Veterinary time savers

RE: Veterinary time savers

Rob Loxley — Fri, 13 Jan 2023 08:27:49 GMT

[quote userid="5012" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240524#240524"]A bigger issue is people arriving late. what do others do with these? I has one tonight; double appointment for 2 dogs, vaccinations, KC, nails, AG's - they arrived 25 minutes late for a 30 minute slot. I turned then away and made them rebook[/quote]

Sounds the right answer; better if reception are empowered to do this rather than the vet having to so the turning away, and are supported by management etc

RE: Veterinary time savers

Clive Ansell — Thu, 12 Jan 2023 20:53:17 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240521#240521"]

Neil Wheadon said:
Here I am at 11:15, appointment at 11:15 and the client has just rocked up and at reception asking for flea and wormer.

I suppose the solution is for them to say you are ready to see them and they will get the flea and wormer ready while they see you?

I will shamelessly call clients in when talking to reception.......

[/quote]

If the appointment is 1115, and the client is on premises I would call them in overriding the nattering at reception. At the moment I work in a very busy practice, 15 minute appointments, so time is valuable and clients are paying good money for it. If someone wants to spend 5 of their allocated 15 minutes gas-bagging thats fine, but I will be seeing the next appointment at 1130 on the nose. I almost always run to time.

A bigger issue is people arriving late. what do others do with these? I has one tonight; double appointment for 2 dogs, vaccinations, KC, nails, AG's - they arrived 25 minutes late for a 30 minute slot. I turned then away and made them rebook as insufficient time to do my job properly and see the next client on time. Full booked evening surgery with 2 extras, so no spare time or slack in the system to deal with it.

RE: Veterinary time savers

Michael Woodhouse — Thu, 12 Jan 2023 17:58:33 GMT

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240519#240519"]Here I am at 11:15, appointment at 11:15 and the client has just rocked up and at reception asking for flea and wormer.[/quote]

RE: Veterinary time savers

Rob Loxley — Thu, 12 Jan 2023 16:42:29 GMT

[quote userid="19431" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240516#240516"]If there are definite PTSs to do, get all your consent forms printed, draw up the juice, make sure you have clippers etc ready to go and discretely stashed in your room, and give the nursing team the heads up that you'll need help at a certain time[/quote]

Or delegate this to reception / nursing staff

RE: Veterinary time savers

Neil Wheadon — Thu, 12 Jan 2023 11:17:13 GMT

[quote userid="19431" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240516#240516"]Start on time! The number of vets I know who run behind, purely because they start the day late.[/quote]

Any suggestions for late clients.

Here I am at 11:15, appointment at 11:15 and the client has just rocked up and at reception asking for flea and wormer......tick, tick tick

They are in good company, maybe over 50% do this

Neil

RE: Veterinary time savers

Steven Odell — Thu, 12 Jan 2023 09:17:08 GMT

Start on time! The number of vets I know who run behind, purely because they start the day late. If you start late and always playing catch up, you'll finish late! Simple?! I'm always amazed by the folk that rock up at 8.59 to start morning surgery at 9 and are still taking their coat off/chatting about last night's TV/making a coffee with the first one or two clients sitting there promptly on time for their appointment, and then moan about how rushed they are.....

Look through the list before you start consulting. If there are definite PTSs to do, get all your consent forms printed, draw up the juice, make sure you have clippers etc ready to go and discretely stashed in your room, and give the nursing team the heads up that you'll need help at a certain time

Booster that needs some bloods as well-either get a nurse appointment lined up for the latter if available, or get the tubes etc ready in the room rather than have to hunt around for them once the client is in with you

Get the first op prem-ed by your wonderful organised nursing team before you start the final consult, so that its cooked and ready to induce as soon as you've finished consulting

Its the law of incremental gains -

being organised gains a couple of mins here and a couple there, and all of a sudden you've gained 15-20mins. While it may be used up with that extra walk-in, you'd still have needed to do that extra one if you weren't as organised.

I know all of this won't fix our hectic days but you may as well try and skew the deck in your favour as much as possible!

RE: Veterinary time savers

Neil Wheadon — Wed, 11 Jan 2023 10:46:16 GMT

[quote userid="4181" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240498#240498"]

Julie Innes said:
I know a lot of people like to do this afterwards, but sometimes that seems to take longer than the consult!

