Exotic and something off my chest!

Re: Exotic and something off my chest!

Julian Earl — Wed, 04 Mar 2015 16:51:18 GMT

[quote user="Rob Davis"]

[quote user="Anthony Todd"]

These days if I, or the non-qualified non-specialist, should treat with or without a diagnosis, we would be liable to receive a claim for loss and sanctions from the DC for not referring it to a qualified expert immediately.

[/quote]

Tosh! (sorry, couldn't resist it )

As long as you are honest with the owner about your knowledge and skills, and have discussed other options including referral if appropriate, then there is no position to defend. You are more likely to get into trouble with the DC if you refuse to see it. Offering more appropriate alternatives would be absolutely reasonable, but absolute refusal to see it would not.

[/quote]

Blimey, do people not read what I have said? I am not critical of someone for not over-stepping their knowledge and abilities! am critical that someone apparently did not recognise a head tilt etc. in a young animal as being potentially serious and thendoing something helpful such as seeing the animal, before contacting a specialist for advice or referral. To me it was blatantly clear the creature needed help and steps should have been taken. Okay? Clearer? As before: "ENOUGH! ALREADY! please? "I agree, not seeing it at all was a worse crime than seeking help.

Re: Exotic and something off my chest!

Rob Davis — Wed, 04 Mar 2015 14:28:31 GMT

[quote user="Anthony Todd"]

[/quote]

Tosh! (sorry, couldn't resist it )

Re: Exotic and something off my chest!

Julian Earl — Wed, 04 Mar 2015 11:27:40 GMT

Thanks Catherine for a very reasonable reply. As I said before, I have never suggested anyone exceeds their ability, but whatever was said, a reptile was left with nowhere to go and I think that is a poor show. There could have been all sorts of practical issues: transport to a specialist, cost, out of hours and so on, but these were never addressed because the reptile wasn't seen and the owner was despairing when he spoke to me [that's how many of my clients feel I think! I do take your point about a new graduate, if indeed the case, that might not know of local referral people but one can ask colleagues or use the practice register perhaps? Okay thanks again but otherwise to all: Enough already!!

Re: Exotic and something off my chest!

CatherineThomas — Tue, 03 Mar 2015 20:43:32 GMT

I don't think the fact it was a reptile was an excuse, I think it was a very good reason not to see it.

Reptile pathology is often quite different to that of mammals and the differential diagnoses in a reptile with neurological symptoms would differ substantially from those of a dog or cat.

If a vet who knows nothing about reptiles sees this patient as an out of hours emergency what would they be able to do for it? If you haven't spent a reasonable amount of time researching the ins and outs of reptile husbandry you probably wont pick up the minor deficiencies in husbandry which could lead to problems. Often clinical examination alone wont give many clues and further investigations such as blood samples and faecal samples would be required to get a diagnosis. I wouldn't expect a new graduate with no experience of reptiles to be able to get a blood sample from a lizard.

So if this vet had seen the lizard they would have charged the client probably £100 or more for an out of hours consult and might not be any closer to actually doing anything for the animal. They could probably prescribe a course of baytril - but there's a pretty good chance the cause is not bacterial. That £100 would be better going towards investigation when the reptile is seen by someone who has an idea of what to do. I'm not saying that has to be a specialist but a vet who has an interest in reptile medicine.

It's pretty easy to find details of reptile vets on-line, there's many websites with listings or a simple google search might bring up details. If the vet is a new graduate there's a good chance that he or she doesn't know the local practices well as hasn't been there long and the client is more likely to know the area and determine how far away the practices are which come up in these searches. I think it would be reasonable to suggest to the client that they use the internet to find the nearest reptile vet and if they can't then call back.

If there is no one else available and the animal obviously needs to be euthanased then that is a different matter and any vet should be able to offer that in an emergency. but it doesn't sound like that is the case here.

Re: Exotic and something off my chest!

Julian Earl — Tue, 03 Mar 2015 17:49:29 GMT

[quote user="Anthony Todd"]

[quote user="Julian Earl"]the fact it was a reptile as the excuse to not see the animal[/quote]

OK, so the non-specialist, non-qualified vet agrees to see the reptile and offers an opinion, and even treatment, but the reptile dies.

Back in the day this is what I would have done or probably suggested referral, client probably happy with either option.

This may well be applied to any "non-expert" vet in any field in this day and age, so clients will be referred more and more for less and less.

All that modvets will need in the future is the ability to take blood and other non-invasive diagnostic procedure, type into a referral template letter, then decide to which specialist branch of veterinary medicine the creature should be referred.

