Lost skills...?

RE: Lost skills...?

Niki C — Tue, 07 Mar 2017 00:42:55 GMT

Having spent most of my working life in the UK as a locum, and therefore seeing lots of practices, I can say that the boss generally doesn't choose....

Another point I would make is that I feel I have done myself a disservice. My peripatetic lifestyle has meant I am lacking in a number of surgical competencies, especially ortho, but others as well. When the surgical case comes in, the locum is put on consult double-duty whilst someone else sorts it out. I would hate to lose doing my routine neuters and especially my dentals though. That's one procedure that the regular vets are often very happy to leave to me ;)

RE: Lost skills...?

rhmrcvs — Mon, 06 Mar 2017 08:53:14 GMT

[quote user="David Mills"]

[quote user="An On MRCVS"]Which just goes to prove what a knob jockey he is.[/quote]

To reply to other jibes, my stance on cpd was that it was useless, not time. Why not go look

Audits are very easy. You need a defined patient population and endpoint. RCVS knowledge has lots of this.

My last look had a 3% minor complication rate. Not a patch on the 0% of Mr A over the last 10 years but even in an ivory tower there's a bed in which to dream. Why don't you do it Atko? You're semi retired anyway is it the fear?

To rhmrcvs

[/quote]I have just read posts on this thread having not done so for a number of days.

Could someone advise me what the reference to me is please in the above post and explain what it means ? TIA

RE: Lost skills...?

Evelyn Barbour-Hill — Sun, 05 Mar 2017 16:51:54 GMT

[quote user="mariette asselbergs"]Exactly Julie, that is what I love in my small team emergency night and weekend work: there is often all the time in the world to relate to the clients in their stressful situation with their pet. No 15 minute euthanasias or surgery decisions for me![/quote]

It can be that way in the ordinary GP daytime practice too, if the boss chooses.

RE: Lost skills...?

Anthony Todd — Sun, 05 Mar 2017 14:59:18 GMT

[quote user="Danny Chambers"]People don't care how much you know, they want to know how much you care."[/quote]

Ah, the art of practice yet again.

Watch Noel!

Does he care?

Listen to Uncle Clive!

Does he care? [sorry, it must be "did" by now Martin??]

RE: Lost skills...?

Danny Chambers — Sun, 05 Mar 2017 14:33:35 GMT

[quote user="Julie Innes"]

People need to believe we care. And we really should.

[/quote]

When I first graduated my cousin who is a phenomenally popular GP said to me, "Just remember one, thing- People don't care how much you know, they want to know how much you care."

RE: Lost skills...?

grumpyoldman — Sun, 05 Mar 2017 14:09:19 GMT

[quote user="Mark Rowland"]Yes there is referral and it has to be offered[/quote]

We find its refused 90% of the time due to ,cost, time, geography, lack of client commitment, poor inadequate insurance or insurance with too many clauses and a 30% excess.

We do lots of orthopaedics, eyes, Spinal and soft tissue surgery, in fact anything that comes through the door. It is always the senior partners that do it. The new graduates definitely are less inclined to get involved and are happy to leave it to someone else if possible. In a business employing 5-6 vets this does create performance and financial "pressure" on the surgical vets. But it does give the younger graduates more time to bond with clients and develop a rapport. In future we will probably seek out vets who wish to develop surgically, although after graduation they may not know what they want themselves and will probably say anything to get that first job under their belts.

RE: Lost skills...?

mariette asselbergs — Sun, 05 Mar 2017 13:12:56 GMT

Exactly Julie, that is what I love in my small team emergency night and weekend work: there is often all the time in the world to relate to the clients in their stressful situation with their pet. No 15 minute euthanasias or surgery decisions for me!

Mariette

RE: Lost skills...?

