Re-visits charge when the patient is fixed and literally walks in and out

RE: Re-visits charge when the patient is fixed and literally walks in and out

Martin Atkinson — Wed, 31 Jan 2018 11:48:00 GMT

[quote user="Gillian Mostyn"]This seems remarkably commonplace. My nurse did the same...breaking her wrist. I wonder if people often haven't skied in quite some time and forget they may be a bit rusty??[/quote]Don't forget I do 3-4 weeks skiing/snowboarding a season so I find I'm straight back into it on the first run and I'd already skied a whole day off piste in far more challenging conditions. It was just the sort of crash that happens every day and you get away with there just happened to be a big fence in the way.

[quote user="David Mills"]Does this mean your wife now has to dress you other than at weekends?[/quote]Well... the first couple of days my daughter had to dress me and cut my dinner up. I joked it was good practice for her for when I do become a geriatric with dementia. Fortunately I was able to wipe my backside - she may have drawn a limit at that one!!

As it is I'm making exponential progress, the shoulder specialist says nothing disastrous, bones will heal, torn infraspinatous should heal, first time I've ever consented to a Depomed injection into a bursa, managed to drive to the surgery to annoy the locum and nurses who probably don't want to see me until next week and most importantly - should be OK for skiing again in March.

RE: Re-visits charge when the patient is fixed and literally walks in and out

David Mills — Tue, 30 Jan 2018 23:25:24 GMT

[quote user="Martin Atkinson"]

[quote user="Gillian Mostyn"]I'm going to regret asking this but....are you still working?[/quote]Well I booked a locum for 2 weeks as I had another week skiing with friends after CITS week but I aborted that - even I can't ski with 2 fractured scapulae. Fortunately I was with my daughter and another friend who were able to drive back. But subject to having a review with an orthopod this evening I intend going back to work next week, I can move my arms within the range needed to do perform examinations and normal surgery but the nurses will have to restrain and lift animals for me.

Thanks for the good wishes.

[/quote]

Does this mean your wife now has to dress you other than at weekends?

Get well soon etc.

Next stage broken hip when climbing the stairs.

RE: Re-visits charge when the patient is fixed and literally walks in and out

Gillian Mostyn — Tue, 30 Jan 2018 21:03:06 GMT

[quote user="Martin Atkinson"] I was skiing, crashed on the first day[/quote]

This seems remarkably commonplace. My nurse did the same...breaking her wrist. I wonder if people often haven't skied in quite some time and forget they may be a bit rusty????

RE: Re-visits charge when the patient is fixed and literally walks in and out

J G Wray — Tue, 30 Jan 2018 19:22:03 GMT

[quote user="Martin Atkinson"]No, I was skiing,[/quote]

Should have gone cycling

"..Most things that are fun make you fat or give you diseases. Not cycling..."

RE: Re-visits charge when the patient is fixed and literally walks in and out

Neil Wheadon — Tue, 30 Jan 2018 17:37:31 GMT

Ditto

I hope the fence gets well soon

Neil

RE: Re-visits charge when the patient is fixed and literally walks in and out

Mark Hedberg — Tue, 30 Jan 2018 16:10:50 GMT

Ouch, get well soon Martin Atkinson!

RE: Re-visits charge when the patient is fixed and literally walks in and out

bob lehner — Tue, 30 Jan 2018 15:28:16 GMT

[quote user="Martin Atkinson"] But subject to having a review with an orthopod this evening I intend going back to work next week, I can move my arms within the range needed to do perform examinations and normal surgery but the nurses will have to restrain and lift animals for me. [/quote]

If I said you are an idiot - would you take a fence ???

RE: Re-visits charge when the patient is fixed and literally walks in and out

Martin Atkinson — Tue, 30 Jan 2018 09:19:45 GMT

Thanks for the good wishes.

RE: Re-visits charge when the patient is fixed and literally walks in and out

vs0u — Mon, 29 Jan 2018 11:26:32 GMT

[quote user="Martin Atkinson"]No, I was skiing, crashed on the first day and spent the rest of the week sitting around the hotel.[/quote]

Shame it was the first day! Good pics though.

RE: Re-visits charge when the patient is fixed and literally walks in and out

Edward Jones — Mon, 29 Jan 2018 09:01:19 GMT

[quote user="GrooveJet"]A simple question I often ask myself: is this client in a position to make the judgement that the issue is truly resolved? [/quote]

I also use the 'reassurance' criteria. If the client is benefiting from the reassurance of my assessment that everything is fine, then it's chargeable.