Anthony, I think you might: [/quote] have missed my point as well The vet seems to have used the fact it was a reptile as the excuse to not see the animal.r[according to what the owner said to me. rather than investigating the issue for referral or self-research. I have not criticised anyone for not over-stepping their abilities but feel any vet should recognise a head tilt etc. . as potentially serious and have offered some sort of advice, which did not happen because the chap was obliged to ring someone too far away to get to easily, and he was left stranded with a possibly dying pet. Yes, I have repeatedly acknowledged I don't know what was said specifically, but the outcome was clear, a client still looking for help for his ailing reptile. If the vet had seen the reptile it is easy to then explain one is not a specialist, but that these are available or else by using one's own resources might provide a solution. I don't really want to argue about the non-specialist aspect, but basic pathology tells us this reptile was in trouble and I believe the vet should have pursued some sort of attention even if the immediate referral to an exotics vet was required; but not apparently do-nothing

Re: Exotic and something off my chest!

Gerry Henry — Tue, 03 Mar 2015 14:08:10 GMT

Unless you are in the room or have listened to the recording, with the greatest of respect, you don't have a clue what was said - and you shouldn't go off on one on the basis of hearsay. I personally loathe reptiles (grass snakes excepted) I have no interest in them, nor their multiply pierced , tattooed, nose ringed owners, furthermore I have no desire to learn about them nor to cure their ailments.

Thank you.

Re: Exotic and something off my chest!

Cat Henstridge — Tue, 03 Mar 2015 12:44:58 GMT

[quote user="Julian Earl"]

I might be guilty of going off half-cocked as it were, because I don't know exactly what was said, but I suspect some people here are missing my point, that is, that assuming the message was truthful, the owner was clearly upset and felt he had been fobbed off. I have clearly not suggested anywhere that the vet should overstep his/her capability only that no suggestion of the nature of the problem potentially being serious was apparently offered, nor any offer to see the reptile prior to referral etc. Consequently the chap rang a vet thirty miles away for advice. As it happens he wasn't able to travel hat far to us for whatever reason, and therefore I told him to contact somebody local again otherwise his lizard might die. I was disappointed if a qualified vet could not see that a head tilt and circling [IIRC] indicted action should be taken for a probable serious disorder. . If one did see it as first-line step, then one can use books or the telephone or google etc., but certainly not just stand by. My point was my disappointment tha tit wasn't see as potentially serious, that is all, no matter how experienced the vet was.Again, dependent on the actual words not being known.

Apologies if being critical was unduly offensive?

HTH.

[/quote]

The problem is we don't know exactly what the original vet said but I can understand your frustration when faced with a distressed owner and a suffering animal, who felt that they had been 'fobbed off' from their first phone call.

However, I do think (and maybe I'm wrong) that you are being harsh when you expect any normal small animal vet to be able to have an idea of what to do with a head tilted and circling reptile. Sure, we would know it was serious, which to my mind is all the more reason to try to get it to a specialist, and maybe the first vet could have been more helpful in arranging this but I probably would have done my best not to see it.

In an ideal world I wouldn't mind learning more about exotics but from where I stand (a knowledge base of more or less zero), in order to be able to do anything useful for them and their owners I would have to learn a HUGE amount and, to be frank, I just don't have the time. Especially when I think about all the other things I need to learn about for the betterment of my treatments of my usual patients!

Re: Exotic and something off my chest!

Anthony Todd — Tue, 03 Mar 2015 09:48:34 GMT

[quote user="Julian Earl"]the fact it was a reptile as the excuse to not see the animal[/quote]

OK, so the non-specialist, non-qualified vet agrees to see the reptile and offers an opinion, and even treatment, but the reptile dies.

Back in the day this is what I would have done or probably suggested referral, client probably happy with either option.

This may well be applied to any "non-expert" vet in any field in this day and age, so clients will be referred more and more for less and less.

Re: Exotic and something off my chest!

Martin Atkinson — Tue, 03 Mar 2015 09:29:05 GMT

[quote user="ChrisBVSc"]I disagree with keeping a lot of these species as pets in the first place (personal opinion - I'm not looking to start a debate!!) Obviously there's the argument that they're here already & our job is to ensure their welfare etc.. this is how I get through consults with ridiculous man made monster breeds like bulldogs!![/quote]We have chosen a profession in which with hindsight we are dealing with problems we'd rather not have to and given ideal circumstances would eliminate. This would get rid of 90%of our work (no exotics, no in-bred animals, no breeders, no un-neutered pets, no stupid clients). It is a strange irony that in our ideal world we would put ourselves out of a job.

Re: Exotic and something off my chest!

Julian Earl — Tue, 03 Mar 2015 09:21:49 GMT

[quote user="Mark Rowland"]

Ha Ive enjoyed reading this thread

It does highlight something to me which the college have tried to improve over the years. You can decide if they have succeeded or failed.

