Oct. 13, 2021

#53: What are we so afraid of? With Drs. Kate Clarke and Magdoline Awad.

#53: What are we so afraid of? With Drs. Kate Clarke and Magdoline Awad.
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Season 1

“I am an old man and have known a great many troubles, most of which never happened.” Mark Twain

In episode 49 we dissected one of the biggest fears that many vets have: the fear of an official board complaint, from the perspective of a practitioner facing a complaint against them. In this episode, we look at the same issue from the side of the official body that deals with complaints. I’m a firm believer that the more we know about the things that we fear, the less scary they become, so let’s face this one together

Drs. Kate Clarke and Magdoline Awad are vets with experience serving on vet boards. They join us to answer all of our questions about board complaints - like how likely is it happen in the average career, what the most common complaints are, what the process looks like if you do have one lodged against you, as well as practical tips for avoiding them in the first place. Kate and Mags also walk us through all the possible outcomes, in other words - what's the worst that can happen, but then - what is the much more LIKELY to happen.

Kate has over 20 years experience as a GP vet in regional Australia and the UK, with membership of the Australian and New Zealand College of Veterinary Scientists in Small Animal Medicine and a Master’s degree in Business Administration. In addition to her role on Victoria’s Vet Board, she’s also the founding director of Engaged Solutions, a veterinary HR consultancy, and serves on the Australasian Veterinary Boards Council’s Sustainable Practice Committee. She's an AVA graduate mentor and a Policy Council Advisor for the AVA’s Veterinary Business Group, tasked with developing the AVA Great Workplaces Policy, and is also leading the development of a new not-for-profit called Sustainable Veterinary Careers. Somewhere in between all of that Kate also has a veterinarian husband and two teenage kids. 

Have your say at https://sustainableveterinarycareers.org by completing the survey. 

Mags is Chief Veterinary Officer at Greencross. (https://www.greencrossvets.com.au/) She did her memberships in animal welfare and has a degree in Veterinary Professional Practice Management. She was appointed to the Veterinary Practitioners Board of NSW in 2019, and is a member of the UNSW Animal Care and Ethics Committee and is the NSW representative for the AVA Welfare and Ethics special interest group. Between 2008-2015 Mags was Chief Veterinarian at RSPCA NSW, after starting with the organisation in 1996. She’s also been involved in the development and management of community programs in remote regional areas of NSW, working with local veterinarians and government to improve the welfare of pets in those communities. 

 

Go to https://thevetvault.com/podcasts/ for show notes and to check out our guests’ favourite books, podcasts and everything else we talk about in the show.

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Mags Kate, welcome to the red.Well, thank you for joining us.Thank you.You have to say hello.I'm Gerardo Pollard.
I'm you became strap, and this is the vent valve.I love it falters and welcome back to another episode, which is kind of a follow-up to a previous episode.
Got two questions that we want to try and answer in this episode.What are we?So afraid of what's the worst that can happen in episode 49?We dissected one of the biggest fears that many vets have the fear of an official board complaint from the perspective of a practitioner facing a complaint against them with dr.
David tablet in this episode.We look at the same issue from the side of the official body who Deals with the formal complaints.I'm a firm believer that the more we know about the things, we fear, the less scary they become.So let's face this one together.Now, we appreciate that the exact rules and interpretation of rules will vary, depending on where you are and who you're regulating body is.
But I'd imagine that the sentiments and principals would be much the same and that you could safely, extrapolate, the general gist of this conversation to your own circumstances, by all means.If you are in a board or a council or another regulating body somewhere else or I know somebody who is and you feel that there's something to add to this conversation.
Then please get in touch and correct us doctors, Kate clock and Magdalene a wide, our vets with experience serving on vet boards.They join us to answer all of our questions about board complaints, like a common.Are they what the most common complaints are what the process looks like.
If you do have one launched against you, as well as practical tips, for avoiding them in the first place.Caden mags.Also walk us through all the possible outcomes in other words.How much trouble would you actually be?In if worst comes to worst basically.What's the worst that can happen?
But then what is much more likely to happen?Now about our guests, Kate has over 20 years experience as a GP vet in Regional Australia and the UK and hold the membership of the Australian and New Zealand College of Veterinary.Scientists in small animal medicine and has a master's degree in Business Administration.
In addition to a role on Victoria's vet board which is also the founding director of engaged Solutions a veteran.Eh Consultancy and tips on the australasian veterinary boards.Councils sustainable practice committee.Kate is an Australian V8 Association, graduate mentor and a policy Council advisor for the aviators veteran business group tasked with developing the AV a great workplace is policy.
