My colleague is trying to blame his clinical mistake on me! Help!

Re: My colleague is trying to blame his clinical mistake on me! Help!

Gillian Mostyn — Mon, 29 Dec 2014 21:33:05 GMT

[quote user="An On MRCVS"] I haven't actually seen my colleague for a few days with it being Christmas etc,[/quote]

And there lies the problem. Clients are happy to lie when it suits...make sure their account of events, and of what has been said and done, is actually accurate!

Re: My colleague is trying to blame his clinical mistake on me! Help!

An On MRCVS — Mon, 29 Dec 2014 19:29:40 GMT

Yes indeed, colleague :)

Re: My colleague is trying to blame his clinical mistake on me! Help!

An On MRCVS — Mon, 29 Dec 2014 19:28:52 GMT

Hi there, thanks for all your support and comments! In my mind I know I've done nothing wrong but I'm quite an anxious person by nature so anything like this really plays on my mind and I lose sleep! Yeah i was unsure about the 'transition period' as I thought you would just have to switch, but there you go, that was just the advice I received from the specialist. I haven't actually seen my colleague for a few days with it being Christmas etc, but I will have to ensure if the issue does come up I am clear and polite in telling them if they have any oncerns over my supposed involvement, to just check my clinical notes-which believe me are more than comprehensive, I could smell trouble on these clients miles off!

Thanks again guys!

Re: My colleague is trying to blame his clinical mistake on me! Help!

Gillian Mostyn — Mon, 29 Dec 2014 16:47:23 GMT

Have you had an open and frank conversation with your colleague? I suspect the (unreasonable) client is trying to play you off against each other. Make sure you keep communicating with each other, and that neither of you discuss eachother's actions with the client. You may disagree with how the other vet has handled things, but beyond ensuring your notes are complete, I would stay out of it.

Re: My colleague is trying to blame his clinical mistake on me! Help!

Martin Atkinson — Mon, 29 Dec 2014 16:11:07 GMT

For once I'm in absolute agreement with David Mills, especially with the Lantus Glargine which is very difficult to overdose. How else are you going to change insulin unless it is sudden? OK maybe reducing the dose of the new one slightly to start, I'd have thought mixing them while you wean off would be fare more prone to decompensation.

No, I think you have a client with unreasonable expectations who isn't able/prepared to do their part and, along with your colleague, is trying some blame transfer behaviour to excuse himself.

I would not lose any sleep over this. There is always going to be some difficulty with a complicated case being seen by more than one vet (one reason to be sole charge!). You've done nothing wrong and I would either take over case yourself if you want to or leave your 'colleague' to stew in his own juice.

Re: My colleague is trying to blame his clinical mistake on me! Help!

Hannah Wynne Richards — Mon, 29 Dec 2014 10:37:28 GMT

Colleague????????????????

Wynne

Re: My colleague is trying to blame his clinical mistake on me! Help!

An On MRCVS — Sun, 28 Dec 2014 22:38:19 GMT

Elevated BUN in a patient presenting for DKA is hardly surprising and ceratinly not evidence of kidney disease (especially in the absence of pre-iv-fluid urine concentration measurement).

Otherwise I can but agree with the above and share a little anecdote (where I've changed just a few key identifying details):

