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An Address by Dr R R R Pascoe BVSc MVSc, DVSc FRCVS, FACVSc, Veterinary Specialist, to Graduating Veterinary Students on Behalf of the Veterinary Surgeons Board.

A practical approach to Veterinary Surgeons' relationships with clients, other veterinarians and the Veterinary Surgeons Board

The Veterinary Surgeons Board of Queensland has expressed concern at the number of complaints laid down before it relative to the treatment of animals by veterinary surgeons.

In most cases, particularly in regard to small animals, the underlying cause of complaint is in relation to charges, with exception being taken to methods of ensuring and obtaining payment, especially when the client considers the treatment to be at variance with his or her own diagnosis. This leads to accusations that the veterinary surgeon in question is incompetent, careless etc.

The Board carefully considers each allegation and studies the veterinary surgeon's response thereto and in many cases although the Board can find no evidence of misconduct in a professional respect, it does consider that the veterinary surgeon has erred in the field of human relations (communications).

The Board believes it may help to obviate some of these problems if practising veterinarians are made aware of the kind of situations which can occur.

Practitioner client relationships

For good relationships to develop with your clients, you should ensure whenever possible that your clients are well informed, by either yourself or a responsible well trained receptionist, on all aspects of their dealings with your practice.

This includes hours of attendance, emergency service, care of patients before, during and after treatment (either medical or surgical), fees, method of payment of accounts, and a general overall professional approach to every case.

One of the commonest areas of discontent and the cause of many complaints to the Board is that of fees and their collection. If there is a range of fees available to members of the AVA based on a periodical survey of practices, it is suggested that this range be used as a guide to fees charged under normal circumstances.

It is suggested that the method of avoiding trouble with clients in this area may be as follows:

i) Discuss fully the cost of any procedure before admission of the case, unless a serious emergency is presented. Under those conditions, stabilise the condition of the animal and then discuss further treatment and/or surgery. For every day procedures, this can be accomplished by a competent veterinary nurse. For the more complicated problems, the veterinarian is better qualified to carry out the explanation.

ii) Where fees fall within the range of the surveyed scale of fees then the amount discussed usually does not have to be justified except by a simple explanation that this is likely to be a commonly charged fee for a standard procedure - BUT be sure you are correct if you use this statement. Exceptions are often made by the individual veterinarian, depending on the economic circumstances of the client eg, pensioners.

iii) Where the charge may exceed the fee that might be commonly expected, reasons should be stated before medication or surgery is commenced and the owner should be fully aware of why the fee will be different, ie a spey for a six month bitch compared with a hystero-ovariectomy of an eight year old pyometron brought in to be speyed.

iv) It is possible to give estimates of fees for most procedures. Common sense must prevail and daily fees for hospitalisation - amounts for set prices of surgery, x-rays, drugs etc. - can easily be reasonably arrived at and should be fully discussed. Where estimates are given and accepted, you can be sure an argument will develop if you then exceed this amount. Some latitude can be obtained by daily or weekly assessment of the case. However most complaints stem from large unexpected bills not previously discussed with the owner. At all times when a significant cost increase occurs, it is imperative to consult with the owner in advance if possible to discuss the increased costs that are or will be likely.

v) While it is time consuming, it is essential that out-of-the-ordinary case costing should be discussed between client and veterinary surgeon, not between veterinary nurse and client unless under special circumstances, and then must be subject to the affirmation of both yourself and your client.

vi) Once agreement is reached on the necessity for the treatment and the fee to be paid, then discuss the method of payment -ie cash, credit card, terms or account. A deposit to cover essential costs is often a means of overcoming the client who eventually does not pay due to a sudden change of address.

Be especially careful not to perform unnecessary treatments without the owner's consent. If you do so, then be prepared not to be paid.

Be equally careful, if you ask for an animal to be presented for surgery at a given time, that you explain when surgery will be performed - both clients and animals can get very upset if kept waiting around for hours and the service is not performed.

vii) Be sure to explain where the cost of one visit ends and the next begins. Explain the necessity (if one exists) for revisists and the cost of such visits. Full explanation is essential to allow a client to assess his or her financial ability to meet the cost. Wherever possible, always suggest alternative treatments, again always ensuring that you advise the type of result that such alternative treatments will give, ie a cheap treatment that is not going to work could be construed as a negligent act on you part.

