Hi, Mark,
When something goes wrong, SOMEONE is to blame - is that your point?
I do not recall EVER attributing a post-op infection ( happily, I seem to have had very view in the light of your comments) to the owner!
There are several possible causes of peri-operative infection in veterinary surgery:
Animal skin is very much more difficult ro cleanse and sterilize preoperatively than is human skin
Dogs sustain a transient bacteraemia when they defecate, with the very real risk of infection of surgically traumatised tissue.
Dogs and cats tend to lick their surgical wounds - and there mouths are very far from sterile, being meat-eaters. (cats particularly have severely infected, and infectious, mouths).
Operating under an 'antibiotic umbrella' is now frowned upon, but in the human field where there is an identifiable risk of peri-operative infection is is still practised.
Surgical asepsis is difficult ( sometimes impossible) to achieve, and adds considerably to the cost of surgery, already a contentious issue with veterinarian's clients, ( but compare veterinary surgery fees with private human surgery fees, remembering that the same skills and aseptic protocols are required.)
So, it can be very difficult to identify the precise cause of post-operative infection when there are so many possible alternatives. A veterinary surgeon may well be totally innocent of malpractice when the operation site becomes infected, and refusing to 'come out with his hands up' as you seem to wish, would be wholly innappropriate.
W

Hi,
My daughter is in isolation right now. She is believed to have MRSA. The results are not back yet. All signs go to MRSA. At home they have a chocolate lab that has had a large open sore on this paw. The vet has never done a culture. The sore has been there for over a year. He has been treated with several antibotics--with no success. What we are wondering is there any chance that this animal has MRSA? We did talk to the vet and he said the chance is less than 1 percent. Our whole family is very concered of her returning home when this is over and getting this back from the dog. Please let me know your thoughts on this. Also I would like to mention the dog has been wearing a cone for months and at times is able to get to the sore and continues to lick when possible. But the point is that the sore never heals. We know that animals sometimes do this because of nervousness, but shouldn't this have healed by now? Thank you very much. I look forward to hearing from you soon.

Sincerely, Tammy

Hi, Tammy,
I think that the sore on the dog's leg is very unlikely to be an MRSA infection - but it would do no harm for the veterinary surgeon to be asked to send a sample to a laboratory for culture.
This sounds to me - but remember I have only your description to go on - like a 'lick granuloma' . This is caused and maintained by the dog persistently licking at one spot. It is really a neurological problem - often in the first instance produced by boredom. Again the vet could do a biopsy and get it checked at a laboratory.
In any case, after going on for so long, it might be a good idea to get it referred to a veterinary dermatologist - there are plenty around.
Walter
W

Hi Walter,
You know, people reading our exchanges on this could think that we don’t agree on the issues! Actually, I think our views are a lot closer than they seem. I don’t see this necessarily as an issue of blame, but one of professional response.
Pet owners, like relatives of patients in hospital, are not part of our magic circle; they don’t understand our terms and jargon and, for the most part, they are excluded from our own reasoning process and simply presented with bald alternatives and asked for a decision based on what we tell them the consequences will be. Post-operative infections do arise from a number of causes, it’s true, and cannot always be prevented, but if the first and only thing an owner is told is that it couldn’t possibly have anything to do with the vet or the practice then that simply generates confusion and distress. If, however, vets were helped more to understand that their style and approach can have as profound emotional effect upon owners as their actions, then they could prevent much of the conflict that arises from treatment failures or complications. Of course, pet owners also have to accept that vets are not all-powerful, but at present they are the ones left in the dark and feeling the guilt. Let them into the reasoning process, no just the cold facts, and they are likely to be more understanding themselves.