Yes, and they complain they haven't enough 'admin time' or are late leaving (or notes just don't get written up); I strongly advise our new grads to write up notes at the time. We also give standard 20 minute appointments so there should be time; make sure clinical notes templates on your PMS are working for you; do you have standardised postop sheets written for common procedures etc.

[/quote]

Vets noting consults after the event is an absolute disaster. I've worked in practices where this happens and the detail isn't there. Worst still quite a number get missed, so when you see the case you are well and truly stuck and you look really dumb (or the practice)

It's an art but it's easily done.

Simply type as you are talking to the client and get the information down. I had a case yesterday where a client came in to start Vetoryl, the notes were frankly rubbish, no record of the conversation, no plan zippo. It look 30 minutes out of my day to sort it out in the middle of a busy surgery

I wrote these yesterday in a 15 minute consult, it can be done, and in my honest opinion a core skill.

History - Back end going wobbly
Seen in October and had 5 days gabapentin
Seemed to stop the crouching down thing

This time back legs were crossing
Has got a bit better
(The reflexes were fine last time in October)

I TYPED THIS IN THE 2 MINUTES AT THE START, let the owner talk

Examination - Panniculus intact all the way
Deep pain intact
Very good withdrawl
The feet stay turned over for >2 seconds and consistent
Has pain in the L-S area as before

Diagnosis - differentials
1) Slipped disc
2) Bleed in the spine
3) Tumours
4) Embolus- can get better

Plan - 1) Pain Relief - initilally
2) Radiological - £450
3) CT scan them - much better diagnosis, costly

PLAN
NSAID's
Note Librella was mentioned by XXX, but this is for arthritis not this

RE: Veterinary time savers

Rob Loxley — Wed, 11 Jan 2023 08:31:20 GMT

[quote userid="7811" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240494#240494"]Have 1 of everything in each consult[/quote]

Absolutely, also means you have multiple otoscopes/chip readers in the building for when something inevitably breaks (and of course nobody has mentioned that the bulb went a week ago!)

[quote userid="7811" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240494#240494"]Consulting- read previous notes prior to the consultation if possible[/quote]

Not sure I quite do this, but it is worth making reception flag up any histories/referral/OOH reports to be read and summarised to the pet notes prior to an appointment. Also must have previous vet history in advance - it so sucks time if reception are still chasing it when the client is due to be seen

[quote userid="7811" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240494#240494"]I know a lot of people like to do this afterwards, but sometimes that seems to take longer than the consult![/quote]

[quote userid="7811" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240494#240494"]mops up all the bitty things that have been admitted (xrays, blood tests etc)[/quote]

Another time suck is trying to do these bits during the consult, rather than admitting them to be done at more leisure (and under less pressure). Also empowering your nurses to do all these things so their OSCEs weren't in vain!

[quote userid="7811" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240494#240494"]Judicious use of time[/quote]

It's really worth looking at all the stuff that's written on the concept of the Golden Patient, which is all about getting the ops list started (and from there progressed) timely and efficiently. It can be a simple thing to audit (from the GA record probably) at what time the 1st patient was induced each day for the last few weeks. Often it's not very early compared to what we might imagine or hope, and everything runs late from there, and improving it is a real team effort in terms of prompt admission, dose charts, empowering nurses to have the bloods run, iv's placed and whatever else you think of.

RE: Veterinary time savers

Julie Innes — Tue, 10 Jan 2023 17:45:03 GMT

I like to be organised to save time.

Consulting- read previous notes prior to the consultation if possible. (I go through afternoon appointments in the morning) Means I am up to speed and often have a plan of action. It also cuts out the long drawn out waffle from the client "So I see you were in last Thursday to see my colleague, X, because Y was vomiting? She gave you this medication and the plan was to do some further investigation if no improvem ent. How is Y today?" If you let the client tell you you will often be there all day, recapping stuff that is either irrelevant or already in the notes!!

If I'm not quite sure where I want to go with a case I will spend an extra minute auscultating the chest- gives you peace and quite for a minute to think! (Clients think you are being thorough!) Don't get me wrong, I know most of my clients well, and am guiltier than most of having a wee chat if I know I've got the time, but there are some people you just can't encourage!

