Talking about mistakes

Re: Talking about mistakes

Thomas Johnson — Sat, 23 May 2015 12:01:30 GMT

[quote user="Martin Atkinson"]

[quote user="Thomas Johnson"]

Does anyone know if you can buy wormers for children over the counter at a pharmacy?

[/quote]Sounds like a leading question! When my children got threadworm from school the whole family had to be treated.I took one Telmin KH tablet which cost me a few pence, Mrs A went and bought the equivalent from the pharmacy and it cost her several pounds. Of course I couldn't encourage such illegal behaviour in others Thomas.

[/quote]

Not a leading question, I don't have any children! I was just wondering if a doctor would expect worming treatments to be available over the counter based on their experience of human medicine.

Re: Talking about mistakes

Martin Atkinson — Sat, 23 May 2015 10:36:30 GMT

[quote user="Thomas Johnson"]

Does anyone know if you can buy wormers for children over the counter at a pharmacy?

Re: Talking about mistakes

Hannah Wynne Richards — Sat, 23 May 2015 08:55:30 GMT

Milbemax - once weekly for 4 weeks, 4 weeks off, give single dose. Restart regime 4 weeks later (that should really be 3 weeks) That effectively clobbers everything.

Wynne

Re: Talking about mistakes

tess — Sat, 23 May 2015 08:00:33 GMT

[quote user="Thomas Johnson"]

Does anyone know if you can buy wormers for children over the counter at a pharmacy?

[/quote]

Yes, it's mebendazole (Ovex)

Re: Talking about mistakes

Robin Grimmer — Fri, 22 May 2015 19:50:26 GMT

Ok, I apologise Wynne.

But how effective is Milbemax for lungworm? As I understood it was only for prevention if given monthly?

Re: Talking about mistakes

Hannah Wynne Richards — Fri, 22 May 2015 19:20:51 GMT

Thanks Martin

Wynne

Re: Talking about mistakes

Hannah Wynne Richards — Fri, 22 May 2015 19:19:52 GMT

I couldn't have given him Drontal - because I don't stock it in the first place. It doesn't touch angiostrongylus, so I consider it useless in this area.

Wynne

Re: Talking about mistakes

Martin Atkinson — Fri, 22 May 2015 19:14:59 GMT

[quote user="Robin Grimmer"]No, I wasn't being tongue in cheek, it was because Wynne was getting on her high horse about prescribing wormers and was actually incorrect. [/quote]Unnecessary Robin. And if Wynne is like me she doesn't stock Drontal - why should I promote a product someone can just go and buy at a shop for far less. I only stock Milbemax.

Re: Talking about mistakes

Robin Grimmer — Fri, 22 May 2015 18:09:51 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"]Not all wormers are POM. You could have given him Drontal.[/quote]I trust that was a tongue in cheek reply Robin.

I've told you all about this one before but for the benefit of those who haven't heard it: Another GP client whose dogs was on NSAIDs she chose to source herself to save money, kept giving them even when it got severe HGE then phoned up to ask how she could tell if a dog was dead. I went round a little later and it was lying a pool of bloody diarrhoea, cold, stiff as a aboard and covered in maggots. You couldn't make it up could you?!

[/quote]

No, I wasn't being tongue in cheek, it was because Wynne was getting on her high horse about prescribing wormers and was actually incorrect. (Leaving aside the ignorance of the doctors and that in this case it did need seeing - but that's beside the point.)

Re: Talking about mistakes

ruths — Fri, 22 May 2015 18:08:22 GMT

I honestly had a GP ask if cats have bones in their legs

Re: Talking about mistakes

Martin Atkinson — Fri, 22 May 2015 17:17:21 GMT

[quote user="Robin Grimmer"]Not all wormers are POM. You could have given him Drontal.[/quote]I trust that was a tongue in cheek reply Robin.

Re: Talking about mistakes

Thomas Johnson — Fri, 22 May 2015 17:12:40 GMT

[quote user="Hannah Wynne Richards"]

I've had a medical cosultant, who was married to another medical consultant just appear in the surgery asking for wormer for a dog which hadn't been seen in years. First conclusion - stupid dolt was totally ignorant of dispensing laws.

I (after pointing out that my livelihood would be at risk if I just complied with his request) asked why he wanted wormer now. His reply "The dog was losing weight" Second conclusion, stupid dolt was totally ignorant of the whole range of diseases which could cause weight loss. His speciality was in the medical field!

