Help with mobile clinic please (#2)

Re: Help with mobile clinic please (#2)

Niall Taylor — Wed, 12 Oct 2011 21:55:27 GMT

[quote user="Arlo Guthrie"]Last week, a first timer to the forums came asking for advice... [/quote]

Can anyone point me to the original thread or has the whole thing been removed?

Niall

Re: Help with mobile clinic please (#2)

Martin Atkinson — Wed, 12 Oct 2011 18:45:10 GMT

I do agree on the whole business of building quality but I'm sorry to persevere Arlo: she most definitely did question why she should have to provide a 24 hrs service when she was sole charge and had a young family. And yes she did communicate in good English which is why using the language barrier as an excuse to us misunderstanding her is so lame.

Re: Help with mobile clinic please (#2)

Arlo Guthrie — Wed, 12 Oct 2011 18:14:23 GMT

[quote user="Martin Atkinson"]she definitely suggested that the RCVS/VMD was being over officious in expecting certain standards of safe-keeping for drugs and was miffed that she should have to provide a 24 hour service because it didn't suit her lifestyle.[/quote]

No, she did neither of these things. Of that I am quite sure. She asked for clarification about what was acceptable regarding the building (wood or brick) and I really don't think it was possible to read it any other way. Well, obviously it was, because you have! I just disagree with you!

[quote user="Martin Atkinson"]learn to speak the language of the country she proposes to work in fluently [/quote]

Speaking to her on the telephone, I thought her spoken English was very good, certainly far better than my French after seven years of living in France.

Re: Help with mobile clinic please (#2)

Bob Russell — Wed, 12 Oct 2011 18:11:04 GMT

[quote user="Martin Atkinson"]

[quote user="Arlo Guthrie"]

[quote user="Martin Atkinson"]I think the problem was Arlo that the OP was bringing into question why she should have to abide by the RCVS rules that the rest of us have to live with and considered them unreasonable.[/quote]

Hi Martin,

I guess we all read things differently. Although the OP has been deleted (not by me), that is certainly not how I remember it, and nor does it tally with the conversation I had with her.

[/quote]

I can't remember the details of what Laura wrote either but besides the advice requested over operating in people's homes she definitely suggested that the RCVS/VMD was being over officious in expecting certain standards of safe-keeping for drugs and was miffed that she should have to provide a 24 hour service because it didn't suit her lifestyle. If she wants our respect and considered advice perhaps she should get the baby off her arm into the hands of her partner or child minder after all what is she going to do with it when she's driving her mobile clinic around?, and learn to speak the language of the country she proposes to work in fluently or worse disasters will occur than a misunderstanding on a website forum.

[/quote]

Ouch! I bet this gets a red star but i was not quite brave enough to move the thread down this route.

Re: Help with mobile clinic please (#2)

Martin Atkinson — Wed, 12 Oct 2011 18:02:09 GMT

[quote user="Arlo Guthrie"]

Hi Martin,

I guess we all read things differently. Although the OP has been deleted (not by me), that is certainly not how I remember it, and nor does it tally with the conversation I had with her.

[/quote]

Re: Help with mobile clinic please (#2)

Hannah Wynne Richards — Wed, 12 Oct 2011 17:04:23 GMT

Totalagreement with Niall

Wynne

Re: Help with mobile clinic please (#2)

Niall Taylor — Wed, 12 Oct 2011 17:02:03 GMT

[quote user="Arlo Guthrie"]Laura deleted the content of the original post... Our system only keeps a record of posts that are deleted, not posts that are edited. So no, I can't repost the original[/quote]

But surely anyone suggesting that the 2nd 'original' post was rewritten must have a copy of both - I know I wouldn't trust my ageing memory with that sort of detail, particularly if I was going to accuse someone of being economical with the actualite. I was assuming that those making the accusations must have copies of the 'original' original post somewhere.

Apart from anything else though the point really isn't who wrote what when, it's about how a poster is addressed (particularly one who hasn't posted before) by the rest of the forum. Even if they have had the worst idea in the world they deserve to be given, by others, the benefit of the doubt on a personal level, while pointing out that their idea is wrong. OK if they persist with nonsense despite rational arguments to the contrary then there may be some scope for questioning the motives of the poster, but it takes quite a while for me to get to that point.

