The future?

Re: The future?

David Mills — Mon, 31 Oct 2011 22:33:38 GMT

Yes, I think you need to choose your audience - cities especially would do well with this system (especially if the cost of the consult is less than transport to the nearest charity clinic).

And I'm not sure that the nurses have to be super-dooper amazing either. Just trainable and keen to learn. As an aside, I think expecting nurses to be fantastic at everything is like expecting the same of vets - despite some of us thinking of ourselves as omnicompetent, we ain't.

Re: The future?

Alan Tevendale — Mon, 31 Oct 2011 21:54:44 GMT

[quote user="Martin Atkinson"]

good qualified nurses are rarer than vets!

[/quote]

Good experienced nurses are truely rare I must admit although we're very lucky at my practice. If anything I find experienced mixed vets even rarer. Generally I agree with you that I prefer to send patients to the nurse for ongoing treatment after diagnosis and plans are put in place than the other way around but I do think that these sorts of clinics could dramatically increase the number of clients being seen by a practice and in turn allow the vets to diagnose and treat more animals.

Re: The future?

Martin Atkinson — Mon, 31 Oct 2011 18:41:43 GMT

[quote user="Alan Tevendale"]

I have been thinking of a silghtly similar system where nurses run geriatric clinics for example and anything showing up abnormalities on these are recommended that they are referred onto the vet. As long as the nurse is only looking for specific parameters and the client is aware of this it may help to pick up on animals that would otherwise go undiagnosed. Alternatively would this cause clients to avoid coming to the vet if they thought something might be wrong but had had a 'clear' clinic recently?

[/quote]

My take on geriatric clinics is that the patient is referred to the nurse for dietary and exercise advice etc after being seen by the vet not the other way round. I don't know if its because I'm a control freak but it doesn't seem to work in practice because there are too many variable parameters that need to be double checked by the vet. The same goes for other clinics like weight watchers and puppy clinics for that matter -, if there is a place for the nurse it is after the vet not before. Besides given what a nurse who would be capable of performing a clinical examination is worth these days I can't see us saving much, good qualified nurses are rarer than vets!

Re: The future?

plantagenet — Mon, 31 Oct 2011 18:14:43 GMT

Not, I am sure, what my clients want.

Re: The future?

David Mills — Mon, 31 Oct 2011 17:32:58 GMT

I think people are missing the point a bit here. The set up is simple. 4 nurses consult simultaneously, 1 vet floats behind the scenes. Nurses bring animal out, away from client, and summise findings. Vet checks. Examines. Has option of taking more history from client or clarifying things. Nurse can take back in, dispense drugs/injections/show ear drops etc.

Question is how many times in regular GP practice does a vet need to take the history, do the exam and everything else? Not many. How many times do we treat symptomatically/without a full diagnosis? Lots. How much bias is removed by examining an animal without the owner present? Lots.

Easy to train nurses/vets in spotting normal, and doing full clinical exam each consult. They report the abnormal.

Economically, the savings are enormous. Can run more consults, more quickly, for a lower cost. And run properly the system is very efficient.

I think this idea that everyone wants to see a vet is an ego massage (again). What people want is their pets to be healthy, or reassaurance, or prompt treatment. If animals are triaged by a nurse first then so be it, especially at a lower cost. Its all legal. Vets still provide treatment. It's just a focused use of knowledge - clinical exam (technical), history taking (technical), diagnosis/treatment plans (intellectually demanding (sometimes)).

Re: The future?

bob lehner — Mon, 31 Oct 2011 14:52:55 GMT

[

[quote user="katie mountford"]

I locumed in a practice a while back that used a similar system, I think it was called 'Safari'-it was a US import! The clients were booked 30min appointment slots, 10mins of which was allocated to a receptionist (pet health care advisor I think they were called) who asked basic questions re vaccs/fleas/worms etc, then the client was passed onto the nurse who took the history (and I think also did an clin exam) and then this information was given to the vet in a mini-handover type way and the vet then went in to do the exam/diagnosis.treatment.

I thought it was actually quite inefficient as clients were often kept waiting between each part of the consultation

[/quote]

Yes - I've worked with the 'Safari' system and to be honest it drove me bonkers. In my opinion a waste of the client's time - unless they were the sort of ditherer with too much time on their hands anyway and just wanted a lot of waffle. Wasteful of vet's time as you were either kept waiting for nurse to finish her bit - then tending to do your own complete consultation/history/examination anyway.

As others have said - I would much rather do the whole thing myself in my well-tried and stereotyped manner, honed over the years.

I think the nurses did quite like it as it gave them more to do - but from a business point of view I couldn't see the benefit.

Re: The future?

patrick murphy — Mon, 31 Oct 2011 13:32:03 GMT

I had to see an opthamologist while at NAVC once, and they used the same scheme. I saw receptionist, waited, then optho tech who took history and even examined me and proferred a daignosis(wrong), waited, then was given the privelge of a two minute exam by opthamologist with a mickey mouse tie on, then waited, and saw another tech, who showed me how to put drops in my eye, then I went to another recptionsit and paid.

here, my opthamologist walks into the room, says hello, shakes my hand, and the gets on with the consult and examination.