Negligence and misconduct

Many complaints deal with what your client terms as your incompetence, negligence, misconduct, rudeness, and occasionally even lack of interest in the case. Your personal interest must be given to all cases you undertake to treat. Failure to do so usually ends in antagonism with your client.

A discussion concerning the course of treatment and/or surgery should include possible risks and possible outcomes to unexpected events.

Negligence may be defined as not doing what a prudent and average veterinarian would do in the area normally practised. You should recognise your limitations in treatment and/or surgery and if presented with a case beyond your normal scope, it is your duty to suggest a referral to a specialist if such is available.

Remember, if you employ lay assistants, they are acting as your agent and you then become liable for their actions carried out on your behalf, so any lack of competency can be attributable to you.

You should plan your surgery and treatments, especially with large animals, in an area where they are safe, and if this cannot be accomplished, you are duty bound to point this out to the owner, and either refuse to operate/treat because of inherent dangers from location, handlers or the animal itself, or have the owner accept the responsibility of accident under those circumstances, and remember this does not allow you to opt out of a negligence charge if one arises.

You should be aware of safety factors for anaesthetics ie overdose due to incorrect preparation, due to excessive struggling followed by further dosage, etc.

Think carefully before carrying out irreversible steps. You must be especially careful to carry out your obligations once engaged upon a case and you cannot morally or legally remove yourself from a case until its termination unless asked by your client for a second opinion or a referral. However following full consultation with the client 'you' may choose to recommend that the client seeks a second more experienced opinion.

This applies not only to actual consultations but can legally be extended to telephone advice. If in doubt of your competency in these cases, refuse to enter into discussion of the case, eg a small animal practitioner with a foaling mare or a calving cow etc.

Incompetence

Such a charge can arise out of failure to carry out normal clinical procedures ie failure to take temperature, pulse and respiratory rate, failure to use single diagnostic tests such as faecal smear, blood smears etc, use of drugs - make sure you know the side effects of drugs as well as their supposed clinical use eg Neguvon - colic, bots.

Remember there are areas requiring special expertise such as examinations for suitability and the writing of certificates, pregnancy diagnosis etc and unless you have the necessary experience, you may need to refer some cases for a more expert appraisal ie the $250 pony compared with a $50 000 race horse.

Advice by personnel

This is indirectly coming from you and must be correct. You should occasionally check your assistant's knowledge and correct any errors which time may have allowed to occur.

Preliminary contact with new clients

Be cautious in first contact discussions; give guarded comment on problems and be careful with the prognosis of conditions until further test and examinations can be carried out. Also be careful that you are not infringing on another veterinarian's case. Enquire always as to whether the case has already been treated by another veterinarian, and if so, it is correct procedure to enquire if he or she has discharged the case because people who hurry off on their own accord for second opinions will probably treat you in the same manner if you are not very careful in the handling of the case.

Another area of discontent can arise from lack of clear instruction regarding home treatment. At all times you must stress the need for contact back to the veterinarian if the predicted course is not being achieved. At this point some clients can be very trying and while it is difficult for a veterinarian not to be rude to clients, it is damaging to your relationship with clients in general if it is rumoured you have a discourteous nature.

Relationship between veterinarians

It is your duty as a veterinarian when commencing practice to visit the neighbouring practices on a courtesy visit, and inform them you are setting up practice in the locality, and it is equally the duty of the established practice to be courteous to you as the newcomer.

Avoid discussion and criticism of other veterinarians wherever possible.

Endeavour to maintain standards to prevent criticism by the general public of the profession as a whole.

Where referrals are made, remain ethical and only undertake the referral work. On its completion, refer the client back to the former veterinarian.

The same standard is required when confronted by emergency cases belonging to other veterinarians - as soon as can be safely accomplished the client should be instructed to return to his or her own veterinarian for follow-up treatments.

Relationship between practitioner and the Veterinary Surgeons Board

The Board's function is to administer the Act, to be of assistance to both practitioner and public alike and while it protects the practitioner from unfair complaints by the general public, primarily it maintains vigilance that the practitioner is not guilty in any of the foregoing areas.

It is well that you should know the provisions of the Veterinary Surgeons Act and Regulations as they are laid down for your guidance. The Board is not bound to offer legal advice to registered veterinary surgeons. Where this is required, legal opinion should be sought from a member of the legal profession.