Have 1 of everything in each consult .My absolute rage- inducing time waste is wandering around for 5 minutes of a 15 minute consult looking for an opthalmoscope/ microchip reader etc. I have even gone to the lengths of colour coding things with tape, so that when every pair of scissors/ nail clippers/ staple removers mysteriously migrate together in 1 room I know where each one goes. If I find a yellow coded piece of kit in the red zone I go nuts! SUCH a useless time waste!!

When consulting I usually take the history while doing the clinical exam, and I write up my notes as I go. (I know a lot of people like to do this afterwards, but sometimes that seems to take longer than the consult!). And I tend to either admit for a couple of hours for work up, or take bloods/ skin scrapes etc and tell the owner I will call with results later (put on telephone consult list), rather than start work up then and there- we have a "second ops" vet, who consults 9-10, then mops up all the bitty things that have been admitted (xrays, blood tests etc), while the first op vet cracks on with the surgical ops. Means consults can flow more easily, and we get a chance to discuss cases later

In surgery I like everything to be ready weighed, and to have all the requred meds drawn up before even starting, in individual bags with the animal's name on them.

Judicious use of time- eg pre-med bitch spay, triple combo cat spay, then take blood sample while waiting for cat to sleep. Spay cat then bitch spay is ready to go. pre-med dental before starting bitch spay, or ask someone else to. I can't stand standing around waiting for things to go to sleep/ wake up! Any time I need to, write up notes and check if any telephone consults need doing.

RE: Veterinary time savers

Beats — Sat, 07 Jan 2023 11:04:29 GMT

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240405#240405"]‘Always think of the next man’[/quote]

With regard to clinical notes, the "next man" is usually going to be myself. I am not a locum and see the same cases again and again. As such, my "notes" are just that - things I want to remember myself for the next time and am not sure I will (such as the weight), to aid me in my next interaction.

I work with the same vets day in day out. I can read between the lines of any notes they have made; they can read between the lines of any notes I have made. If either way we have any doubt, then we talk to each other about it (most days we are all in the same building anyway, a few metres from each other - thank goodness for the end of COVID restrictions!).

If I'm handing a case over to another vet, I do so verbally, not with an essay - this allows two-way communication.

On rare occasions, I have done cover due to illness at the local out-of-hours place. That is totally different. I write the notes for the "next person" in those circumstances, in the manner I would want to read them if I was the "next person".

RE: Veterinary time savers

Clive Ansell — Fri, 06 Jan 2023 14:56:58 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240407#240407"]I hate long notes. Don't see any use (practically or defensively) for stating an ET tube size or have any desire to explain the pre med when the drugs and dose are booked out. If it failed to go to sleep, I'll mention it, otherwise assume so[/quote]

Me too, and as Neil point out excessively long notes are a killer and a time waster, certainly as a locum if not see the case before. Keep it in note form, very short sentences, even single words. Don't want a 2000 word essay on a simple uncomplicated case of otitis externa.

Needs to be as concise, but as detailed, as possible.

My notes for an uncompliacted routine bitch spey would be;

i/v cannula R cephalic v

GA: dom/methadone/propofol-intubate-iso/o2. metacam

Routine spay. 3m vicryl throughout, transfixed ligatures, routine uninterupted suture midline closure, s/c skin with glue

TGH with Metacam for wt, POC 3 and 10 d please

It is all that is needed. Other information such as tube size, drug volumes and times, pulse ox readings etc are all on the hand written anaesthetic chart which is later aded to the clinical notes. I would mention any complications or other findings. If it were a tricky anaesthetic I would probably include all drug volumes.

RE: Veterinary time savers

Sara Ramsey — Fri, 06 Jan 2023 14:23:52 GMT

I hate "phone tennis". I email clients (from the practice email) with the results, the plan, side effects etc and when I want them to be re-seen. I write it in such a way it can be copied into the file as my clinical notes also.

They get written instructions they can refer to, my notes are detailed and the client contact record has been updated. This saves me time and does seem to reduce clients calling back querying something.

When I confirm owners are happy to receive email, I tell them I take a week to respond to emails so any important queries should be phoned in.

