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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It will be a very sad day for animals if this requirement is removed.
Wynne
It would be a very good day for veterinary surgeons, though, removing a source of anxiety in a profession characterised by a high suicide rate.
Equally, it could be a very good day for animals, who can benefit from better facilities at the practice than at the owner's home, and owners taking greater responsibility.
I don't think it would be a sad day for animals. In almost every case I have ever dealt with, the quickest way of administering emergency care is to get the animal to the surgery as quickly as possible. I can think of only 3 cases in 17 years where a home visit as been essential on the grounds of welfare, 2 of which were entrapments.
What do we think the public would want? That is a key question for a code provided by a regulator.
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!
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)
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.
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.
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.
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.