Informed Consent

Re: Informed Consent

Evelyn Barbour-Hill — Sat, 30 May 2015 00:44:20 GMT

[quote user="J G Wray"]

Ref GBS he was always a bit wobbly about medical stuff

"We have not lost faith, but we have transferred it from God to the medical profession. "

[/quote]

That from a man who always wore Jaeger underwear for his health..

Re: Informed Consent

J G Wray — Fri, 29 May 2015 16:45:10 GMT

[quote user="Evelyn Barbour-Hill"]

Oh come, Mr. Wray.

"The professions are a conspiracy against the public". From The Doctor's Dilemma. Which I always have thought was a stupid play, because I can just not see that there was any dilemma.

[/quote]

Full marks for quick thinking. I agree with you about there not being a dilemma about the veterinary profession particularly as we are bathing in the glory of a 94% public trust measurement, 78% satisfied or more with our services and 70% who believe our fees are fair or more than fair value. However, I'm not sure the profession is all that good at claiming all this for themselves.

On the subject of fees, there are those who write:

"..But it is also clear that there is more to be done in relation to public perceptions of value for money. ..."

No prizes for guessing that this comes from someone who has never set a fee in their life or for that matter been asked to justify fees. They need for there to be a conspiracy against the public by the profession in order to justify their existence, a neat paranoia without evidence.

Ref GBS he was always a bit wobbly about medical stuff

"We have not lost faith, but we have transferred it from God to the medical profession. "

Re: Informed Consent

Evelyn Barbour-Hill — Fri, 29 May 2015 16:28:10 GMT

[quote user="J G Wray"]

[quote user="Evelyn Barbour-Hill"]Unfortunately some people (none of them my clients) take the view of that silly old lecher George Bernard Shaw.[/quote]

This could be so many things, but I favour

"Those that can,do. Those that can't, teach. Those that can't teach, administrate/go into Government service.."

[/quote]Oh come, Mr. Wray.

"The professions are a conspiracy against the public". From The Doctor's Dilemma. Which I always have thought was a stupid play, because I can just not see that there was any dilemma.

Re: Informed Consent

Bob Russell — Fri, 29 May 2015 12:51:36 GMT

99.9% of the time clients are happy to trust the vet to use medicines appropriately for the species and condition being treated. 0.1% of the time there are problems.

I still believe "any concerns, ring me" covers it nicely. Common sense and VDS cover the 0.1% IMO.

Re: Informed Consent

Anthony Todd — Fri, 29 May 2015 12:39:21 GMT

[quote user="Robin Grimmer"]Actually it's the opposite. Informed consent protects the vets as if there are any complaints we can demonstrate that the risks were discussed and the client was fully informed. [/quote]

Yes, sort of, but are we serving our clients and their patients best by having to state or write "licensed for cats not crocodiles"

So it's the printed disclaimer , 'cos you'll forget one of the caveats for sure, which, sure as eggs, alarms the client [see "causes cancer" post] and actually helps no-one!

There must be a more sensible way.

Why can't everyone just rely on the training, diligence and competence of a qualified vet to use the best drug in the circumstances, or do we need to inform our clients that coffee is hot!

Since vets began vets and clients were happy without all this ass covering, no animal was harmed, no client concerned unnecessarily, problems explained with a phone call, everyone seemed happy.

"Any concerns, ring me" covered it nicely for all the dinovets I know, why not now?

Re: Informed Consent

Bob Russell — Fri, 29 May 2015 12:32:40 GMT

[quote user="J G Wray"]

This is a moot point. Over the next couple of years you will see two significant changes in regulation, re accreditation and a change to outcome focused regulation. Under outcome focused regulation the onus changes and paper trails become traps not shields. It ain't gonna stay as it is now.

[/quote]

Tells us more!

The RCVS has no mechanism for re-accreditation of vets that I know of. I await outcome focused regulation with interest!

Re: Informed Consent

J G Wray — Fri, 29 May 2015 11:45:14 GMT

Re: Informed Consent

Robin Grimmer — Fri, 29 May 2015 11:31:35 GMT

[quote user="Anthony Todd"]

[quote user="J G Wray"]Other endings [/quote]

After all the posts isn't it obvious that informed consent is a catch all to catch us vets out.?

[/quote]

Actually it's the opposite. Informed consent protects the vets as if there are any complaints we can demonstrate that the risks were discussed and the client was fully informed.

Re: Informed Consent

Anthony Todd — Fri, 29 May 2015 10:56:09 GMT

[quote user="J G Wray"]Other endings [/quote]

After all the posts isn't it obvious that informed consent is a catch all to catch us vets out.?

Can't the powers that be take what we've all said and make "informed consent" reasonable and sensible?

