Tangent: personal responsibility

RE: Tangent: personal responsibility

grumpyoldman — Mon, 14 Dec 2015 09:49:14 GMT

Sorry "Other Peoples Clients"

RE: Tangent: personal responsibility

Hannah Wynne Richards — Mon, 14 Dec 2015 08:42:52 GMT

What on earth are OPCs?

I hate MSPD

Wynne

RE: Tangent: personal responsibility

grumpyoldman — Sun, 13 Dec 2015 14:43:14 GMT

I hate dual registrations that get hooked up there on some crappy vaccine deal ,then drag me out of bed at 2am for a c/section. Some clients can behave like fickle gargoyles without vet practices actively encouraging it.

RE: Tangent: personal responsibility

grumpyoldman — Sun, 13 Dec 2015 14:37:22 GMT

[quote user="Neil Wheadon"]You can't do a lot, it's the clients choice[/quote]

We are caught between a rock and a hard place with that one, but they will wait until welfare is the overriding factor . I thought that the v4P model involved attracting OPCs on Sunday afternoons to retail parks etc without an OOH consult fee that would be charged at the usual practice on a Sunday afternoon ?. The V4P will close its doors at closing time and redirect them to VN, so they will then hop back to their old vets who are suddenly much more attractive after all . With all the records and clinical info all over the place .

RE: Tangent: personal responsibility

Utlendigur — Sun, 13 Dec 2015 13:47:57 GMT

[quote user="Neil Wheadon"]I'm doing a Sunday surgery in a Vets4Pets and have worked in quite a few on the W/E. All have a similar policy. The client calls and they are told that they need to switch registration if they want to be seen.[/quote]

Strangely not my experience of Vets4Pets. Had several clients on a w/e where they turned out to be clients at other vets, and this only emerged in the consult - reception didn't ask. One was an emergency with dyspnoea whose own vets provided their own (much nearer) OOH cover anyway, whereas if it had needed further monitoring I would have had to ship it off to a vetsnow much further away! I felt part of the issue with Vets4Pets is that a lot of people take their dog shopping, see the vet practice in-store, and treat it as a drop-in centre.

RE: Tangent: personal responsibility

Neil Wheadon — Sun, 13 Dec 2015 13:21:00 GMT

[quote user="grumpyoldman"]They would have driven past us to get to it. It happens most weekends , not sure what if anything you can do about it. [/quote]

You can't do a lot, it's the clients choice

I'm doing a Sunday surgery in a Vets4Pets and have worked in quite a few on the W/E. All have a similar policy. The client calls and they are told that they need to switch registration if they want to be seen. Lots of promises of oh yes we will. One lady this morning saw on the website that her surgery was closed, she had no idea of the 24/7 commitment and many clients don't. I have a dog that's had a fit coming in later. They use another vet. I have no history, so my inclination is to triage and simply call them myself and get it seen again if I feel that's necessary. In essence when a client digs their heals in we have no option do we?

Neil

RE: Tangent: personal responsibility

grumpyoldman — Sun, 13 Dec 2015 11:28:55 GMT

[quote user="Hannah Wynne Richards"] However one problem I have when clients of other practices phone me ooh, saying that their practices ooh service won't see them, is my past experience of Swansea Vets Now giving telephone advice to people who were desperate to be seen, means I genuinely don't know what to think. They may want to be seen, but are too polite to insist, or they may want to be seen, but not to pay an ooh fee![/quote]

I know what you mean , I had a VN refugee at 1am friday night , donor practice had seen it in the day with an unfolding abdominal catastrophe ,it had synulox and met cam . It was collapsed ,tachycardic,t39.8 , 200bpm, vomiting for 3d , 10% dehydration . Fast scan intra consult indicated free fluid ,possible mass in duodenum+ pancreatitis , So , I offered ,lactate ,tap and smear ,istat, fluids+/- ex lap and further better imaging when stable . But they only had the £98 OOH consult fee and were only there because VN had quoted £170 . So it was another OOH euth. I am not sure they were also offered a work up at the 1st vets in the day but had decided to see how it went. It went predictably badly. It was interesting that the other practice was slightly cheaper than us for routine things ,but far less well equipped.And avoided any overnight hospital cases.They would have driven past us to get to it. It happens most weekends , not sure what if anything you can do about it.

