GI foreign bodies

Re: GI foreign bodies

Bob Russell — Wed, 26 Jan 2011 15:04:49 GMT

[quote user="bob lehner"]

[quote user="Bob Russell"]

If I feel the risk of removal exceeds the risk of wait and see then I wait and see.

[/quote]

Surely the exact opposite can be equally valid.

I guess it's down to judgement (and possibly a degree of luck). For example, I have often seen quite large stones pass happily through the bowel, but also those that have become absolutely stuck fast, leading to a devitalised area of intestine

Wait too long and you can end up operating on a much sicker animal, which may need bowel resection as opposed to an enterotomy.

Personally I would often prefer to go for an earlier exp lap. It's all very well for the 'expert' to say 'wait and see' - but if you do and it all goes pear-shaped you're not going to look too clever or get many thanks from the owner.

[/quote]

I have to admit that if I identify a FB it is very unlikely it will remain there! I would rather do a simple enterotomy! The dog that ate the milk bottle had done so several hours before the owner realised. I considered the risk of surgery high and the dog was bouncing around with a bl**dy great grin on his face so I chickened out with surgery. Very glad I did!

Re: GI foreign bodies

Anthony Todd — Tue, 25 Jan 2011 23:45:44 GMT

[quote user="Hannah Wynne Richards"]since RCVS are highly unlikely to turn the clock back,and ban lay ownership of practices[/quote]

And nor they should!. Clinical competence and action is the responsibility and liability of the particular veterinary surgeon; the sequels to his or her actions the liability of their employee, MRCVS or not, as the VDS will confirm.

Agencies always supply competent VSs don't they....... What the vets say they can do is vastly different from what they actually can do, and that revelation is always retrospective.

Oral references are worth much more than the paper they're not written on too.

Re: GI foreign bodies

Gillian Mostyn — Tue, 25 Jan 2011 18:48:45 GMT

I had something similar happen - employed a locum whose knowledge and skills were far below what I expected in my practice. I fired them after 3 days.

I think phipps has said everything for me. No, I wouldn't employ a new grad to work sole charge, but any mistakes the new grad made would still not be my responsibility as far as the DC are concerned. Every vet is responsible for their own clinical work, and nobody else's. I can't see how anything else could be fair?

If I were the boss/director of a company that employed somebody completely unsuitable for the role, then I would be sacking the HR person......as would happen in any other industry. If I had done the recruiting myself, then I obviously have very little concern for my own company...which doesn't look good for it's future....

Re: GI foreign bodies

Julian Earl — Tue, 25 Jan 2011 18:24:23 GMT

[quote user="Richard Carter"]

[quote user="phipps"]how they managed to recruit a locum who was wholly unsuitable[/quote]

mmm - am aware of a practice who employed a qualified, registered MRCVS through an agency for sole charge cover who then announced after arrival she had not done a bitch spay and was not confident with anaesthetics.

[/quote]

I've been caught out like that. A well-known locum agency recommended this fluent-English speaking Italian vet with three years' experience, able at mixed practice, worked in this country etc., etc.

Cue the arrival of a barely-understandable young Italian, whose "experience" was meat inspection, had "worked" for three weeks at an equine practice in an EMS-type way, and had never speyed a cat. I became a bit suspicious when his first morning was taken up by a veerrry long cat spey. He was the only locum that I have ever sacked, and the only reason he lasted three days was because I was off on one of the three!

Re: GI foreign bodies

Glen McIntosh — Tue, 25 Jan 2011 18:22:28 GMT

[quote user="Hannah Wynne Richards"]Legally the deficits of an employee have always been the responsibilty of the employer-like it or not[/quote]

But not the professional conduct of that employed MRCVS. The individual MRCVS is entirely responsible for their own professional conduct, and part of proper professional conduct is not to perform work beyond your skill level, like it or not.

The RCVS is only concerned with professional conduct.