RE: Veterinary time savers

cairncross — Fri, 06 Jan 2023 08:57:00 GMT

This hasn't solved the problem for the town though it has one less doctor on ow presumably.

RE: Veterinary time savers

David Mills — Fri, 06 Jan 2023 00:39:37 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240407#240407"]Maybe we should have a CPD week where we spend a day in each others practice (there's a bed hopping channel 4 programme similar) and see what we can learn from each other.[/quote]

This is a very good idea. I would love to see another practice and how it works. Eons ago it used to be quite commonplace. I used to see practice when doing my cardio cert. In my first job we used to go across to each others practices and scrub in on ops. (Different competing companies, same town). If anyone wants to come to the PDSA let me know.

Macro - SA practice - pets per vet is the main one. I’m not sure it’s been modelled but there is an optimum and there is a sub optimum (too few and too many).

Macro - diary management and appropriate booking. “Possible PTS” in a 10 minute consult is a killer. Diary management should be apppropriate to the practice, there is no one size fits all.

Macro - vet to nurse/clinical support staff ratio. If you can roughly 2-3x clinical support staff per 1 vet then efficiency greatly improves. I’m not in favour of the corps pushes for nurse practitioners (or safari consulting) but often clinical support staff are chronically under utilised. I can achieve more with me and two nurses than me and another vet with one nurse each.

Macro - empower and develop clinical support staff so you can write the plan and they will drip, give meds, run bloods, do X-rays etc.

Macro - over populate reception. Overworked and multitasking receptionists will lateralise work to others which doesn’t make things more efficient just shifts to someone else.

Macro - limit the ways clients can contact you within limits. 2 ways is ample (one analogue by phone, one electronic). Don’t get into to and fro electronically it sucks time (q a bit of work of this in offices - emails disrupt hugely)

Macro/micro on surgery shifts - pre medding proactively, delegating, and there is a lot of work on surgery speed in human medicine around repeated non-essential actions. Talking in theatre another one. I like mainly silence and concentration because people concentrating cannot multitask.

There are solutions but some are harder than others and even within the same organisation it’s not easy. Essentially use vet time for the things only vets can do (or can do far more efficiently than anyone else).

RE: Veterinary time savers

Neil Wheadon — Thu, 05 Jan 2023 23:42:20 GMT

[quote userid="12930" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240408#240408"]Shadowing another vet for the day has got to be the most beneficial form of CPD. I think we don't do it simply because we don't wish to commit the time (and the more we've done, the less likely we think it is that we'll learn something new - I think we would all be surprised however).[/quote]

Welcome to the land of the locum vet

I have learnt so much from other surgeries and watching other vets work. I've altered the way I castrate a dog gradually over the past 10 years. Aberdeen knot from practice X, Do it closed from practice Y and use local in the spermatic cord from practice Z

Surgery is the easiest as you can wander in and out

[quote userid="12930" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240408#240408"]I think VetSurgeon would be infinitely enriched by you uploading a video recording from the consulting room of one hour of your open consults - I mean that genuinely[/quote]

It's valid isn't it. I asked a vet the other day how they consulted as we have little idea, how others do it (see above) There are so many little things that you can do to make it so much better. It would though be excruciating for the vet being filled as few like to see themselves on camera

Neil

RE: Veterinary time savers

Beats — Thu, 05 Jan 2023 23:29:50 GMT

I often think that most of what I learned about consulting was from time as a student shadowing and I would learn a lot by shadowing even other vets in my clinic for a day (but I don't think they would like it very much!)

Shadowing another vet for the day has got to be the most beneficial form of CPD. I think we don't do it simply because we don't wish to commit the time (and the more we've done, the less likely we think it is that we'll learn something new - I think we would all be surprised however).

What about on line recording to watch instead? Certainly not the same thing at all, but I think VetSurgeon would be infinitely enriched by you uploading a video recording from the consulting room of one hour of your open consults - I mean that genuinely - even if was audio only would still be a useful activity I suspect. Just get the receptionists to tell the clients that you are recording that morning for training of other vets, that may be publicly accessible, and do they consent to being included and help show those Londoners how it's done in Yorkshire and I'm sure they'll be up for it. Indeed given the level of clickbait this could be, I dare say Arlo would drive up for the day to film you!