RE: Tangent: personal responsibility

Hannah Wynne Richards — Sun, 13 Dec 2015 10:03:50 GMT

I agree with you that punishments are far far too lenient - that's why I'd suggest cleamimg sewers for community service - and allowing everybody to reproduce certainly doesn't help matters. If we could just get out of the EU and get shot of the Criminal Rights Act, then flogging could be reintroduced for those people who ill-treat animals. The only "animal" I'd ever allow them to come in contact with in the future would be a nine-tailed cat!

However one problem I have when clients of other practices phone me ooh, saying that their practices ooh service won't see them, is my past experience of Swansea Vets Now giving telephone advice to people who were desperate to be seen, means I genuinely don't know what to think. They may want to be seen, but are too polite to insist, or they may want to be seen, but not to pay an ooh fee!

Wynne

RE: Tangent: personal responsibility

grumpyoldman — Sun, 13 Dec 2015 08:25:07 GMT

IME , bans get ignored or circumvented , a relative spouse WAG etc becomes the legal owner . Fines tend not to get paid because of a sob story. Wandering around a park litter picking is hardly the chain gang. Punishment, if your going to use it has to hurt ,this doesn't. Better to re-educate in the state education system ,with welfare and husbandry teaching woven into social and moral tuition. Basically replace what they are not getting at home anymore at school.

RE: Tangent: personal responsibility

Hannah Wynne Richards — Sat, 12 Dec 2015 15:18:41 GMT

Prosecuting them can lead to a lifetime ban from keeping animals, which will protect other animals.

Fines can be deducted from benefits at source.

Community service can be used as a punishment - although I'd prefer if they were made to do something really nasty - like cleaning sewers, not decorating old ladies' homes.

Wynne

RE: Tangent: personal responsibility

grumpyoldman — Sat, 12 Dec 2015 13:52:25 GMT

Its a pointless waste of time expecting people who are crap at every other aspect of life to suddenly become reasonable kind caring quality clients and responsible pet owners. Its also a waste of time prosecuting them ,because you can fine them as much as you like but most bailiffs will tell you its impossible to take a stocking of a bare leg.

RE: Tangent: personal responsibility

Hannah Wynne Richards — Fri, 11 Dec 2015 10:12:54 GMT

If the police actually performed their legal statutory duty, and investigated all crime, including offences against animals, I might see the point of taxation - as it is, I greatly resent money which I could use to further animal welfare being stolen to feed/clothe/house wastes of space. Grrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr

Wynne

RE: Tangent: personal responsibility

Clive Ansell — Fri, 11 Dec 2015 09:50:30 GMT

[quote user="Nhombokisheni"]

[quote user="Clive Ansell"]

In my view, my responsibility ends right there and they have to step up to the plate and make the decision in light of all the facts.

[/quote]

I have to disagree......you are the expert, the fountain of knowledge in their eyes.....your responsibility is to do everything in your power to protect the pet....if it means putting euthanasia on the table then so be it.

[/quote]

The problem is that we are limited in what we can do, or rather in what we can enforce.

The animal owner is full and 100% responsible for the welfare of their pet. Our role is to advise and help them reach an acceptable decision as to the pets welfare, and I will often present euthanasia as an option early on. However, we cannot legally make someone consent to treatment or euthanasia if they decide not to. We can be forceful, very forceful, even brutal with our advise, we can even threaten to report them to the RSPCA, but ultimately it is for them to decide.

Incidentally, the RSPCA have no legal authority and are not a law enforcement agency. Technically, allowing or permitting (2 separate offences) animal suffering is a criminal offence and should be enforced by the police, but there is more chance of amoeba from Saturn enforcing the law than the police getting involved.

