Ethics

RE: Ethics

James Dunne — Mon, 19 Dec 2016 13:17:45 GMT

I see there have been quite a few replies to this and I am late in the discussion, but here goes:

1. Not taking clinical history from another practice before neutering, a bit unprofessional alright, probably not a big deal in the majority of cases but should be done anyway. Firstly for inter-professional courtesy we should all lead by example, regardless of what the other practices do and secondly to train the public into realising that we are more than a retail outlet.

2. 'Take-home' pain relief: for an ovariohysterectomy it's warranted. For castration, possibly not. As for what to dispense...there are a lot of overstated risks regarding NSAIDs. They are licensed and effective in the majority of cases and they reduce inflammation so they should probably be fine for 2-3 days postop. Very sensitive animals consider the use of paracetomol [licensed as Pardale V and also has an incredibly low dose of Codeine mixed with it]. Gabapentin is also useful even though most people probably use it for chronic pain syndromes or spinal disorders and it is unlicensed. Tramadol is variably effective and associated with many problems, on top of which it is scheduled and addictive. The bottom line is, that while many of us can describe our pain and have very variable tolerances to it, animals cannot and they are conditioned not to express pain in the same way as humans, so we should treat it as if it were present. It is not about anthropomorphising at all, just ensuring our patient's needs are attended to. Pain is the one diagnosis where we should treat even if we are unsure that we are correct.

RE: Ethics

Bob Russell — Mon, 19 Dec 2016 11:14:34 GMT

I tend to consider this lowering professional standards rather than an ethical dilemma. I would do the usual 'is it on any medical treatment, prescribed or otherwise' to cover my back. I would also want to know vaccination and flea status as that has an influence on risk.

Our consent forms include 'is the pet vaccinated?' and when was the last flea treatment applied and what was it?

I don't want a flea ridden beast on the premises without knowing about it (and treating it). I would also like to know if they are at risk of parvo.

Most practices around here are good at providing/requesting a history so not that much of an issue. A few clients take advantage of the £99 spays and we only become aware later.

RE: Ethics

Martin Atkinson — Mon, 19 Dec 2016 11:12:55 GMT

Its all a bit like the issue of incomplete small animal vaccination certificates. There are one or two on here that think it is unnecessary to fill the breeder's/previous owner's details whereas most of us realise that the issue of blank vaccine cards is the hallmark of dodgy breeders/dealers who have something to hide and the vets who go along with it are complicit in their unethical trade.

I know which side I stand on and am not about to lower my standards.

RE: Ethics

Iain Richards — Mon, 19 Dec 2016 10:55:34 GMT

The gelding scenario is a useful example that the issue it isn't absolutely clear. What is clear is that a vet, faced with an animal of unknown history, should attempt to find out something about it before treating it. It's advantageous for the animal and useful if a problem occurs and a wily lawyer uses the non investigation of history as grounds for a negligence case. The individual vet has to decide if it's appropriate. IF they've made an effort to to find out, they've done all they can. The issue has two aspects first a definable, if small, medical risk owing to having no history. Second, a feeling that not seeking history and just doing the work is a lowering of professional standards.

RE: Ethics

Wren — Mon, 19 Dec 2016 09:52:26 GMT

[quote user="Alastair Welch"]It matters not whether it is a horse or a dog[/quote]

This is true - it doesn't matter, but it does make a difference. Often in equine practice you either are in possession of huge amounts of history which you can't share with the client, or none at all.

Unlike small animals horses have often had many owners. The current owner has no right to obtain any history relating to the horse before they purchased it (unless the previous owner(s) have given consent). This makes for difficult scenarios, like where one of your clients has sold the horse to another of your clients - you have pages of history on the recurrent colic/chronic lameness/joint injections etc that the horse had with the previous owner, but no right to disclose them to the new owner!

Or the opposite scenario, which is endemic in these parts, which is that the horse is registered with 2 or 3 practices and the owners use one for lameness, one for routine work, one for stud work etc. etc. No one vet ever has the whole picture. I find it incredibly frustrating when I go to see a horse for a vaccination and they mention in passing that it has just had an OCD op at X hospital but the owner self-referred it because they knew we'd only come out and do exactly that. I have no issue with them taking the horse for the op, but wish there was some routine way of at least sharing the information. There is also one particular hospital that we refer horses to for complicated lameness work-ups that we never, ever, ever get any sort of report back from, which I find unacceptable. I wouldn't use this hospital from choice, purely because of this, but unfortunately it is a favourite with clients who compete in a particular discipline.

