannah Wynne Richards"]

Since pentobarb is a POM then it would be illegal for any of us to supply it other than for animals under our care There's also the fact that RSPCA Inspectors (some of whom are women) are prepared to go on an OOH rota and carry out visits (sometimes to some extremely unpleasant criminals - such as members of dog-fighting gangs) whilst we apparently are not.

If anyone says they shouldn't have become Inspectors unless they were prepared to do so...............errr should we have chosen this career if we weren't also prepare?. No-one forced any of us to become veterinary surgeons

Wynne

[/quote] A few points on this (but on ipad so it won't let me do bullet points/paragraphs, sorry!) 1) Most of the on call work that I have done the client phones vet directly so if living alone no-one knows where you are. 2) 'should we have chosen this career if we weren't also prepare?'. I don't think anyone, until they start the job, realises that the reality of OOH visits is (often) going alone and no-one knowing where you are and that there are possible dangers associated with this-people don't think about the technicalities of it until they're doing it. (When I first started my family were horrified when they found out I was at farms in the middle of the night and no-one knew where I was!) 3) I think that 'these days' people are more concerned with the safety aspects of things in general-I was reading something recently about childrens playgrounds, walking to school etc and how things have probably gone too far with health and safety and not allowing children their independence etc. I think the general feeling is to err on the side of caution in most situations now so people reconsidering the safety implications of solo OOH visits is in keeping with this. However, I happily do on call, happily do OOH visits (many of which probably aren't for the welfare of the animal eg. the owner would prefer a PTS at home) and don't think the current situation needs changing. I guess what I'm saying is that for people who are very 'anti' the vets who are concerned about doing OOH visits maybe think about how society in general is tending towards this kind of attitude-I don't think the comments about being lazy or uncaring are founded (at least I really hope they aren't!)

Re: Truth or fiction?

Francisco Gomez — Tue, 01 Apr 2014 20:59:01 GMT

[quote user="sandpiper"]

The requirements of 'good customer service' have become insane.

[/quote][quote]

If any one of those criteria is not met, the next step is sometimes to complain.

[/quote][quote]

People can't have everything they want all the time.

[/quote]

Wow indeed. " />

[quote user="Gillian Mostyn"]the vast majority of the public are sensible people who appreciate their vet and aren't resentful of paying you[/quote]

My opinion is that you're also right Gillian. But those 5% are the ones making your life hell, the ones that don't let you sleep at night and the ones that you spend more time and money on (taking it off other nicer ones unfortunately)... and the ones that benefit from a more harshly regulated profession. Is that going to help animals? I don't think so.

The problem is that the RCVS might be wrong in the path they use to protect the public and animal welfare

Maybe the welfare of animals would be best served if those thousands spent on promoting PSS, were spent on educating animals owners instead. (As opposed to increasing penalties and the length of the Code which makes nobody a favor).

As I have said before:

[quote user="Francisco Gomez"]

Walking into a practice without knowledge of how it works... It must feel like walking into a gym and pretending to know how to use its machines without a proper induction.

[/quote]

Re: Truth or fiction?

Gillian Mostyn — Tue, 01 Apr 2014 19:59:41 GMT

I agree with grumpyoldman.

Sandpiper - the vast majority of the public are sensible people who appreciate their vet and aren't resentful of paying you. They also don't expect you to work 24/7 or run around after them. It is easy to lose sight of this, and get too influenced by the behaviour of the few. However, you do need to be able to assess your clients and decide which group they fall into - and change your own behaviour accordingly. Just because there are idiots out there who expect procedures FOC, or demand house visits simply because they can't be a****d to bring their pet to you, doesn't mean it should cause you that degree of stress.

Re: Truth or fiction?

Francisco Gomez — Tue, 01 Apr 2014 19:54:59 GMT

[quote user="grumpyoldman"]

Your best bet is to look at their history[/quote] Can't do that if you work in a OOH covering practice ;-)

Re: Truth or fiction?

grumpyoldman — Tue, 01 Apr 2014 19:45:16 GMT

Can I just say that I hate clients more than most , after a while you do develop a radar for the kind of people your describing ,its probably under 5% . Your best bet is to look at their history ,as they usually arrive on your doorstep with a tale involving a dispute with another local practice . Either do not register them ,or if they slip through that net just write to them and just inform them that you do not wish to do business with them and that they should avail themselves of alternate suppliers of veterinary services . It extremely satisfying and liberating and allows you to concentrate on the 95% of nice people who are grateful for your efforts and want to pay you for it . Every sperm is not sacred and quite frankly the world and your life will be a better place without some of them in it .