In my case above with the Pyometra in 13 year old Westie, the owners want a quick and convenient fix and want to off load their responsibility on to someone else (me). My job is to advise them based on my clinical skill and experience and for them to decide. At the moment the dog is hospitalised on IVFT, is much better and brighter, and we are awaiting a decision from the owners, who are unobtainable on the telephone this morning (which opens up another debate - what if we cannot get hold of them?; given it's Friday all cases over to OOH clinic for the weekend, who would transport it? , who would pay?, should we just treat it? should we just pts it? ???)

RE: Tangent: personal responsibility

Francisco Gomez — Fri, 11 Dec 2015 09:26:31 GMT

[quote user="David Mills"]

it is easy to pass the buck in these cases and hide behind legal statutes and RCVS code etc - but someone needs to take responsibility for the animal

[/quote]

The very problem with this take is that you spend with your patient less than 0.1% of the patient's life. I can't physically prevent suffering when it is most needed (at the time of prevention) because I don't live in each of my patients' houses.

I don't pass the responsibility to the owner because it somehow allows my conscience to discharge guilt. Quite the opposite, it haunts me when I send some people home after some puppy (as example) consultations because I know they won't apply what I advise but I have no way to prove it so I can't legally prevent what will happen.

If you don't preplan and delude yourself, you will be even more deluded if I allow it, because I will be encouraging it.

A week ago a client found a cat and brought it to the practice. The poor thing, with no chip, was broken, we xrayed it and euthanased it free, even though we're a private business. The client is known by us and would've paid but we didn't let them. Ask the RSPCA? Client didn't even think about asking a charity for financial help.

The same week a client with no job in sight comes with a newly bought staffy puppy, and says they're planning ahead: they want her for breeding. We've already explained the risks of a C-section during OOH to a deaf ear.

When you say we should take more responsibility with this second example, what do you actually mean? Give me an example.

RE: Tangent: personal responsibility

Hannah Wynne Richards — Fri, 11 Dec 2015 09:11:25 GMT

Since the AWA puts the onus on owners to prevent disease, then an unvaccinated dog with parvo is an open and shut prosecution case. A £50k fine - or community service at minimum wage until £50k (post tax) has been paid off would soon get parvo eradicated

Wynne

RE: Tangent: personal responsibility

Francisco Gomez — Thu, 10 Dec 2015 19:52:23 GMT

[quote] It is these latter ones, who don't preplan, delude themselves

[/quote]

It became clear to me in my work at PDSA. One puppy come from parvo treatment, will not want to hear the word 'euthanasia' until almost gone by itself. Try to educate, all the right advise about responsibility and care-vaccinations for puppies, desinfection of the house etc.. , 1 week later gets another puppy, no vaccine, and develops same signs. Its free anyway innit?

RE: Tangent: personal responsibility

David Mills — Thu, 10 Dec 2015 19:25:17 GMT

[quote user="Francisco Gomez"]The risk of being more involved have the consequence of less than optimal education, because it might encourage a behaviour rather than helping the immediate patient. [/quote]

This is kinda utilitarian - for the greater good (like off Hot Fuzz). I don't agree with it though because...

[quote user="Francisco Gomez"]

'I won't take another pet in, because I might not be able to care for it' rather than 'It doesn't matter, my vet will help me if I can't cope'.

[/quote]

Snowball in hell, at least IME.

What I'm getting at is that of course it would be great if owners did assume adequate responsibility. Some do. Some don't. It is these latter ones, who don't preplan, delude themselves (or don't understand) etc. (I wasn't on about affordability, but it is a factor) - what I'm saying is that it is easy to pass the buck in these cases and hide behind legal statutes and RCVS code etc - but someone needs to take responsibility for the animal, or it suffers, immediately and probably greatly. To me the rest is a distant concept that is not going to be solves or changed in the circumstances that have brought this discussion about.

RE: Tangent: personal responsibility

Nhombokisheni — Thu, 10 Dec 2015 16:59:29 GMT

[quote user="Clive Ansell"]

In my view, my responsibility ends right there and they have to step up to the plate and make the decision in light of all the facts.