I'm exhausted just reading that never mind doing any of it, but we're not done.Kate is also leading the development of a brand-new not-for-profit called sustainable Veterinary careers or Ace VC, which has a revolution.Very approach to helping members of the red profession.Achieve exactly what it says in the title, have a sustainable career, I'll tell you a bit more about that after the podcast.
So stick around or check out the links in the show description and have your voice heard by completing a very important survey for SVC somewhere in between all of that gate also has a veterinarian husband and two teenage kids.Max's Chief Veterinary officer at Green Cross.
She did her memberships in animal welfare and has a degree in Veterinary, professional practice management.She was appointed to the veterinary practitioners Board of New South Wales and 2019.And now I'm going to list some of her other leadership roles member of the University of New South Wales, Animal Care and Ethics Committee.
These are the world's representatives for the a VA welfare and ethics special interest group previously, a member of the animal research and review panel of New South Wales, as well as part of the DVM selection committee.For the University of Sydney mags was Chief veterinarian at the rspca New South Wales from 2008.
To 2015 after starting with the organization in 1996, she's been involved in the development and management of community programs.In remote Regional areas of New South Wales, working with local veterinarians and government to improve the welfare of pets in those communities.She's also spent four years as the chief Veterinary officer for Petra where her mission was to increase, pet insurance, awareness, and penetration in Australia, what a pair of slackers?
I'm going to put on my CV that once I managed to schedule it to Our podcast recording with these two plus, the famously elusive, Gerardo Polly.Please, enjoy gate Clark and makes a wad Hey, it's Kate, welcome to the VIP.Well thank you for joining us.
Thanks for having us.Thoughts are looking for talking about it.Now I'm gonna I know why.Wait, I'm here to get a just-in-case listeners out there thought like, but I wasn't even here.Yeah, nobody cares.So, I want to start with why we're doing this episode with you guys in your roles as board members.
I, well, all of us, Kate.I know you and me.Definitely have a shared interest in that we care a lot about.What?Happening in the profession and how can we make it better?But mags I'm sure in your role.That would be a big issue for you as well.How do we create a sustainable career or a happy place for vets to work in?
And I know Dorado feels the same so I spend a lot of time thinking and reading up and trying to find out what the problem is, why why are so many vets and happy with their careers.And I know it's multifactorial, there's lots of reasons for it.But I haven't theory that I've been thinking about more and more and and it's I think one of the Is we become with because we want to help.
Yeah right.We want to, we love animals and we love people or some of us have people, some people don't, but most of us have a desire to help and we go into this career path from a place of caring and love I suppose but then by the time we hit the floor by the time we roll out there, there's so many things that we worry about the things that can go wrong.
That is sometimes shift to a fear-based way of practicing.And I think when you, when you come from that point of view, rather than saying I'm doing this because I love it, the things that I do, I'm doing because I'm scared of consequences, it changes it.I think that definitely detract from potential enjoyment so I don't know.
Do you think the theory is valid potentially any of you?Yeah.I think the theory is valid for sure is that they have experienced that kind of mindset myself at times and and you're right.I think it's certainly something that actually detract from your enjoyment but also detract from your growth as a vet which obviously then beads into you.
Enjoyment and motivation to do things.So then, the next part of my thinking is about looking at where that fear comes from, what are the things that we're afraid of, and in other spheres Justified, I know from personal experience and from chatting too many, many events over the years.
One of the primary fears is that fear of getting into trouble with the board, or with your local Council, or whoever you're regulating, body is where you work.The other thing that I'm learning about fear, is that fear usually comes from ignorance, doesn't it?It's people, people are scared of stuff, they don't understand.
And that the better we get to know the thing that we face, so much less afraid would become of it.So, I would love to know more about our boards so that hopefully will realize that most of our fears about the boards are unfounded.So let's start with what exactly the board is what exactly is the role of the vet board.
For example, are you guys there to represent?Isn't or to protect vets or what?Exactly is it way, where do you fit in?I guess the board's mission is is obviously, under the ACT, is there to protect the public and the Health and Welfare of animals by regulating B.
And that might sound controlling and punitive but it's not actually the mindset but factually behind what we do.So protecting animals, The public's about reducing risk to them.So while that might mean deterring behaviors or restricting, how people practices, it's more often than not.
It's about Writing clear, guidance about the capabilities and Professional Standards that are expected and providing objective and peer in public feedback and direction for further development, if it's needed.So I think there's a wareness at board level that, that is something that that experience, is that that fear.
