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Decision making
Comments on the dilemma in the February issue: ‘Shortcomings in locum practice procedures’
  1. Siobhan Mullan

Abstract

The dilemma in the February issue questioned what you should do if you disagreed with practice procedures while working as a locum (In Practice, February 2012, volume 34, pages 110–111). In the example discussed, a client asked for a repeat prescription for acepromazine tablets for a dog in the run up to bonfire night. You knew that it was not the ideal treatment from a behavioural point of view, but other clients' records showed that acepromazine was widely prescribed by the practice for firework phobias. Richard Green commented that locum vets had obligations to the animal, client, practice, colleagues and themselves, and that it was useful to use an ethical matrix to allow due consideration of each of these stakeholders' interests. It was inevitable that there would be differences of opinion on how to do things between the locum and the practice, but very few of these would impact on patient welfare. In instances where the practice was falling short of best practice, locums could use their influence to change things for the better. Many practices were willing to change but did not do so because of inertia or lack of awareness. Best practice changed all the time, and it should be possible to tactfully discuss alternative treatments to the customary ones without overtly criticising colleagues.

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Siobhan Mullan works part-time in small animal practice, as well as at the University of Bristol. She holds the RCVS diploma in animal welfare science, ethics and law.

Siobhan Mullan comments: This case centres on the difficulties encountered when best practice changes and some vets adopt newer regimens, while others do not. There is inevitably a lag between the development of a new approach for treatment, its validation as being better than previous treatment options and its widespread adoption as best practice. I know that many people would argue that the lag period is currently far too long, thereby limiting the welfare benefits to be had from better treatments. Where there are financial interests, such as the licensing of a new drug, it could be expected that the pharmaceutical company will try to ensure that the lag period is as short as possible. Where there are no such interests, such as with behavioural or surgical treatments, the route to adoption is less clear. It usually begins with the publication of an experience, although this may be in the form of case reports rather than scientific trials. There is now more pressure from funders on researchers to disseminate their study results widely, and promotion by the RCVS of continuing professional development aims to speed up the use of new, better veterinary practices. However, the benefit of a slow uptake of a new approach is that it is potentially protective, allowing for gradual informal testing in a wider range of circumstances than could be possible in a research trial. The practitioner's role in achieving the optimum balance is to actively seek out new ideas, engage in discussions with colleagues and be open to changing their practices when sufficient evidence becomes available.

Have you faced a dilemma that you would like considered in a future instalment of Everyday Ethics? If so, e-mail a brief outline to inpractice{at}bva-edit.co.uk. We pay a small honorarium for contributions that are published.

Notes

THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved. In addition, a possible way forward is suggested; however, there is rarely a cut-and-dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Genetic testing for coat colour in cats’, is presented and discussed by Sean Wensley. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue. Discussion of the dilemma ‘Shortcomings in locum practice procedures’, which was published in the February issue of In Practice, appears on page 175.

The series is being coordinated by Siobhan Mullan, of the University of Bristol. It is hoped it will provide a framework that will help practices find solutions when facing similar dilemmas.

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