[/quote]

Most come with hope.....no matter how small that hope is...it's still hope. The issue could be some vets feed on that hope instead of calling a spade a spade.

These situations happen everyday.....the OP is essentially asking....should we do something to stem the suffering we know is going on.....our should we turn as blind eye, offloading the "guilt conscience of suffering" on to a what main tightly calls "low life scam" of an owner. Do we have a moral and legal obligation to do more....our are we happy with the status quo??????

RE: Tangent: personal responsibility

Nhombokisheni — Thu, 10 Dec 2015 16:36:50 GMT

[quote user="David Mills"]

Tangent of: RE: Who's client is she anyway?

There is a tension between the statutes and the oath. Legally, it's the owners who have primary responsibility, but our oath is about ensuring animal welfare above all else.

Should we be taking more responsibility on suffering when the animal by fair means or foul is in front of us?

[/quote]

Agreed...The bottom line is that the client makes the ultimate call.....vets are subject to litigation if they act without client consent......however the key phrase is "primary responsibility". When that is not meet then the client is legally violating the pet's rights as espoused by the five freedoms.....giving you the right to take them to task to protect the pet....

Can we do more on welfare?????? Client education and written acknowledgement....

I come from a region of the world where discussion of death is essentially a taboo......and when it comes knocking, dealing with its reality is very difficult for many. So my first suggestion is "obtaining consent during the happier days".....works it seems in elderly care sector. As part of the puppy clinics OR new client consultations, the subject of unnecessary suffering, options available, client role in upholding poet welfare etc if raised "plants a seed", which subconsciously is nurtured such that by the time you need to broach the subject, clients will have ruminated the matter everyone the pet faced a health challenge...for good measure throw in an optional consent form giving the vet the power to act should the need arise.....there are significant numbers out there who prefer the vet makes the ultimate decision......comparable to taking the weight off their shoulders.

Another option would be for all vaccination certificates to carry small print of available powers to vets (somebody said we have the powers.....original OP).....legislative or regulatory, and clients can be asked to sign to acknowledge awareness/complications...this increases client awareness of what can happen if these acts/regulations are violated, hopefully allow vets to act without danger of litigation, and most importantly make clients aware of their welfare responsibilities.

Thirdly, I personally feel there is no point in beating ourselves about this unless we are ready to call for a change in legislation that will make it possible to override clients and are prepared to shoulder the resultant responsibility. While the majority of owners do their best.....that small percentage needs a black and white approach.

RE: Tangent: personal responsibility

Martin Atkinson — Thu, 10 Dec 2015 16:19:40 GMT

[quote user="Clive Ansell"] In my view, my responsibility ends right there and they have to step up to the plate and make the decision in light of all the facts.[/quote]Absolutely, the guilt is all theirs and they should not be given the chance to palm it off on us. Trouble is these are the low life who then slag us off on social media with comments such as money grabbing vets don't love animals and there are plenty of idiots who will read it and agree with them because they only want to see one side of the equation.

We picked up on a couple of these sorts of reviews on Google slagging off the surgery. One was a rat that didn't survive surgery for a grossly neglected necrotic mass despite all the risks being explained and a rabbit that had a displaced fractured spine the owner accused us of causing when we clipped its incisors despite the fact it went home perfectly healthy and had had the procedure safely many times previously. It was so displaced the only way this could have happened if it has been dropped from a great height or struck very hard. Our 18 year old work experience went an replied off her own cognisance that we were the best vets she ever been to and these people were only doing this because of their own ignorance and guilt. She has got a job waiting here when she qualifies!

RE: Tangent: personal responsibility

Stephen Courtney — Thu, 10 Dec 2015 14:45:57 GMT

Absolutely agree. That dog should have been spayed years ago which would have prevented the situation completely. In addition it likely has another 2-3 years of reasonable health to look forward to. I assume it's not so full of preds that surgery is a bad idea?

Maybe they want a new puppy for Christmas?

RE: Tangent: personal responsibility

Clive Ansell — Thu, 10 Dec 2015 12:59:09 GMT

[quote user="David Mills"]Should we be taking more responsibility on suffering when the animal by fair means or foul is in front of us?[/quote]

Most of the time, no I don't think so.