Watching other vets operate in real-time is also very valuable. There are some great videos out there (eg VetDojo livestreams on youtube), but what is often missed is the efficiencies before and after lifting a scalpel and placing a final suture, and there is still no good video on a classic flank cat spay that I have seen - someone should definitely make this - two views played side by side with one of the room generally (the big picture) and one of the actual surgery site would be ideal.

RE: Veterinary time savers

Michael Woodhouse — Thu, 05 Jan 2023 22:55:39 GMT

[quote userid="8958" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240392#240392"]and maybe you rum over by 15 minutes [/quote]

Are you accusing me of drinking on the job?

I also don't run over.

But I do appreciate I have it lucky, 20 years ago every practice I knew of was a mixed practice. In this area 4/6 neighbouring practices are also mixed.

What I hate is waiting for people. Gaining some time back at 5.30 and the next appointment is 5.40 drives me mad - I can never find a useful use for that time. It's why I like open surgeries - you have 30 mins to book in and sit down and then I will get to you when I do. With good nurses and by being organised you can do quite a lot, even in 10 mins.

Maybe we should have a CPD week where we spend a day in each others practice (there's a bed hopping channel 4 programme similar) and see what we can learn from each other.

I hate long notes. Don't see any use (practically or defensively) for stating an ET tube size or have any desire to explain the pre med when the drugs and dose are booked out. If it failed to go to sleep, I'll mention it, otherwise assume so. Suture choice useful to know and then anything abnormal.

RE: Veterinary time savers

Neil Wheadon — Thu, 05 Jan 2023 22:13:46 GMT

Replying to the original question

We had an old farm labourer in Devon called Jack. He rarely left Devon, wore a sack around his waist to protect his trousers and smoked a pipe. His greatest advice was

‘Always think of the next man’

One of the biggest time wasters in consulting is wading through other vets notes, especially in long cases.

1) I don’t want to read about the fact that the dog is a ‘lovely boy’

2) Do a synopsis of the case

3) Write the results in the records, pointing out the abnormalities. This saves trawling through numerous lab results.
if the cat has had 4 tests for T4 done over a year, just take the time to write them in the notes together, it’ll save time long term.

4) I capitalise things in notes. Don’t overdo it though

5) Above all, please write a plan. You’ve examined the dog, you know what should be done, just write it. I worked with a brilliant vet who if you saw the case you knew exactly where to go AND the client does as well

One other tip

Use templates. I have them in my email. Why spend forever writing about your bitch spay with pre med , tube size etc when all you need to do is copy/paste and adjust.

Neil

RE: Veterinary time savers

bob lehner — Thu, 05 Jan 2023 21:39:08 GMT

[quote userid="19228" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240403#240403"]In the link one of the solutions proposed is to reduce the number of clients per vet in a practise.[/quote]

Interesting - I needed an appointment with my GP today. Rang the surgery at 10.00 a.m.. Call answered immediately by a charming receptionist and was given an appointment for 11.45 the same morning. I saw the Doctor bang on time and had a thorough examination.

I complimented him on this exemplary service (especially in view of all the current adverse media coverage of GPs).

He said they only have 2,900 patients and 4 part-time doctors, so can cope very well (it's a very rural practice). Previously he'd worked in a very busy town practice, but had suffered burn-out and had to resign.

RE: Veterinary time savers

cairncross — Thu, 05 Jan 2023 20:36:06 GMT

In the link one of the solutions proposed is to reduce the number of clients per vet in a practise, as a solution to situation where we have ever more clients and patients and have ever less vets ?? This is an exact example of the micro solutions exacerbating the macro problem

This thread has partly become a debate on the down side of shorter consults v the benefits of longer ones . Neil above makes some very valid points/ examples of the benefits of the individual case having more time , it's what keeps happening As a profession we haven't got enough vet hours and yet almost everyone champions things that need even more vet hours, each time the topic is raised. It's because no one is prepared to compromise what they do Ambulances are lining up outside hospitals for 12.hours .

. Neil also makes a really really good point about after a bout of intense consults the escape of getting out in the car to relive this. Very definitely a change is as good as a rest I don't think I would have stayed in the profession very long if chained to a consult table for regimented days on end . What time is lost in efficiency is definitely gained in retention .