Hi, Mark,
Thank you for your interesting comments.
Are you a practisimg veterinary surgeon yourself?
W

Hi Walter,

No not a vet; I've been a registered nurse and researcher for over thirty years and my main areas of interest are person-centred care, particularly in the care of people with dementia. I've researched treatment outcomes, clinical effectiveness and cultural effects on staff and patients. I guess the interesting thing for me is that the issues involded in working with pet owners are closely paralleled by the inssues involved in working with relatives of people with dementia, and in particular the issue of MRSA which is now probably endemic in nursing homes. I have spent a long time looking at the way those relationships work, and my interest in veterinary care comes from the experience I had last year of seeing a pet die from a post-operative infection. I understand very well the difficulty health professionals have in bringing distressing news and information to relatives (and this is also a feature of veterinary practice)- it's one of the most difficult things we do - and I have sometimes been dismayed at the approach my colleagues have taken, but I believe that it's the dialogue that matters first and foremost, and the message second. Neither side finds it easy, and the only hopeful route involves the refusal to abandon the effort.

Do opinions expressed by non veterinary professionals, matter to MRCVS. Or are the opinions of only those who have been, hardened by the stress of veterinary practice taken to be of any worth. That those who have never seen practice can have no objective opinions about the care their pet has received. Having sat on RCVS PIC Committees, what is your prosepective, of non-professionals who complain. Who does believe the owner, how much does it matter that an owner should also be a 'fellow professional' as that must mean they are more straightforward and believable?.

Mark
Hi, Mark,
Thanks you for details of your background.There is one very significant difference between our respective professions, which DOES have major effect upon our relationship with our clients/patients. Veterinary sursgons in practice are providing a service FOR WHICH FEES ARE CHARGED.
Sadly, there is an increasing perception in the public mind that veterinary surgeons should work on a 'no cure, no fee' basis.
Fo many members of the public, the veterinary surgeon is the only provider of professional services for which they have to pay (cf doctors, dentiists, architects, lawyers, etc)
Veterinary practices are businesses, and must be run on proper business lines, otherwise there would very soon be no practice. All the overhead costs of running the practice - purchase and maintenance of premises, including 'commercial' rates, staff wages and salaries, pensions, medicines and equipment all have to be paid for out of fees before there are any 'profits' for the partners.
Only veterinary suregons working for animal welfare charities have the luxury of not having to balance what is the cost of the proposed course of treatment against the client's willingness/ability to pay.
I think that you will probably regard the above as being very mercenary - but veterinary practices DO go bankrupt if they allow altruism to overtake business principles.
Walter

Hi, 'non-professional '
(and I do wish that contributors would not hide behind pseudonyms!)
Yes, I sat on the Preliminary Investgation Committee of the Royal College of Veterinary Sugeons for 8 years, 3 as vice-chairman and 3 as chairman, and in that time I looked at hundreds of cmplaints made against veterinary suregons by members of the public.
I can promise you that every single complaint is scrutinised very carefully. In the first instance the Head of Professional Conduct - a Barrister, not a veterinary suregon - determines whether or not the complaint comes within the RCVS's jurisdiction. If he thinks that it does it is forwarded to the Chiarman and Vice-chairman of PIC ( both veterinary surgeons) who consider the complaint, and both have to agree that it is either unfounded or not serious enough to be taken on to Disciplinary Committee. In either case a full and detailed response is made to the complainant explaining why.
One must also bear in mind that the disciplinary authority of the RCVS was defined by Parliament in the Veterinary Surgeons Act defining what issues are subject to the jurisdiction of the RCVS.
Allegations of professional negligence do not fall into this category, unless the negligence is so serioous as to amount to professional misconduct.
Negligence is a matter for the civil courts, who can award damages if the complaint is upheld, whereas the RCVS cannot.
Explaing to an aggrieved owner why the RCVS cannot take up complaints where the complainer accuses the veterinary surgeon of professional negligence is one of the most difficult tasks the Professiona Conduct Dept. of the RCVS has to undertake.
Whenever a complaint is taken up by the College - and most are- permission is sought from the complainant to forward his/her complaint to the veterinary surgon concerned. The response from the veterinary surgeon is given just the same consideration as the complaint in deciding whether to progress the issue further.
If you go on the RCVS web site - RCVS.org.uk - you will be able to read reports of recent disciplinary hearings. The dice are definitly not loaded in favour of the vet!
Walter