I take it we have all noticed that this has turned into the 'forum netiquette' thread! For the record I think a mobile surgery is not a good idea.

Niall

Re: Help with mobile clinic please (#2)

Arlo Guthrie — Wed, 12 Oct 2011 16:44:31 GMT

[quote user="Niall Taylor"]Being a persnickity, evidencey kinda guy, would it be possible to repost both alleged versions of the original post so us bystanders can judge for ourselves.[/quote]

No doubt the conspiracy theorists will have a riot, but Laura deleted the content of the original post when everyone laid into her (and I can't say I blame her. I would have done the same). Our system only keeps a record of posts that are deleted, not posts that are edited. So no, I can't repost the original.

Re: Help with mobile clinic please (#2)

Hannah Wynne Richards — Wed, 12 Oct 2011 16:40:49 GMT

As one of the senior regular contributors to this forum-may I add my bit?

I can remember when both SA and equine practices were far more primitive than we now take for granted. I'm delighted at the improvement in standards which has taken place even though both veterinary fees, and veterinary incomes have fallen in real terms-that proves how we are a caring profession

I'm saddened when I see someone trying toturn the clock back to the "bad old days "

Wynne

PS It's not all an improvement-I'm equally saddened by the changes in cattle practice-I caught the last of the good times-when we had effective treatments,but the individualcow was worth far more to the farmer, so it wasn't all herd medicine

Wynne

Re: Help with mobile clinic please (#2)

Bob Russell — Wed, 12 Oct 2011 16:22:18 GMT

This is a caring profession. We care a lot about our patients, most of the time we care about their owners welfare (often to the detriment of own). With any threat real or imagined the reactions can be robust to say the least.

As vets we are perhaps less tolerant of our own failings than others are. If we were not a genuinely caring profession we would not react strongly so don't be quite so surprised when this happens!

Re: Help with mobile clinic please (#2)

Arlo Guthrie — Wed, 12 Oct 2011 16:03:42 GMT

[quote user="Bob Russell"]The original post has clearly been rewritten by someone well versed in PR. [/quote]

You old cynic.

Look, I saw she was getting a hammering. I suspected it might be unfair. I spoke to her on the telephone. She explained that what she was trying to ask for was guidance as to what was acceptable, not defining what she thought was acceptable. I believe her. Make what you will of it.

Tell you what, though, I am genuinely taken aback by the posts which rush to a guilty verdict, or the ones which are so critical of others. They just seem rather at odds with a 'caring profession'. That is not aimed at you Bob, there have been a handful of rather intolerant posts recently.

Re: Help with mobile clinic please (#2)

Niall Taylor — Wed, 12 Oct 2011 15:43:42 GMT

[quote user="Bob Russell"]The original post has clearly been rewritten by someone well versed in PR. It bears only the most superficial resemblance to the original post... You have re-written history in the light of an explanation from the original poster[/quote]

Being a persnickity, evidencey kinda guy, would it be possible to repost both alleged versions of the original post so us bystanders can judge for ourselves.

Niall

Re: Help with mobile clinic please (#2)

Bob Russell — Wed, 12 Oct 2011 15:25:06 GMT

I responded to a post that made what I considered unacceptable suggestions as to what is or should be acceptable practice in 21st Century Britain. Whilst my choice of language and anger at the original post may have been somewhat over the top with hindsight it is not my place to give the benefit of the doubt and re-write a post in the OP's favour.

If the original post had been written as the 'corrected' one had been my response would probably have been a little less OTT. This is the UK, we speak English and vets are highly qualified individuals.

No invasive surgery should be taken lightly, no anaesthetic or sedative should be administered without careful consideration and very little surgery is suitable for the kitchen table.

I have not tried posting late at night with a child perched on my arm in a foreign language so would not be able to comment as to how easy it is but I probably would not try posting under those circumstances if I expected a professional response from my peers.

The original post has clearly been rewritten by someone well versed in PR. It bears only the most superficial resemblance to the original post. The responses have as a result been much more measured. You have re-written history in the light of an explanation from the original poster.

Actually re-written it rather well!