If the owners in this case wanted to take action against the employer for employing an under-qualified person that resulted in damages then they would need to use the court system and sue the employer. They might well have an arguable case. But they will never succeed in attempting to get the RCVS to sanction the employer, because issues of professional conduct will always come back to the individual MRCVS.

Re: GI foreign bodies

bob lehner — Tue, 25 Jan 2011 18:13:51 GMT

[quote user="phipps"]The individual MRCVS is entirely responsible for the employment in which they engage themselves[/quote]

Yes - but one of the biggest failings of our profession in the past was the frequent way that employers took on young graduates and just chucked them in the deep end with the attitude that they would sink or swim - regardless of the damage that they might do to their patients (and their own mental state) on the way !

I think one must accept that the RCVS and other bodies have done a lot of good work in trying to discourage this sort of behaviour by senior members of the profession.

On the other hand it is generally wise for employers to take up recent references and look at the cpd record cards of prospective employees.

Re: GI foreign bodies

Richard Carter — Tue, 25 Jan 2011 18:06:00 GMT

[quote user="phipps"]how they managed to recruit a locum who was wholly unsuitable[/quote]

Re: GI foreign bodies

Hannah Wynne Richards — Tue, 25 Jan 2011 17:57:15 GMT

I agree with you on this one Mark Legally the deficits of an employee have always been the responsibilty of the employer-like it or not

Wynne

Re: GI foreign bodies

Mark Holmes — Tue, 25 Jan 2011 17:48:04 GMT

I did not suggest that the MRCVS had no responsibility but for an employer to advertise itsself as one thing and then knowingly employ somebody who was unsuitable is fraudulent. As I said earlier how is it different from mis signing an official document.

Its the same as establishing yourself as a referral centre and employing people with no post grad qualifications. No they shouldn't apply or take the job, equally the practice should be accountable if they employ them.

Re: GI foreign bodies

Glen McIntosh — Tue, 25 Jan 2011 17:32:35 GMT

[quote user="Gillian Mostyn"]I feel that blaming an employer (any employer) for a mistake made by an employee is territory none of us want to get into.....it is up to us, as professionals, to be aware of our own skill sets and deficiencies.[/quote]

I agree.

In this case we don't know how this person represented himself to the employer. Even if he did represent himself, his current skill level and his time away from practice honestly to the employer and the employer still employed him in a role that he was clearly unsuitable for, then he - the individual MRCVS - ought to have recognized that he was undertaking to do work for which he was under skilled and said thanks but no thanks. It is the individual MRCVS who has a duty to only perform work within his or her skill level and to refer or ask for help if the work is beyond them. Or, if that work encompasses the whole job, then to not accept employment in that role.

The individual MRCVS is entirely responsible for the employment in which they engage themselves, and that is as far as the responsibility goes in this case, I think.

As for the employer, well they certainly do need to review their recruitment processes to assess how they managed to recruit a locum who was wholly unsuitable and who should have been recognized as being wholly unsuitable. They need to do this, not because of fear of RCVS sanction but because of fear of a repeat episode and the very negative publicity associated with it that will seriously harm their brand. Negative brand publicity is probably a fate far worse than RCVS sanction for a large corporate entity.

Re: GI foreign bodies

Hannah Wynne Richards — Tue, 25 Jan 2011 17:13:54 GMT

You're right Mark This was not a post for a new grad,or someone who's clinical skills were rusty-the problem with these massive corporations is the shareholders (if lay ) cannot be disciplined, and even if veterinary,very little of their time will be spent in clinical work,so DC are effectively impotent-striking off will not adversely affect the bottom line for the owners

I'm hoping since RCVS are highly unlikely to turn the clock back,and ban lay ownership of practices, then recent DC rulings may persude the employees of these concerns that they would be better off working for bosses who are themselves accountable, i.e. practcing veterinary surgeons

Wynne

Re: GI foreign bodies

Mark Holmes — Tue, 25 Jan 2011 16:50:02 GMT

[quote user="Gillian Mostyn"]

But it is the surgeon's own decision to decide what they are and aren't able to do. We occasionally employ new grads to work for us. We do everything in our power to ensure they have a senior vet to hand but if an occasion arose when they were alone and then were faced with something of which they feel they aren't capable, it is up to them to stop and ask for help. Only if that help is then refused could the employer become culpable, surely?