I know which I preferred.

Re: The future?

katie mountford — Mon, 31 Oct 2011 01:57:03 GMT

I thought it was actually quite inefficient as clients were often kept waiting between each part of the consultation which would cause a backlog in the waiting room and I would often have to repeat bits of the history taking to clarify points etc. The system was apparently designed to allow vets to concentrate of 'vetting' ie diagnosis and treatment but I have to say I wasn't a fan-I prefer to do a complete history and clinical exam myself as sometimes the little things a client says that may not be picked up as important can be vital bits of info! The practice also felt that using this system made the clients more bonded to the clinic as the system was marketed as a 'pet health care plan' and each consult generated paper based information for the client to take away. This part was quite useful as it gave clients info about the diagnosis made but did produce reams of paperwork for even a basic booster.

Re: The future?

Rob Loxley — Sun, 30 Oct 2011 18:15:08 GMT

[quote user="David Mills"]Anyone aware of a similar set up here?[/quote]

Inpatients that get TPR'd and pain scored through the day/night by nurses who then flag up issues to the vets to deal with?

Re: The future?

Julian Earl — Sun, 30 Oct 2011 17:44:44 GMT

Slightly different, but only slightly, back when I was a teenager (about ten years ago... give or take the odd decade) I worked as a vet nurse at weekends and then for a year pre-university. The standard system at the practice was for the nurse to collect history before the owner and pet went in to see the vet. This was hugely helpful to a budding vet, and still to this day I think I ask the same basic sequence of questions: eating and drinking normally? Any sickness, diarrhoea, coughing? Well in self? When was she last in season? Age? And so on.

Being in a city, this was extremely useful for learning to recognise the history for all the common problems like distemper, pyos, kidney failure, and so on and helped the vets to mentally prepare for the patient before going through their own diagnostic procedures. As far as I am aware, we did not affect the examinations carried out by the vet immediately afterwards. On the other hand we didn't palpate abdomens, take the temperatures, identify lymph nodes, auscultate chests, etc., some of which are clearly above and beyond even the best nurse.

Re: The future?

Evelyn Barbour-Hill — Sun, 30 Oct 2011 13:36:21 GMT

I think in this country it would approach rather too closely the borders of legality. But leaving that aside, and also leaving aside for the moment the principle of using nurses as cheap substitutes for veterinary surgeons, I take the points that the system could be efficient and could remove subconscious bias.

It wouldn't work for me or for my clients . A nurse doing a questionnaire-style history-taking will not extract a history in the way I would want to (you all know how difficult it can be, with the client trying to second-guess you and tell you what you want to hear). I don't see how a nurse doing an abdominal palpation can fully report the findings to me....... not until advancing technology finds a way of linking her fingertips to my brain. I need to palpate the abdomen myself, nobody can do it for me.

Re: The future?

Anne Seawright — Sun, 30 Oct 2011 13:29:19 GMT

I did a short locum for a practice in the uk where the nurses saw the patients first and filled out a sheet with things like tpr, diet, worming, flea tx etc before the vet saw for vaccination/problem. It was a one vet practice and seemed to work well for them with clients being bonded to team and understanding how the system worked. I found it quite difficult as I tended to forget and repeat everything!

Re: The future?

David Mills — Sun, 30 Oct 2011 13:08:48 GMT

The underlying idea is not that the nurse replaces the vet, but it is rather an objectifying measure. The nurse essentially carries out the same exam regardless of condition and reports parameters to the vet, who then may see the animal (without owner presence) just to check the abnormal bits. It may be, actually, that this system picks out more abnormalities in that the examiner doesn't pattern-spot and take bits of history and run with it (as vets naturally do), and of course saves vet time (expensive) - it is, in many ways, no different to vet teaching hospitals where students take detailed history, full exam then report findings to expert who comes and picks out the relevant bits.

I expected a visceral hatred of the idea. But if these consults were £10 each then people, in the right area, would, I imagine, come running.

Re: The future?

Evelyn Barbour-Hill — Sun, 30 Oct 2011 12:54:57 GMT

If you are going to do that, why not let the nurses decide treatment too?

Horrible.

Re: The future?

Alan Tevendale — Sun, 30 Oct 2011 12:37:12 GMT

I've heard of these set ups in the US but unless we are going over to a system where we have no real relationship with our clients I don't see how this system could work. Obviously works well for large set ups like A&E but not sure it could work for a GP practice. I often base a diagnosis on the fact that I know the animals that are presented to me and I can pick up on subtle changes. Clients like to be able to see the vet and chat about their pet.

I would be scared if the nurses were doing exams they might miss something that an experienced vet would pick up - the vet has the knowledge to piece together what might be otherwise subtle items of history that as a whole may indicate something more serious. Would the nurse know to pass these onto the vet as relevant parts of a history? I'm sure much of this would depend on the nurse.