I certainly don't going ringing up all the practices who have ever seen each horse before I go to see each client, but I do try to get as good a history as I can from each client themselves (and I do find horse owners more clued up on the veterinary treatment their horse had had than pet owners), and research further when necessary. It is incredibly difficult though, and quite a different scenario to small animal practice.

RE: Ethics

Alastair Welch — Sun, 18 Dec 2016 19:05:08 GMT

Gillian,

The OP has suggested that neutering an animal that was previously registered with another VS without obtaining history is unethical and later contributors have gone so far as to say it contravenes the Gd to Prof Con. I was using the gelding example to highlight their wooly thinking.

I am not saying that it is unreasonable to request history in such a situation, but I am saying that not doing so is neither unethical nor does it contravene the Gd to Prof Con. The paranoid utterings of some contributors are simply muddleheaded. I don't understand your comment that you wouldn't chase history from previous owners: either the animal has relevant medical history (from whatever period of ownership) and it is worth pursuing, or it does not.

It matters not whether it is a horse or a dog but if an owner presents you with an apparently healthy animal to neuter, declares that it has no relevant history and it is not receiving treatment then just neutering it is OK.

I am not saying I like the current corporate approach, and I think the College should and could have been much more active at preventing the bad deal (dressed up as a good deal) that many corporates provide but whinging that they are breaking the rules (when they are not) is not helpful.

RE: Ethics

Gillian Mostyn — Sun, 18 Dec 2016 08:53:45 GMT

[quote user="Alastair Welch"]Last week I gelded a colt for a regular client. The horse had been in the yard for a couple of days and I hadn't seen previously. [/quote][quote user="Alastair Welch"] I didn't bother wasting anyone's time by hunting out any 'history', I just cut its balls off and left. [/quote]

To be fair Alastair, I think the SA vets here are wanting any history relating to the current owner. We wouldn't be hunting down history from previous owners unless it was relevant.

I get the 'it rarely matters' and the 'move with the times' arguments. People do shop around more, as they are entitled to do. A simple routine procedure in a young dog is unlikely to be affected by previous clinical history. However, I don't think anyone can argue that having a full clinical history for that animal is what is BEST for it. Some clients have (usually devious) reasons for hiding their pet's clinical details and they don't always have their pet's welfare as their prime concern, unlike us.

Michael - you're right, if I presented unconcious in A+E then they 'd go ahead and treat me. But if I could talk, they spend a significant amount of time taking a clinical history. Most people wouldn't lie to their doctor if it risked their own outcome! We can't do that with our patients- and clients have bad memories and ulterior motives which can make things very difficult!

RE: Ethics

Alastair Welch — Sat, 17 Dec 2016 23:39:40 GMT

Pinhooking is the process of buying horses, putting them through some form of preparation and then selling them (hopefully for a profit!). Typically this would be purchasing a yearling, breaking it and training it then selling it at a breeze up sale.

RE: Ethics

Martin Atkinson — Sat, 17 Dec 2016 21:58:09 GMT

[quote user="Hannah Wynne Richards"] Joke about 2nd opinions.[/quote]No stars Wynne, its a good joke but very old. Sorry.

RE: Ethics

Evelyn Barbour-Hill — Sat, 17 Dec 2016 16:49:43 GMT

[quote user="Alastair Welch"]pinhooked [/quote]

What's "pinhooked"? Is my ignorance the sign I should finally stop doing horses?

RE: Ethics

Alastair Welch — Sat, 17 Dec 2016 10:36:29 GMT

Last week I gelded a colt for a regular client. The horse had been in the yard for a couple of days and I hadn't seen previously. it was bred in the USA, pinhooked in Ireland and then trained in Newmarket for a couple of years. I didn't bother wasting anyone's time by hunting out any 'history', I just cut its balls off and left. I doubt Belgravia towers will be calling any time soon.

RE: Ethics

Clive Ansell — Sat, 17 Dec 2016 08:44:54 GMT

I have another example of a clinical history being useful this morning.

