What would you have done? (me again..)

Re: What would you have done? (me again..)

Clare Tapsfield-Wright — Thu, 31 Jul 2014 21:55:29 GMT

And the people who would arrive five minutes after the finishing time because they didn't want to have to wait !

Re: What would you have done? (me again..)

Nicola Cole — Thu, 31 Jul 2014 21:48:00 GMT

I don't mind open surgeries. The only problem I found was when you had scheduled appointments closely after the end of open surgery....so if you had a busy one (and weekends invariably were) then you were automatically running late for the appointments....

Re: What would you have done? (me again..)

Evelyn Barbour-Hill — Thu, 31 Jul 2014 20:17:54 GMT

[quote user="Mark Hedberg"]

I worked in a practice with open surgery; must admit I rather enjoyed it!

[/quote]

Did it for years. "Appointments" used to be thought a bit too posh for the likes of us. Was once at a place where they had open surgery on Sunday morning!

After experiencing appointments, realised how much I hated open surgeries.

Re: What would you have done? (me again..)

Mark Hedberg — Thu, 31 Jul 2014 19:09:47 GMT

I worked in a practice with open surgery; must admit I rather enjoyed it!

Re: What would you have done? (me again..)

James Laidlaw — Thu, 31 Jul 2014 19:06:34 GMT

[quote user="Malcolm Ness"]

[quote user="James Laidlaw"]f*****g c**t[/quote]

WRT a different thread, both words are to be found in the Oxford English Dictionary!

[/quote] Not sure which thread, I was just utilizing some decorum for protection of the easily offended. If you aren't one of those, I recommend seeing Jim Jeffries live and purchasing one of his signed mugs. http://www.backstreetmerch.com/official_jim-jefferies_g_esday_jimjf02.html

Re: What would you have done? (me again..)

Clare Tapsfield-Wright — Thu, 31 Jul 2014 17:12:23 GMT

[quote user="Malcolm Ness"]

[quote user="James Laidlaw"]f*****g c**t[/quote]

WRT a different thread, both words are to be found in the Oxford English Dictionary!

[/quote] Malcolm you just made me spill my tea ! Re keeping on time I will always be grateful to my colleague who taught me the trick of walking out of the consult room with the lingering chatty client who invariably follows , and then nipping back in and smartly closing the door with a " goodbye , the receptionist will look after you now" . Time management , now there's a topic

Re: What would you have done? (me again..)

Malcolm Ness — Thu, 31 Jul 2014 09:56:37 GMT

[quote user="James Laidlaw"]f*****g c**t[/quote]

WRT a different thread, both words are to be found in the Oxford English Dictionary!

Re: What would you have done? (me again..)

Hannah Wynne Richards — Thu, 31 Jul 2014 09:47:54 GMT

In a perfect world, we would always do a thorough job, and always be on time. In the real world, if it's a choice between scimping a case or running late, then I'll run late - and my loyal bonded clients know that if necessary I'll take extra time with their pets, so don't mind. The type who do mind, I don't want.

Wynne

Re: What would you have done? (me again..)

Michael Woodhouse — Thu, 31 Jul 2014 00:42:30 GMT

There is a solution for running late - open surgeries. When I qualified I worked in 2 practices and one had appointments and the other open consulting. I used to prefer the structure of appointments and it did allow you to manage the work more effectively. You do get problems with difficult cases taking longer, some people don't like been held up if they have been given a time.

We bought the practice that held the open surgeries. We talked (at length) about moving to appointments. The clients didn't want it (they know they may have to wait), you never have to worry if a complex case takes 20 mins and then another takes 5 minutes. From the start of consulting to the end you run one on to the next (I found with consults you either over-run or sit about waiting for people). If someone wants to come last minute they can just jump in the car and come down.

(it does mean that we can't always have a history if they come for a booster or a new problem, but I take a similar view that if it's new then see the dog and ask for history later).

Re: What would you have done? (me again..)