Although I agree that some of the marketing is misleading, and is a trades description issue, I feel that blaming an employer (any employer) for a mistake made by an employee is territory none of us want to get into.....it is up to us, as professionals, to be aware of our own skill sets and deficiencies.

[/quote]

Would you employ a new grad or somebody whose CV clearly showed several years out of clincial practice in a sole charge position which by definition would have a higher percentage of challenging cases?

Re: GI foreign bodies

Gillian Mostyn — Tue, 25 Jan 2011 16:21:46 GMT

Re: GI foreign bodies

Mark Holmes — Tue, 25 Jan 2011 15:28:27 GMT

[quote user="Clive Ansell"]

Do you think the employer should have been hauled up in front of the RCVS DC too? after all, they as the largest provider of emergency care in the UK employed a man that had not been in clinical practice for some years to place in a sole charge position in an emergency clinic where good and up to date clinical skills are, by definition, required. It could be argued that they ought to have known he would not, or may not, be fully competent. ???

[/quote]

I have not got much knowledge of the case but if this is true and I don't have no reason to doubt it, then yes the employer should be hauled up. The largest provider of emergency care in the country markets itself as a company who is providing surgeons who are particlarly experienced in emergency care. I am not sure they use the term specialist but they imply a particularly high degree of experience and expertise. I have always doubted this as my experience of them has included alot of newish qualified traveling locums but to employ somebody who has been out of clinical work for sometime in sole charge seems irresponsible at best and at worst fraudulent. If a vet can be struck off for signing something which is not true surely the same applies to marketing your business publically as that which it is not?

Re: GI foreign bodies

Hannah Wynne Richards — Mon, 24 Jan 2011 09:43:34 GMT

Malcolm I stand corrected-overall impression created by other's posts

I agree that the disciplinary process should have extended to the employer-in this case a veterinary surgeon, and therefore subject to discipline,although he is running a huge company

My personal opinion is that this empire has outgrown the number of veterinary surgeons who are truly so enthusiastic about A&E work that they are prepared to work at antisocial hours for a very modest remuneration, so they are scraping the bottom of the barrel to maintain staffing levels

Wynne

Apologies if I contributed to the misunderstandings regarding this case

Re: GI foreign bodies

Malcolm Ness — Mon, 24 Jan 2011 08:47:06 GMT

Wyn,I think you are reacting not to what was said, but to what others have reported.

In fact, the intervention of the expert in this case significantly mitigated the severity of the case against the defendant. The expert pointed out that while most sharp FBs will pass without incident, that fact is not well recognised amongst the defendants peers and consequently his decision to operate was consistent with normal practice. Prior to the involvement of the expert, this guy was being strung out on the basis of the evidence of vets and nurses in the day-time practice. I am of the opinion that the College's disciplinary process is pretty good - they tend to get things about right almost every time and while it is easy to take umbrage at aspects of certain decisions, generally a reasonable and well balanced result is achieved.

Clive's question re the employer is pertinent: the product on offer at this clinic on the night in question fell well short of the product that is promoted by the country's largest "Emergency and Critical Care" practice. Questions should be asked. I am struck by the implications that these deputisers are somehow experts or specialists in emergency and critical care while their recruitment side sets the bar very low indeed - 6mths experience in an English speaking practice - when and how do they become competent, let alone expert.

Re: GI foreign bodies

Emily Nightingale — Sat, 22 Jan 2011 22:33:26 GMT

Am thinking it would be very interesting to compile a catalogue of pics of foreign bodies found in vet practice..

