Under my care?

Re: Under my care?

Stephen Courtney — Wed, 30 Mar 2011 23:37:28 GMT

[quote user="Clive Ansell"]

Why on earth do free or discounted home visits, or just pop in on the way home?

If a home visited is requested or is needed on welfare, moral, clinical or legal grounds - do it and then charge properly for your time, skill, expertise and professionalism. I think free or cheap home visits set a bad precedent, people come to expect them as a routine.

[/quote]

I have certain clients I have a good relationship, that need the consideration, often housebound little old ladies, insured pet but the insurance company won't pay for a visit just because the owner can't be moved - even though the visit fee includes a consultation. I choose these scenarios carefully, and always make sure they understand it is a favour, and that it may not always be possible, especially at short notice. I make sure they have the pet ambulance phone number. But if I can help, I will. I cultivate an air of friendliness and approachability. Even though i am a misanthropic cynic at times.

Re: Under my care?

Richard Carter — Wed, 30 Mar 2011 18:17:37 GMT

Because in the real world your reputation still has value both personally and as a veterinary surgeon, you are standing on the shoulders of our professional predecessors who did practice with a community spirit that was and still is recognised by our clients and the occasional good will work puts clients in your waiting room (hopefully some paying ones!!)

Re: Under my care?

Clive Ansell — Wed, 30 Mar 2011 13:24:08 GMT

Why on earth do free or discounted home visits, or just pop in on the way home?

Re: Under my care?

Stephen Courtney — Tue, 29 Mar 2011 23:47:42 GMT

I am very very wary of free visits - they tend to become expected, and can put intolerable pressure on you. Clients quickly reach a point where they expect you, as their new best friend, to drop anything at any time, and visit whenever they want - all for free. I do still do them - often to drop meds off, but never on an urgent basis - if it's that urgent they go in a taxi, and the owner pays for it.

Oddly, there have been a few clients that always get visits because I cannot get them out of the consult room! At least at the visit, when your job is done you walk backwards while talking,. all the way into the car and leave...takes practice but can be done without giving offence, especially if they have been told before you come that you are in a terrible rush...

As far as routine meds checks on knackered old animals, I tend to use a mixture of common sense and expediency. In the situation described I would just provide the meds, so long as the owner was clearly informed that a lack of regular checks may allow an undetected illness to progress. At that age the next time you see the dog is likely to be for a PTS, alas.

Re: Under my care?

Mark Holmes — Tue, 29 Mar 2011 17:08:13 GMT

Thankyou, I will proceed along those lines. Its would appear to be the logical approach to me as well. (and I will direct any subsequent investigations to this thread)

Thanks to those suggesting a free visit. I would but they live somewhat out of my way and a "free" home visit on practice time might be frowned at. Besides that last vet who visited was trapped "Misery style" and unable to leave for several hours.

Re: Under my care?

Alan Tevendale — Tue, 29 Mar 2011 17:03:55 GMT

I had a very similar conversation with one of our assistants just ten minutes ago. I would agree that a telephone conversation regarding activity, drinking, eating etc would gain almost as much information as you probably would get from what would be in effect a very limited examination. I would certainly agree that this would constitute the animal being under your care. There would be nothing wrong with going down to yearly visits (if you still wanted to have some contact) with the occasional phone call.

Re: Under my care?

Anthony Todd — Tue, 29 Mar 2011 17:03:28 GMT

[quote user="Rob Davis"] Dishing out medication[/quote]

Rob is one who agrees, but again and again vets and nurses think there is a legal time limit or law.

Use common and professional sense rather than hiding behind some mythical law which really phisses the owner of 'cos it's stupid and the animal will be much worse by being dragged into the surgery; for what??

Re: Under my care?

Rob Davis — Tue, 29 Mar 2011 16:47:58 GMT

[quote user="Anthony Todd"]

BUT, it is your discretion and you must be able to justify it, clinically and morally.

In your case it is bleeding obvious that the dog need not be seen and, in fact, it is not best care for the animal to drag it in.

[/quote]

I agree. I would feel that a detailed telephone discussion with an owner who you know and trust about a patient who you have been treating for a long time would constitute the patient being "under your care". Dishing out medication without discussing the case with the owner would not.

Re: Under my care?

Anthony Todd — Tue, 29 Mar 2011 16:42:48 GMT

[quote user="Mark Holmes"]How long do you think you can justify continuing to dispense in this situation and argue he is under my care before I have to upset the old boy.[/quote]

This is a perennial question and I can only reiterate:

THERE IS NO LAW, RULE, REGULATION or DECREE even in Europe yet !!!

BUT, it is your discretion and you must be able to justify it, clinically and morally.

In your case it is bleeding obvious that the dog need not be seen and, in fact, it is not best care for the animal to drag it in.

Re: Under my care?

plantagenet — Tue, 29 Mar 2011 15:24:24 GMT

These are the ones I pop in on the way home and don't charge visit or consult, to satisfy myself that all is well. Ok I'm ducking to avoid onslaught of 'you shouldn't do work for nothing' but, if I were being entirely mercenary - which I'm not - that sort of think is most likley to ensure the next pup comes your way.

Re: Under my care?

Mark Holmes — Tue, 29 Mar 2011 14:53:58 GMT

[quote user="Clive Ansell"]

If I was happy that the client is sensible and responsible, and I have some knowledge of the dog I would probably dispense the medication. Given he is 17 and coming to the end anyway I cannot see anything different or better being done. There is no legal requirement to see patients at 6 month intervals, just a woolly guideline that they have to be "under our care" I would point out potential side effects of the medication and stress that I cannot check or look out for these without seeing the dog.

It is more difficult as a locum doing a short term stint, as I would not normally have a good knowledge of the client or the patient. I would normally consult with the regular staff/nurses and dispense enough medication at least until the owner/regular vet returns.

[/quote]

Thats my feeling, I have had a long telephone consult with the client. She is aware of the risks of the medication but would want to stop it as she feels the only alternative would be immediate euthanasia. The owner is responsible and (believe me) is down at the first sign of ANYTHING unusual. Its just that "under my care" is very open. Which is good providing you interpret it the same way as the RCVS or VMD on the day you are inspected/investigated/shot

Not sure what would be gained by her stuffing an aged arthritic dog into a small car and him bringing him to the clinic where he is always distressed.

Re: Under my care?

Clive Ansell — Tue, 29 Mar 2011 14:40:44 GMT

Re: Under my care?

Bob Russell — Tue, 29 Mar 2011 14:14:21 GMT

I would probably do a reduced rate visit to keep everything 'legal'! I have found an occasional visit to a long-standing client breaks up the day a bit. We warn them that it will be at our convenience and just phone in advance to check it is OK.

In the past this has had some favourable spin-offs and has generated quite a lot of unexpected goodwill and new clients.

Some of these visits have been little more than dropping off the medication trips (be careful they don't come to expect it though). I would still say 6 months max for a dog in delicate health. Make the usual backside covering notes to explain the long intervals!!