Problems with on-call and home visits - Veterinary Practice
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Problems with on-call and home visits

GARETH CROSS feels tired after a 2.30am call-out and ponders on what happens if an out-of-hours service provider refuses to make a home visit

I AM writing this with the benefit of just having had a power nap. I was sat in our two-year-old’s bedroom debating with him why it really was bedtime and why he should go to sleep.

His response was fairly emphatically “NOT bedtime, not neep”. I entered some horsetrading and offered to lie on the settee if he lay in his bed. In the event I passed out and he sat up and read his book.

The reason this is of some vague relevance to the veterinary readership is that I was tired due to the 2.30-4am out-of-hours call I had been on earlier the same day/night before. I think I remember hearing somewhere that that period of sleep is especially important in doing whatever it is that is done during sleep to refresh us.

The call-out also entailed a home visit to pick up a dog that had just fitted. The owners appeared to be insomniac chain smokers as their spartan front room was thick with smoke and they and their collie were pacing restlessly round it. If they had been asleep, the dog (a long-standing more or less stable epileptic) would probably have had its one-minute fit, gone back to sleep and no one would have been the wiser.

Sometimes when called out for minor things late at night, my wife asks, “How do they know?”, meaning “Why aren’t they asleep (like we were when they phoned) and their animals shut in the kitchen?”

I am not a big fan of late night home visits and these clients do not drive and didn’t seem to want to get a taxi (we all know that’s because you have to pay taxi drivers!). It does make me think, though, that people should make some sort of arrangements for transport in these circumstances instead of summoning the vet-taxi whose payment can be indefinitely postponed.

A more serious home visit incident led to the suspension (for 10 months) of a vet earlier in the year (look up the Albring case, January 2011, on the RCVS website). It makes interesting reading and I would like just to bring a few points to a wider audience for reflection.

In brief, a 100kg dog collapsed in a garden and the owner requested a home visit pts. The owner called the vet at the OOH provider for his usual practice; they suggested an animal ambulance which duly arrived and decided that the dog was too big to move.

The OOH provider then suggested trying another local practice (cheeky) to see if they would attend. In the event, the vet from the other local practice did attend but the vet from the OOH provider did not and was subsequently suspended for it. One point I think the profession will be pleased to note is that the RCVS said in its report that passing the buck to a nearby practice was not acceptable and did not transfer responsibility.

This has been a frequent complaint of practices that do their own OOH within the catchment of an OOH service: that they get extra calls at night as they may be nearer, cheaper, or more likely to do a home visit. The poor vet who gets these calls then feels obliged to take responsibility.

The RCVS only goes as far as saying that the client may be referred back to their normal practice “in the first instance”. In this case it was indeed another local vet, who had no prior relationship with the client, who did the visit and put the animal to sleep.

What if…?

What would be interesting to know from the disciplinary committee (DC) is if the second vet had simply said, “It’s not my client, therefore not my responsibility,” would the committee have also fond her guilty too? Where would it stop?

One of the reasons the vet did not go out was that he was responsible for in-patients and up to 20 other practices’ clients and to leave the OOH centre would leave them without cover. This is a valid point that I don’t think the DC took enough account of.

If he had gone out and an RTA had arrived at the OOH centre, or a dystocia, dyspnoeic cat, GDV, etc., etc., how would he explain to them why their pet died whilst he was off-site? The DC used the call logbook to state that the centre was “not busy” that night.

With the benefit of hindsight, of course, you can say that, but the whole stress of being on call is you never know what is going to happen, nor when.

I was having a lovely quiet night this Wednesday until 2.30am. Unless the OOH clinic is kitted out with a retro-spectoscope, I think that being on site in case of need is a valid point.

However, I agree with the DC that the vet in this instance probably got it wrong, but whether refusing a home visit should ever be a matter for disciplinary action I will have to agree to disagree with them.

Similar case

In a similar case about five years ago, an anonymous journalist from the veterinary press phoned round the DC members who struck off the vet and who were themselves in practice. Most were practice principals.

The journalist described a case very similar to the one that led to the striking off, and requested a home visit. One of the DC member’s practice subscribed to an OOH service that simply said, “We don’t do home visits.” Several others’ practices just refused, despite being pressed. Only one agreed to do the visit.

The DC members didn’t resign or make much comment, but I think eventually the decision was overturned.

The DC needs to be composed mainly of vets who are in practice, who understand the pressures of practice life. They must, however, make sure that they don’t act in a “Do as I say, not as I do” manner, as happened in that case.

Family holiday

On a much lighter note, I have just returned from somewhere where night home visits from the vet must be a rare thing: the Isles of Scilly. We had a family holiday and stayed on what is possibly the smallest commercial dairy farm in the UK.

It is the only dairy herd on the Scillies and milks four cows. During our stay this operation was ably assisted by our three small children.

They also sold milk, ice cream and butter and their own meat. So although a small milking herd, they had complete vertical integration.

Whether smaller herds (not that small) could be viable over here with that kind of vertical integration would be worth looking into – possibly with a customer-co-operative.

It reminded me of a pub we frequented in Liverpool that brewed its own beer – a microbrewery. Maybe co-operatively owned micro-farms could be the next step in the current interest in food provenance and food miles, etc.

The meat on the farm was not such a happy story. The shop fridge had the farm’s meat, 20 yards away were the cows. Sadly, the cattle have to travel by boat to Penzance, then overland to the abattoir, then the meat is shipped back to the farm. Terrible for welfare and frankly ludicrous on environmental and economic grounds.

I discussed this at length with the farmer and a member of the Scillies council. Discussions are taking place regarding an abattoir on the main island, or possibly a mobile one as used in the Highlands and Islands. The veterinary profession should lobby the Duchy of Cornwall on this.

If we suspend someone for leaving a dog in a backyard for a few hours, we should not turn our backs on the suffering of other animals who are unnecessarily traumatised on a routine basis for no good reason.

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