Its CPD

CPD stands for continuing professional development. To me this means study to comply with pet owning demographics as well as developing ones own interests. In fact I believe it should apply more to the former.

Lets say that in your town all of a sudden most of the owned pets were rabbits. That would motivate most practices if they want to compete.

But the truth is that exotic pet ownership and expectation is increasing meaning that the profession has to respond.

Haha it works both ways. I go to small animal CPD, I love my small animal surgery. It makes me a better exotic animal surgeon. Especially with orthopaedics.

I see the advice to seek an exotic vet as fair. I think all small animal vets should just accept that exotics are owned by their small animal clients as well and a bit of basic knowledge (or even just where to look for help) wouldn't hurt

[/quote]I'm glad someone has enjoyed the thread and it has gone in a direction that I did not expect. but to labour my point, It was not about exotics per se, and especially not the morality of keeping them... which needs another thread altogether... but about my disappointment that a qualified vet apparently [note this word!] could not see that a head tilt etc. ; based on basic physiological and pathological knowledge, suggested a dangerous brain lesion and apparently [again!] used the fact it was a reptile as the excuse to not see the animal.rather than investigating the issue for referral or self-research.

Okay?

Re: Exotic and something off my chest!

Gillian Mostyn — Mon, 02 Mar 2015 19:35:01 GMT

[quote user="ChrisBVSc"]I'm swayed too far the other way by the fact I disagree with keeping a lot of these species as pets in the first place [/quote]

I'm an 'exotics vet' and have the same problem. I am especially concerned about birds ... They shouldn't be in cages...

Re: Exotic and something off my chest!

ChrisBVSc — Mon, 02 Mar 2015 16:53:27 GMT

[quote user="Neil Wheadon"]

Interestingly there is an article in the Veterinary Business Journal this week about 'we should be looking at exotics as a new market' so welcome back Mark and please educate us!!

Neil

[/quote]This is a good point. My issue is whenever I think about this & whether exotics CPD would be a good idea so we could offer more, I'm swayed too far the other way by the fact I disagree with keeping a lot of these species as pets in the first place (personal opinion - I'm not looking to start a debate!!) Obviously there's the argument that they're here already & our job is to ensure their welfare etc.. this is how I get through consults with ridiculous man made monster breeds like bulldogs!!

Re: Exotic and something off my chest!

Martin Atkinson — Mon, 02 Mar 2015 10:37:42 GMT

How about this story for the damned if you do damned if you don't/nutty pet owner archive:

A good friend of mine, who is a (human) GP and a client was approached by a neighbour who asked if he knew a good vet. Of course he recommended me. The neighbour then asked if I saw reptiles. My friend answered that he wasn't sure but as I was sole charge and very experienced then I probably would. The neighbour then said,' I can't go to him then I don't like reptiles'. Good enough so far but it gets worse!

Friend replied that he expected the chances of there being one in the waiting room as the same time as her was low and he was sure if she made an appointment at an appropriate time such an unlikely meeting could be avoided. Neighbour then says, 'Oh no I couldn't go there anyway, if there was a chance he'd touched a reptile even several days ago I wouldn't want him to touch my dogs'!

You couldn't make it up.

Re: Exotic and something off my chest!

Arlo Guthrie — Mon, 02 Mar 2015 09:39:25 GMT

[quote user="Neil Wheadon"]

Maybe this could be another benefit of Vetsurgeon

A list of vets happy to see exotics, not necessarily with a post grad qualification. (and feathered creatures)

[/quote]

Already in the pipeline! (part of a new thing I'm going to have built for the site that I hope everyone is going to find really useful).

Still working behind the scenes on the site upgrade, then this is the next thing on the list.

Re: Exotic and something off my chest!

Neil Wheadon — Sun, 01 Mar 2015 22:03:07 GMT

Interestingly there is an article in the Veterinary Business Journal this week about 'we should be looking at exotics as a new market' so welcome back Mark and please educate us!!

Neil

Re: Exotic and something off my chest!

Mark Rowland — Sun, 01 Mar 2015 20:36:36 GMT

Ha Ive enjoyed reading this thread

It does highlight something to me which the college have tried to improve over the years. You can decide if they have succeeded or failed.

Its CPD

Lets say that in your town all of a sudden most of the owned pets were rabbits. That would motivate most practices if they want to compete.

But the truth is that exotic pet ownership and expectation is increasing meaning that the profession has to respond.

Haha it works both ways. I go to small animal CPD, I love my small animal surgery. It makes me a better exotic animal surgeon. Especially with orthopaedics.

Re: Exotic and something off my chest!

Julian Earl — Sun, 01 Mar 2015 19:23:25 GMT

[quote user="Cat Henstridge"]

Honestly, I think you are being pretty harsh.