Anyway, I insisted on seeing the dog - it was diabetic!

Wynne

[/quote]

You were obviously right to recommend they bring the dog in for an appointment, I would have done the same, but you could have sold them a Drontal. Does anyone know if you can buy wormers for children over the counter at a pharmacy?

I am often surprised that doctors don't seem to be able to transfer their knowledge of human medicine to their pets. I wonder if it's because of the way they are taught, totally focused on one species, compared to the way vets are taught, comparative medicine across several species.

Re: Talking about mistakes

Robin Grimmer — Fri, 22 May 2015 16:41:15 GMT

[quote user="Hannah Wynne Richards"]

I (after pointing out that my livelihood would be at risk if I just complied with his request) asked why he wanted wormer now.

[/quote]

Not all wormers are POM. You could have given him Drontal.

Re: Talking about mistakes

Hannah Wynne Richards — Fri, 22 May 2015 16:37:20 GMT

Anyway, I insisted on seeing the dog - it was diabetic!

Wynne

Re: Talking about mistakes

ruths — Fri, 22 May 2015 14:41:12 GMT

[quote user="Francisco Gomez"]

And this part got to me: “So that others may learn, and even more may live.” All of the medical staff involved in Elaine’s operation are back at work. That, says Bromiley, is exactly what he wanted, because they will be better clinicians for their experience, and advocates for the cause."

Maintaining leadership and hierarchy but asking your team questions when you don't have the answer, encouraing the members of your team to speak up is something I have learnt through experience, but It would've helped me knowing this article (thank you ruths) earlier in my career, so I didn't have to get to that conclusion by myself.

In a way this mixes with two other threads:

- What to call lay staff A better differentiation between QVNs and lay staff would help to a better solution to avoid fatal mistakes. Unless you trained your own lay nurse, How are you supposed to know what they can or can't do? I mean in reality, not legally.

- Vet Futures The current regulation of our profession relies heavily in blaming the professional in charge of the mistake, instead of acknowledging that the practice itself and what facilities are at the vet surgeon's disposal play an important part when something goes wrong.

[/quote]

Franciso- I wondered if anyone would be put off by it being the New Statesman -))

Re: Talking about mistakes

ruths — Fri, 22 May 2015 14:39:20 GMT

Aren't nurses now professonally accountable?

The way I think about all of this is that I work in a team.

I take responsibility overall for the clinical aspects of a case and will ask others to do things with an animal (im sorry - that sounds odd but I avoided the word 'procedure') as long as those things are within their capability and jurisdiction.

Eg I'm happy to ask nurses to put int I'v lins and set up drips etc and anaesthetise animals if they are properly trained and are allowed to do these things by law. In the same way, I wouldn't walk off and leave a junior colleague with little experience to do a gastirc torsion or a linear foreign body, or a multiple trauma case.We make professional decisions about delegating and working in a team on a daily basis.

Having done some troubleshooting when anaesthetics go wrong in my last two practices (cert VA)- I would absolutley listen to anyone, whoever they are, if they said they thought somethign was wrong. It's not just vets who are observant- the work experiecne , a trainee nurse or vet, a senior nurse, the receptionist- i don't care who says if they think somethign is wrong. It's my job to filter that information and decide what to do with it...

I hope that isn't rambling.

Working in a team and having repsect for everyone's voice is essential IMO. the more senior/experienced you are, the more responsibility you have to act on the information.

Re: Talking about mistakes

Martin Atkinson — Fri, 22 May 2015 13:55:39 GMT

[quote user="Hannah Wynne Richards"]Given that GPs can refer anyone they're doubtful about to a consultant - whilst we can only do so if the owners are willing to allow us, then I'd say we often have the more challenging decisions to make.[/quote] A GP friend of ours whose dogs are my patients (when he can be bothered to get them treated!) commenting to a mutual friend on my very modest fees is on record of saying that he can't understand how vets earn so much when he has to make several life changing decisions every day. Thus he was at once suggesting I earned more than him by making the common clients error of assuming that all of that fee goes into my pocket and that I don't have to make life changing decisions about my patients including his dogs, one of which went into severe CHF before he sought attention and one with a digital melanoma for which he declined chemotherapy even though the dog is insured and he's minted anyway. You'd think an intelligent person would know better but clearly not.

Re: Talking about mistakes

Hannah Wynne Richards — Fri, 22 May 2015 13:39:36 GMT

Given that GPs can refer anyone they're doubtful about to a consultant - whilst we can only do so if the owners are willing to allow us, then I'd say we often have the more challenging decisions to make.