Re: Help with mobile clinic please (#2)

Arlo Guthrie — Wed, 12 Oct 2011 15:07:53 GMT

[quote user="Gerry Henry"]Rewriting history again Arlo, you just can't resist it can you, the prerogative of the moderator I suppose. [/quote]

I think that's unfair. I haven't rewritten history. I repeated the original question without rewriting it at all. And I have simply added the explanation I was given (and happen to believe), by the OP.

[quote user="Gerry Henry"]Does anyone know of any official list of minor surgical procedures (if any) that can be performed at home, such as neutering, lump removals or de-matts?

This suggests very strongly that the poster thinks procedures such as neutering are minor[/quote]

Given no other context, I guess I would have to agree. However, I (unlike you) have had the benefit of talking to her, and I am quite convinced that she does not consider spaying an obese lab bitch a minor procedure.

[quote user="Gerry Henry"]I think we all know what the poster meant[/quote]

On the contrary. I think that until you have tried posting a question to a forum of your peers in a second language, late at night, with a child perched on your arm, you can have absolutely no idea how easy it is to post something which isn't actually what you meant.

Re: Help with mobile clinic please (#2)

Gerry Henry — Wed, 12 Oct 2011 14:36:45 GMT

Rewriting history again Arlo, you just can't resist it can you, the prerogative of the moderator I suppose. The original post asked, quite specifically,

Does anyone know of any official list of minor surgical procedures (if any) that can be performed at home, such as neutering, lump removals or de-matts?

This suggests very strongly that the poster thinks procedures such as neutering are minor; this is worrying. As I din into every EMS student that comes to my practice, neuterings are not minor procedures, they can be straightforward or they can be difficult and but they are never minor. It might be tricky coping with an obese lab bitch whose ovarian artery greases out of the clamp and disappears, pumping blood, into adipose infinity - in someone's front room. I'm old enough to remember vets who operated at home, boiling kits on the AGA, immobilon for anaesthesia, the whole James Herriot thing, very good reading and very cosy but not where we want to be in the 21st century.

I think we all know what the poster meant, she expressed herself very clearly, it was the content that most people found disturbing hence the response.

Re: Help with mobile clinic please (#2)

Arlo Guthrie — Wed, 12 Oct 2011 13:46:01 GMT

Hi Martin,

I guess we all read things differently. Although the OP has been deleted (not by me), that is certainly not how I remember it, and nor does it tally with the conversation I had with her.

Re: Help with mobile clinic please (#2)

Martin Atkinson — Wed, 12 Oct 2011 11:04:48 GMT

[quote user="Arlo Guthrie"]

Last week, a first timer to the forums came asking for advice, and was given a very hard time both for asking what, if any, minor procedures might be acceptable to perform at home, and for the fact that English was not her first language.

I've spoken to her, and she has very sportingly (under the circumstances), agreed that I can repost her questions, both to help with her English and to ensure that any discussion does not descend into personal slight. I do hope that this time, you'll welcome her, keep the discussion friendly and supportive. I also hope we can make a fresh start here, and Laura will become a regular and welcome member of VetSurgeon.org

[/quote]

I think the problem was Arlo that the OP was bringing into question why she should have to abide by the RCVS rules that the rest of us have to live with and considered them unreasonable. There was no misinterpretation of this due of her language skills which weren't that bad considering English is not her first language. In all honesty the initial response she had was not disproportionate if it made her realise that these rules are there for a purpose and apply to everyone no matter how unreasonable she may think they are and if it made her realise that you only get out of veterinary practice in the UK what you are prepared to put into it if you want to to do professional and ethical job i.e. there are no short cuts. I would not take back anything I posted originally other than suggesting she was a troll which I do now realise was out of order so apologies for that.

Re: Help with mobile clinic please (#2)

Laurence Webb — Wed, 12 Oct 2011 10:07:02 GMT

[quote user="Helen Wallace"]

I don't know of any official guidance as to what proceedures you can carry out at home but I'd think it has to be limited. I think you'd also need to research what the client demand would be. I can see folk wanting a sedate to clip nails but probably not surgery that involves blood and mess :)

It would be worth asking the VDS how you'd stand in an emergency situation. I have to say I don't even sedate at our branch as we have no oxygen if anything goes wrong. My boss does and has never had problems but I just wouldn't feel happy.

