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 . Learning from peers is best . The example below is taken from an actual case that went before the Complaints Committee and is offered as a self-reflection tool to improve practice across the province .
COMPLETE MEDICAL RECORDS ARE ESSENTIAL
CASE SUMMARY
A member performed a dental procedure on a small dog . After the dog was anesthetized , the member determined the severity of the dental disease required numerous extractions and 23 teeth were removed during the surgery .
The clients were not contacted prior to the extractions . They understood the dental procedure was to clean the dog ’ s teeth . There were no diagnostic x-rays or a suggestion they were needed . The member did not directly inform the clients of the potential for numerous extractions .
CASE OUTCOMES
Although the panel had concerns about the actions of the member , the panel decided the nature of the allegations did not warrant a discipline hearing . The member was advised of the importance of maintaining complete medical records . The panel felt that advice could adequately address and remediate the risks in this case . Veterinarians are expected to maintain medical records in accordance with the requirements .
CASE CONSIDERATIONS
Record keeping is an integral component of veterinary practice . Complete and comprehensive medical records are essential to the health and well-being of the patient . Comprehensive medical records facilitate good patient care , support continuity of care , provide communication , and satisfy ethical and regulatory obligations for maintaining appropriate records . The College ’ s Professional Practice Standard , Medical Records states a complete medical record is a legal document representing the veterinarian ’ s thought process , decisions , judgment , actions and interactions with others .
The following elements were lacking in this case :
– findings of a physical examination
– interpretation of diagnostic testing such as bloodwork
– detailed dental charting
– proper anesthetic monitoring sheets including the time the induction agent was administered , total time of the procedure , patient ’ s temperature , total intravenous fluid volume administered and patient ’ s pre- and post-anesthetic status
– details of client communication
The lack of detailed records in this case made it difficult to understand the communications that occured .
It is prudent before proceeding with treatment that requires anesthesia to perform a thorough physical examination particularly in a case like this when the dog hadn ’ t been examined in nine months . In addition , the member must ensure appropriate communication with clients and that consent forms reflect the services provided .
The panel ’ s advice is meant to be educative , not punitive , and serves as a remedial tool to assist veterinarians in correcting problematic areas . Advice provides education about professional standards and expectations to improve the veterinarian ’ s practice and to underscore the seriousness of the issues addressed so that concerns of a similar nature do not arise again .
When the clients booked the appointment for the dental cleaning , they specifically said they did not want any teeth to be removed and requested only a cleaning . The clients were reassured by the clinic ’ s staff they would be contacted if extractions were necessary . The clients were shocked when they learned almost all of the dog ’ s teeth were removed .
The lack of clear client communication in this case led to this misunderstanding . The estimate indicated that extractions may be necessary , but the consent form did not . The client ’ s concerns about extractions were not communicated to the member .
The dog ’ s physical examination was nine months prior to the procedure . In the panel ’ s opinion , given that anesthesia was required , it would have been prudent to perform a physical examination as an animal ’ s condition can change substantially over nine months . This would have provided an opportunity for the member to explain that due to periodontal disease , multiple extractions would likely be required .
It can be difficult to determine the extent of dental disease until after the patient is anesthetized and x-rays are taken . The panel noted the possibility of more serious dental disease being revealed during a dental procedure is common given the difficulty of performing a thorough oral exam on awake patients . The panel also noted it would have been prudent to attempt to contact the dog ’ s owners prior to extracting any teeth , regardless of a specific request to do so .
Client communication is an integral component of professional practice and conversations with clients assist them in understanding the medical issues related to their pets and the advice and treatment provided . The member has now adjusted their approach to dental extractions and now contacts all clients before extractions occur . Communicating appropriately with clients and including a client communication section in the medical record are essential .
6 College Connection Winter 2020 cvo . org