Out-of-hours survey

RE: Out-of-hours survey

Silvia Maldonado — Wed, 22 Dec 2021 19:46:44 GMT

Not only that, but also booking OOH appointments that are far from being emergencies. Perhaps it's the current situation with the pandemic as well, but I noticed clients are more distressed on the phone and miss most of the info you are telling them. They end booking an appointment and realising it could have perfectly been alright until the next day. But the "damage" (bill) is done.

RE: Out-of-hours survey

Andreas Ege — Fri, 17 Sep 2021 15:43:30 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29963/out-of-hours-survey/232997#232997"]don't need to be a photographer just to point a camera at a wound, if the picture quality is good, the just need to hold it still. [/quote]

And have to get the right spot into focus, like the area they want to show you and not the owners fingers.

Pointing at the right spot, getting it in focus and keeping the camera still seems rather challenging for a lot of people.

RE: Out-of-hours survey

cairncross — Sat, 11 Sep 2021 19:02:48 GMT

Yep , that sort of thing you can't unsee

RE: Out-of-hours survey

Helena Rymaszewska — Sat, 11 Sep 2021 16:17:47 GMT

yep, that backfired on one of our clients , flicking through pictures of his puppy at reception. There was a delightful picture of his naked girlfriend ,dressed only in Christmas deeley boppers.......

RE: Out-of-hours survey

cairncross — Sat, 11 Sep 2021 13:28:29 GMT

In the old days pre covid owners would often get their phone out to show you something , usually diarrhoea . They would hold the phone out and you would lean in to see the picture , THEN they would flip through a series of photographs to get to the one they want, whilst you get a slide show of personal things you really didn't need to see.

RE: Out-of-hours survey

Arlo Guthrie — Sat, 11 Sep 2021 09:33:47 GMT

Yes, I get that - I was thinking webcams, where you have the opportunity to say: "Left a bit, right a bit, hold it still"

[quote userid="2235" url="~/001/nonclinical/f/life-in-practice-discussions/29963/out-of-hours-survey/233000#233000"]we frequently receive pictures from which it is impossible to work out whether you are looking at an animal or a piece of carpet[/quote]

THAT has made my morning.

In some cases, though, I wonder whether you could tell whether it was a piece of carpet even when brought to the surgery.

But you have given me an idea for a short YT film. Vet doing consultation via webcam, looking at something which looks like it might be a piece of carpet. Finally, vet says ... "I am afraid you're going to have to bring the animal in" ... cut to shot of owner at entrance to practice, with a piece of carpet on a lead.

RE: Out-of-hours survey

Rob Davis — Sat, 11 Sep 2021 09:25:54 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29963/out-of-hours-survey/232997#232997"]people don't need to be a photographer just to point a camera at a wound, if the picture quality is good, the just need to hold it stil[/quote]

You'd think so, wouldn't you, but..... As Sarah has pointed out, we frequently receive pictures from which it is impossible to work out whether you are looking at an animal or a piece of carpet, let alone which part of the animal. Never underestimate peoples inability to take photographs...

RE: Out-of-hours survey

Sarah Keir — Sat, 11 Sep 2021 08:53:02 GMT

Sorry if you mis-understood me Arlo. Someone may have a fabulous camera but unless

1. the pet is in the picture

2. it is still

3. the focus is on the correct item in the frame

4. the entire item is in the picture

5. some need an idea of scale

then the picture is useless. I have found that 9/10 pictures sent to me are useless.

RE: Out-of-hours survey

Arlo Guthrie — Sat, 11 Sep 2021 08:34:46 GMT

[quote userid="9515" url="~/001/nonclinical/f/life-in-practice-discussions/29963/out-of-hours-survey/232940#232940"]The potential quality of images may improve but not the skills of the people taking them.[/quote]

Well, you're right, but then again people don't need to be a photographer just to point a camera at a wound, if the picture quality is good, the just need to hold it still.

Delighted to see Vet Times picking up on our survey: https://www.vettimes.co.uk/news/vets-and-vns-say-most-ooh-calls-not-emergencies/. Good of them to give VetSurgeon and VetNurse such a nice mention.

