RIDING a unicycle is not as easy as it looks and, believe me, if you watch me try and ride mine, I make it look bloody difficult. If you imagine a middle-aged man having some sort of mild epileptic fit on half a bicycle, then you get the idea.
I have already worn one out and so invested in a second sturdier one, which the proceeds from these columns are funding. It began as a birthday present that turned into what everyone needs – a good distraction from revising for an exam and doing other worthwhile things, one of which was writing my talk for BSAVA on nurses’ clinics.
My colleague and I spoke to about 40 nurses on doing clinics. The academic content was interesting but equally interesting and what fuelled most of the discussion was: why do them, what can nurses do and what are they for? What is the benefit for the practice that will already be replete with vets to see the patients? What does the RCVS allow nurses to do in that context?
The answer to the last question was given in an e-mail the RCVS sent me as part of my research and was pretty disheartening for the nurses in the audience as it initially seemed that they could do little in the way of thinking or giving recommendations, specifically suggesting possible things that may be wrong with a patient.
Care when consulting…
This is not making a diagnosis, which we all agreed was the remit of the vet, but even suggesting possible problems that may require further investigation by a vet. So nurses must be careful when consulting for their own sake and for that of the practice.
A way to accommodate this, we decided, was to have set protocols that the nurses could follow in their clinics which would not require specific decision making but allow progression of a case through the vet.
So what is the point if we have already decided that they are so limited? Well the key words here are screening and footfall. One of the reasons given by several vets we surveyed not to hold nurses’ clinics was, “The vet sees sick patients and clients expect to see a vet.” Dead right. But people don’t present their animal to the vet if they think it is well, except for the percentage of active clients who vaccinate who do so once a year, and, for older pets, a year is a long time.
So the nurses’ clinic should only be for pets who the clients perceive to be well. These patients would never even step (or be carried) through the door if it were not for the free offer of a nurse’s clinic. So they increase footfall – any practice owners not want to increase that?
Many of these pets will have treatable diseases which, when suspected by the nurse, can be fielded to the vet for further treatment. One practice ran a trial of senior pet clinics and found that only 20% of animals presented were disease-free. The percentage of disease-free patients for, say, a dental clinic, will be much lower. We surveyed our clients, asking them what they thought were disease symptoms and what were just due to ageing. The results indicated a predictable mismatch between what they thought was “just getting old” and what we know are likely early indicators of disease. So the benefit to the patients is potentially huge.
Early detection of renal disease, hypertension, dental disease, etc., with ensuing long-term successful treatment rather than end-stage palliative care or euthanasia, is of huge health benefit to the patient (and with that comes potential financial rewards to the practice). It was also intriguing to discuss the different way nurses are treated and utilised in different practices. Some were well motivated and used to the full potential of their qualification, and others much less so.
No receptionists
One nurse said her boss would not let any nurse use an auroscope or stethoscope. Some others worked in a practice that solely employed nurses and no receptionists. So instead of having receptionists doing their job well and enjoying the job they signed up for, they had nurses on the front desk and answering ’phones who would much rather be nursing.
Reception was merely the bit of the rota you got lumbered with every now and then. And any practice management consultant will tell you that having someone who can give too much good advice on the ’phone or desk is a good way of reducing the number of appointments booked to see the vet.
One nurse even used the sentence (in a room full of nurses) “…but we are just nurses”. Needless to say I didn’t have to correct her on that one, a room full of nurses (not just nurses) did it for me, but it demonstrates how nurses are not just sometimes undervalued by their employers but by themselves also.
The mood of the discussion was generally pretty confident, though, and we met many nurses who enjoy their job in good practices. Many clearly face a struggle to be recognised within their own practices and show their worth, which is significant both in the clinical setting and financially.
We did some figures on income generated as spin-offs from the nurse clinics and they confirmed this in no uncertain terms. Anyone who wants further details on this or to make any other comment on the column can always contact me on garethcross@hotmail.com.
Interview ahead
On a different subject and regarding a future column, I have secured an interview with the famous Dr Ben Goldacre from the Guardian and badscience.net.
Anyone unfamiliar with his work on tackling scientific misreporting in the media and exposing bogus medical practices and claims can have some homework from me: look him up either online or in the Guardian newspaper or buy his book (other books by other doctors are available…).
If you would like to e-mail me questions for him please do so at the address above. Fans of hoopi ear candles, fad diets and detox therapies need not apply. Homoeopaths, calm down, take some rescue remedy or something and keep it civil.
