Advice about PTS gone sour :(

Re: Advice about PTS gone sour :(

Evelyn Barbour-Hill — Fri, 25 Jul 2014 20:10:01 GMT

Wot everyone else says.

You have done nothing wrong.

To which I would add;

a)[quote user="An On MRCVS"] repeatedly referring to the colleague she was used to seeing. [/quote]

My technique now, ah with the benefit of years, with that one would be to interrupt her with "would you like me to make you an appointment with Mr. Colleague, that can easily be arranged". If she says yes, everyone's happy. If she says no, she cannot complain that you are not Mr. C. It also sends a subliminal message to her that you know what she's playing at.

b) [quote user="An On MRCVS"]Today I see that she phoned in to speak to the senior partner and that I am being asked for an apology to the lady.[/quote]

You mean the senior partner has asked you to apologise, or that an apology is what the lady wants? If the former, that's very unfair.

If I were your senior, i'd put the lady on hold, as it were, and have a long talk with you (and the nurse, too, but not behind your back), and probably then telephone her back personally with "we are sorry you feel so upset" and other emollient words as appropriate, while being politely firm that I did not think you had done anything wrong. (And if I did think you'd done something wrong, I'd have it out with you quietly, in private).

Unfortunately there are some bosses to whom the concept of supporting one's employees is a strange one; it sounds as if yours is more worried by the idea of losing the custom of one unpleasant client than he is by the idea of upsetting you.

An apology, if any, should come from the senior partner. In my opinion, to make you give an apology is not right. It sends the message to the client "we're sorry we've got a bad employee here, rest assured he's had a dressing-down and if he doesn't mend his ways he'll be out on his ear". Moreover, if it's a letter, it may well be pored over, picked apart, reproduced on Twitface, and even "used in evidence".

Do the apology if you wish, but talk to VDS first. Then if you do it verbally, be sure you stay polite but stick to saying you are sorry they were so upset: don't be drawn into more than that. If you do write a letter (which I would advise against), the same.

Re: Advice about PTS gone sour :(

Robin Grimmer — Fri, 25 Jul 2014 14:57:23 GMT

[quote user="emma_j"]

[quote user="An On MRCVS"]

that there was a reasonable degree of skill by the nurse and myself in the pts off the needle (that's the pts culture at this practice) of a bouncy collie

[/quote]

This is the only thing that leapt out at me - you're working as a locum in a practice that prefers to euth off the needle - would you personally have preferred to place an iv in this case?

I likely would have - to avoid the situation where the vein blows half way through with a bouncy dog - but also as taking the dog away to place the iv gives the owners time without the dog 'looking at them' to go through the consent form, wishes post euthanasia, and to explain the procedure to them, and to ensure that everyone is calm before it goes ahead. Another advantage being then not needing a nurse to restrain during the injection, so things can be more relaxed at that point, rather than the owner witnessing their pet muzzled and restrained for it's final moments.

I completely accept that my view is my own and others will feel differently - but if you as the vet would have preferred to place an iv, but didn't because of the 'practice culture' where you are working as a locum, then I feel that's a bit wrong. I have done a lot of locum work, and would simply place an iv when I felt it appropriate for my patient.

[/quote]

Agree with this 100%. As a locum never do something you are not comfortable with just because it's allegedly practice culture. Taking the dog away for placing the iv takes the stress away from the owner, also you can muzzle the dog out the back, and with an iv in place may then not have needed muzzling. I feel for you and have been in this situation myself, where you obviously have a difference of opinion with the husband and wife.

Also this is worrying: "I presented the consent form and asked for authorisation and the lady ignored me. I looked at the husband to see if he would sign it and he gestured in his wife's direction, so I asked her again, and she brusquely signed the form" It's clear from this that things are not going well, did you discuss cremation arrangements prior to euthanasia?

Re: Advice about PTS gone sour :(

Rob Reid — Fri, 25 Jul 2014 11:16:39 GMT

Sounds like you've been a victim of circumstance here!