Sometimes clients come in only because you've asked them to, when it's obvious to the condition has cleared, and they don't want the reassurance. There's no value to client to had (or created or whatever). Blindly charging this client can result in them being lost.

RE: Re-visits charge when the patient is fixed and literally walks in and out

Gillian Mostyn — Sun, 28 Jan 2018 22:32:58 GMT

[quote user="Martin Atkinson"]No, I was skiing, crashed on the first day and spent the rest of the week sitting around the hotel. Its amazingly difficult to dress, wash and eat with both arms rather painful to move.[/quote]

I'm going to regret asking this but....are you still working? Afterall, injury and illness has never stopped you before!

Oh, and get well soon Martin!

RE: Re-visits charge when the patient is fixed and literally walks in and out

Martin Atkinson — Sun, 28 Jan 2018 21:30:59 GMT

[quote user="vs0u "]Crashed your bike? How did that happen?! Sounds painful![/quote]No, I was skiing, crashed on the first day and spent the rest of the week sitting around the hotel. Its amazingly difficult to dress, wash and eat with both arms rather painful to move. But as it was on Congress in the Snow I didn't have any excuse to miss lectures!!

Here's some pictures of the aftermath you might be interested in. My friend was going to transport a piece of the fence down as a souvenir but it was bit big to go in his backpack!! Sadly I can't download the radiographs they're copy protected.

Now got to get mended for Snowscene in 6 weeks.

RE: Re-visits charge when the patient is fixed and literally walks in and out

Miriam Lodewyks — Sat, 27 Jan 2018 16:24:49 GMT

A simple question I often ask myself: is this client in a position to make the judgement that the issue is truly resolved? If it's stopped coughing, then probably "yes"... but whether it's ear infection is really resolved and it's eardrum still intact, probably "no"... so see again.

I also will sometimes simply ask: "would you like me to check that all's going as planned, in x-days time?"

RE: Re-visits charge when the patient is fixed and literally walks in and out

Francisco Gomez — Fri, 26 Jan 2018 20:15:47 GMT

[quote user="J G Wray"]

[quote user="Francisco Gomez"]Well, hopefully you don't have to ask them the same questions from the begining! Imagine how repetitive this would be! [/quote]

The word assume has three components

There is a lot of repetition and mundanity in practice. So what?

[/quote]

My nurse with a certificate in dentistry challenged me to take a solid feline canine out without fracturing it. He said he'd give me 10€.

This to later realise I had to take 2. So I demanded he'd pay me 20€.

He was not impressed.

RE: Re-visits charge when the patient is fixed and literally walks in and out

J G Wray — Fri, 26 Jan 2018 18:21:00 GMT

[quote user="Francisco Gomez"]Well, hopefully you don't have to ask them the same questions from the begining! Imagine how repetitive this would be! [/quote]

The word assume has three components

There is a lot of repetition and mundanity in practice. So what?

RE: Re-visits charge when the patient is fixed and literally walks in and out

Francisco Gomez — Fri, 26 Jan 2018 17:57:31 GMT

[quote user="J G Wray"]

Why do you charge less for follow-up examinations? Are you spending less time?

[/quote]

Well, hopefully you don't have to ask them the same questions from the begining! Imagine how repetitive this would be!

RE: Re-visits charge when the patient is fixed and literally walks in and out

J G Wray — Fri, 26 Jan 2018 17:14:56 GMT

[quote user="Martin Atkinson"]I always charge for a follow-up consultations - it is my time and expertise albeit there is a sliding charge for 2nd 3rd and regular consultations. If I've seen something several times and it is 100% better on the final check then that one may be FOC.[/quote]

Why do you charge less for follow-up examinations? Are you spending less time? Are you rationing your professional expertise? If you base your policy on the time you, as a professional, offer, and not on the resolution of a condition then why less second or third time round?

RE: Re-visits charge when the patient is fixed and literally walks in and out

Anthony Dennison — Fri, 26 Jan 2018 14:57:26 GMT

[quote user="Martin Atkinson"]What everyone seems to have failed to recognise is that if you put the onus on the client to come back if they think the animal is not better and it goes tits up, you've put the responsibility on them to recognise clinical signs when they are not qualified to do so and you will be responsible. if you tell them to come back for a check and they don't then it is their problem.[/quote]

I said this early on, but you've put it better than I did.