Julie Innes — Wed, 01 Mar 2017 22:29:23 GMT

If I'm honest, I am a lot less "have a go" now than I was many years ago. I think when I first qualified everything was equally new and daunting- actually, I was more terrified by bitch spays than anything else, as I felt the pressure of taking a happy healthy animal and potentially doing harm! So I happily undertook urethrostomies, ferret spays, pinnings and much more. We were a two vet mixed practice, and my boss would often briefly outline the technique then bugger off to dehorn 150 cows! Nothing like the hand-holding that seems to be the norm now! Was it stressful? Hugely! Was it satisfying when it went right? Hugely!

However I do cringe at some of the ops we did- who remembers the over-the-top technique for cruciates, which was so brutal and left the stifle like a balloon?! I admit to being lazy with orthopaedics nowadays- I don't like drilling and hacking at bones, and when I see how brilliantly my cruciates come back from the referral centre after their TPLOs I find it hard to justify me going in for a go. I do have many clients that can't afford referral, and for the most part rest and pain relief has the dog back to functioning ok quicker than I suspect they would if I went poking about in there! Periodically I consider doing a course, but I know it will never be a favourite area of mine, and I prefer to use my CPD on things I am actually interested in (medicine, soft tissue surgery)

I do think a lot depends on the individual graduate and the practice they are in. My new vet is great, and happy to try new things, and I am happy to hang around for any help and discussion if required. Often we are learning things together when we discuss and research cases.

one of the "skills" I think is missing now is the ability to LISTEN, empathise and relate to clients. I know we are meant to be very professional and formal these days, but I like to know my clients- it can often have a bearing on the case. Like, I know Mrs X husband has cancer, and they are coping the best they can, which is why she needs a bit of extra reassurance now her old dog has had a few hiccups. I know Mrs Y is off work with anxiety, and so I need to be extra gentle breaking the bad news to her about her dog's splenic mass. I know that dog Z belonged to an elderly client that died a year or so ago, and so I know just how hard it is for her daughter to let the dog, who is now TFBUNDY, go. As we become all super-duper techno clinicians in 10 vet practices, I think the old fashioned "James Herriot" aspect of the job is in danger of being lost. People need to believe we care. And we really should.

RE: Lost skills...?

Mark Rowland — Mon, 27 Feb 2017 20:37:06 GMT

But as for my take on this (without reading all the thread sorry)

I think the onus is as much on the practice leaders to drive the younger vets. If nothing else it would sort the wheat from the chaff.

I took on a new grad. 6 months later after I had showed him once, he did his first tort spey. In my clinic, I still see new things (not as much I concede) so when I employ I look for people who have drive. Im too busy to carry people.

Yes there is referral and it has to be offered. However as a practice we also benefit from local small animal referrals for orthopaedics and soft tissue surgery where clients are not insured but have a certain amount of cash. So I can say to clients that I don't have post grad qualifications but Ive done lots of tibial crest transpositions and been on orthomed cruciate courses etc. Its a good source of extra revenue. Drive has to come from the lesser qualifieds and bosses alike.

RE: Lost skills...?

Mark Rowland — Mon, 27 Feb 2017 20:27:56 GMT

Haha this is making me think of a rude limerick I read as graffiti over 20 years ago

(the left hand thread bit)

The first line is "Out of the woods came dead eyed dick"

Pm me for the rest its a bit rude unless Arlo wants to moderate. Its pretty funny :)))))

RE: Lost skills...?

Martin Atkinson — Mon, 27 Feb 2017 19:02:20 GMT

[quote user="Clive Ansell"]

which direction would one turn it if a trans-sexual?

[/quote]Leave it in the middle?

[quote user="Clive Ansell"]Hands up who's never been caught out by a left hand thread; left pedals and left bottom bracket bearing cups on bikes,[/quote]That's easy: left hand thread on left pedal left hand thread on right side BB cup - i do have to think about the latter though.

[quote user="Clive Ansell"]left hand side wheel studs on HGV's and most agricultural vehicles, and some left hand wheels studs on old cars and some high performance cars I believe.[/quote]Well I I didn't know that I confess, but only 'real men' drive those sorts of vehicles.