RE: Veterinary time savers

Arlo Guthrie — Thu, 05 Jan 2023 16:33:21 GMT

[quote userid="19228" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240372#240372"]

Beats said:
I would be concerned that what I consider to be "time-saving" may be considered "bad practice" by others!

I don't think it would just be considered poorer standard care it often will be lower standard ( not u specifically but in general) . In my original post on the other thread I wasn't refering to micro changes individuals can make or asking for individuals to put their head up and attract this stigma.

[/quote]

cairncross - sorry, I misinterpreted you.

Macro is a very interesting point, although the first thing I thought when reading your point below, was where would that leave referral practices?

[quote userid="19228" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240372#240372"]Is it good practise to perhaps put an animal through many thousands of pounds of care and use up tens of hours of professional time on 1 individual when perhaps dozens of animals could have benefitted from this .[/quote]

Surely the most resource intensive care is provided by referral practitioners, not GPs. Or do you think there are examples of treatments which take up too much GP time / resources?

Also, I am quite sure there must be micro time-saving tips which don't compromise the quality of care. They could, of course, be non clinical ones, which give more time for better clinical care.

And in the first great coincidence of 2023, look what arrived in my inbox today.

Very topical: https://www.vetsurgeon.org/news/b/veterinary-news/posts/bsava-shares-18-time-management-tips-for-vets

RE: Veterinary time savers

Neil Wheadon — Thu, 05 Jan 2023 11:45:27 GMT

[quote userid="3169" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240375#240375"] You can check colour, MM, eyes, ears, nose, LN's, chest, skin, abdomen, mammary glands/testicles in less than a minute and only if you find something abnormal does it warrant discussion. How long does a booster for a fit and well 3 year old dog need to take? I weigh everything, check last 3 digits of chip. I sometimes run ahead on 10 min appointments[/quote]

10 minute appointments grind a vet down, lead to low client satisfaction and in our digital age, places that provide a service will win. With respect you're not doing this for 8 hours a day, you're doing this for 90 minutes, that's 9 clients, maybe 3 boosters that you can 'speed' through and maybe you rum over by 15 minutes before jumping in your car and heading to a farm where you can turn on the radio, enjoy the glorious Yorkshire views and destress

I've done open surgeries, moved to 10 minutes and now 15 minutes is the norm. I cannot go back

Take this morning where I have had a little more time

BOOSTER

Cavalier, no murmour. I took the heart rate for reference, explained about murmours (throwing in the gag to 'breed from this 5 year old') fully examined and the client thanked me for being so thorough. Why did she say that? 6 months ago, she had moved from a mixed practice. She said unprompted 'you didn't just have me in and jab the dog' Clients say, and more importantly think for a reason

LIBRELLA

Sounds simple doesn't it

1 minute, out the door.

In reality been on for 5 months and not quite cutting it. We reviewed exactly what was happening. Turns out, the more you let them talk the more comes out. Underdosing with paracetamol at home, taken off galliprant etc

Result, clinical plan, delighted client, wished me a Happy New Year and thanked me loads

CAT GONE BLIND OVER CHRISTMAS

That's life - simple consult

Nope - retinal haemorrhage, blood sample taken, BP checked, medication dispensed, delighted client

In areas where there is choice and these are high demographic areas, clients have choices, there are 4 vets in this small market town.

10 minutes wears you down, you have no time to think, your vets are stressed and yes the clients notice

Happy New Year

Neil

RE: Veterinary time savers

Martin Hamilton — Wed, 04 Jan 2023 01:18:52 GMT

I think you misinterpreted my comment Michael - I meant that for certain cases it can be seen as an investment to take longer to explain things/manage a client and patient so that they require less rechecks/repeated visits further down the line. For example, take 30 minutes for a comprehensive derm evaluation and discussion, and all being well you see them for a quick recheck 4 weeks later, take your swabs/scrape to make sure things are resolved, then don't see the patient again for 6 months while they continue an elimination diet/apoquel/cytopoint. As an added benefit, cytology of ears and skin means you don't end up over-prescribing antibiotics when the only causative organism present are fungal.