Walter,
Actually, I don’t consider vets to be mercenary for having a profitable business; I have no problem with the reality that a vet has to make money in order to provide the service he or she does, but it is really not correct to say that vets are the only provider of services for which clients have to pay; anyone who has consulted a dentist, architect, lawyer or private doctor will have had to pay for those as well and accept the premise of fees for service. That’s not my point, though. Although professional accountability is through the courts, those who work for the NHS are accountable to their employers for their practice as well, and this serves to put the employing Trust in the position of advocating for, and representing, the interests of the patient. This is not the case in veterinary practice, and MRSA, has become a crossover issue that illustrates how difficult it can be to get a meaningful response from a vet when questions are asked. This is more a question, in my view, of culture rather than obstinacy, but I believe that it has to change.

Hi, Mark,
Sorry if I did not make my point clearly enough - the great majority of the public DO NOT employ professional people on a face to face fee paying basis - few employ architects, lawyers mostly on legal aid or via CAB, and dentists, only a proportion of their fees are payable direct.
Walter

How do Plumbers, Electricians,Mechanics,Decorators, Gardeners, Builders, get paid, if not on a face-to face fee paying basis?. Each one if they did not have professional skills to compentently 'do' the job contracted for, could potentially do you,your family,your property, serious harm. Why do you consider the veterinary profession, sometimes descibed as an orphan profession, to be more like the Medical, Legal, Architect, Dental professions in that these at times are subsudised for the majority of the 'public'. When vet practices are trying to be like other 'small' high street businesses, like Plumbing, Electricians, Decorators, Gardeners, Hairdressers, or Builders. Which can go 'bust'. Veterinary Practices are now becoming more like 'retail chains', on retail parks,owned by corporates.The veterinary profession is a very 'young profession' apparently, still finding its feet. Legal aid is only available for criminal cases, except if you believe those red top tabloids, where Ernest Saunders, the Maxwell boys and a Ms Koo Stark, supposidly received legal aid, they perhaps had a very good legal teams. Its' who' you know everytime. As an member of VAA&J, you may not need the services of CAB, I wonder would you actually know if they can help with a veterinary negligence case? Do you know of an area which still has an NHS Dentist?. I'm willing to travel. I'd love to pay subsidised fees.

Non-Professional
I use the term 'Professional' as meaning someone in what used to be called a 'learned profession' i.e someone whose skills have been learned
to the satisfaction of his/her professional colleagues, and who is subject to regulation and discipline by those colleagues. I would include the medical, dental and nursing professions, accountants, architects, civil engineers, lawyers and barristers, schoolteachers, ministers of religion, amongst others.
I do not include, for example, 'professional' rodent operatives, 'professional window cleaners, 'professional' road sweepers, however admirable and essential these occupations are in today's society.
What precisely do you mean by an 'orphan' profession? The Royal College's foundation charter is well over 150 years old - hardly a 'new' profession.
I note that you seem to have researched my CV pretty thoroughly, even having identified me as a member of VAAJ. You clearly prefer to remain anonymous!
W

Vet Times May23rd 05. Jill Moss 3 page article, 'Foundation to push for further research into MRSA and animals'.

Hi, Non-Professional,
Yes, I did see the article.
Research into MRSA on all fronts is essential.
W

My cat had wounds when I got her back from a friend. A couple of days later my boyfriend got MRSA. Is it possible my cat had it. Cuz two weeks after my boyfriend was over it. I got MRSA. And what do you do for it, and what is the test for cats.

Hi, Amanda,

Only a laboratory test can confirm MRSA.
If you think that your cat infected you, or your boyfriend, you must get your veterinary surgeon to take a sample from the cat's injuries and send it to a laboratory. Have the wounds on the cat healed OK?
Walter

CAN HUMANS PICK UP STAFF INFECTIONS FROM DOGS?

Hi, Barbara,
See my reply elswhere on the site.
Walter

would you like information on the 1st International conference on mrsa in animals walter? I think you need to be updated on recent research

Hi, BMF,
Thank you for your suggestion, received in quadruplicate!
W