“YOU’VE got a community face,” a
friend told me recently. I wasn’t sure
I liked the term, it sounded like a
non-custodial sentence, but I knew
what she meant.
I had told her that I had walked
into a local shop (for
local people) and the
member of staff there said, “You must
have a lovely view
from your new loft
room.”
I only knew the
woman as the shop
assistant and had no
idea she knew me, let
alone where I live.
Such is the curse of
having the
“community face” of
the local vet’nry.
I was in the shop
with children on my
day at home. I am now, in a very
modern-parent way, working a job-
share arrangement with my wife. I have
a day at home with the children and she
has a day at work. It’s working well and
I think “a change is as good as a rest”
for both of us.
It also means we can work without
the tyranny of child-minders’ deadlines,
etc., and all the associated hassle and
costs of paid-for childcare. Downsides
are obviously no net increase in income
and the extra costs of VDS and RCVS
cover for an extra vet without gaining
any extra vet-hours for the practice (see
Cross-words September).
The other downside happened
recently when I thought our 15-month-
old son was going to die on me and we
entered the land that time forgot, i.e.
the local A&E department.
He had a febrile convulsion, aka
pyrexic fit. It went on longer than I was
happy with, five minutes is a long time
to be holding a normally wriggly
boisterous lump of a baby when he was
limp, twitching and slightly blue.
I had heard of pyrexic fits and
thought that was what he was having,
but I have seen too many of those
respiratory cats go from ill to struggling
to dead in the few seconds between the
cat box and the oxygen machine. Those
images of the speed that death can
come kept flashing through my mind.
I was also convinced he was going
to choke on his snotty thick saliva so
tried to clear his airway. This, I have
since been told and can verify from
experience, is the wrong thing to do.
Not least because he bit me and I
couldn’t get my finger out for several
minutes which caused much bleeding.
I ran up to two girls clutching the
unconscious baby, unable to move my
hand and both of us liberally covered in a mixture of blood and snot. They
called an ambulance for me after I had
assured them that I “wasn’t joking”.
We had a painful three-way
conversation with the operator and the
boy finally came round just before the ambulance-car arrived.
A brief check-over
confirmed he was
currently OK and the
paramedic phoned
through to the GP
clinic to find out if he
needed to be seen by a
doctor.
The GP
reprimanded the
paramedic for not
checking the baby’s
temperature – a great
way to back up your
colleague within
earshot of the patient/client. I then
heard a pause, just long enough to check a watch in, and the GP and
paramedic then engaged in a subtle
game of passing the buck.
Neither wanted to be the one to
send us on our way, but the GP clearly
didn’t want to see us just before he was
due to turn on the practice
answerphone and go home. Ringing
any bells out there with you yet?
So the buck was passed to A&E
and we set off, or rather we didn’t. I
noticed the paramedic had a half-read
novel in the passenger seat and I
imagined that him sitting reading with
all his equipment on had drained the
battery.
You know the advert, “Remember
when you said you’d never buy a xxx
make of car”, well that time is now if
your are the procurement officer for
the ambulance service. It was dead.
He summoned another ambulance
for us, and the “fourth emergency
service” for himself. Just then my wife
turned up in the veterinary ambulance,
which caused an amusing double-take
from the paramedic.
We waited and waited…
Anyway, we entered A&E children’s
waiting room. I think they just corral
the children there and the first one to
keel over gets seen by a doctor. There
was one child covered in blood with a
gaping head wound who was playing
leapfrog with the sister of one with a
broken ankle.
We all waited and waited. A doctor
approached us and just as he was near
he went into the toilet. He reappeared a
few minutes later, wiped his hands on
his trousers and called us over. I only
wish I was making this stuff up!
He diagnosed tonsillitis as the cause
of the pyrexia and then disappeared.
We waited and waited. Footfall is a big
thing to try and increase in a vet
practice. We could instead try the NHS
tactic of “footrapping” where you don’t
need more people coming in: you just
trap the ones who come in for much,
much longer.