James Laidlaw — Thu, 31 Jul 2014 00:10:33 GMT

I on the other hand was dumbfounded when client x called her dog a f*****g c**t in the waiting room in front of at least 3 separate people... She had tried to "kick" it out of the way of the other animals it was barking at and it bit her - surprise surprise.

Re: What would you have done? (me again..)

Rob Loxley — Wed, 30 Jul 2014 23:36:02 GMT

[quote user="Malcolm Ness"]If differing standards of politeness and professionalism are appropriate to different (dare I say it?) "classes" of client then who should judge and what criteria might they use?[/quote]

I was very polite, waiting for this morning's client to have time to finish their Special Brew, before seeing their dog

Re: What would you have done? (me again..)

Laurence Webb — Wed, 30 Jul 2014 23:22:16 GMT

[quote user="shanley barber"] Recently I have been inundated with poorly behaved Labradors with sore ears that need to be looked at to check for grass seeds, then swabbed for cytology after wrestling with them for 8 minutes in the prep room!!! How can I possibly stay on time?[/quote]

If you can't do it in 10 minutes then why try to pack it into a single consult? If you went to your GP with a problem they would take a history and examine you. If you needed anything other than some medication prescribed you would have to come back for another appointment with the doctor or a nurse for investigation or treatment.

If you are trying to pack 20 minutes of work into a 10 minute consultation then you are never going to stay on time. Admit the animal and charge appropriately or get them to come back.

Re: What would you have done? (me again..)

Utlendigur — Wed, 30 Jul 2014 23:06:08 GMT

[quote user="James Laidlaw"]You cannot, in my opinion, take a full history and do a thorough clinical exam and provide treatment for most non routine appointments in 10 minutes without either skipping over some part of history/exam/explanation/treatment. ... Most of these have long standing problems, and usually long standing histories which say something annually along the lines of booster - NAD. That's JUST dentistry. I'm sure I don't pick up every orthopaedic or ocular problem as they're not my fields of interest or expertise. Not trying to condemn, just raising a point.[/quote]

Which aswell as doing the pet and owner a disservice is also missing potential income for the practice and to really get owners on board you not only need to have the time to spot the problems, but also discuss what you are recommending and why - again difficult in a 10minute consult unless you have a few quick appts to catch up. That's if you get 10minutes - thanks to reception errors my afternoon surgery started with 3 completely different clients all turning up for the same 1st appointment, with appointment cards to prove it - 3.3minutes per client

Re: What would you have done? (me again..)

shanley barber — Wed, 30 Jul 2014 22:16:09 GMT

[quote user="James Laidlaw"][quote user="Anthony Todd"]

[quote user="Elizabeth Billimore"]What do the people who never run late do with late arriving clients? I feel you can't really say anything about to the client (unless you're at the PDSA).[/quote]

Yes but the same vets who are always running late are never never ahead of the list by seeing people before time.

Booking back, if well booked, is anathema to 99.999% of the vets I have ever known.

When you point out that you'll finish early, if you're full, if you start early it's as if you suggested working thru midnight......

I really, really wonder whether there is much to be gained by long appointments if you were to measure diagnostic accuracy and patient/client care.

Wasn't there some sort of medical survey which found that patients could only remember five things the doctor said?

The art [which I wish I had developed] is to be quick, if you have to be, but with the client getting all the necessary information and the patient getting all the necessary treatment and advice, all without appearing to hurry.

Often less is more!

One more truism : clients who are late are always late and I never found a way to make them punctual!

[/quote] You cannot, in my opinion, take a full history and do a thorough clinical exam and provide treatment for most non routine appointments in 10 minutes without either skipping over some part of history/exam/explanation/treatment. I'm sure I've seen an astounding number of patients with malocclusions, fractures, missing teeth, retained deciduous teeth, worn teeth which all should or do require treatment or further investigation which are as obvious as the difference between night and day. IF - someone looked in the mouth. Which they haven't. Most of these have long standing problems, and usually long standing histories which say something annually along the lines of booster - NAD. That's JUST dentistry. I'm sure I don't pick up every orthopaedic or ocular problem as they're not my fields of interest or expertise. Not trying to condemn, just raising a point.