But I think there's also consciousness of trying to move away from that.So pets are the sent you did say pets.Yes, I said animals.Okay, cool.Is the animal, which as a veterinarian, then like when you said that, it made it takes on make my head, which was this is not about me, potentially its on about the owner because at the center of it between me and the owner is the pet.
And if the assessment and the objective of the vet, says mortars to ensure the Health and Welfare of pets has become animals, has been taken care of.Then, it makes me like I'd somehow takes it personal Attack the personal, whatever it is away from it.
But that's how I've just personally felt just then yeah.I mean the board's there to make sure that the legislation is actually enforced.And part of the legislation is the welfare of animals but also to ensure that the consumers of the services that we provide actually will informed about the competencies of the vets, and there is an acceptable standard of care that's provided from a public interest perspective.
If and we're not just talking about small animals and stuff because you've also got fits in food safety, you've got bits in trade, all those sorts of things and really there's also that public health protection.So whilst the animals are important in terms of their welfare and the outcomes.
It really is about making sure that we provide those Services as best we can, it's about mitigating risk to the public as well.So for me there's always been that issue as a veterinarian.You can all be looking after.You know, we're almost like We're looking after the patient but we've actually got a client or an owner and in the case of a pediatrician, a parent, or a guardian.
So it's a really difficult thing because we've got to meet, you know, the expectations of the owner, or the parent.But our main advocacy is for that welfare of that pit.And that's, you know, come out in our code that the welfare of the patient comes first, so, the role of the board, because a lot of complaints that I hear about the borders, people say, well, we pay these fees towards the boards.
But they're not they're not doing anything to protect us.Is that a is protection of veterinarians, a role of the board or should we just get over that idea and say, well, the likewise it there to protect the profession or the individual or what's the hierarchy is it?The first depict, the owner, the red?
We how does it work?I think what we just talked about in terms of putting the animals welfare and erratic the center of it is for be crucial and that kind of recognizes and reflects that were all rather than having a sort of an awesome them.Mindset.We're all on the same team.
Yeah, the way public or beds to achieve that Animal Welfare.So that's the first thing.Certainly, as Meg said, the public need that assurance that there's a standard and I think that that can be certainly viewed as positive for that.So let's say we have an ability to stand and say, well, that's and we're respected for what we do and it does add to the trust that people have in us as individuals on a daily basis.
But also as a profession, it's important to recognize that while the feeds from vets.Go to the Board to do their work.That work is actually all of that comes under a piece of legislation.That's not something that we can just change.
I thought, when I joined the board, I could just get her.We could just make this a bit more current up to speed takes decades, to do that.I was quite naive.That doesn't mean we're not trying, but on that big picture thing, really?We're talk about.All of us to Serve and Protect the animals and the public, we actually have to look after the profession and the individuals in it.
So I think there's really Strong recognition of that.So Wade where our role is boards both at the state and the national level is looking at making sure we've got enough fits with the right skills.Clear, understanding of what's required of them and accountability for what they do and sufficient health, or the provisions to manage any sort of in ill health to ensure the Professional Standards can be maintained.
So while we're not better advocate for the profession, we are key to helping us all do, what we signed up to do is vets, which is look after Amal health and well-being.Yeah, and that's right.And I'm specifically in New South, Wales aboard, sort of functions.They really have a few functions, obviously, registering Veterinary practitioners, and we actually also licensed veterinary hospitals, and part of that licensing process is also making sure there are minimum standards and there's actually an inspection process as well.
So that allows a hospital inspector to visit their clinics, to actually, give advice, all the things that are important to maintaining high standards but also ensuring that they comply with the ACT.The code so things like you know making sure there's good record-keeping not just for you know SAS and other things like from a health perspective, but also ensuring that you consent forms that there is actually a process for informed consent.
All those sorts of things are in place.So that part of it is also a really important part.And the view, of course, the most important part in terms of investigating complaints.That's one of the biggest roles of the board and in some cases taking disciplinary action against veterinarians.If a complaint is filed, Found to stand I guess the board's composition is really important and a lot of the legislation is state-based and so therefore we can't just have a blanket way of doing things across each Stacy.
Every state is different.I can talk on behalf of the New South Wales board in terms of how it operates, but there are actually a veterinarian's on the board representing.That's in rural areas, Urban vets are Specialists debt.You know, that's working in Academia, and to veterinarians that are Acted by the minister and of course we have our consumer representative.
So we've got two of those.So the board actually does have quite a varied composition and I think where there is a need to seek legal advice.The board will do that.But for the most it is made up of veterinarians representing different parts of the profession and their your peers.