Reptiles are totally different to the usual companion animals we see and I don't think it is at all unreasonable for a normal small animal vet to have very little idea about what might cause a head tilt. Sure, I could reel of a list of differentials from first principles but I wouldn't have a clue how to decide what it might be or treat it, and I don't think that is particularly unusual or unreasonable.

I would tell a client this and point them in the direction of a local exotics vet, and although I would see it if I had to (and madly google beforehand) I would be very reluctant to.

I work once a week in a practice that sees a lot of exotics and what this has mostly taught me is how incredibly different they, and the correct approach to history taking, diagnostics and treatment, really are!

[/quote]

Apologies if being critical was unduly offensive?

HTH.

Re: Exotic and something off my chest!

Hannah Wynne Richards — Sat, 28 Feb 2015 18:08:06 GMT

Mike Jessop's in Merthyr - not too far from Newport.

Wynne

Re: Exotic and something off my chest!

CatherineThomas — Sat, 28 Feb 2015 17:31:15 GMT

Lance Jepson and Sophie jenkins run Origin vets for exotics and I believe they visit several practices in Wales. They've got a website.

There's also Mike Jessop and Mark Evans both work in Wales, I don't know where they are in relation to Newport though.

Re: Exotic and something off my chest!

Neil Wheadon — Sat, 28 Feb 2015 17:17:04 GMT

[quote user="Hannah Wynne Richards"]

Neil - Lance Jepson at Fentons in Haverfordwest. He also does clinics at St James' Neath branch.

I'll tackle most species, (advantage of being a dinovet) but haven't a clue with reptiles.

Wynne

[/quote]

Thanks, very useful. I was very close to Newport, so that's a bit of a hike, any east of Swansea? for future reference as just over the bridge is as far as I'll go

Neil

Re: Exotic and something off my chest!

Hannah Wynne Richards — Sat, 28 Feb 2015 16:52:10 GMT

Neil - Lance Jepson at Fentons in Haverfordwest. He also does clinics at St James' Neath branch.

I'll tackle most species, (advantage of being a dinovet) but haven't a clue with reptiles.

Wynne

Re: Exotic and something off my chest!

Neil Wheadon — Sat, 28 Feb 2015 15:58:23 GMT

Maybe this could be another benefit of Vetsurgeon

A list of vets happy to see exotics, not necessarily with a post grad qualification. (and feathered creatures)

I was asked in South Wales this week, if I saw reptiles, I said no, and that far better to see a vet who would. The thing is I didn't know where to find the information and John Chitty in Andover was too far away (he's good)

Over to you Arlo

Neil

Re: Exotic and something off my chest!

Cat Henstridge — Sat, 28 Feb 2015 15:48:11 GMT

Honestly, I think you are being pretty harsh.

I would tell a client this and point them in the direction of a local exotics vet, and although I would see it if I had to (and madly google beforehand) I would be very reluctant to.

Re: Exotic and something off my chest!

Caroline Hewson (The Pet Loss Vet) — Fri, 27 Feb 2015 14:03:16 GMT

HI All,

I wonder if the original vet had been trained in client communication? I wasn't and only since learned--in theory and the hard way--how it's an evidence-based, learned skill, just like surgery. That is, for consistently good patient outcomes and peace of mind all round, both skills involve core basic knowledge (eg anatomy and psychosocial aspects, respectively) which we consciously learn to apply to individual cases.

As a locum, I've not found the vet literature as helpful "in the clinical trenches" as human medical literature. (The MDs say you're never done mastering it, we humans being such a very motley crew. Keeps me going when some client encounters still don't go as well as intended! ) But the Handbook of Vet Communication by Moffett & Gray is still a great addition.

Re: Exotic and something off my chest!

Virginia Campbell — Wed, 25 Feb 2015 17:48:11 GMT

[quote user="Julian Earl"]Some-times one has to learn as one goes along surely?[/quote]

Yes, and this includes the fine art of balancing gaining the client's trust in you whilst not giving them an unrealistic idea of your knowledge and experience.

I would have been in no better position to help this client now than when I was a new grad (vit A in case immune suppressed, check diet and environment, Baytril and hope for the best....I could have done that in week 1, couldn't do any better now- we do almost zero reptiles) but reckon I'm better at soothing troubled owners now. As a new grad I worried about everything different or difficult - I was achingly conscious of the fact that somebody else could do it better than me and I'm sure the owners knew this. Now I know that a lot of vets 12+ years qualified like me couldn't do any better in certain situations like this one; and I can reel off the names of those who work locally who could, even if they don't have a cert.

You can't really teach people how to have a soothing honey tongue, it just comes with experience.