But I'm struggling to understand why they need left hand threads as there are no rotational forces on wheel nuts (are there)?!

RE: Lost skills...?

Richard Carter — Mon, 27 Feb 2017 17:17:31 GMT

[quote user="Anthony Todd"]pinning on a cat femur and sometimes without an Xray too.[/quote] for the first 3 years after qualifying in rural South Africa, only the local (human) hospital had an xray machine - if we promised not to leave a mess and they weren't using it, we might be allowed to use it so most fractures were repaired by opening up with Mr Peirmattei open on the side to have a look. Lots of wires and pins or as Mr Ness has recalled of his time in Zimbabwe, plaster cast with splints made out of halfed plumbing pipes or bent metal for the zig-zag bits.

was more fun than the current - we have to send you to Mr XXX at the cost of £XXXX

RE: Lost skills...?

Clive Ansell — Mon, 27 Feb 2017 16:49:53 GMT

[quote user="Michael Woodhouse"]

[quote user="Martin Atkinson"]This is clearly important as it seems to be a universal female trait that they can't understand which way to turn a tap on and off and have to have a mnemonic to help them. [/quote]

In defence of the ladies, I say it in my head whenever undoing anything!

(nb Calor gas regulators have a left hand thread!)

[/quote]

which direction would one turn it if a trans-sexual?

Hands up who's never been caught out by a left hand thread; left pedals and left bottom bracket bearing cups on bikes, left hand side wheel studs on HGV's and most agricultural vehicles, and some left hand wheels studs on old cars and some high performance cars I believe.

RE: Lost skills...?

Anthony Todd — Mon, 27 Feb 2017 16:12:43 GMT

It was rumoured back in the day in NZ that you could do a closed pinning on a cat femur and sometimes without an Xray too.

Never seen it done though but sounds possible....

A far cry from £3.5k!!

RE: Lost skills...?

Clare Tapsfield-Wright — Mon, 27 Feb 2017 15:51:17 GMT

[quote user="Wren"]

[/quote] I agree Wren but I don't think we silly girls should bother our pretty little heads about it. Its a good job we can rely on our menfolk while we lie uselessly on the chaise longue eating chocolates

RE: Lost skills...?

Anthony Dennison — Mon, 27 Feb 2017 15:46:44 GMT

[quote user="Michael Woodhouse"]

In defence of the ladies, I say it in my head whenever undoing anything!

(nb Calor gas regulators have a left hand thread!)

[/quote]

Me too!

RE: Lost skills...?

Wren — Mon, 27 Feb 2017 15:29:13 GMT

RE: Lost skills...?

David Mills — Mon, 27 Feb 2017 15:00:56 GMT

[quote user="mariette asselbergs"]

[quote user="Neil Wheadon"]

[quote user="David Mills"]Partly it's progress. We understand a lot more about disease processes and biomechanics. It's no longer a case of whacking the biggest pin you can in a cat's femur and saying it'll be fine. Whilst lateral sutures are straightforward, there are geometrical rules to be followed and judgements to be made.[/quote]

OK David from your protected view within the RSPCA, comment on this.

Prophetic really

13 week old cat comes in yesterday afternoon into a 3 person practice with a broken femur. I'm the only vet there who has done one but this is my last day.

The only option to get this fixed is refer

£3500 is the estimate which includes hospitalisation over the W/E

The system is broken.

Neil

[/quote]

A cat with a broken femur will be well in 6 weeks with just cage rest. No need to pin or refer. Certainly no need to amputate! (Hiding under the table now). Mariette

[/quote]

I think a blanket statement that they will all heal is a little strong, as it depends on whether limb shortening (or rather, to what extent) and muscle contracture will occur, amongst other things, but yes, cage rest in a young animal is certainly a viable option in a lot of cases. Open fractures would require careful mx. I've got an older cat living with me that I had 2 cracks at fixing a fractured humerus (pin/wires and ex fix), neither of which worked, and leaving the leg alone for 12 weeks has produced a functional leg which at times I struggle to tell the difference c.f. the other. The x-rays aren't pretty but that's immaterial.