So from that perspective, I think that gives a lot of reassurance to vets that the people that are on the board are actually their peers and they're making decisions based on their Appearances and their knowledge, which is very similar to the experience and knowledge of the people that we're investigating the complaints against thousands quite similar and Victoria.
We've got six registered vets out of the nine.People on the board.One lawyer and two more community members as well.So we've also got that range of perspectives for both the skills that we're bringing about to the board, and the governance side of things, but also the impartiality, and when we're looking at complaints, what?
We're not looking at Gold Standard, although obviously we Courage, best practice where you can, but what the actual measurement for us under the ACT is, whether a behavior meets, the expectations of the Vets peers.And the public.What I didn't know when I was when I, before I joined, was that the majority of fees go to the staff who are doing the majority of the day-to-day work.
And we've got a real cross-functional team there with it and financial Communications registration team, a general manager registrar and in the complaints and Negation steam.We've actually now got a mix of lawyers and a vet to make sure both the proper processes are followed but also the appropriate technical information is gathered.
So that's where the feeds are all going to making sure that the profession is well regulated but also that that support and there's a really accessible point for both vets and public to access information about vet services.So I just want to share my experience with the board at least in Queensland.
And he was like a Lynch Mob.No, just kidding.No, I got a pretty scary clearly, look at it.What what I was expecting what I was expecting was this kind of Lynch Mob experience like intended Spanish Inquisition, it's the Spanish Inquisition.
I'm standing in front like nine judges.And I remember when I first got this email from the best surgeons board saying the request ID, copy the records, my recollection of the experience.I was just like holy Shit that's it.I'm done.
You know my career as a veterinarian is gone and I've completely effed up and you know, I'm sick of this, I'm done with this and I really felt as if like I went through phases of, I've done the best that I can, and here I am right now, getting dragged across the hot coals because of this thing.
And then I went there and I remembered writing this massive Submission.And it was like, this is the stuff that I've done, this is the education I've done.It was two pages of continued professional development and what I contributed to the veterinary profession and all sorts of things and because so defensive I was so defensive by the whole experience.
And I went there and that just had a chat.And they talked about, hey, doubles, what happened?What was the experience?Hey, this is what they said there was a, it was a right.Felt was a very fair and objective experience.It's limited to the facts.What could have done better?And I was found guilty and I was found guilty of terrible history writing, but ultimately my experience from that walking out after is much different.
And I'm actually in the process of being taken to the board again right now, and it's a much different experience.It's one of.Hey, look, they just they're investigating.I give them information, we'll have a chat and we'll talk about it, and if I've done something wrong, then I will change.
I can Adjust will just a processes, adjust the protocols, but it's for the better.Yeah.And I look I think any kind of complaint whether it's a board complaint, as you know, Jurado being the director of your hospital as well.And in my role as well, there are complaints that don't go to the board and those complaints and I guess something, the majority of them don't go overboard.
But when they do come to you, it's like well, you know what happened?Let's work out the facts, let's talk to the people involved.Let's look at the medical notes.It's a very similar process in you would In-house, right?But I guess the thing is, it's just a thought of being deregistered, those thoughts, go in your mind and I can understand that because it's veterinarians our careers, if it's all very linked to who we are as people.
So we feel that there is a failure on on us and I completely understand how people feel and I guess with our board, our Deputy Registrar is actually a trained counselor and she takes those calls from the complainants before the complaints come in, and she will talk to them about or have you gone back?
To you that have you had a discussion because sometimes it's actually one of those things where the client just wants to be heard and say they ring the board, they have a conversation and the board is we'll have you spoken to the vet and some of the times actually happen and they'll go back to the vet.And if I can just say one thing to vets, who get a client come to them and ask them to go through the case with them and make them understand what happened.
And no, listen to people be open and honest don't be defensive because people genuinely They would spot reassurance that they could pet owners and they want you as their vet to tell them that they are.And part of that is having those open conversations and really honest conversations with them.
And sometimes that's enough to make the complaint not happen and obviously there's going to be complaints that can go on regardless of that conversation, but that's really your opportunity as a vet to actually really try and make things good with the client listening to them.And if there are changes that you're going to make, you know, tell them about those changes.
We might change this process but one thing I will say about complaints, Unfortunately they be there, an individual, vet complaint.So the complaint goes against you Dorado, but a lot of the times it complaints in the majority of our around processes and the people and the systems that are in place.
And so from my perspective, we are to have a quality management working group, which looks at all these things within our organization, the try and refine all these processes because it isn't about a single person.It's about a system.And that hasn't been supportive of the people in the environment that they're in.