Here's a link to one I did earlier!

http://www.gazette-news.co.uk/news/4518919.Our_dog_felt_under_par___he_d_eaten_nine_golf_balls/

Re: GI foreign bodies

Clive Ansell — Sat, 22 Jan 2011 13:53:06 GMT

[quote user="Hannah Wynne Richards"]

Again DC over-icing the cake ,or their expert witness doing it for them.The surgery was botched,the veterinary surgeon had been out of clinical work for years,and was stupid to go straight into a high pressure job,which by definition involved a lot of very sick animals-and his employers were equally stupid tohave employed him.He would have been better off spending 2 or 3 years in a 1st opinion practice where he could have regained his surgical skills whilst working under supervision

It would have been easy to find him guilty of working out with his area of competance-and todiscipline him on that

Instead, a specialist said that the glass MIGHT have passed through without causing harm,and perfectly competent surgeons are nervous of operating GRRRR!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Wynne

[/quote]

In addition should there not be some form of assessment or monitoring in place to ensure colleagues returning to clinical work after several years out are up to speed both with practical skills and with CPD?

Re: GI foreign bodies

Hannah Wynne Richards — Sat, 22 Jan 2011 09:45:27 GMT

It wouldhave been easy to find him guilty of working outwith his area of competance-and todiscipline him on that

Instead, a specialist said that the glass MIGHT have passed through without causing harm,and perfectly competant surgeons are nervous of operating GRRRR!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Wynne

Re: GI foreign bodies

Anthony Todd — Sat, 22 Jan 2011 07:11:39 GMT

[quote user="Bob Russell"]

If you remove a FB successfully you can never be proved wrong! If you fail to remove a FB you can be proved to be very wrong!

If I feel the risk of removal exceeds the risk of wait and see then I wait and see.

[/quote]

Er, don't you mean "if the risk of the exploratory [IMHO nearly nil] exceeds the risk of wait and see then I wait and see."

But still a five star post.

Re: GI foreign bodies

Laurence Webb — Fri, 21 Jan 2011 22:36:24 GMT

Ah, so we should telephone the specialist that's going to give us the answer that we want before deciding on treatment? "Ah, you honour, I telephoned Mr XYZ, at Clever Vet Specialists who told me I should wait and see/ex lap and remove it immediately" then let them fight over it.

Re: GI foreign bodies

bob lehner — Fri, 21 Jan 2011 21:17:27 GMT

Yes indeed - 'So Mr X - you knew the dog had swallowed some sharp pieces of glass, but you decided to do nothing about it. Sadly the glass perforated the bowel and the dog died . What do you have to say for yourself?'

Re: GI foreign bodies

Mark Holmes — Fri, 21 Jan 2011 17:41:05 GMT

[quote user="bob lehner"]Personally I would often prefer to go for an earlier exp lap. It's all very well for the 'expert' to say 'wait and see' - but if you do and it all goes pear-shaped you're not going to look too clever or get many thanks from the owner.[/quote]

And if it all goes pear shaped you will probably be sat in front of another (or even the same) expert saying you should have removed it!!

Re: GI foreign bodies

bob lehner — Fri, 21 Jan 2011 17:26:45 GMT

[quote user="Bob Russell"]

If I feel the risk of removal exceeds the risk of wait and see then I wait and see.

[/quote]

Surely the exact opposite can be equally valid.

Wait too long and you can end up operating on a much sicker animal, which may need bowel resection as opposed to an enterotomy.

Re: GI foreign bodies

Hannah Wynne Richards — Fri, 21 Jan 2011 17:08:24 GMT

Ah but when things went wrong-admittedly he seemed to have made a spectacular mess of the surgery, one veterinary surgeon was in front of DCand a specialist said that glass should have been left !!!!!!!!!!!!!!!!!!!!!

I would be far happier removing glass

Wynne