Re: Truth or fiction?

sandpiper — Tue, 01 Apr 2014 19:26:52 GMT

[quote user="Hannah Wynne Richards"]

Clare If we, a profession supposedly dedicated to the health and welfare of animals ( does anyone other than me remember our oath) are unwilling to visit or do OOH yet pet crem workers are - what effect will that have on public perception?

Wynne

[/quote]

Wow.

As one of the very many holding a fundamentally different view, who have been repeatedly insulted by the many choice remarks offered by a partially sighted few, these are some of my thoughts -

- I am not unwilling to visit, when clinically appropriate. The problem is that the yardstick defining what constitutes 'appropriate' and 'necessary' has shifted far away from obvious clinical grounds of the vet's domain, to the shifting sands of owner circumstance and preference. This has been entrenched by multiple DC decisions on visits and compounded by the lay component but the party line remains firmly in James Herriot territory. Invoking Todd's Law and repeating others, it seemed to me that Chikosi went on the visit because he realised that the owner was not going to bring the dog to the practice, not because he primarily considered a visit necessary on clinical grounds. This again is the problem - in a huge majority of cases, the owner will not bring/does not want to bring the patient in - for whatever NON-CLINICAL reason - and by extension, as a direct result of the owner's position rather than the patient's clinical state, a visit then has to be made. Should the powers that be accept that this outline is consistent with THEIR interpretation of 'necessary', that would aid clarity. The only problem is, that would confirm that vets are expected to be at the owner's beck and call when the owner chooses to abdicate responsibility and that whichever way you slice it, the owner is in control and the professional is far from enabled to exercise independent professional judgement. I think that that essentially is the working situation, but the powers that be just refuse to rubber stamp it and we are still urged to see it otherwise. The public will hang on tooth and nail to something they have had for years (home visits and dumping responsibility on the vet from the word go), rather than relinquish it and accept that the world is moving on.

- Many people will promise anything at the time when they're distressed, but then later the situation changes. Not only are VS's effectively landed with debt, but I suspect pursuit of the debt might at some stage be qualified as SPM by the DC. The Kutschera case highlighted that trying to establish assurance of payment prior to seeing the poor animal is viewed very negatively. But dire emergencies with small to large bills attached are daily occurrences for many of us. We already tread very carefully, but the signs are that seeking surety of payment, or possibly in the future pursuing payment, is at risk of being judged SPM. Being a vet = forced to accept unpaid debt frequently = unsustainable

- OOH work. When I started 10 years ago, I deliberately chose jobs with OOH to gain experience in emergency work. Many medicine consultants have regaled me with stories about their early days on call, in hospitals etc and mistakes they made where they're glad they didn't kill anyone. Obvious differences from the vet sector are that the hospital environment means a tired head is never working on its own, there is intrinsic oversight for more junior staff, equipment is available and readily utilised - as is security - without the price tag being waved in the face of the patient. Beyond that, the GPs some time ago negotiated a much sweeter deal for themselves including getting out of OOH. Complaints feed into the huge machine of the NHS and disappear.. (sure, occasional to GMC etc) I don't hear anybody speaking about human medicine as a vocation any more, it mostly seems to be painted as a nice lucrative, intellectually stimulating status career with very good prospects. What a contrast to our sector, with no cushion between the individual and the RCVS, with DC nearly half lay members. There is still a strong expectation that vets should have a strong vocation. That's fine, I do still, as do likely the vast majority. The problem here is that the expectation of that vocation is extended to martyrdom. There is a line between acting as a professional with dignity and self respect, working hard with dedication and commitment, vs being pressured into running around after clients, dropping everything for someone to do for them what they should be doing for themselves (client, not patient obviously) because of threats and emotional blackmail, faced with constant ethical and professional dilemmas (sometimes courtesy the manager or boss) all for free, because you are required to, otherwise somebody will scream SPM. The burden for 'effective communication' rests with the vet (ie turning the abusive client who is 'upset' and prone to finding fault with everything, into a well-managed case with collected revenue for the practice). The requirements of 'good customer service' have become insane. How can stress in the profession continue to be a mystery to anybody? No wonder so many burn out and the average stay in the profession is 5 yrs (from recent Vet Record article, happy to be corrected with more current data).