So I think, as an individual get to receive those complaints when you may not have the ability to change other things within the practice, and I think it's great that you mentioned there, the not all complaints come to the veterinarian, but also the fact that you said there that have you spoken to them, but it's also like my experience.
And I'm not going to name names and organizations and things, but we had advice from a particularly like very defensive position where it's like, don't speak to them.But then what the end, what we did is we end up caning that support and in talking to our Indemnity Professional Insurance company and going like, hey can we actually talk to our clients that we learn to listen and stuff?
So now I process with the company is calling clients listening and like, 95% of the issues they have, it's all about being heard, and then acknowledging, hey, look, that is Amazing.Thank you so much for listening and like I say, thank you so much for sharing that with me.
Because what I can do now is, I can go back to the team and go.Hey, look, this was the clients experience.It was potentially, as a result of, as you said mags are processed that, we have, that isn't quite working.So how can we adjust and change?And then like the vast majority of complaints about a call once that which can be adjusted by listening and then going, hey look, thank you for sharing that because we can go back and we can change things.
Yeah.I mean, at the end of the day, that's what all of this process is about the whole complaints thing is just an opportunity for feedback, so whether that's at that client level or whether it then does go.And I guess as a maid said, no, obviously we're speaking from not even on behalf of our boards, but just as people who have board experience in different states out of very similar, we certainly not only grown the after we had that process of the complainant ringing in and as Meg said in the last three years less, than half of our phone, Compliance have actually progressed on to a formal complaint.
Having said that the actual phone complaints themselves have more than doubled over the last three years.So, a lot of work coming into the board at that level, and they're doing a fantastic job of providing the three things that at least, starting that process because as maids and you've said, Dorado, people need three things.
The first is to be heard, the second is to understand what happened because of this, it's really challenging to get your head round.Something if you just don't understand why this happened and their It is to make a difference.The most common thing that we hear at the end of any complaint is, we don't want this to happen to other animals.It's really not about blame and shame and punishment.
That's not what people want.They want to make sure that they can make something constructive, out of what's been really hard thing for them.So our staff are really approachable and fair and impartial in that they're listening to people's concerns.The other thing that they do is do a little bit of triage because some things that people want to talk about aren't We in the vets that acts jurisdiction.
So things like these have nothing to do with us and there's also other things like drug storage that we get a lot of queries about drugs storage and Disposal and prescription that actually all falls under in Victoria the medicines and poisons area not that act.So all of that stuff happens and a lot of all of this happens before it actually gets to the point of a written complaint being launched and then once that's lodged, even all of those don't end up through going through.
To the point where you get your phone call from the vet board to the vet, there's a lot of work that goes on before, then about of the third of the actual written, lodged complaints don't actually get progressed past, the very first board meeting and that's so there is a sort of a filter.So it's not there's not some obligation to that.
The board has that let's say somebody complains about me.It's a completely silly complaint or very obvious thing that I haven't done anything wrong.They call you guys with the be somebody there, who looks at it and go.Yes, we hear you but I'm not going to I'm going to stress.
You were down by phoning him and saying look there's been a complaint or do you always?Yeah.There's a really important tool set out under the ACT.We have to follow that but there absolutely is a process.Basically, anything that is lodged as a written complaint has to be viewed in Victoria by the whole board.So there is no such thing as I'll just get rid of that one, okay?
Everything is seen by the board and we're only basing decisions at that stage on the information that we've got of hand, which obviously is really very Very well, the more the better, because sometimes we have to progress things just to get the clinical records to understand what actually happened.But at that stage, the whole board makes a decision on whether a complaint is lacking in substance.
So that might be for example, that the owner wasn't happy with the outcome, but there's actually nothing related to Professional Standards in there if the complaints vexatious.So that's if it's borne solely from that anger, retribution, kind of place or if the issue doesn't fall under the board's jurisdiction.
So that's about a third of complaints.Get lodged hole in that that bracket in the last few years and so the other two thirds are then delegated on to what's called preliminary investigation.So that's really, that's when the phone call happens, that's when the actual information gathering starts.
And I guess it's important to understand that, that is just a preliminary investigation.As Dorado said, it's quite easy to think and understandable that you think?Oh my God, it's an investigation and there's going to be a finding of all bad at the end of this, it really.Ali, is that for and it's understandable.
But I think it's really important to remember as drought has said that this is just an objective fact, finding exercise.It's a preliminary investigation.There's no finding, at the end of that part of it, it's just tell us what happened, provide any sort of information or evidence you've got whatever that looks like to help us.