If it's a first time ear infection - yes, don't bore them to death, but inform them that if it recurs then we need to have to consider allergies and come up with a plan that works for them and their pet. Have had plenty of second opinion derm cases from disgruntled clients that have been going to the same vet for years, every month or two, for ear infections and are just fed up with a quick in and out the door approach. Depends on the clients in your locale I suppose.

I agree that for booster etc they can be done in 5 mins, or by a nurse if you're seeking to maximise practice efficiency!

My take home was not that we should take 30 minutes for every consults, rather be selective on which ones you can "invest" your time in to make long term management easier, and not use too much time for the banal stuff (and/or utilise your support staff).

RE: Veterinary time savers

Michael Woodhouse — Wed, 04 Jan 2023 00:55:36 GMT

I think this is the problem.

[quote userid="16672" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240362#240362"]the first consult ended up being 30 minutes[/quote]

Ok, so playing devil's advocate, but we have 3 consulting blocks of 1 hour approx. 10 min appointments. Occasionally double booked if something looks quick. I can do morning surgery be done by 10. Operate between 10 and 1. Have an hour for lunch. Afternoon surgery 2-3. Do a farm call, sick cow, some scanning, bloods etc and be down for evening surgery 5-6.

Your 30 min consults means you are seeing animals for 9 hours solid to see the same number I see in 3 hours - and I bet I can get 90%+ of what you get done, done. You can't do 5 days of solid consulting so you want to work 4 days. Then when do you operate? You've just made yourself 1/3 of my productivity - yes you may charge more and may do more upselling, but 3X as much? How do you select the cases then for a 30 min appointment? Some dogs only get a bad ear once in their life - do they need discussions on food trials, Cytopoint and atopy? Do you really think I don't bring those things up if they keep coming back?! (How very dare you - in the voice of Catherine Tate's grandma). I suspect a client may well remember as much information from 3x10min appointments (with repetition) than a 30 min lecture with Martin........ (I struggle to concentrate for 30 mins in CPD......)

My aim wasn't to have a go at Martin for raising his head, but more the modern feeling of having all the time in the world. Faffing about getting started on ops and consults and then running into their dinner time. Being careful what I say, but what I consider a busy day and some younger vets are poles apart (and I expect an hour for lunch most days and to finish on time). Despite having all the admin work of running a practice I consistently have the highest turnover. I take my half day and I'm usually home by 6.15 to get my oldest his tea and put one or two kids to bed.

Honestly I think we have a duty to relieve most suffering to as many animals as possible. The solution to having fewer vets isn't for them to work slower, it's about getting more done in the working hours. Be more efficient and get on and then have your breaks. A bitch spay shouldn't be taking an hour when you are 3 years qualified. You can check colour, MM, eyes, ears, nose, LN's, chest, skin, abdomen, mammary glands/testicles in less than a minute and only if you find something abnormal does it warrant discussion. How long does a booster for a fit and well 3 year old dog need to take? I weigh everything, check last 3 digits of chip. I sometimes run ahead on 10 min appointments, and I believe I am thorough (learnt with open surgeries, so you hone your craft).

RE: Veterinary time savers

cairncross — Tue, 03 Jan 2023 22:26:49 GMT

[quote userid="12930" url="~/001/nonclinical/f/life-in-practice-discussions/30529/veterinary-time-savers/240370#240370"]I would be concerned that what I consider to be "time-saving" may be considered "bad practice" by others![/quote]

I was thinking of more macro changes/ attitude rather than individual micro ones . The what can we do about having ever fewer resources to spread thinner, how do we turn around the current trajectory where we are aiming to have ever higher standards regardless of the impact that it means an ever increasing percentage of our resources then are only available to the wealthy few patients. NHS does I understand have a system for this in trying to direct best possible use from finite resources and I expect it's going to become a lot more prominent going forward. Surely this is one area of human medicine we should be aiming to emulate but it's not popular or glamourous .

Is it good practise to perhaps put an animal through many thousands of pounds of care and use up tens of hours of professional time on 1 individual when perhaps dozens of animals could have benefitted from this . Where is the balance on this.

Perhaps it is a micro thing , should there be a stigma about trying to provide affordable care sustainable to most of a local community?