[/quote] Completely agree with above. I can rattle through most cat boosters in under ten minutes, but most dogs over 10 years, especially large breed dogs, often have lumps, lameness, coughs, etc, and I really struggle to deal adequately with these concerns on a ten minute slot. I also feel that the booster appointment is an opportunity for the owner to 'get to know me' so they feel they trust me when a big decision needs to be made. Recently I have been inundated with poorly behaved Labradors with sore ears that need to be looked at to check for grass seeds, then swabbed for cytology after wrestling with them for 8 minutes in the prep room!!! How can I possibly stay on time?

Re: What would you have done? (me again..)

Sammy82 — Wed, 30 Jul 2014 22:08:44 GMT

Agree. 10min are fine for a booster vaccination including general examination, weighing, drawing up the vaccine and signing the card. If any problems are found during the exam that require further examination, e.g. getting the ophthalmoscope out, performing a neurological exam, taking the dog outside for lameness assesment etc. the 10min are quickly up. And if the clients ask you about the worming/vaccination/ house training regime for the new puppy their mother just aquired, do you give advise or just kick them out with the words "Sorry your 10min are up"? Maybe we should enforce the one patient/one condition per appointment rule most GPs have to avoid delays.

Re: What would you have done? (me again..)

James Laidlaw — Wed, 30 Jul 2014 21:21:31 GMT

[quote user="Anthony Todd"]

[quote user="Elizabeth Billimore"]What do the people who never run late do with late arriving clients? I feel you can't really say anything about to the client (unless you're at the PDSA).[/quote]

Yes but the same vets who are always running late are never never ahead of the list by seeing people before time.

Booking back, if well booked, is anathema to 99.999% of the vets I have ever known.

When you point out that you'll finish early, if you're full, if you start early it's as if you suggested working thru midnight......

I really, really wonder whether there is much to be gained by long appointments if you were to measure diagnostic accuracy and patient/client care.

Wasn't there some sort of medical survey which found that patients could only remember five things the doctor said?

Often less is more!

One more truism : clients who are late are always late and I never found a way to make them punctual!

Re: What would you have done? (me again..)

Emily Nightingale — Wed, 30 Jul 2014 19:21:18 GMT

I stand corrected. Thank you.

Re: What would you have done? (me again..)

Evelyn Barbour-Hill — Wed, 30 Jul 2014 19:03:18 GMT

[quote user="Emily Herskind Nightingale"]

Hi Evelyn (thanks for the )

I think I am being asked to take over a case, when a client registers her pets with our practice having presumably been seen elsewhere for the dogs previous boosters. I'm being asked by the owner, but not the previous vet.

What say you?

[/quote]

No, it's a healthy dog, not a case. The owner told you, or could have told you, it had no current health problems, had no recent illness and was not under any treatment. And when you examined it you would have found it healthy (or not healthy, in which case you would have asked the owner whether she knew of whatever ill-health it was, if the previous veterinary surgeon had mentioned it and so on.....).

You weren't taking over a case, you were receiving a new patient.

Re: What would you have done? (me again..)

Emily Nightingale — Wed, 30 Jul 2014 18:42:51 GMT

Hi Evelyn (thanks for the )

What say you?

(incidentally the client has not rebooked.. which tells me clearly she did NOT think I did the right thing.. hmmm)

Re: What would you have done? (me again..)

Malcolm Ness — Wed, 30 Jul 2014 15:01:01 GMT

[quote user="Elizabeth Billimore"] I feel you can't really say anything about to the client (unless you're at the PDSA).[/quote]

I know it was a little throw-away line at the end of a post, and I know that some vets retain the right to be rude to clients whatever their circumstances, but it got me thinking.