Yeah, and the important thing around that is when the board does have to notify that there's a complaint and they need to gather the information, the quicker, you can get all the information.Actually information that they require is set it up when they send you the letter, the better it is in terms of the timeframe for resolution of that complaint, the thing is that it is a process and we have to make sure that we go through the process so we can't just finalize that within one day and I know that the longer it takes the more pressure on the backs because they're willing on it.
They're turning around you.What's happening with my complaint.We do keep people informed and where it's at.And obviously the process is that the client has a right of reply as well.Once the the information comes through and then it goes back to the vet who has to reply again.So that process the quicker.
The information comes back to us the quicker that the complaint can be resolved but it was really interesting because the number of complaints versus a number of registered vets, in New South Wales, you have a 1 in 25 chance of actually getting a complaint.You know I had to get that step for you guys because what it means is that it isn't unlikely that you will get one so you know you are amongst peers as Even the most amazing vets will get complaints and it's not a reflection of you.
Personally, in most cases it's like we're talking about before and when things go wrong, it's usually because the client you know, there's lots of reasons.Obviously we're seeing a lot more complaints come through, where there's a lot of money involved where there's a lot of grief involved, and a lot of client expectations that haven't been met and of course, where we haven't developed that trust.
And I think, Gerardo, You know, in your line of work in emergency, you have most likely never met these clients before.So your ability to have that ongoing trust, you have to develop that trust there.And then and what we're finding is I'm about UK within our boards, a lot more complaints through emergency hospitals as well, where the fees are higher because of obviously the critical nature of the cases and the complexities of that.
But also the fact that there's no no general practice veterinarian, client Bond, that's been developed over years.You have to develop that trust very quickly and I can see how breathing lots of money involved critical case never developed a relationship of trust with that bit.
You can see how complaints can rise As probably isn't, I don't think there's a clear sort of increased necessarily in the emergency stuff in Victoria but there certainly is a high percentage of the the complaints that we see that involve more than one bit practice.
And that's not necessarily to say that there's been anyone throwing anybody under the bus, but it just highlights that the when you get different perspectives are different levels of trust or different language used even owners hear different things.They take that and layer it on what they're feeling and what beer?
Suspicions or fears or uncertainties are and confirmation bias tells us that they hear something and go, yeah, that that and hold on to that.And then shape it into a whole, another concern that ends up giving rise to a complaint against the first atom.So we certainly see that pattern and I guess open communication and and self-awareness as well.
When you say seems like that is incredibly important for vets.Yeah.And you know, over the years I think having it you know, employed a lot of new graduates and See, a lot of students, the first thing I would always say to them is remember every other wedding, every other practice is your colleague.
They're not your competitor, their, your colleague, you might be working for them.They might be looking for you in the future.And remember that when you are the second opinion, vet, or the vet that sees the case, two days later, you've got the benefit of progression of disease and because of that and because the client might Now find themselves in a situation where, you know, that the period of time that's gone by, in the progression of disease, has resulted in a more critical case.
Yes, they're probably going to say yes to their Diagnostics and the treatment that the second vet is going to offer them and they may have declined that with the first step.So just be mindful that the first it has probably made those recommendations or recommended those treatment options or Diagnostics but you're at the time when the animal was in critical may have been declined.
So pick up the phone call that vet said about your client this is what I'm seeing now.Just letting you know it's here with us.It's just that professional courtesy and you may find out more about that.That might help lend itself to resolution of that animal stop signs and illness in a timely manner, like not having to run a test because it's Bend up, all those sorts of things, but we just got to be mindful that the person that's all the case.
Two days ago, it may have presented very differently and it may have actually progressed to a point now where it's very obvious and I'll always remember and this is something that happened to me as a new grad, had a large breed dog where it wasn't obvious that the dog had a foreign body in the stomach, you know, x-rays back then, work the the Polity that they are now didn't have an ultrasound machine.
And when it progressed to a specialist Centre, a few days later, obviously, it had progressed.And you could feel the corn cob you didn't even have to do an ultrasound.But I guess the nice thing about that, it remains in my mind, the specialist picked up the phone, and he rang me.And he said, mags, I just want to let you know that the clients here.
I've let them know that there was no way.You could have possibly felt that or seen that on the X-ray that you took.And, you know, the dogs find out surgery is being done.And when they put down the phone, And I remember thinking to myself, I'm so glad I heard that because that's how I'm going to treat every case from now on and every other vet that I'm a second opinion bet on but it sticks in my mind about that kind of collegiality within our profession and also making sure we do the right thing by the pit and the owner wanted to just highlight here that called cobs are the ultimate pain as of our bodies.