£3.5k is extortionate, and there will only be so long that people will refer to such places - hence my comments about an intermediate tier. One would have to question why it needed to be in hospital over the weekend as it wouldn't be an emergency repair, probably not done til Monday.

I don't see why people have a problem with increasing expertise in a structured manner. The old days of doing it from a textbook are limited I feel. To equate this with referring everything is to misunderstand the subtlety of the point.

RE: Lost skills...?

David Mills — Mon, 27 Feb 2017 14:49:17 GMT

[quote user="Martin Atkinson"]

[quote user="David Mills"]To reply to other jibes, my stance on cpd was that it was useless, not time.[/quote]The point is that you suggest that we should be auditing and applying clinical governance to our work but you don't think that your CPD should be monitored to ensure it is actually of some benefit.

[/quote]

I do chuckle when people start making things up once they've been shown their arse in an argument. Reflecting on CPD - for which there is little/no evidence that it's of benefit - is very different to having CPD monitored. The latter I have no problem with. The lack of self-critical audit I'm afraid I do. You could even count the latter towards your CPD - now there's a thought for you.

Do you want to try again old fruit?

RE: Lost skills...?

Martin Atkinson — Mon, 27 Feb 2017 13:44:44 GMT

[quote user="Michael Woodhouse"](nb Calor gas regulators have a left hand thread!)[/quote]There is (was) a satirical cartoon on Have I Got News For You which showed a Russian turning off the gas supply pipeline and he was turning the wheel anti-clockwise so we had a laugh that he was actually turning it on. Maybe it was a Calor gas pipeline and it was correct after all. Or maybe you're just looking at the cylinder from the back/upside down and you're an honorary woman!

RE: Lost skills...?

Utlendigur — Mon, 27 Feb 2017 13:27:28 GMT

But equally another n=1. I saw a cat a few years ago where that course of action had been tried (at a different practice). 12 weeks down the line it was still a non-union and by that time a simple fracture was beyond repair.

RE: Lost skills...?

Joyce Whitehead — Mon, 27 Feb 2017 12:47:16 GMT

I nearly put this very reply on Mariette, so I'll hide with you. i had a cat with a smashed humerus years ago and the owner couldn't afford surgical repair and would not even consider amputation. With advice, we cage rested him for 6 weeks with lots of pain relief. I saw him for boosters for years and after a couple of years it was impossible to say which leg it was.

RE: Lost skills...?

mariette asselbergs — Mon, 27 Feb 2017 11:38:51 GMT

[quote user="Neil Wheadon"]

OK David from your protected view within the RSPCA, comment on this.

Prophetic really

13 week old cat comes in yesterday afternoon into a 3 person practice with a broken femur. I'm the only vet there who has done one but this is my last day.

The only option to get this fixed is refer

£3500 is the estimate which includes hospitalisation over the W/E

The system is broken.

Neil

[/quote]

A cat with a broken femur will be well in 6 weeks with just cage rest. No need to pin or refer. Certainly no need to amputate! (Hiding under the table now). Mariette

RE: Lost skills...?

Michael Woodhouse — Mon, 27 Feb 2017 10:56:37 GMT

In defence of the ladies, I say it in my head whenever undoing anything!

(nb Calor gas regulators have a left hand thread!)

RE: Lost skills...?

Martin Atkinson — Mon, 27 Feb 2017 10:12:33 GMT

[quote user="Liz w"]I was taught something on an external fixative course that I use almost every day - righty tighty, loosely leftie.[/quote]

This is clearly important as it seems to be a universal female trait that they can't understand which way to turn a tap on and off and have to have a mnemonic to help them.