RE: Out-of-hours survey

Sarah Keir — Thu, 09 Sep 2021 07:30:41 GMT

[quote userid="2100" url="~/001/nonclinical/f/life-in-practice-discussions/29963/out-of-hours-survey/232757#232757"]I mean the quality of video is improving all the time [/quote]

The potential quality of images may improve but not the skills of the people taking them. A camera does not make a photographer.

RE: Out-of-hours survey

Anthony Todd — Mon, 06 Sep 2021 16:50:29 GMT

How many vets would be prepared to do one night a week in an effectively triaged system [as explained before] after 7pm??

[and not be on the rota at weekends off.!!]

And how many would do it if paid per callout??

RE: Out-of-hours survey

Anthony Todd — Mon, 06 Sep 2021 13:20:31 GMT

Just a few thoughts and obs.

Our current dentist, but totally faultless., charges fees that make my eyes water. [compared with previous dentists]

They also do a scheme where a client/patient pays £25 every month and in return gets reduced fees as and when they are required.

Would a similar system, with the guarantee of OOH calls, if considered necessary, [and triaged remotely] work in eliminating silly OOH calls from non-clients? [ie incorporating oral separate remote telephone triaging].

As usual, [for me] the suggestion of a "group" triaging arrangement has met total silence.

Isn't it better and worth paying for not being phoned for something trivial at 1am etc.?

Is the sleep/recreation/rest disturbance just as annoying as the "consult" itself, or a large part of it?

Would it be just as bad to be rung back an hour later to be told that they have decided to come tomorrow...?

[By the way, the profession should do more to enhance the skill recognition of even the ordinary practitioner. Comparative A levels for entry might be a start...]

Or even a free booster and checkup included [which I will check with my dentist.......] Wormers and de-fleaers extra..but almost always sold......

RE: Out-of-hours survey

ian bates — Mon, 06 Sep 2021 10:27:05 GMT

excellent summary

RE: Out-of-hours survey

Gillian Mostyn — Sun, 05 Sep 2021 19:11:04 GMT

[quote userid="19228" url="~/001/nonclinical/f/life-in-practice-discussions/29963/out-of-hours-survey/232881#232881"]Could you reflect on this complication in any feedback on the cert?[/quote]

It became irrelevant ....life got in the way of completion and the system completely changed soon afterwards.

RE: Out-of-hours survey

Alastair Welch — Sun, 05 Sep 2021 19:04:25 GMT

Julian,

To be clear I am suggesting that VS should be in a position to refuse to see an animal in either the a) suffering or b) life-saving category.

I am of the opinion that the dual drivers of

i) The willingness (some might even say haste) with which a large portion of the profession have shed their opportunity to partake in the delivery of services OOH and

ii) The unwillingness of our second rate regulator to adequately enforce the Code of Conduct as it was intended with regard to the provision of OOH services. That is to say that the Code reminds us of our obligations to provide 24/7 care (even if we don't actually physically deliver this ourselves), but the College don't really check to see that such cover is meaningful and certainly don't upbraid those who are falling short of their obligations.

Played out over my working lifetime (22 years) the result is that in many areas clients are very poorly served OOH.

I would categorise OOH provision into 4 basic groups:

1) Practices that make no pretence of providing OOH care to a particular client. These are the 'motorway vets' of the horse world. Driving country (sometimes continent) wide with magic injections. Their clients pay top-dollar, safe in the knowledge that the local firm will see the Friday 10pm colic for fear of a thick envelope from our expensively rented HQ.

2) Practices that make a pretence of offering OOH cover but that practicalities of it (the provider is too far away or too expensive or both) are such that the OOH clinic may as well be on the moon for all the good it does.

3) Practices that outsource the OOH work but do so in a way which is both close enough and affordable enough so that clients of the primary practice are able to make use of the OOH provider.

4) Practices which provide their own OOH cover in house.

Increasingly category 2 seems to be quite common and the net result is an increase in pressure on category 4. I'm sure there is quite a degree of geographic variability but given the eye-watering sums on offer for short term OOH locums I think its safe to say that we are not replete with VS working OOH. The description that James Bryson provides of being near-overwhelmed with OOH work from other practices is not sustainable in the long run.