I blame I blame KFC for those little corn Corbett's whatever.They are, they just seemed to fit very nicely to get to the pylorus And then all of a sudden they just stopped, you can't see them.There's little bastards on until days later.
And then you're like, oh, I love you, Max.You mentioned an increase in case and complaints and we talked about a lot of complaints from emergency clinics, I'm curious.Is there a standout type of complaint that you guys deal with mostly like what are some of the most common complaints that you get tight?
You want you want to go first?So, I think we've certainly alluded to for the number one, which is communication.Absolutely.Always number one and that can play out from things, like a poor understanding of the benefits and costs or the instructions, or the alternative options, which then feeds into unexpected outcomes or alternatively, pour on a compliance but then leads to poor outcomes.
So in sufficient Clarity of consent is a really, really big one because we're not just looking for a signature on a piece of paper.It really has to be in informed consent.So they need to understand everything it's behind what they're agreeing to and that stems from communication.
So, the written communication, the written consent is only one piece of a much bigger communication picture that has to happen.As we just talked about the communications between practitioners that sometimes can actually hand the best treatment for the animal because they just didn't know what went on or who's responsible for.
It is another part.And then as we've talked about before that, that challenge and having constructive After things don't go well that then lead people.Like they don't understand or that things are being hidden from them.People don't want to feel understandably, like things have been hidden from.
So I guess from that point of view, that's probably number one.And there's lots that we talked about, I guess, the things that we can do to stop that.Obviously, prevention's obviously, best with that one, so building your own and others skills around communication.Now, in our Victorian guidelines, which have just been revised in the last 12 months, after lots of lots of it.
Input.We've actually in the context of rcpd one.Even though it says a national standard for how much C PD you have to do, there is actually now we call out that there's a lot of non clinical stuff that it really contributes to the professional standard of your work.And so we'd really encourage people to take up on things like communication skills, having hard conversations, self-awareness, emotional intelligence, all of the stuff that is going to help you in your professional life.
To uphold those standards and build those relationships.But it also helps outside your work life, which obviously It took me about people driving, we're not just that's working at work, it's about the bigger picture and how everything's going across the board.So there's heaps of value in that stuff as made said before, manage your expectations, openly and continuously no one ever complains to us about too much communication.
So we often get things where, you know, they've got consent for a dental staff, but then there isn't another phone call to say, right?We actually now that we can see, we need 12 teeth out and that has to happen.So we get a lot of complaints like that.So, Keeping that evolving.
As the case does is important.If things do go wrong, being really open about it.And acknowledging, the distress that things have caused that first and foremost, it doesn't, it's not the same as saying I did something wrong.You might have, and that might need acknowledging to, but it's often about just acknowledging that.
And I guess the other thing I'd say, is being conscious of how you bring yourself to those situations is that people can get quite defensive or even aggressive.Sometimes, the vets in terms of how they respond to this sort of Action because that's understandable.They're just as upset as the owner.And there are going to be their own harshest critic, but to maybe Park that for a moment, be aware of it pocket.
Go into the conversation, listening attentively, but then go and seek support for that for yourself later.Afterwards is really important.Yeah, I think managing client expectations.That's a big one and I think who worked his profession for a long time.I think what we probably find hard to do is to tell people bad news.
Or at least give people the understanding that things may not progress will and the animal may have a poor prognosis or even die.And I think offering euthanasia in those cases is really difficult for some vets because we're trying to actually make everything better and fix things.And sometimes if those conversations are had, some people just want to be reassured that they can make that decision and by having a vet say to them, you know, at any point in time, if the animals deteriorating, please let us know.
Because euthanasia is, and Option and sometimes when people hear that at the start and they make that decision down the track when the animals not progressing.Well, then they feel that you've backed them in that decision.Whereas I think sometimes complaints happen because there's going to be a poor outcome, they spent a lot of money, the animals died, no one's given that option at any point in time and then I've seen a lot of complaints about if I knew it was going to be a bad prognosis or die, I would have euthanized it from the start but I was never offered that option.
I see that a lot especially in.Pretty cool, kid.Gerardo us.He's nodding there but maybe that's an area where we as vets need to.Look at that and say euthanasia is a good depth and in some cases is warranted in those critical guarded, prognosis cases, where the client may not have the funds and may elect to euthanize prior to encourage a lot of funds because that's where I think things their expectation is if they're paying for something, the animals going to live.