The public want an excellent service, to be on their doorstep, immediately available, provided by a vet who is bright eyed and bushy-tailed at all hours, with a big smile and endless time for the individual patient (that we'd love to give, IF we had the time), along with all the gizmos necessary, for a tenner or preferably on credit (aka free). If any one of those criteria is not met, the next step is sometimes to complain. Cynical, perhaps, but often true. People can't have everything they want all the time. There's a system, provided by human beings, who do a fantastic job most of the time, living up to standards, which are set higher for us than for colleagues in the human health sector. I would like individuals equipped to influence policy and infrastructure in our sector to see that many - including some of our own number - expect vets to be martyrs and that is not right.

Re: Truth or fiction?

Thomas Johnson — Tue, 01 Apr 2014 15:28:15 GMT

[quote user="Utlendigur"]

[quote user="Hannah Wynne Richards"]Yes the dispatcher knows where they are - so does the practice telephonist![/quote]

Even OOH? For the 18years I did on-call, the client phoned the vet direct on the mobile number given in the recorded message. There was no effective lone working policy, my concerns over this were repeatedly dismissed/belittled, and living on my own meant that if something did go wrong it could have been up to 36hrs before anyone noticed!

[/quote]

In my last practice we used an answering service out of hours, but the only difference that would have made would be that when I didn't turn up the next day for work they'd have known who the last person I got a call from was.

Whereas the RSPCA can monitor where its inspectors are all the time:

http://www.computerweekly.com/news/2240157948/RSPCA-mobilises-workforce-with-AMT-SYBEX

Re: Truth or fiction?

Utlendigur — Tue, 01 Apr 2014 14:49:12 GMT

[quote user="Hannah Wynne Richards"]Yes the dispatcher knows where they are - so does the practice telephonist![/quote]

Re: Truth or fiction?

Thomas Johnson — Tue, 01 Apr 2014 14:34:28 GMT

[quote user="Hannah Wynne Richards"]

Thomas Actually you're wrong. RSPCA Inspectors don't work shifts, they do the normal day job+ on call on top - like we used to do.

[/quote]

From the National Careers Service Website:

In the RSPCA, you would work 35 hours a week. As the RSPCA provides a 24-hour service, you would work shifts including weekends, nights and bank holidays.

Re: Truth or fiction?

grumpyoldman — Tue, 01 Apr 2014 13:39:06 GMT

[quote user="Malcolm Ness"]The liberal professions are not terribly popular within government[/quote]

Do you mean the Sir Humphreys in Whitehall or the elected preverts, tax dodgers, and all round liars ???.

Re: Truth or fiction?

grumpyoldman — Tue, 01 Apr 2014 13:34:16 GMT

I think that some members of the public ,thinking particularly about a certain type of dog breeder ,probably would like an Isle in B&Q dedicated to the sale of antibiotics, metacam ,minor surgery kits ,with instructions on simple procedures ,and Pentobarb ,for those end of life moments. Frankly I quite like the idea of them going there instead of sitting in my waiting room dissecting bills and trying to squirm out of service charges .

Re: Truth or fiction?

Bob Russell — Tue, 01 Apr 2014 13:31:25 GMT

We are clearly a very insignificant profession to government. The closure of AHVLA centres has been criticised by the Royal College of Pathologists as a risk to public health. Not a hint of interest in veterinary surgeons views!

This was on radio 4 this morning!

Re: Truth or fiction?

Malcolm Ness — Tue, 01 Apr 2014 13:15:18 GMT

[quote user="Clare Tapsfield-Wright"]It was commented that if vets are in a unique position having the right to prescribe and that if vets were unable to provide services that animal owners wanted then others should be allowed to provide them. [/quote]

Those who are vociferous in their wish to have the life of veterinary surgeons wrt OOH cover and visits made easier should take careful note of this. The liberal professions are not terribly popular within government (we are seen as privileged and over-powerful). The veterinary profession is a small profession and therefore a "soft" target for any up and coming minister or spin-doctor. If we make too much noise or leave too much of a vacuum, then we shouldn't be very surprised if some big, external and unpleasant changes are imposed upon us.