Most of us, most of the time I think carry out a thorough clinical exam and give as good a prognosis and set of options that we can. Our job can already be demanding and stressful enough without having to be burdened with responsibility that should be taken full square by the animal owning client.

I have had a case in point this morning; 13 year old Westie with an open pyometra and clearly sick, but healthy up until about 2 weeks ago. The owners do not want to spend any money, and want a quick and convenient solution, and ideally want a vet to say "I cannot treat and it needs PTS" It seems to me they want to off load their grief and guilt on to someone else to take responsibility and make the call for them. I've given them options of medical vs surgical (my preferred) treatment and PTS. In my view, my responsibility ends right there and they have to step up to the plate and make the decision in light of all the facts.

RE: Tangent: personal responsibility

Francisco Gomez — Thu, 10 Dec 2015 10:52:06 GMT

[quote user="Martin Atkinson"]

If the only option for the best interests of the animal if I'm not prepared to sponsor it out my own pocket is PTS then so be it. The animal is best out the way anyway because the same situation is only going arise again at some time in the future.

[/quote]

I agree with this.

There is much more to it than being more involved. The risk of being more involved have the consequence of less than optimal education, because it might encourage a behaviour rather than helping the immediate patient. I believe that there's much more need to push in the mind of some: 'I won't take another pet in, because I might not be able to care for it' rather than 'It doesn't matter, my vet will help me if I can't cope'.

I'm talking about affordability here, not sure if that is your question David. I might be barking at the wrong tree.

RE: Tangent: personal responsibility

Martin Atkinson — Thu, 10 Dec 2015 10:26:21 GMT

[quote user="David Mills"]It is easy to hide behind the legalities in financially, logistically or ethically difficult circumstances. Either telling client to get lost, go somewhere else or passing the case onto someone or something else (e.g. RSPCA). This is passing responsibility with a veneer of reason and a helping of self-congratulation. [/quote]You are painting with too broad a brush David. Sometimes the buck has to stop with the individual vet but on most occasions the animal is either not at immediate risk and telling them to get lost is a reasonable option or there is someone else who is better placed to assist. The RSPCA option is open because they are there to fulfill this very need. Emergency, client has no money, its PTS or take it to the RSPCA hospital - I see no passing of responsibility with a self-congratulation here, this is the best option for the animal. Afterwards I don't feel good about it I feel guilty and I should not have to be put in that position by some impecunious low life owner, the situation has occurred because of their own irresponsibility in keeping a luxury they cannot afford.

That said I am more than generous to those genuinely in need. Only yesterday I agreed to perform orhthopaedic surgery at a greatly reduced cost for someone who has scrimped and saved and when I realised the dog's best interests were served by a referral I phoned the referral clinic to appeal for them to reduce their fee.

But I'm done with helping out those who are not prepared to help themselves. If the only option for the best interests of the animal if I'm not prepared to sponsor it out my own pocket is PTS then so be it. The animal is best out the way anyway because the same situation is only going arise again at some time in the future.

RE: Tangent: personal responsibility

Kate Richardson — Thu, 10 Dec 2015 10:06:57 GMT

Good question, and I think yes we should.

I also find that all too often, euthansia isn't even considered as an option when faced with a potentially poor prognosis or a chronic condition eg a diabetic animal. Some conditions may be treatable or manageable, but I think a really frank discussion with owners is usually a good idea and even floating the idea of PTS out there just to assess their response is valuable- some owners need permission that considering PTS is OKAY. I think some owners are guilt tripped into treating an animal when they don't want to. Its a tricky conversation, but if it saves an animal and an owner suffering for longer than nec (and I believe treating chronic conditions inadequately to be causing suffering), there is also the finacial side to it. I bet we've all seen cases where you just think, why oh why didn't someone mention PTS 2-3 months ago, you mention it as a consideration and the owner almost seems relieved and grateful that they are allowed to make this decision and you are not going to make them feel like they have taken the 'easy'' option.