RE: Re-visits charge when the patient is fixed and literally walks in and out

J G Wray — Fri, 26 Jan 2018 13:09:10 GMT

[quote user="vs0u "]

[quote user="Martin Atkinson"]I'm supposed to be skiing this week but having crashed into a rather solid wooden fence and fractured both my scapulae[/quote]

Crashed your bike? How did that happen?! Sounds painful!

[/quote]

"..Most things that are fun make you fat or give you diseases. Not cycling..."

RE: Re-visits charge when the patient is fixed and literally walks in and out

Clare Tapsfield-Wright — Fri, 26 Jan 2018 11:03:51 GMT

Ouch Martin , sounds really painful , get well soon.

I agree with you , do a thorough exam , charge for your time, if it’s a good client and justified then give a free of charge but make it clear that it’s a one off and a thank you or for your own peace of mind. Much easier for senior vets and owners, I have sympathy for younger colleagues.

RE: Re-visits charge when the patient is fixed and literally walks in and out

vs0u — Fri, 26 Jan 2018 11:02:03 GMT

[quote user="Martin Atkinson"]I'm supposed to be skiing this week but having crashed into a rather solid wooden fence and fractured both my scapulae[/quote]

Crashed your bike? How did that happen?! Sounds painful!

RE: Re-visits charge when the patient is fixed and literally walks in and out

Martin Atkinson — Fri, 26 Jan 2018 10:38:12 GMT

I'm supposed to be skiing this week but having crashed into a rather solid wooden fence and fractured both my scapulae I have a bit of time on my hands. Yes I know you use your legs for skiing but holding the poles would be tricky - actually impossible!

What everyone seems to have failed to recognise is that if you put the onus on the client to come back if they think the animal is not better and it goes tits up, you've put the responsibility on them to recognise clinical signs when they are not qualified to do so and you will be responsible. if you tell them to come back for a check and they don't then it is their problem. Occasionally with someone I know well I will joke, 'I have to tell you to come back otherwise I am responsible if something goes wrong but use your common sense'.

I always charge for a follow-up consultations - it is my time and expertise albeit there is a sliding charge for 2nd 3rd and regular consultations. If I've seen something several times and it is 100% better on the final check then that one may be FOC. Equally post routine op checks where there is nothing other to say than the wound has healed would not be charged. I rarely have a problem with clients complaining about charges for follow up consults they do recognise they are still taking up an appointment slot,

RE: Re-visits charge when the patient is fixed and literally walks in and out

vs0u — Thu, 25 Jan 2018 21:13:04 GMT

IMO, I should have said.

[quote user="J G Wray"]

[quote user="vs0u "]The 'free' final recheck builds trust as they can see that you care about the pet.[/quote]

How do you know?

[quote user="vs0u "]These checks don't take that long and provide a bit of light relief in between other things. [/quote]

?!?!?!

[/quote]

Yes...it's nice to see happy clients and recovered animals. Rewarding and makes me happy

RE: Re-visits charge when the patient is fixed and literally walks in and out

Francisco Gomez — Thu, 25 Jan 2018 18:31:32 GMT

I don't disagree but...

[quote user="J G Wray"]

none of this matters if the employee has a fixed and entitled mindset. For them there are only fleeting moments of contentment

[/quote]

that's quite a sweeping don't ya think?

RE: Re-visits charge when the patient is fixed and literally walks in and out

J G Wray — Thu, 25 Jan 2018 16:58:08 GMT

[quote user="Francisco Gomez"]Do you think employers who constantly complain about their employees attitude are always right?[/quote]

Not if they don't look for ways of addressing the issue.

[quote user="Francisco Gomez"]I suppose it is difficult because many hardly ever have the opportunity of rating themselves beyond employee turnover. Employees, on the other hand, have the choice to change employment.[/quote]

It's not just retention that gives you some idea of how you're doing as an employer. Profit in all the senses you define it is quite a good measure. Staff engagement - remember Mr Stace's first act at RCVS? - can be measured and the problems facing everyday management give you a feel for how you're doing.

But then, none of this matters if the employee has a fixed and entitled mindset. For them there are only fleeting moments of contentment