Some good advice from others, not much to add except don't be afraid of the apology bit. You've done nothing wrong but a diplomatically worded apology can reflect this, it is not so much an apology as an acknowledgement that the other person is upset.

Something along the lines of :

"I can appreciate that you're unhappy and I'm sorry that you feel like this"

works very well. There's no admission of wrong-doing on your part (mainly because you've done nothing wrong) but it will demonstrate empathy and help to diffuse things in most cases. The VDS will offer you some good advice on how to exactly phrase things.

Good luck!

Re: Advice about PTS gone sour :(

emma_j — Fri, 25 Jul 2014 11:15:43 GMT

[quote user="An On MRCVS"]

that there was a reasonable degree of skill by the nurse and myself in the pts off the needle (that's the pts culture at this practice) of a bouncy collie

[/quote]

This is the only thing that leapt out at me - you're working as a locum in a practice that prefers to euth off the needle - would you personally have preferred to place an iv in this case?

Re: Advice about PTS gone sour :(

Hannah Wynne Richards — Fri, 25 Jul 2014 09:41:02 GMT

I get the impression you were caught in the middle of a "domestic" Wife wanted PTS, husband didn't. Wife bullied him to agree - and now feels bad about it. You're a convenient scapegoat.

Wynne

Re: Advice about PTS gone sour :(

Jo Dyer — Fri, 25 Jul 2014 07:29:55 GMT

[quote user="Linda Filshie"]But I do sometimes worry about those in our profession who get too deeply drawn in to clients' manipulative bullshit (not at all classing most clients/PTS situations as this, of course). I do my best for my patients and my clients, but I don't think I'm there to be bullied or used as a target for their guilt and anger.[/quote]

Absolutely!!

It sounds as if you did the very best in a tricky situation. Don't spend any more time thinking about it than you absolutely have to.

Re: Advice about PTS gone sour :(

Braden Collins — Fri, 25 Jul 2014 00:27:29 GMT

My feeling is this client was feeling very guilty about not treating this dog sooner/not being able to afford treatment and is trying to transfer some of the blame and guilt to you.

We had a similar case here a few weeks ago with a dog with renal failure. It had lost 10kg in the last few months and was very unwell on presentation. The client was a previous bad debtor but the vet that saw the dog did a good job with the money the client had. The reality was the client had left it too long and nothing was going to save this dog.

She obviously stewed on it for a few weeks then called the clinic to complain that not enough compassion was shown to the client and we should have comforted her more. I felt the best way to deal with the situation was to phone the client myself and talk the client through everything. I got the impression there was a lot of guilt from the owner and she was looking to more the blame onto us.

I think your boss would be better off phoning the client themselves rather than having you write a letter. A letter can easily be misunderstood or they may pick up on little points which may upset them more.

Re: Advice about PTS gone sour :(

ChrisBVSc — Thu, 24 Jul 2014 23:47:05 GMT

I'd have been a bit annoyed about the fact it wasn't actually booked as a PTS, when clearly the owner brought the dog in for this reason. As you said, how can you be expected to read minds. Maybe if the appointment actually said "PTS" and you'd approached it as a euthanasia as soon as they walked through the door, things might have gone more smoothly (I find some clients like this definitely prefer the 'get on with it' approach). Perhaps the initial time examining the dog & discussing the condition/possible treatment options just wound up the owner even more. However none of that is your fault, it's just something else you could use in your defence if you need to justify what you did, due to the lack of forewarning about the PTS.

On the other hand, I've had one or two appointments in the past that were booked as a PTS, but actually weren't! Luckily managed to talk my way out of it before the owners became too shocked!

Re: Advice about PTS gone sour :(

Mark Hedberg — Thu, 24 Jul 2014 23:15:24 GMT

My mother would have said 'szar ügy' (please don't make me translate that) - we're scientists in an intensely emotional world; the owner could have been either relocating guilt, or just trying to show a passive-aggressive racism. You'd be surprised how some Brit clients like to put down or demean non-UK individuals.

