college connection
LEARNING IN PRACTICE
Members of the veterinary profession have a responsibility to uphold standards to ensure the public has access to safe, quality veterinary care. When those standards are compromised, the College responds. Every veterinarian can learn from these situations and publishing the details of complaints received and resolved is intended to support that learning. The example below is taken from an actual case and is offered as a self-reflection tool to improve practice across the province.
MEMBER GIVEN GUIDANCE ON PROFESSIONAL OBLIGATIONS
CASE SUMMARY
The member examined an older spayed dog with concerns of lethargy and pain. The member’ s assessment included a finding of a cardiac arrhythmia.
The next week, the member again examined the dog who had a new growth near her right ear. The member recommended surgery to remove the lump, which was suspected to be a mast cell tumour. The client had concerns about general anesthesia with the dog’ s cardiac disease and sought a second opinion prior to the surgery. At the second clinic, a fine needle aspiration was performed which confirmed the mass was benign and no treatment was required.
The client submitted a complaint with the allegation the member recommended surgery without discussing options available for sampling and diagnostics to determine the nature of the mass, instead relying on visual observation and clinical experience. Surgery and anesthetic both posed risks for the dog. CASE OUTCOMES
The panel decided the nature of the allegations did not warrant a discipline hearing and that educational advice for the member would be more appropriate.
The member was advised of a veterinarian’ s responsibility to exercise appropriate professional judgement in all circumstances, regardless of any personal challenges he / she may be facing. The member was also advised of the panel’ s concerns regarding patient health assessments and subsequent diagnostic and treatment options. CASE CONSIDERATIONS
In consideration of this complaint, a panel reviewed the material provided. As is standard practice for investigations, the panel considered previous proceedings against the member.
In the complaint, the client alleged the member inappropriately recommended surgery to remove the dog’ s mass without first discussing diagnostic options to determine the nature of the mass.
The client said she asked the member why a biopsy had not been done before recommending surgery. According to the client, the member was sure it was a mast cell tumour based on experience and visual inspection. The client cancelled the surgery and sought a second opinion, which averted an unnecessary surgery in an older dog with a heart condition.
The member explained he had been experiencing some serious health concerns at the time and was distracted. The member noted when he realized the error, the client had taken the dog elsewhere for a second opinion. The member apologized for being distracted and for giving poor advice. After realizing the error, the member changed his opinion and said he would not have put the dog through surgery.
In addition, the member said a visual inspection of a mast cell tumour was a mistake in judgment. The panel agreed with the client and the member that it was an error to diagnose a mast cell tumour in this manner and the panel concurred.
The member acknowledged the error in judgment and the panel took into account the member’ s explanation of being distracted with serious health concerns. While the panel was empathetic, it appeared the member permitted personal issues to distract him from his obligation to provide care in the best interest of his patient.
The panel was concerned the dog may have undergone an unnecessary surgery which would have exposed her to risks associated with surgery and anesthesia. For this reason, the panel offered the member
advice concerning his professional obligation. The panel expects that if the member was experiencing medical issues that clouded his professional judgment, he would have taken appropriate measures to ensure his patients were not placed at risk.
The panel also noted the member had a serious enough concern about the dog’ s arrhythmia to recommend a referral to a cardiac specialist. However, during the following visit, the panel could find no documentation of the dog’ s arrhythmia in the medical records. The panel was concerned the member did not follow up on the arrhythmia or take it into account when making a decision about surgery to remove the dog’ s lump.
In the panel’ s opinion, it was the member’ s professional responsibility to re-evaluate the dog’ s arrhythmia at this appointment particularly in view of the fact that surgery was scheduled. The panel reasonably expects the member would have taken into account the risks associated with surgery for a patient with a pre-existing cardiac condition.
Veterinarians are obliged to have the best interest of patients as their primary concern at all times. In situations where personal circumstances are such that professional judgment may be clouded, veterinarians are expected to exercise appropriate discretion in limiting their practice in the interest of providing patient-centred care. When proposing a plan of care, the member should have recognized other options besides surgical excision under sedation.
The member should also have taken into account the specific situation of his patient, such as the dog’ s cardiac disease, and should have considered the risks associated with performing surgery versus performing a fine needle aspiration with no sedation versus monitoring the lump.
6 / College Connection