Tolerating negligence

RE: Tolerating negligence

Rach — Fri, 27 Apr 2018 08:31:08 GMT

Are you a BSAVA member?

There is a podcast from 2016 by Anne Marie Svendsen Aylott called ‘Just say no! What to do when you disagree with a colleague or client’ that might be worth you listening to, especially if you decide to speak directly to your colleague and don’t have confidence/experience in delaing with these sorts of situations.

RE: Tolerating negligence

Glenn Hodgson — Fri, 27 Apr 2018 07:03:15 GMT

Alyaska.

In your shoes I would be speaking with my colleague upon their return. This would have been my first port of call personally. I'd want to know/give them the benefit of explaining their side.

Then I'd escalate with management if concerned.

then ask management if they have dealt with my views if I was concerned they had not.

If your employer is a good one they could well praise in public and give the harder guidance behind a closed door. They may be a good employed to stay with.

You'll only know by speaking with them though.

RE: Tolerating negligence

Kate Richardson — Thu, 26 Apr 2018 08:21:36 GMT

A lot of wise advice above.

My additional thoughts-

I agree with talking to the colleague first about clinical decisions rather than management but I get the impression from the OP that the colleague is away travelling? So discussing concerns about cases with a senior vet would be appropriate if that is the case.

You don't have your colleagues side of the story, but equally, that is what clinical notes are for, so if they are inadequate then that is something that needs to be addressed (and I think that should be management as it affects everyone).

But be less critical and take the approach of seeking advice on how to deal with situations where you disagree with previous treatment. You can't change the past, and if not handled correctly by you will lead to an disgruntled client, so sometimes we have to swallow our emotions and work out a way of changing things in a diplomatic way. I‘m sure we’ve all had situations where we’ve thought with regards to a clinical decision and because we are often so passionate about what we do it often makes us particularly if we feel that an animal has suffered as a result of those actions. But it is important to remember that just because you feel the suffering is as a result of the treatment but it may be nothing to do with it. Sometimes it does, but 1+ 1 does not always equal 2.

RE: Tolerating negligence

George Cooper — Thu, 26 Apr 2018 00:24:41 GMT

I'm going to respond as one who might be "accused" of perhaps unconventional therapy - which I personally would back up with my own observations as to the success of the treatment. It may fly in the face of :academic "received wisdom" but given the actual case before me, and some years of experience in dealing with such cases, I would expect improvement in the case. If my notes were not as fulsome as perhaps someone might want then I could see that this could be misconstrued.

I would also expect a colleague who takes over and is uncomfortable to discuss the case WITH ME directly and not to default to management or the senior VS in the camp.

RE: Tolerating negligence

Clare Tapsfield-Wright — Wed, 25 Apr 2018 22:21:43 GMT

I would also be very careful of being egged on by others who, while not willing to put their own heads over the parapet, may welcome the entertainment of seeing the drama unfold when you volunteer yours .

Looking at another vet’s treatment with the benefit of hindsight can give a skewed perspective but you have quite rightly raised your concerns and matters should and most likely will be discreetly investigated by those in charge.

RE: Tolerating negligence

Jill Butterworth — Wed, 25 Apr 2018 21:50:15 GMT

Not sure of your age, but were you taught EBVM? I was not, but have listened to the webinars, and I think it could be renamed: 'tactful methods of persuading the stubborn old duffers [that you work with] to use up to date treatments'...

Be wary of causing divisions within the practice, it could backfire, and it is better to have regular clinical discussions for example, as in house CPD, with all your vets, so that you will feel supported in turn.

RE: Tolerating negligence

Rach — Wed, 25 Apr 2018 20:59:32 GMT

Am I right to read between the lines here and say that the issue is not so much if your colleague has been negligent, or even if those animals died as a direct result of his/her practice, but that you are being put in a position where you either have to contradict your colleague or do something you are not comfortable with. If that’s the case then you have my sympathy, it is a really tricky situation to be in. Ultimately you need to be comfortable with your clinical actions, but you also need to continue a working relationship with your colleague.

It may be that their clinical decision making is poor, but it could be that actually your colleague is discussing the potential issues in great detail with the client but not recording this in the notes.

As an aside, I once put an elderly dog with a pyometra that was not a surgical candidate on steroids to perk it up for its last few days (it was booked in for euthanasia later the same week) but it perked up so well that it plodded on for a number of months! But, I had a really, really, frank conversation with the owner as to what we were doing and recorded that in the notes. I also spoke to a colleague before going on holiday to flag that the case existed and that I was happy for more steroids to be prescribed ‘on my head be it’ whilst I was away. Now that is not my usual treatment for a pyometra case, but I feel it improved the dog’s quality of life for that time, and I would feel pretty aggrieved if a colleague carte blanche suggested I was negligent for prescribing it.

I think that out of fairness to your colleague and to you that this needs adressing, but I would caution you not to do this directly, I think it needs to be done by management to protect yourself from accusations of ‘nitpicking‘ and bullying. I would suggest speaking with your senior vet again, but rather than being directly critical of your colleague I would explain how and why the current situation is making things difficult for you, so that they can help you both find a way forward.

RE: Tolerating negligence

Julie Innes — Wed, 25 Apr 2018 18:02:08 GMT

Like others I would be wary of using the word "negligence" regarding these cases, especially as your ex-colleague is not around to explain their thinking/ reasoning.