I fully recognise that James would be both 1) well within his rights and 2) on very safe ground refusing to see the vast bulk of those who phone him (remember there are only consequences if something untoward happens), but if one adopts a harder line about seeing the time-wasters there is no doubt that sooner or later you will find yourself involved in a College Concern. The flat footed inhabitants of Belgravia House will take months to find that you have no case to answer but during the interim period life is probably a bit stressful and most VS want to avoid the grief.

By removing the obligation to provide 24/7 care James (or any one of us) can rest easy that telling the worried well or the pain-in -the-arse chancers to wait until morning will not result in any form of sanction. James is still free to see any case that he sees fit but no-one can (as has happens regularly) hover the sword of a College Concern as method of talking their way into the building. It will also remove the "I can't pay but you have to see me" brigade at a stroke.

I am fully aware that some animals will suffer and some will probably die but I have reached the view that the benefits to the health and well-being of the VS involved outweighs the downsides.

In practice the vast bulk of animals who need to be seen will be seen. The 'can pay but won't' will have to, and for those who are genuinely without means I suspect that some form of charitable solution will appear.

RE: Out-of-hours survey

cairncross — Sun, 05 Sep 2021 18:28:58 GMT

Do we have any idea how many people the 24 7 responsibility falls on the head of? How many practising bosses are left having to scramble to keep themselves and employees doing this. It cant be many more than a few hundred responsible for the care of 60 million pets and 250 million farm animals for 16 hours a day and every last weekend

RE: Out-of-hours survey

cairncross — Sun, 05 Sep 2021 14:40:40 GMT

Could you reflect on this complication in any feedback on the cert? Students tell me that vet school now can be a tightrope of massaging egos to get through rotations, any questioning or attempts to discuss other options (encouraged in my day) is now seen as a black mark.

RE: Out-of-hours survey

Gillian Mostyn — Sun, 05 Sep 2021 09:40:41 GMT

[quote userid="19228" url="~/001/nonclinical/f/life-in-practice-discussions/29963/out-of-hours-survey/232875#232875"]My direction in this really was that if vet school had to at least reflect on these realities it would undermine the "gold standard only" eminence based medicine[/quote]

Completely agree. As a profession we need to stop using the term gold standard - there's no such thing. It all depends on too many variables - age and long term condition of pet and financial situation of owner being the biggest ones IMO.

There was far too little emphasis on the financial realities of practice when I was a student - it was quite a while ago but I assume things haven't changed. (It also came into play when I started to work towards a certificate - it was virtually impossible without self-funding the treatment as most clients wouldn't/couldn't pay for tests that were being done just for 'completeness' eg lots of follow up bloods/rads when the animal was doing great. But without them the 'gold standard' treatment couldn't be produced in a case report.)

RE: Out-of-hours survey

cairncross — Sat, 04 Sep 2021 22:06:06 GMT

It is largley good but its a company that sells financing of big vet bills to those that have good enough credit to afford it and the interest and profit. It is i think what comes next as insurance has moved out of reach of many. It may bring affordability to a small slice. I would worry that paying iff long term bills is ok for the first incident but what happens next time and the next..

RE: Out-of-hours survey

Helena Rymaszewska — Sat, 04 Sep 2021 21:59:40 GMT

Yep,I told her not to see it.Could easily wait til Sunday

RE: Out-of-hours survey

cairncross — Sat, 04 Sep 2021 21:52:48 GMT

Actually a lot of the vet students seemed well aware of the realities but expressing them was shot down very quickly and no alternative was allowed to be considered, offering anything other than the thousands of pounds option was presented as a complete no no.