Re: Advice about PTS gone sour :(

Utlendigur — Thu, 24 Jul 2014 22:48:40 GMT

I do feel sorry for you because like others have said, it does sound like you were just in the wrong place at the wrong time, or she may just have been that sort of client who doesn't cope with unpleasant situations and wants to lash out at whoever is most convenient. I would try to find out what she is complaining about - whether it's the actual process or the discussion/decision - as it will help in deciding how to handle it, what you're supposed to apologise for(and to stop yourself going over and over it in your head). I have found that if I am starting to feel hostile vibes from a client that saying something open and non-committal like "What are your thoughts?" gives them an opening to say what's bothering them, but unfortunately some clients are just totally unpredictable and you're stuffed whatever you do (Virginia put it much more eloquently)

Re: Advice about PTS gone sour :(

Linda Filshie — Thu, 24 Jul 2014 22:31:22 GMT

Do you want to locum for this practice again? Is the senior partner involved supportive? If so, write the letter as suggested with the blandest non-apology apology. If it would make you feel better to write a nice condolence card or phone her, then do it.

But I do sometimes worry about those in our profession who get too deeply drawn in to clients' manipulative bullshit (not at all classing most clients/PTS situations as this, of course). I do my best for my patients and my clients, but I don't think I'm there to be bullied or used as a target for their guilt and anger.

It is one of the downsides of locum work that you are often not who the client expects (or wants) to see. As far as I can see the only thing you could have done differently in this case was to mention that their beloved usual vet was due back on XYZ date and maybe they would like to speak with him/her before making an irrevocable decision (especially as in this case the dog was literally bouncing and there was no clinical indication for immediate euthanasia.)

Re: Advice about PTS gone sour :(

Nicola Cole — Thu, 24 Jul 2014 22:23:00 GMT

Definitely sounds like some degree of 'wrong face at the wrong time'-I would think if your colleague who had been dealing with her dog initially was the one doing the pts then it would have been a very different response from the owner. I would speak to the boss first, but if they can't smooth it over, then speak to VDS as above.

Re: Advice about PTS gone sour :(

John Flynn — Thu, 24 Jul 2014 22:16:23 GMT

I don't think it sounds as if you were at all in the wrong. That said, if you've ever suffered grief you might not mind extending some slack and extra compassion in the owner's direction in the confident knowledge that you have acted professionally in this instance and need not change your approach at all in future occasions - I find the most agonizing ones that keep me awake at night to be when there ain't anything I would do differently, no matter how much I go over it or peers reassure me, but there always seems to be that little element of doubt of "maybe there is something I should have done different" - try not to repeatedly agonize over it if you can consciously avoid it.

You could phone or write to compassionately say that you're sorry that the experience has been so traumatic for her, and you understand how different an experience it is when it is your own pet so you totally feel her pain - even if you know that it's the right thing to do it is still horrible to have to say goodbye to such a beloved friend. If it offers any consolation, you feel that "X" passed away peacefully and was not consciously aware of anything after the first part of the injection, and that you hope, with time, she will feel reassured that she did the best by "X" in allowing him to pass away without having to go through the suffering that a debilitating illness can cause. If you made that most difficult day any more traumatic than it had to be for her, then you can but extend your sincere and deepest sympathies.

In the unlikely event that the owner happens to be combative beyond this, then I'd politely stick to my guns that I'd reflected upon the experience, and while I can feel her pain I do not feel that my conduct nor care was below expected standards, and unfortunately I do not think I can help further other than to direct her to "appropriate counselling service" where she can discuss the experience further with others who have gone through the same trauma - a process that you know others have found most helpful in the past.