New client booked in with 2 young Labradors "only for vaccinations". History shows that one is aggressive and the owner is in denial and refuses to muzzle - again really helpful to know in advance, and could prevent someone being injured.

RE: Ethics

Hannah Wynne Richards — Sat, 17 Dec 2016 08:40:42 GMT

Joke about 2nd opinions.

A man takes a dead parrot to the veterinary surgeon.

Veterinary surgeon " I'm very sorry, there's nothing I can do. Your parrot is dead."

Man "He can't be! I want a 2nd opinion."

The veterinary surgeon calls a Labrador in. The dog sniffs the parrot, and shakes his head sadly.

Veterinary surgeon " There's your 2nd opinion. Your parrot is dead."

Man "I want another opinion"

The veterinary surgeon calls in a cat, who also examines the parrot, and shakes his head sadly

Veterinary surgeon "Now do you believe your parrot is dead?"

Man "I suppose I must do. How much do I owe you?"

Veterinary surgeon " £300 please"

Man "£300 just to tell me my parrot is dead!"

Veterinary surgeon "If you'd taken my word for it, it would only have been £30, but what with the lab test, and the cat scan................."

Wynne

RE: Ethics

Anthony Todd — Fri, 16 Dec 2016 19:20:05 GMT

[quote user="Clive Ansell"]If any clients objects to a history being obtained one surely has to ask why?[/quote]

Almost always it's either because they just want confirmation of a diagnosis or treatment without upsetting their usual vet or because they think the first vet is very wrong.

They think that if the second vet knows it is a "second opinion" they won't get the truth, just a back-up of the first...

They [used to, and probably still do] think that all vets are in some sort of cartel and if they tell the second vet the name of the first then their treatment will be different, also their first vet will take umbrage at their decision to seek another opinion, which, incidentally, I always encouraged if my diagnosis was grave.

Or you could adopt the well-used approach "If you want a second opinion, come back and see me tomorrow!"

RE: Ethics

Clive Ansell — Fri, 16 Dec 2016 18:04:48 GMT

[quote user="Anthony Todd"]

[quote user="Clive Ansell"]How does that refusal help the animal?[/quote]

I coped equally well and had excellent relationships with my neighbours without ever demanding a previous history yet always getting it if it was in anyway relevant or necessary.

As I said, if the history is necessary then a sympathetic explanation worked every time; blank refusal and off to another with a silent history for sure.

Times change, and not necessarily for the better.

[/quote]

That's great, but contravenes our RCVS CoPC. Why take the risk?

If any clients objects to a history being obtained one surely has to ask why?

RE: Ethics

Martin Atkinson — Fri, 16 Dec 2016 17:54:56 GMT

[quote user="Alastair Welch"]You can continue to wrap yourself in the self-satisfied smugness that only a hair-shirt can provide but I'll just get on and do the job. [/quote]Entirely your choice but you won't be so self-righteous when something goes tits up and you're reported to the RCVC for not following the GtPC.

RE: Ethics

Anthony Todd — Fri, 16 Dec 2016 17:40:07 GMT

[quote user="Clive Ansell"]How does that refusal help the animal?[/quote]

I coped equally well and had excellent relationships with my neighbours without ever demanding a previous history yet always getting it if it was in anyway relevant or necessary.

As I said, if the history is necessary then a sympathetic explanation worked every time; blank refusal and off to another with a silent history for sure.

Times change, and not necessarily for the better.

[Gave the usual one star]

RE: Ethics

Clive Ansell — Fri, 16 Dec 2016 12:57:10 GMT

[quote user="Anthony Todd"]

[quote user="Clive Ansell"]I have a second opinion booked for tonight, where the owner is refusing to name the existing vet because they don't want us to obtain the history. Unless that changes I will be declining the consultation (as per the code of conduct), unless there is a very good reason or emergency care is required (skin case, so unlikely)[/quote]

How does that refusal help the animal?

[/quote]

I did not refuse, I stated I was not prepared to accept the case until I had a full clinical history. Eventually the clients gave details of previous vets

This was a good example of why we should be obtaining clinical notes. case was a pruritic westie, that has been on increasing doses of pred which is not working. From previous notes I could see it has had demodectic mange in the past, clients routinely don't keep check appointments, and are known bad debtors - all things we need to know in order to attempt to manage the case.