Here’s a quick multi-choice
for you:
Very young patient, recent pyrexic fit,
still pyrexic. Do you (a) cool him down
on an appropriate ward and offer fluids,
or (b) not offer any fluids for five hours
and place him in a hot, busy ward with
no bed and only his parents (also now
hot and dehydrated) to sit on? They
went for “b”.
A nurse did say she had asked a
porter to fetch a beaker and some food.
Twenty minutes later we heard
someone shout, “What’s this about
some Weetabix or summin?” We said
not to worry about the food but a
beaker of water would be good. Half
an hour later my wife found him sat in
the nurses’ station and found a cup of
water herself.
The irony of any state-owned
public-service institution is that unlike
our customer service-focused private
industry, their income and business is
guaranteed regardless of service level.
If the veterinary practice you work in is
having a busy day, all the staff are busy,
especially the clinical staff. In an NHS
hospital, no such relationship seems to
exist.
Colleagues who have recently been
languishing in NHS wards have had the
same experience. I think that overall the
clinical service is good, but there’s just
no concept of “customer service”.
Come to think of it, it sounds like a
great place to work: all the interest of a
clinical job without having to pander to
the clients/patients!
I have since learned that the
differential diagnosis list for common
causes of pyrexic fits includes tonsillitis,
ear infections and cystitis. How do you
get a urine sample from a baby? Well,
the idea of one A&E doctor was to
“get him to pee in pot”. A steep
request for a baby who can’t stand up
and has no idea when he is peeing.
The solution was to tape a special
bag thing to him under his nappy. I am
sure some of you have done a few
nappies, and changing a shitty nappy on
a plastic A&E chair does, as I am sure
you can imagine, leave the odd bacteria
or million in that area.
I am glad he didn’t wee, as we
would then have had some spurious
diagnosis of a urine infection made. I
was tempted to take the bag and wee in
it myself in a reverse “Withnail and I”
style. I know parents whose baby is
going through all sorts of tests and kidney scans, etc., due to cystitis that
was diagnosed by an in-nappy bag.
We eventually made it to a
paediatric ward where they did have a
cot for him, but no penicillin. After five
hours we had effectively had a clinical
exam and a shot of clamLA and an
NSAID. Plus, they had managed to
generate a file of printed-paper and a
few sheets of sticky labels.
However, when you finally climb
that mountain of bureaucracy and get
to the peak of the clinical hierarchy and
see the consultant, you are suddenly in
awe of a clinician who really knows
what he (or she) is talking about (not
like us jack-of-all-trades) and all the
waiting seems worth it, just about.
So how does the NHS compare to
our private system? I suppose on the up
side I didn’t have to get my credit card
out there and then, but free at the point
of delivery isn’t free, all that tax I pay
must go on something other than
duckhouses.
Anyone can get to see an NHS
specialist. As I discussed in last month’s
article, veterinary specialists are only
within reach of less than half of our
pet population (i.e. the insured or
wealthy).
In the UK (2004) spending on
“health” as a percentage of GDP per
capita was 8.3% in the UK and 16% in
the US [source: Guardian newspaper].
So a fully nationalised system is cheaper
per person across the country than an
insurance-based one like we vets have,
or don’t have…
Office hours only
So although private care is better at
customer service, that service adds
cost. A major downside we
experienced and one that pet owners
are also getting used to is that their GP
may no longer be available after office
hours.
A GP would have dealt with us
quickly, near home and without the
added cost of the hospital visit. Many
veterinary clients are also experiencing
costly trips across town as their pet
falls ill just a bit too late in the evening.
Comparing the NHS to vets makes
me proud of our profession and what
we achieve.
We are made up of multiple, self-
sufficient small businesses with
minimal financial backing, self-funded
postgraduate clinical training, and yet
manage to provide GP services, out-of-
hours cover, specialists, etc.
We will never have the
comprehensiveness of the NHS in its
regional delivery, but between us we
manage to do a hell of a lot stuff very
well and very quickly!
- To contact the author, e-mail
garethcross@hotmail.com.
