Devon vet Jo Dyer has launched a petition for the RCVS to remove mandatory house visits from the Code of Professional Conduct, in response to the College's call for evidence on the provision of 24-hour emergency veterinary cover.
Clause 3.13 of the Code currently says: "Clients may request attendance on a sick or injured animal away from the practice premises and, in some circumstances, it may be desirable to do so. On rare occasions, it may be necessary on clinical or welfare grounds. The decision to attend away from the practice is for the veterinary surgeon, having carefully balanced the needs of the animal against the safety implications of making the visit; a veterinary surgeon is not expected to risk 'life or limb', or that of anyone else to provide the service."
In other words, whilst it is not mandatory to accede to every request for a home visit, the Code starts by saying: 'it may be desirable' and 'it may be necessary', thereby implying that the veterinary surgeon will need to explain themselves if they decide against.
Jo argues that this ambiguity, coupled with outcome of recent disciplinary cases and the risk, however small, of losing one's livelihood, means that there are many practitioners, particularly younger and less experienced graduates, who are now fearful of refusing home visits, rendering them to all intents and purposes mandatory. It's a situation compounded by the perception that if push comes to shove, a practitioner's actions will be judged by a Disciplinary Committee whose members may be out of touch with the sometimes harsher realities of life in practice.
Jo also points to the increased risk of assault that practitioners face when making home visits, rather than treating the patient from the relative security of the practice premises. She also makes the point that leaving a practice unattended (as can happen if the only vet on the premises has to go on a home visit), may compromise the welfare of any other animals that need emergency treatment in the meantime.
The petition calls for the complete removal of clause 3.13 from the Code, and for clause 3.2 to be amended to read: 'The responsibility for the welfare of an animal rests primarily with the owner, keeper or carer of the animal. Veterinary surgeons are unable to make a definitive decision regarding diagnosis and treatment until they have undertaken a physical examination of an animal. This examination may take place at the surgery or other address entirely at the discretion of the veterinary surgeon on duty. It is expected that farm animals and equines will mainly be examined away from the surgery and pets at the surgery."
Jo said: "It is important to stress that I am not calling for the abolition of home visits, and nor do I think this would be the effect of my proposed change to the CoPC. The profession is almost entirely made up of people who care desperately about the quality of the service they offer, and who want to offer the best to their patients and their clients. Of course we'll continue to make home visits. But I do feel passionately that the decision in each case must rest unambiguously with the veterinary surgeon concerned and not be subject afterwards to the judgement of others."
To sign the petition, visit: http://www.change.org/en-GB/petitions/royal-college-of-veterinary-surgeons-remove-mandatory-house-visits-from-the-code-of-professional-conduct
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These are excellent responses and considered comments. I have 21 - no, damn, 22 this summer!- years experience and I have done a lot of house calls in that time, and it is absolutely true that they are rarely essential if the animal is genuinely unwell and more effective and timely intervention is possible if the animal is brought in. Euthanasias are an obvious and very specific exception, and I have seen a handful of animals for elderly or infirm clients, or for spouses left without a car but with a 70kg collapsed Great dane, and essentially been the pet taxi for them. Most owners, however,could have brought the animal in with a bit of effort and some situations were, with hindsight - most were when I was an enthusiastic young gun and saw them all as new challenges - potentially dangerous.The changing demographic of the profession and the reliance on OOH clinics to provide care for a number of smaller practices mean that there will be more and more circumstances where it is either inappropriate for the vet to risk the visit or impossible to leave multiple other animals inadequately attended in a hospital.In my experience a sympathetic but honest discussion by telephone makes people realise that they both can and should attend the surgery and the advent of Pet taxi services is a real boon. However, the more I read and consider this, the more I agree the wording itself is less of a problem than the DCs willingness to interpret it unnecessarily harshly. the debate has to be had though and I doubt the RCVS will recognise that the rulings and interpretations are out of kilter with the times without being lobbied intensively, so I will sign it in any case and hope they are forced to consult more effectively.
I was among many who were shocked and saddened by the DC's ruling the Chikosi case. I will stand and be counted in saying that I think the expectations of the DC were unrealistic and the ruling harsh. However I am cautious about making a change to the current code. I have done my share of visits which were for client convenience rather than animal welfare. I agree that in most cases, with the exception of euthanasia, that the animals needs are almost always better met at the surgery. I also agree that there are situations in which our personal safety may be compromised and have on one occasion refused a visit out of hours because I felt that it wasn't safe (there were several drunk people on the other end of the phone using less than pleasant language)and I didn't feel that a visit was required or appropriate (the dog had got its lead stuck on it's foot).
I have also had to attend (out of hours) a GSD impaled on a gate, a collapsed Newfoundland owned by an elderly couple to name a few. These cases required attendance away from the surgery.