[/quote]My suspicion is this would all be down to informed client consent. Horses have routine surgical procedures carried out in the field. You could argue that they should only be carried out in a fully equipped hospital so that any complications can be satisfactorily dealt with. They aren't on the grounds of cost and convenience.

As long as you discuss the pros and cons of procedures at home vs at a practice and some careful thought is carried out about whether that particular procedure is appropriate to be done under those circumstances then I feel some procedures would be OK to do. I think clients must be made aware of the limitations of monitoring, adjusting anaesthesia, dealing with complications etc if you are single handed but many people would be willing to trade that off for the convenience of having minor procedures carried out at home.

What would be wrong would be to just tell people that you can do surgery at home without letting them know any of the potential pitfalls. Stitch-ups fine, orthopaedics not!

Re: Help with mobile clinic please (#2)

Michael Woodhouse — Wed, 12 Oct 2011 00:51:14 GMT

[quote user="Bob Russell"]The requirement seems to be for a permanent structure.[/quote]

Brought in to try and stop the 'man with a van' going around selling POM-VPS products out of the back of it IIRC. Didn't work, they just pre-order then and deliver later.

Re: Help with mobile clinic please (#2)

Robin Grimmer — Tue, 11 Oct 2011 20:41:14 GMT

I think a mobile clinic could work well if you work with local practices. I think it could be mutually beneficial.

You could refer anything you can't deal with to them and you could help them out with visit requests.

Most practices don't like doing visits IME - they are a pain, time-consuming and often very inconvenient.

Re: Help with mobile clinic please (#2)

Helen Wallace — Tue, 11 Oct 2011 16:02:21 GMT

Now that you mention it Hanna, I'm sure the CPL used to have a mobile theatre van for doing cat neuters.

Re: Help with mobile clinic please (#2)

Hannah Wynne Richards — Tue, 11 Oct 2011 10:24:43 GMT

I believe I heard somewhere that the RSPCA had a lorry kitted out as an operating thetre, and sent it round the country (with veterinary surgeon and nurse ) to do blitz neuterings in certain areas-sounds expensive but may be a solution(though you couldn't provide a cheap service ) I don't understand the ban on storage in a dwelling house-if it's only BVA not RCVS you can ignore it-after all many practices have assistants/nurses flats upstairs-and no seperate entrance This sounds more secure than a shed-just stick a notice saying "Practice " on a spare bedroom door

OOH Either you do it or enter into a contractual relationshipwith another practice to do it

Wynne.

Re: Help with mobile clinic please (#2)

Mark Rowland — Tue, 11 Oct 2011 09:22:49 GMT

I looked into this a few years ago. In the States you can buy small lorries fully kitted out with better stuff than you will find in many small animal practices, gasses, xray, op table, kennelling. If you want i will try to find the brochure to post. Its actually not that expensive (or wasnt) to get one kitted out, converted to right hand drive and shipped over here. It all depends on how much money you wanted to spend.

Goodluck

Re: Help with mobile clinic please (#2)

Stephen Ashman — Tue, 11 Oct 2011 09:04:37 GMT

[quote user="Bob Russell"]The idea of a mobile clinic is fine IMO but the choice of procedures carried out should be appropriate. If you have a van with a fully kitted out operating theatre and kenneling why would anyone be concerned if major procedures are carried out there? Years ago there was an advanced operating facility linked to Grand Prix racing that was able to tackle major head trauma cases.[/quote]

Animals are also anaesthetised in lorries - the mobile MRI scanner lorries.

Re: Help with mobile clinic please (#2)

Bob Russell — Tue, 11 Oct 2011 08:58:24 GMT

There is nothing wrong with a wooden structure and our referral dermatologist runs his practice from a log cabin. The requirement seems to be for a permanent structure.

The idea of a mobile clinic is fine IMO but the choice of procedures carried out should be appropriate. If you have a van with a fully kitted out operating theatre and kenneling why would anyone be concerned if major procedures are carried out there? Years ago there was an advanced operating facility linked to Grand Prix racing that was able to tackle major head trauma cases.

See if you can work with local practices as has been suggested above. Work to the highest standards but remember clients trust you to do the best for their pets and VDS will struggle to defend your actions if you try to do to much.

Try not to get overly ambitious with a mobile clinic and seriously consider the acceptability of operating on the kitchen table to the general public in the UK!