I have seen vets fawning obsequiously over clients they knew (or believed to be) titled, wealthy, or famous and it always unsettles me. Why should anyone be deserving of better attention/more politeness/grovelling subserviency etc merely because their dad was a Lord or because they themselves turned out to be especially good at football or singing? Similarly, I am not sure why it might be acceptable to admonish a PDSA client in a way that wouldn't be considered acceptable if the client were fee-paying.

If differing standards of politeness and professionalism are appropriate to different (dare I say it?) "classes" of client then who should judge and what criteria might they use?

Re: What would you have done? (me again..)

Evelyn Barbour-Hill — Wed, 30 Jul 2014 14:49:27 GMT

[quote user="Emily Herskind Nightingale"]Does this change anything at all?? I still think I did the right thing [/quote]

No, I don't think so. Because you were not being asked to "take over a case".

The trouble with all this highly prescriptive 'code' business is that common sense is abandoned.

Re: What would you have done? (me again..)

Emily Nightingale — Wed, 30 Jul 2014 14:26:06 GMT

Does this change anything at all?? I still think I did the right thing

5.4 Although both veterinary surgeon and client have freedom of choice, in the interests of the welfare of the animals involved, a veterinary surgeon should not knowingly take over a colleague's case without informing the colleague in question and obtaining a clinical history.

5.5 When an animal is initially presented, a veterinary surgeon should ask whether the animal is already receiving veterinary attention or treatment and, if so, when it was last seen; then, contact the original veterinary surgeon for a case history. It should be made clear to the client that this is necessary in the interests of the patient. If the client refuses to provide information, the case should be declined.

5.6 In an emergency, it is acceptable to make an initial assessment and administer any essential treatment before contacting the original veterinary surgeon.

(last part doesnt apply.. cant remember the last emergency booster I did =)

Re: What would you have done? (me again..)

Linda Filshie — Sat, 26 Jul 2014 00:32:15 GMT

If we're fully booked and people turn up more than 10-15min late without giving us a call first then we usually get them to rebook (unless it's an animal in extremis of course). If we're not too busy then they will be seen after the people who've turned up on time for their appts who are already there. I dont mind seeing someone 5-10 minutes early if I can. For the most part my clients are extremely well trained!!

Re: What would you have done? (me again..)

Anthony Todd — Sat, 26 Jul 2014 00:26:57 GMT

[quote user="Elizabeth Billimore"]What do the people who never run late do with late arriving clients? I feel you can't really say anything about to the client (unless you're at the PDSA).[/quote]

Yes but the same vets who are always running late are never never ahead of the list by seeing people before time.

Booking back, if well booked, is anathema to 99.999% of the vets I have ever known.

When you point out that you'll finish early, if you're full, if you start early it's as if you suggested working thru midnight......

I really, really wonder whether there is much to be gained by long appointments if you were to measure diagnostic accuracy and patient/client care.

Wasn't there some sort of medical survey which found that patients could only remember five things the doctor said?

Often less is more!

One more truism : clients who are late are always late and I never found a way to make them punctual!

Re: What would you have done? (me again..)

Bibs — Fri, 25 Jul 2014 21:21:10 GMT

I'm surprised by how many people seem to never run late and think its awful to be running even 10mims late at any point. There are things that are just out of our control unless you are very abrupt. Even today my evening appointments started at 4.30pm. The 4.30pm app rocked up at 4.50pm and the 4.45pm appointment turned up at 4.50pm. That gives me 10mins to get through 2 appointments that were supposed to be 15mims each and still do a perfect job. The 5pm appointment was seen 5.10pm at the earliest and all the rest were therefore slightly late. Around this time a random client turns up "wanting a word" and reception say that's no problem and just add her to the list and she wants to come into my room for me to explain to her the long term plan with her dog's skin disease. I suggest I could call her later when I have more time to chat and she looks at me blankly. What do the people who never run late do with late arriving clients? I feel you can't really say anything about to the client (unless you're at the PDSA).