After all the RCVS councillors do say they read the forums and this trap for members comes up again and again....

Re: Informed Consent

J G Wray — Fri, 29 May 2015 07:26:40 GMT

[quote user="Evelyn Barbour-Hill"]Unfortunately some people (none of them my clients) take the view of that silly old lecher George Bernard Shaw.[/quote]

This could be so many things, but I favour

"Those that can,do. Those that can't, teach. Those that can't teach, administrate/go into Government service.." although I'm not sure that last bit's a correct quote from Man and Superman, more something that's been added later. There's plenty of examples of this of course and the quote as it stands might fit those who spend decades at RCVS for instance, instead of being vets or solicitors or barristers.

Other endings might include

"...Those that can't teach (or do), go in to referral practice/practice management/business coaching..."

All credit to the Man from Bangor for bringing the subject up.

Re: Informed Consent

Evelyn Barbour-Hill — Thu, 28 May 2015 23:27:35 GMT

All I can add to Mr. Todd's excellent posts is that whenever I am obliged to inform a client that the medicine I am using is "not licensed" I also try to explain what the "licensing" system actually means!

Mostly I suspect they don't take too much of it in. They trust me as a professional. That's why the professions exist.

Unfortunately some people (none of them my clients) take the view of that silly old lecher George Bernard Shaw.

Re: Informed Consent

Anthony Todd — Thu, 28 May 2015 18:00:34 GMT

[quote user="Bob Russell"]Why is it licensed only in cats?[/quote]

Ohhh, 'cos it's sooooo dangerous in other "unlicensed" species.

Actually the manufactured would have made the choice on purely commercial grounds!

It'll never get a licence for crocodiles!

Re: Informed Consent

Bob Russell — Thu, 28 May 2015 17:44:44 GMT

[quote user="Anthony Todd"]

[quote user="Bob Russell"]

Perhaps we should just replace the term 'informed consent' with 'good communication' and be done with the subject!

[/quote]

+1 in spades, but it won't satisfy the lawyers or the pedants and the clients and patients will suffer [see post from Luca re licensed in cats only!]

[/quote]

A consent form is just a hard copy of good communication IMO. Nothing will satisfy the lawyers, pendants and ratbags. That is why we have VDS and that is why they are so often able to give us gentle but comforting support when claims appear out of nowhere.

A product licensed in cats but used in a dog needs to be explained to an owner. Why is it licensed only in cats? Why can it be used in dogs with only minimal risk? Good communication preferably in writing!

Re: Informed Consent

Anthony Todd — Thu, 28 May 2015 17:43:13 GMT

[quote user="Robin Grimmer"]Yes, but you can't just ignore the data sheets.[/quote]

Of course, and I didn't ever, but neither did I or anyone of my generation need to say or broadcast the possible side effects of chronic misuse, but as Bob says, good communication is key....

Sorry, Ovarid was really really badly promoted, chronically overdosed and over used.

Re: Informed Consent

Luca Poddighe — Thu, 28 May 2015 17:40:22 GMT

[quote user="Martin Atkinson"]

To be fair Luca, this dog is probably also atopic and predisposed to Malassezia infection. Washing it regularly with Malaseb and using other treatment to control its atopy is a far more practical long-term strategy than a one-off course of itraconazole with far less risk of side effects. I would question the judgement of the referral dermatologist personally and this is one occasion (maybe the only one in history) where the client was right!!

I await brickbats for such presumptive arrogance.

[/quote]

Martin, I would answer with a yes and not... Long term strategy up to that moment had been Malaseb associated with Cephalexin and preds to treat secondary bacterial irruptions and mitigate pruritus. Owner had rejected/stopped in past immunotherapy and Atopica. Unfortunately at some point my patient stop to respond even for short term to the therapy I was following and the owner wasn't happy with it. This was the reason for the referral and offered a different treatment.

Again without any significant explanation my patient has started to improve again, on the same therapy, with the only insertion of EFA supplement, that by itself shouldn't really improve the outcome. I'm sorry to not have explained the situation in the original post but I only wanted to put in evidence that the client was fairly happy to go ahead with the treatment until I mentioned the two magic words 'off-licence' and 'consent form'.

Re: Informed Consent

Anthony Todd — Thu, 28 May 2015 17:36:27 GMT

[quote user="Bob Russell"]

Perhaps we should just replace the term 'informed consent' with 'good communication' and be done with the subject!

[/quote]

+1 in spades, but it won't satisfy the lawyers or the pedants and the clients and patients will suffer [see post from Luca re "licensed in cats"only!]

Re: Informed Consent

Anthony Todd — Thu, 28 May 2015 17:34:08 GMT

[quote user="Martin Atkinson"]I await brickbats for such presumptive arrogance.[/quote]

Well not the expected and usual arrogance, more just not paying attention, although the quick tutorial on allergic skin disease could be useful for some.