Many years back, I saw my first diabetic cat. I was very proud of myself, but sensible enough to not try working out my first ever insulin dose in a hurry - so I sent them packing with a few urine dipsticks to "confirm" things and told them to come back in a week. They did, I was no more prepared, but realised I had to take the time to figure it out right. We had 40IU/ml insulin and 100IU/ml syringes (or was it the other way round?) and I treble-checked my calculations before explaining carefully to the owner what to do and demonstrating with water etc etc. I eventually wrapped up the remainder of the rather jam-packed consulting room that followed and went off to bed very tired. I woke up early the next morning to that infernal sound of my on-call phone, though I wasn't on call. It was my boss. In a country accent that won't come across well in type, he asked me if I'd seen a diabetic cat the evening before? I went white and simply said yes. He continued that some drunkards had bothered him in the middle of the night about their diabetic cat which was fitting, he arranged to see them and they were ranting about where was Fred and they needed to see him now. He calmed them by advising that Fred wasn't there and they were stuck with him, and in 15 years he had never diagnosed seen a diabetic cat so they would just have to be a bit more patient, before putting them out of the clinic altogether. He went on. After obtaining a blood sugar sample [*he paused for me to congratuulate him*] of 1.2mmol/L he figured that it had changed from diabetes mellitus to diabetes insipidus. He couldn't get a vein though to put on a drip, but managed to give some diazepam into a vein. I picked myself up to ask if he needed a hand. He replied that he was at home now. I asked about the whereabouts of the cat, which had apparently been left on the table at the clinic as it clearly wasn't going anywhere. I said I'd go take a look and physically ran to the clinic after discovering that my car had been boxed in. I found the cat as he described, in a rather catatonic state, placed a drip and gave iv glucose and barely left its side for the next 48hrs while I contemplated what a short career I'd had. I'd done my calculations wrong you see, and prescribed the cat 10 times the recommended dose of insulin; my mistake being compounded by the owners misinterpreting me and injecting the cat twice that evening. Anyway, after maintaining the blood glucose between 5 & 10 mmol/L for about 12 hours and the cat still just lying with the occasional groan, I thought hope was fading. Then a thought occurred to me and I rang my boss to ask how much diazepam he had given the night before. "A good vial" came back the response, "she was fitting bad you know"... pause... "was that too much you reckon?" After about 2 days, the cat happily regained consciousness and lived on until at least its 22nd birthday (according to it being claimed to be 21 years old when I first saw it).

Why share this story?

Well, both me and my boss-at-the-time are still practising, that may or may not be of any comfort, but at least you should know that having done nothing wrong clinically yourself and clearly being a competent and caring vet, you have nothing to fear on this one. Write down all you can recollect of your involvement in the case (you have probably already done that for the thread) and don't give it a further thought.

Re: My colleague is trying to blame his clinical mistake on me! Help!

David Mills — Sun, 28 Dec 2014 16:52:45 GMT

[quote user="An On MRCVS"]they advisedot to change the insulin even though it wasn't first line cascade material, and if the decision as to change then do so slowly over a long transition period.[/quote]

This is bad advice, if this is what was said. As Andrew says, I'm unsure what a 'long transition period' entails. Remember that this is opinion based medicine. I'm sure many on here have switched insulin instantly without any problems (I know I have from caninsulin to glargine for instance).

The cat sounds poorly controlled, and this may be due to the owners' refusal to listen. Alarm bells ring with things such as 'insist on taking home'. And yes, wholeheartedly agree with the client expectations - very much sound like 'cure my cat with one injection and minimal cost please'.

[quote user="An On MRCVS"]BUN to still be elevated, so much so that kidney issues are now a ddx on top of DKA[/quote]

What was creatinine doing? BUN is phenomenally non-specific for renal disease. It certainly has no place in staging renal disease. In fact, I no longer use it for investigating possible CRF.

Re: My colleague is trying to blame his clinical mistake on me! Help!

Andrew Kent — Sun, 28 Dec 2014 16:35:29 GMT

Hi Anon,

These cases are pretty complicated but it sounds like, as in most cases, the major issue is in client expectation. Changing insulin would always have the risk of destabilising the disease which was hopefully discussed with the owners. I am not sure which insulin the cat was on before but it sounds like it wasn't your decision to change it and so therefore not an awful lot to do with you.

I would also suspect your colleague has done nothing wrong either but perhaps has not handled the clients in the most appropriate way. Im not sure how you would gradually transition insulin - you can't really combine different types so adjustments tend to have to be abrupt.

As already advised I would make sure your clinical notes are complete for all of the dealings you had and otherwise try not to get involved. Perhaps speak to a partner for advice as it might be better for it to be handled by somebody not directly involved in the case.

As long as your notes are along the lines of your post then you have nothing to worry about.

Andy

Re: My colleague is trying to blame his clinical mistake on me! Help!

emma_j — Sun, 28 Dec 2014 16:23:05 GMT

How is your colleague trying to involve you?

I would review my clinical notes to ensure I recorded all this at the time. Otherwise I would stay out of it at this point, apart from making sure the practice manager was aware of the situation.