RE: Ethics

Clive Ansell — Fri, 16 Dec 2016 12:26:29 GMT

But why not try and get a clinical history in every case, as per out CoPC ? easy and quick enough to do in most cases. I just cannot see a reason not too.

I think excuses like "were now in the 21st century", "its a changing corporate world", or "haven't got time" are a cop out.

RE: Ethics

Neil Wheadon — Fri, 16 Dec 2016 12:02:37 GMT

The neuterings are 1 year olds or younger, folks do this as it's cheaper. The chances of having a chronic illness are pretty small. If an animal is older then start asking questions, but they are rare.

As for older animals, they fall into 2 catagories

1) Ask politely at the start and most will be truthful

2) Careful probing through the consultation usually gets you there and at that point you get the history from the previous vet. If a person is determined to lie they will, but we're in it for the animal aren't we? If an owner has fallen out with the previous vet they may be angry/embarrassed so haranguing them for a history is in no-ones interest is it?

Neil

RE: Ethics

Martin Atkinson — Fri, 16 Dec 2016 11:31:16 GMT

[quote user="Alastair Welch"]if the owner reports that it is not being treated or has never been unwell I am not going to turn Poirot in case they are being economical with the actualite. [/quote]Then ask them how come they've had this animal all its life but it has never once needed to go to a vet even for vaccination or neutering. They are lying or have a severe case of amnesia and there may be something they are hiding unless there is a genuine reason that is believable like its been re-homed and there is no chance of getting history without, as you say, turning Poirot.

PS I didn't one-star you!

RE: Ethics

Alastair Welch — Fri, 16 Dec 2016 10:45:12 GMT

Martin,

I'm not suggesting that one shouldn't enquire of the owner as to the current health and treatment status of the animal, or as the code puts it

'ask whether the animal is already receiving veterinary attention or treatment and, if so, when it was last seen; then, contact the original veterinary surgeon for a case history'

but if the owner reports that it is not being treated or has never been unwell I am not going to turn Poirot in case they are being economical with the actualite. I don't feel the need to 'protect' myself against some vanishingly small chance of things going awry and if I judge their not good for the money I'll make them pay up front. You can continue to wrap yourself in the self-satisfied smugness that only a hair-shirt can provide but I'll just get on and do the job.

RE: Ethics

Hannah Wynne Richards — Fri, 16 Dec 2016 10:41:13 GMT

I agree with Martin

Wynne

RE: Ethics

Martin Atkinson — Fri, 16 Dec 2016 09:23:58 GMT

[quote user="Alastair Welch"] It is surely stretching the interpretation of the word case to consider an apparently healthy animal presenting for neutering as such a 'case' and somehow requiring contact between practices.[/quote]I've picked on your post Alastair not because its special but just the latest example of the same argument in this thread.

The point is you don't know this animal hasn't had some treatment at a previous vet directly related to the reason they have now rocked up at your practice - in the case of a neutering that it may have some hormonal therapy. Or it is on treatment for a condition that may affect the anaesthetic which the owner has chosen to ignore either innocently or deliberately.

That is long before wanting to why they've jumped ship for personal or financial reasons. Surely you want to protect yourself and its just common courtesy to warn your colleagues. There is a practice near me who I would wish no good and would willingly leave with bad debts but I still consider the welfare of the animal.

You et al may have decided to forgo basic principles in some grudging acceptance of the dog eat dog world we seem to practice in now but some of us still have them.

RE: Ethics

Alastair Welch — Fri, 16 Dec 2016 00:12:20 GMT

Many contributors seem to be taking a rather strange view on interpretation of the details of the Gd to prof con. VS should 'not knowingly take over a colleague's case without informing the colleague in question and obtaining a clinical history'- that is to say that if the animal is a 'case' then a previous practice should be contacted. It is surely stretching the interpretation of the word case to consider an apparently healthy animal presenting for neutering as such a 'case' and somehow requiring contact between practices. I am no fan of the corporates and the College should have done more to make life difficult for them long ago but we need to live in the 21st century and face the future rather than wishing for a long gone golden era.