Poor old maligned Luca was diligently explaining the duty of informed consent which requires the mention that the drug, although superior, is only licensed for cats and the patient was a dog and therefore different.

[sigh] Uncle Clive told me you were quite smart and could be quite a good vet, given time and training.

Re: Informed Consent

Bob Russell — Thu, 28 May 2015 17:33:07 GMT

Perhaps we should just replace the term 'informed consent' with 'good communication' and be done with the subject!

Re: Informed Consent

Robin Grimmer — Thu, 28 May 2015 17:29:26 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]And your point is what exactly? As a veterinary surgeon, you should have a good working knowledge of the data sheet anyway. Much of what is listed is common to all corticosteroids. It doesn't mean you have to discuss all this with the client, but you the vet should be aware of the contra indications before prescribing.[/quote]

Sorry Robin I thought it had been sort of covered.

My point is, and it's been alluded to in many of the posts, is, while the vet should and almost always will, have a good working knowledge of the data sheet anyway, the state of play now is that the vet is required to impart all the caveats and possible side effects to an [uncomprehending] owner.

Depomed is a good example as the side effects, although, not usually serious are many and various.

To go through them with an owner is time consuming and often a waste of time for all sorts of reasons which I and others have already mentioned.

The BSAVA advice may be better, but it's difficult to explain osteoporosis, for example, a possible side effect of Depomed quickly and easily.

I shudder to think how one would get on trying to cover oneself when talking about a general anaesthetic!

Although the USA 1975 way was just OK then I doubt if it OK now and unless you practising vets now suggest a simpler way it's going to get more and more ridiculous and you'll have to hand out a double sided sheet of A4 every time you give anything to an animal.

[/quote]

Yes, but you can't just ignore the data sheets. For instance, I agree a one off injection of DMV to a cat with miliary dermatitis as unlikely to do it anything but good. However, if it keeps coming in for frequent injections I would be worried about inducing diabetes and would advise the owner accordingly. I have seen this happen. BTW- I don't know why I was red starred in asking for a reply, but I know it wasn't you!

Re: Informed Consent

Anthony Todd — Thu, 28 May 2015 17:21:20 GMT

PS the red star wasn't me and I have.

Re: Informed Consent

Martin Atkinson — Thu, 28 May 2015 17:20:52 GMT

[quote user="Luca Poddighe"] I had recently a case of malassezia overpopulation, being a English Setter he was as well over sensitive to it, that I've tried to convince the owner to use Itrafungol as suggested by a local dermatology referral center.[/quote]To be fair Luca, this dog is probably also atopic and predisposed to Malassezia infection. Washing it regularly with Malaseb and using other treatment to control its atopy is a far more practical long-term strategy than a one-off course of itraconazole with far less risk of side effects. I would question the judgement of the referral dermatologist personally and this is one occasion (maybe the only one in history) where the client was right!!

I await brickbats for such presumptive arrogance.

Re: Informed Consent

Anthony Todd — Thu, 28 May 2015 17:17:57 GMT

Sorry Robin I thought it had been sort of covered.

Depomed is a good example as the side effects, although, not usually serious are many and various.

To go through them with an owner is time consuming and often a waste of time for all sorts of reasons which I and others have already mentioned.

The BSAVA advice may be better, but it's difficult to explain osteoporosis, for example, a possible side effect of Depomed quickly and easily.

I shudder to think how one would get on trying to cover oneself when talking about a general anaesthetic!

Re: Informed Consent

Robin Grimmer — Thu, 28 May 2015 16:53:54 GMT

Anthony, care to reply to my post above?

Re: Informed Consent

Anthony Todd — Thu, 28 May 2015 16:43:37 GMT

"Informed consent" 1975 USA style. [verbatim]

A very switched-on tech. at Penn Uni took her sick cat to the local vet ,who prepared an injection, after a cursory exam.

"What's that?" she enquired.

"It's med-e-cin" he said.

"Yeah, but what for?" she enquired again.

"To make the cat better" the vet replied ,slowly and distinctly, obviously dealing with someone who was needy of explanations.

Adequate in 2015?

Re: Informed Consent

Anthony Todd — Thu, 28 May 2015 16:42:28 GMT

"Informed consent" 1975 USA style. [verbatim]

A very switched-on tech. at Penn Uni took her sick cat to the local vet ,who prepared an injection, after a cursory exam.

"What's that?" she enquired.

"It's med-e-cin" he said.

"Yeah, but what for?" she enquired again.

"To make the cat better" the vet replied ,slowly and distinctly, obviously dealing with someone who was needy of explanations.

Adequate in 2015?