There is no issue doing a nobivac booster alongside a nobivac rabies, not sure about other brands. And there are some circumstances where an animal may be on NSAIDs and steroids at the same time, not all cases are black and white. It really depends on how these issues were discussed with the clients at the time, but I would be hesitant to shout negligence from these examples

RE: Tolerating negligence

Utlendigur — Wed, 25 Apr 2018 17:52:47 GMT

[quote user="Bob Russell"]Licensed does not make it acceptable or unacceptable. L4 and Rabies is not likely to be dangerous in any way nor should it have any impact on the PETS passport because there is no scientific reason why the vaccines should interact.[/quote]

Completely agree but bureaucracy doesn't always act scientifically or rationally

RE: Tolerating negligence

Chris Geddes — Wed, 25 Apr 2018 17:36:53 GMT

[quote user="Wren"] If there is evidence of the dog dying as a result of vaccine administration (regardless of brand), then this needs to be reported as an adverse reaction[/quote]

If a dog dies (or has any kind of unexpected reaction) shortly after any kind of licensed medicine/biological has been given it needs to be reported as a Suspected Adverse Reaction. No evidence required, it is the role of the Market Authorisation Holder/s to investigate.

RE: Tolerating negligence

Bob Russell — Wed, 25 Apr 2018 17:33:03 GMT

[quote user="Utlendigur"]

[quote user="Bob Russell"]Rabies vaccination and normal boosters should not be an issue[/quote]

I thought the nobivac rabies was licensed with L2 but not L4 - but that would be more an issue to do with the validity of the passport rather than a safety issue

[/quote]

Licensed does not make it acceptable or unacceptable. L4 and Rabies is not likely to be dangerous in any way nor should it have any impact on the PETS passport because there is no scientific reason why the vaccines should interact. Mixing in the same syringe should only happen if the data sheet says it can be. Inactivating agents might inactivate the live components when mixed.

I don't mix brands or mix contents in a single injection. Not sure what happened to the story released that suggested some authorities were unhappy with vaccinations being done at the same time.

RE: Tolerating negligence

Richard Carter — Wed, 25 Apr 2018 16:41:35 GMT

similarly I have a cat on both nsaid and low dose cortisone on advice from the relevant specialist and apparently is used commonplace on the continent where the cat comes from (Germany if that helps?).

also rabies vaccine is inert - there are no living organisms so the only restriction I am aware of is a note from the VDS advising not to do kennel cough at the same time although why this should have any effect on the response to a rabies vaccine, no idea. In USA, UE and lots of countries that have annual rabies, these are always done with the other annual vaccines.

Regarding the terminal cat - not that unusual to have hyperthyroid cats with renal parameters off scales that seem to still be holding the various pieces together so is a case of treat the patient, not the blood results.

Is really tricky but then also remember you will go on leave and your colleagues will be reviewing your cases

RE: Tolerating negligence

Clive Ansell — Wed, 25 Apr 2018 16:21:58 GMT

You have already spoken to management and a more senior veterinary surgeon and expressed your concerns, therefore you professional duty has been done. How or if they progress it is a matter for them.

I would exercise caution in accusing a professional colleague of negligence on an internet forum. None of the things described are necessarily negligent, for reasons others have already given. Sometimes what we do is less than optimal for various reasons; cost constraints, client demands, difficult cases, terminal cases.

There is an old Westie in one of my practices with severe spondylosis, where it has been found by trail and error that a combination of Metacam and low dose pred (1mg sid) works well for him. That does not constitute negligence, it is off label of course, but just a case of doing our best with what we have.

RE: Tolerating negligence

Utlendigur — Wed, 25 Apr 2018 16:07:09 GMT

[quote user="Bob Russell"]Rabies vaccination and normal boosters should not be an issue[/quote]

I thought the nobivac rabies was licensed with L2 but not L4 - but that would be more an issue to do with the validity of the passport rather than a safety issue

RE: Tolerating negligence

Bob Russell — Wed, 25 Apr 2018 13:45:27 GMT

Rabies vaccination and normal boosters should not be an issue, just not mixed in the same syringe. Mixing brands might cause a raised eyebrow or two.

I have used steroids and NSAI's together on a few occasions but only in terminal situations and with the permission of the owners following discussions. Not had problems but clearly not good practice.

Some owners would prefer to have a very sick pet home for a few days and here we have to look at the welfare issues.

These could all be problems but may not be negligence as such. If you believe that cases are being handled badly then you have a choice to try to change things or leave.

General practice is rarely black and white, right or wrong!

RE: Tolerating negligence

Wren — Wed, 25 Apr 2018 13:42:09 GMT

[quote user="Alyaska"]Dogs having Rabies vaccination together with annual booster(died),[/quote] [quote user="Alyaska"]I tried to find data about can rabies be given with other vaccines ( I know always keep few weeks apart)[/quote]

Did your investigation take you as far as the data sheets? Nobivac rabies is licenced to be given with their boosters, and can even be mixed with them. If there is evidence of the dog dying as a result of vaccine administration (regardless of brand), then this needs to be reported as an adverse reaction.

RE: Tolerating negligence

Vet2Vet — Wed, 25 Apr 2018 13:31:57 GMT

You may not be or have been informed of what action they will or will not take . It may not mean that nothing will be done . It can also be difficult to prove cause and effect just reading from clinical history . Things can inferred perhaps .