My worry with saying that the responsibility lies entirely with the client to get their animal to the surgery does not take into account the circumstances whereby it is genuinely very difficult if not impossible.
I am cautious about there being no requirement for a vet to attend away from the surgery where it is appropriate and it being left entirely to the conscience of the vet. I know we are for the most part a conscientious bunch who do this job because we do care about animal welfare.
I think this is a thorny issue and if the DC would just admit that they got it wrong in the Chikosi case and take a more realistic view of what it is like to be in the front line, then a change to the code would not be necessary.
If that part of the code is being poorly interpreted, why not remove it and leave that negotiation between the vet and their client to proceed without fear of censure. I believe that many a vet would rather do an unnecessary visit than go through the stressful process of defending their decision to the DC.
perhaps better clarification of the circumstances necessitatnig a visit rather than outright removal - true many visits are totally unnecessary and are usually for the owner's convenience, coupled with the fact that beyond euthanasing a patient or transporting it back to the practice you are extremely limited in the clinical service you can provide. However, refusing to attend what sounds like or could be an emergency is pretty poor behaviour for a vet irrespective of their level of experience or how long they've been practicing (which are not the same thing!)
Trust an "Oldie" to wish to provoke discussion about Jo's rationale, but here goes:
The existing Clause is fine as it is. Jo is wrong in para 2,line 1,which should read "whilst it is not mandatory to accede to most requests.." And Line 2 "thereby implying, if there is an adverse outcome, that the vet will..." In other words, for a case which ends up at the DC, it is not unreasonable for the vet who refused a visit to explain why.
If Jo believes the DC doesn't currently "take on board the harsh realities of life in practice", then the better option would be to make changes to the DC.
Such a DC would then recognise as spurious her remark about "leaving the premises unattended". The vet had made the judgement to visit in line with the Code's requirement, and so could not possibly be held to be at fault if a contemporaneous welfare case arrived.
Sorry Jo, but there will always be some cases not just RTAs but other traumas, collapse and a variety other cases where distressed owners, especially the old & infirm will be physically unable (because of pet's condition,or owner's
condition) to move the pet to the surgery. And how, from a phone call, would a vet be "unambiguously" able to ascertain all of the factors in such circumstances?
Of course there are a number of owners who attempt to exploit the profession's goodwill, and the vet has to make best endeavours not to accede to their unreasonable demands. Conversely, not everyone out there is uneducated, some (often unknown to the vet), are even qualified in healthcare professions. Also, on TV, there's lots of "stuff" (maybe too much!) about not moving human patients, so many owners really do understand that moving on animal without a professional diagnosis could not only be harmful, but be fatal.
Finally, whenever personal safety is an issue the existing clause is clear in its guidance to the vet & the DC.
So, in summary, I believe the existing text is appropriate and Jo's changes are not necessary, better the RCVS makes improvements to the interpretations of the existing Code.
I agree with Caitlinwitch that the only really useful small animal visit is for euthanasia. In the majority of genuine emergency cases we often need further diagnostics which will never be portable, or the animal will need to be hospitalised eg on a drip, so what's the point in the visit.
Many of the demands for out of hours calls are usually because the owner cannot drive, either they've been drinking (unsafe for us) or they've no transport (no money so potentially bad debt). If there's little money then surely what little they have is not wasted on an almost certainly pointless visit.
with the exception of euthanasia i have always felt that house visits just add a delay to the animals treatment. I also think most clients understand this when explained. I am also not happy leaving critical patients alone in the wards whilst driving out to a house visit. I have had calls late on a saturday night from owners who are not clients, live in rough areas and start the conversation that they cannot drive as they have been drinking…what female vet on their own is going to rush out to that nature of call? After all…doctors usually have a driver with them when they attend houses.
We had a case on Saturday morning displaying this issue perfectly. A client who portrayed they were desperate and that a visit was the only way to deal with their animal dragging the vet away as reception could only agree. Two able bodied owners with a mode of transport and an animal that could have been taken to us with no welfare implications. The implication that a visit is essential is rarely the case but difficult to refuse given recent events.
It would indeed be a very sad day for the animals if a perfectly competent and caring vet was struck off because of antiquated ideals imposed by a disassociated ruling body (which are incidentally made up of a lot of caring individuals trying to do the right thing in a committee setting, and getting a hopelessly out of date result)
I agree with Jo. There's nothing sad for animals and owners to be provided with the best possible care at 24hour premises and make vets working properly and in a safe environment. Let's not forget please that the very majority of small animal vets are girls nowadays, so the nurses!
Publishing Editor: Arlo Guthrie
Clinical Editor: Alasdair Hotston Moore MA VetMB CertSAC CertVR CertSAS FRCVS
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