Be careful what you wish for!

Re: Truth or fiction?

Hannah Wynne Richards — Tue, 01 Apr 2014 13:12:39 GMT

Thomas Actually you're wrong. RSPCA Inspectors don't work shifts, they do the normal day job+ on call on top - like we used to do.

Yes the dispatcher knows where they are - so does the practice telephonist!

There's only approx 350 Inspectors to cover the whole of England and Wales,so they certainly haven't the man/woman power to send 2 on calls.

Add on the fact that they're involved in prosecuting evil criminals - makes our job look a bit of a doddle!

Wynne

Re: Truth or fiction?

Clare Tapsfield-Wright — Tue, 01 Apr 2014 12:54:02 GMT

The recent three day session was about OOH in general not just house calls. It was commented that if vets are in a unique position having the right to prescribe and that if vets were unable to provide services that animal owners wanted then others should be allowed to provide them. These are not my views or RCVS views but we had the general public there as well as vets and I am interested in your opinions. I am not suggesting anything , I am asking for your views but maybe I am not being very clear or this is not the right place to ask . If so let me know . There has to be a certain amount of devils advocate here but I don't want to create any misunderstandings . [quote user="Jane Adams"]

[quote user="Clare Tapsfield-Wright"]If RSPCA inspectors could carry pentobarb and euthanase all animals and vets no longer did house calls would it then be reasonable to allow a suitably trained person such as a nurse or a pets crematorium employee to do so? Would it then be reasonable for lay people to treat animals in their own homes , since vets did not reserve that as their correct role eg for vaccinations and minor conditions? This is me , Clare , asking not proposing any Machiavellian RCVS plot . Just interested in your opinions

[/quote]

The above would require that significant amendments be made to the Animal Welfare Act 2006, I can't really see this occurring because one RSPCA inspector had some difficulty getting a veterinary surgeon to attend to one cat.

The Act does not legislate against euthanasia being performed by anyone. It only requires that it be done without causing unnecessary suffering. It already is acceptable, in the eyes of the law, for the nurse, or crematorium employee to euthanase a domestic animal on the instructions of its owner. You seem to be suggesting that if powers to euthanase an animal without the owner's consent were devolved to lay persons we'd be on some kind of slippery slope to Sodom and Gomorrah, welfare-wise. That's a bit of a leap, isn't it?

[/quote]

Re: Truth or fiction?

Thomas Johnson — Tue, 01 Apr 2014 10:52:13 GMT

[quote user="Hannah Wynne Richards"]

There's also the fact that RSPCA Inspectors (some of whom are women) are prepared to go on an OOH rota and carry out visits (sometimes to some extremely unpleasant criminals - such as members of dog-fighting gangs) whilst we apparently are not.

[/quote]

Two points to make in response to this. RSPCA inspectors work shifts, they won't be doing a full time day job and then nights on call on top of that.

Also I suspect the RSPCA have quite strict rules about where their inspectors go, where they should and shouildn't go on their own, arrangements to track inspectors when they are visiting people know to be a risk, and arrangements with the police to provide back-up if necessary.

Re: Truth or fiction?

jd2008 — Tue, 01 Apr 2014 09:55:43 GMT

[/quote]

Re: Truth or fiction?

Hannah Wynne Richards — Tue, 01 Apr 2014 09:54:57 GMT

Euthanasia isn't an act of veterinary surgery. It's the supply of pentobarb which is legally problematical.

I suppose the Inspector could have euthanised the cat with a captive bolt - that would have been both legal and humane, but perhaps not very aesthetic

Wynne

Re: Truth or fiction?

Francisco Gomez — Tue, 01 Apr 2014 09:50:02 GMT

Thank you Clare.

It was my understanding that euthanasia was not an act of veterinary surgery. Anyone can do it. Of course I would agree that it would be better for a vet to do it, in aim to reduce suffering in the process. I believe (I might be wrong here) that RSPCA are not allowed to carry pentobarb because of the danger of the drug going astray (but not because they shouldn't euthanase).

Where can we draw the line? Well, I don't think there is one, or it needs to be one.