Wynne

Re: Talking about mistakes

Martin Atkinson — Fri, 22 May 2015 13:39:16 GMT

[quote user="Richard Carter"]The nurses who can do a considerable amount of clinical work (drips, ICU, GAs, medication etc) don't earn this because they don't make these decisions.[/quote] Nurses don't earn as much as vets because the vets are bosses and most are tight arses when if comes to paying, they pay the market rate because they can get a way with it!

[quote user="Francisco Gomez"]I can't see why a nurse can't earn more than a vet if they make the money to justify it,[/quote]But they don't generate the income - the vets do and the nurses, even if they are running clinics and performing less clinical procedures which allow the vet to do other work, would not have anything to do if that work was not generated by the vets in the first place.

Re: Talking about mistakes

Francisco Gomez — Fri, 22 May 2015 13:25:02 GMT

[quote user="Richard Carter"]

The title and the salary you can command is precisely because you will be making life threatening decisions and sometimes you won't get it right. The nurses who can do a considerable amount of clinical work (drips, ICU, GAs, medication etc) don't earn this because they don't make these decisions.

[/quote]

Would you say then than it is justified that a GP should earn more than a vet surgeon solely because they make more important decisions than we do?

The way I see it (happy to be corrected) is that you earn more based on your reliability, versatility, your specialisation and how much/well you can transform the salary you're paid into income. I can't see why a nurse can't earn more than a vet if they make the money to justify it, and this nurse would still be making less life threatening decisions that a vet would do.

I would agree, however, that being reliable could be defined as being able to make those decisions that you're referring to.

Re: Talking about mistakes

Francisco Gomez — Fri, 22 May 2015 13:15:58 GMT

[quote user="Martin Atkinson"]

The difference is more I'm talking from an employer's perspective [/quote]

I think you're right

Re: Talking about mistakes

Richard Carter — Fri, 22 May 2015 12:22:08 GMT

[quote user="Francisco Gomez"]Not sure if the post is directed to me.[/quote] not at all - just an observation about bigger organisations with lots of staff - the ducking and diving to avoid taking on any responsibility seems to get worse the more rules and staff members there are. The continuity with the patient breaks down and there is no 'ownership' of the case.

Re: Talking about mistakes

Martin Atkinson — Fri, 22 May 2015 11:50:49 GMT

[quote user="Francisco Gomez"]

[quote user="Martin Atkinson"]

I don't quite see an issue here Francisco.

[/quote]

Well Martin, I think the difference is that you work solo. From my point of view, I've been employed and locumed in several practices,

[/quote]The difference is more I'm talking from an employer's perspective and you are now explaining from an employee's. I assumed rightly or wrongly you were an employer.

Re: Talking about mistakes

Francisco Gomez — Fri, 22 May 2015 11:31:37 GMT

[quote user="Richard Carter"]

The more rules, the more institutionalised the attitude of the staff - they then avoid taking personal responsibility when they might need a judgement call to adapt / question or even go against the rules. The other approach if the best equipment isn't there, it is easier to blame your tools than work a solution - because that is of course someone else's problem and it is coming to the end of my shift and then I'm out of here.

Think problems in NHS reserved to the NHS?

[/quote]

Not sure if the post is directed to me. But if it is. Have you read the article? I'm not sure you understand what I'm saying, or maybe I'm not explaining it well enough.

Human mistakes shouldn't happen but they will happen. Not talking here about clinical ones, but about how to minimise human ones.

I honestly don't buy this:

[quote]

Yes everyone makes mistakes - every day to be honest, the best you can hope for is that they will not be serious and try do better next time. This is part of life.

[/quote]

... and it's got bugger-all to do with how much a vet surgeon earns.

Re: Talking about mistakes

ruths — Fri, 22 May 2015 11:27:00 GMT

[quote user="Anthony Todd"]

Come on, at least criticise rather than the unsubstantiated red star.

Do read about the controversy surrounding that approach in the aviation industry and the disasters that are believed to be associated with it.

And I've seen, first hand, the results of monitoring the heartbeat instead of respiration.

[/quote]

Will hvae a look at the criticisms of the airline approach- I do know that there's an issue with people nt taking personal responsibility to say something if they see womthing they think is wrong. Mostly the more junior staff feel unable to flag something up to the senior staff...

I suggest you moniter both and keep written records so you can see any changes. Then you cna pre-empt the problems (fingers crossed)