I wasnt at all thinking all vet students are from a life of priviledge, family and friends had to chip in to get me to my interviews years ago. Many actually nearly all that pass through here have their feet on the ground. Ok its good they can see the economic end of things on ems and the high value stuff in vet school but presenting affordable care as a failure and suggesting they shouldnt work or see ems where that occurs? My direction in this really was that if vet school had to at least reflect on these realities it would undermine the "gold standard only" eminence based medicine

For some people going without can mean 10 pounds saved for some it can mean 50 or 80. Meals out sports or music tickets a night in the pub for the vast majority 50 to 80 pounds? Going without woild have paid for a fb, gdv or ooh fee ir made insurance affordable even 7 or 8 years ago for many going without is no longer going to be enough to consider vet care that they could have afforded when they aquired the pup..

Im not defending those who are given options and wont choose they have been properly looked after. I am concerned that we will either not be allowed or not be capable of providing options in the current direction of travel.

RE: Out-of-hours survey

Gillian Mostyn — Sat, 04 Sep 2021 21:31:16 GMT

I've just come across the article, and thought it was extremely well written.

https://vetbilling.com/blaming-and-shaming-vets-and-pet-parents-need-understanding/

RE: Out-of-hours survey

Gillian Mostyn — Sat, 04 Sep 2021 21:14:48 GMT

[quote userid="19228" url="~/001/nonclinical/f/life-in-practice-discussions/29963/out-of-hours-survey/232861#232861"]Some education of our profession as to economic realities on client incomes and demands (from school uniforms to, divorces to limited hours contracts or life on minimum wage with 2 jobs and care responsibilities) adding in your last paragraph on the increased benefits of pets in these most trying of lives. This is not provided as far as i am aware at vet school. [/quote]

I think this is rather presumptive. You seem to think vet students have no knowledge of life in a low income family, which is not the case for everybody

I remember my mum telling me that she had a cat shortly after she was married that she had to take to the vet constantly for its 'skin injections'. The cost was massive at the time, as they had very little money. But they found it - by doing without other things. (Just for some background, at the time her and Dad lived in a 'one up one down' cottage with a shared outside loo. No bathroom in those days..)

My grandma took her dog to the local RSPCA kennels to be put to sleep when it suddenly became ill. She couldn't even consider seeking treatment.

Yes, people have always felt that pet ownership was available - but they either sacrificed in order to afford treatment OR accepted euthanasia as a way to relieve suffering. What they didn't do is expect a high level of care for very little cost. Stories in the press saying 'my vets have demanded £4k or they say my dog will have to die' are becoming quite common. The emphasis always being that the owner is the caring one, the vet is the heartless one.

RE: Out-of-hours survey

Clive Ansell — Sat, 04 Sep 2021 20:18:58 GMT

[quote userid="27499" url="~/001/nonclinical/f/life-in-practice-discussions/29963/out-of-hours-survey/232871#232871"]The client had her online consultation with the vet from the insurance company.They said, IT HAD TO BE SEEN TONIGHT[/quote]

Then they, or their vet should see it , not you!

Me thinks that fees need to rise dramatically, might dissuade this sort of bullsh1t.

[quote userid="27499" url="~/001/nonclinical/f/life-in-practice-discussions/29963/out-of-hours-survey/232871#232871"]our OOH vet has just been compelled to see a dog with skin irritation(already under treatment for harvest mites infestation)[/quote]

As the MRCVS, you call the shots, you could say yes or no to the seeing it at 8pm on a saturday evening. If they're not happy they're free to go elsewhere.

When I worked in OOH clinics, I probably would have seen it, but If I was busy there could be a wait, maybe hours rather than minutes. Would have been triage and emergency care only, shot of dex maybe.

When I worked OOH on call, I would not have seen it, as it could wait until the next day.

RE: Out-of-hours survey

Helena Rymaszewska — Sat, 04 Sep 2021 19:35:47 GMT

Just on a rant.....

our OOH vet has just been compelled to see a dog with skin irritation(already under treatment for harvest mites infestation)....The client had her online consultation with the vet from the insurance company.They said, IT HAD TO BE SEEN TONIGHT.......client would not take no for an answer, saying that is why she pays insurance so she can be seen when her pet needs it-YES BUT WHEN IS ESSENTIAL NOT AT SOMEONE S WHIM.,FFS

GIVE ME STRENGTH-this needs to be addressed ....