Re: Advice about PTS gone sour :(

Virginia Campbell — Thu, 24 Jul 2014 22:15:05 GMT

I've done a small handful of "angry" euthanasias over the years- where there were hostile vibes emanating from the owner though no outright exchange of views - all body language, tone of voice etc. I think you're on a loser from the start with these. If you discuss palliative care, you're making them feel guilty for euthing. If you just say yeah righto time's up you look as if you can't wait to kill doggie and are pushing them into it. If you pre sedate they think you're drawing out the agony, and go into floods of tears at the sight of groggy doggie. If you don't sedate and doggie moves and you blow the vein you're an animal torturing incompetent. If you try to explain why you want to sedate/not sedate or use a muzzle or what might happen in the gentlest terms eg "a few deep breaths" to describe agonal gasps - you are psychologically torturing the owner and should "just get on with it". If you just get on with it without explaining, they will be shocked and horrified by the process even if all goes well.

I think you were just the wrong face - ie not Beloved Colleague. I got a complaint letter after a euth once (of one of the nastiest Westies you could meet belonging to lady who lunches who had no control over him)- I came out thinking, ah well, that could've gone worse - I only got bitten once trying to get the Domitor into the vicious little beast whilst trying to appear gentle and sympathetic and from thereon in I thought it went as well as could be expected - only for a letter to arrive addressed to Beloved Senior Partner explaining all my shortcomings and owner's distress, and that she would not be back after 40 years of taking her dogs to the practice. I was the wrong face at the wrong time.

I agree with the "sorry for your distress at the loss of doggie" letter - keep it as bland and non specific as you can (unless the owner really wants specifics addressed, in which case - have at it with the veterinary explanations, sandwiched between bland expressions of sympathy for doggie's demise).

I'm glad for your sake it wasn't one of the ones that muscle-twitch for ages and the owner thinks it's still breathing and refuses to leave the body and glares at you with a look that says they think it's going to wake up in the freezer, even though you've told them that its had enough Euthatal for a dog twice its size.

Sending strong protective wishes your way that their new pup doesn't turn up your weekend on call with a foreign body or something.

Re: Advice about PTS gone sour :(

Miriam Lodewyks — Thu, 24 Jul 2014 21:52:04 GMT

Guilt is a very ugly and powerful emotion, and I've often experienced the sharp end of the misdirected anger that goes with it. Hard as you try not to take it to heart, often these experiences leave a very bitter lingering taste in your mouth. Very few clients ever take a moment to consider the fact that we are sentient beings too, who feel hurt and sadness and indignation at the unjust way we are sometimes treated. Reading this story upsets me, because it could (and eventually will) happen to me too. Having said that, I agree with the previous post: a card or note saying you're sorry she feels upset. That's not the same as an admission of wrong-doing, but an aknowledgement of how she's feeling. Might be hard to swallow as it's clearly you who's the wronged party, but it seems that this is how it goes in England.

Re: Advice about PTS gone sour :(

emerald — Thu, 24 Jul 2014 21:46:01 GMT

Hi,

I would have a chat with your boss about it to see their thoughts +/- VDS.

Ultimately we would probably write some notes and phone the client for a chat or book an appointment to have a chat about things.

I had an RCVS complaint once about a bad PTS, which every vet has had, and it didn't go anywhere, they just gave some friendly advice.

Hope that helps x

Re: Advice about PTS gone sour :(

James Laidlaw — Thu, 24 Jul 2014 21:38:16 GMT

Maybe I'm not reading it right, but has she given any detail as to exactly why she wants an apology?

Re: Advice about PTS gone sour :(

Ashley Rubens — Thu, 24 Jul 2014 21:31:24 GMT

Sounds like a difficult situation, and I cannot see that you have done anything wrong, or different to what I would have done. Euthanasia is often a difficult situation with lots of misplaced emotions from clients, especially if they're seeing an unfamiliar vet. I can see the benefit in a carefully phrased letter sympathising for how she feels, explaining how every euthanasia can be different and a very carefully phrased "sorry that she feels things have gone badly" without actually saying that anything went badly (VDS are very good at writing these pseudo apologies). I agree you're only writing the letter from a business point of view, not because it's justified! I hope the senior partner has recognised the situation too Good luck!