And so we just got to manage that really well.I think that expectations there are super important because that's not just expectations that are set by us as veterinarians.Sometimes our staff said the expectations he you got him down.Now we're going to take care of him and they're going to be okay.
The Vets here.Now here like the this super amazing veterinarian Hubert is then going to save your pets life and then joubert's like I can't save this, you know, there is this cancer everywhere in spraying chest and every week sometimes expectation is I'll unfairly set by the team but also get mags.
Would you said there that sometimes?It's like, you don't want to see the idea that there is something more Sinister here, then something as easy as it was for me.If it's not a dog that comes down, that's flattened ethology because it's okay.He could be something like 1, 2, 3, 4 5.
But hey, look, it could be something like cancer, you know.I'm a, I'm a bit guilty of that they started.We have been nothing, it just comes from that.And again, we've talked about it so much, there are the personality types.And with the amiable personality, I don't like to worry people, it sounds so stupid, but I don't want them to go home and worry about the dogs.
So I'll downplay stuff or are used to.Now, I'm aware of it, so I try not to.I do exactly what you say.I trying to be more trying little bit, be a little bit more negative about it.And then if you, if you win them and testing the new the hero you're not alone, you're not alone here.It means that they had them like that.
They had complaints like that.People have said, yeah, I just don't want to make people feel bad.Yeah, you don't have to but at the end of the day, I guess it's about the awareness of where that can lead.And I guess from a consumer point of view, obviously looking at human health outcomes and processes have been through.
I want to know the whole range.I want to know what my chance of death is I want to.So, I think affording that to clients is really important.So I think to Kate's Point as well, that no one ever complains about too much communication.If you do find that you admitted the animal and things have progressed to a point where you've got more information, you like, okay?
I now have to change my prognosis.I think those sorts of things that constant communication with the client about where things are at, that's really important, especially in those cases, where in change very quickly in, once you get more information.So communication and obviously meeting client expectations to me.
Informed consent is not just a consent form where client sign they have to know what's happening.The implication, the treatment that you're offering all the Diagnostics and Implications of not doing something that's even more important because if someone declines something, you should actually let them know by doing this, we won't have this information.
So we're making decisions based on very limited information and I think we, as vets have been doing that for many, many years, we make decisions every day and we make them with as little information sometimes and the expectation of the client is, we have all the answers, but the information that we have is incomplete and we do that.
Every day is as vets, and we just got to let clients know that if we don't have.That information we're making decisions based on limited.So then declining a treatment, we have to just let people know what that means and that's part of the informed consent process and of course, managing expectations from the start and you need to be realistic.
And the other thing that I think is important apart from making sure you've got great clinical notes, what I've been finding in with the shortage of x's, we've we do have a lot more vets looking after certain cases because you might have more locums coming in and that becomes even more important to either have hand.
Around or really good plans and communication notes on your medical notes because of the number of vets at may be treating a case.And what I found is where there's more vets treating a cat, is the more likelihood that there is going to be a breakdown in communication.So just being mindful of having really good plans and handovers if cases.
And the other thing I think don't be pushed to treat by a client.If it doesn't fall within your skill set, or you have concerns.Because I find that to fold from a A clinical perspective that's really hard to justify internally.But also from an animal welfare perspective, there are things that clients may ask you to do when you feel like, No, actually, that's not in the best interest of the animal.
I think you need to call it out.And I also think you can decline to do things based on those things and I think when things go wrong, it's because you may have actually performed something that you aren't comfortable with.So that's where I think your peer support team is important and referring internally or at another pet clinic is important.
And obviously, as Kate Encouraging CPD, within the clinic both, from a clinical perspective.And from a communication perspective, that is really where I think that's and vet clinics need to go because we know that we can only progress people so much within clinical skills and education.
But I think from an EQ perspective, there is so much more to gain by having effective communication.Running a consults in a way that actually is structured so that the clients walk away with clear expectations.And then the other thing of course is How you make people feel because it's that whole client experience.
If they walk away going, I feel, you know, like I feel really relieved that that is looking after my pet.That's what you want to get to that.So yeah, in terms of just going back to the three kinds of talked about the communication bags just touched on clinical records, which obviously Jurado sounds like he's poster boy for to say about this layer.
Just wait, just wait you guys.Okay, it's coming back.I guess when I eggs talks about having really good clinical notes, but something that we don't always see in there is that it's not just the facts and findings that need to be recorded.It's also the reasons behind why things did or didn't happen record that stuff.
So you've got some proof, a year down the track.If you need, it of help us as boards to understand how did things unfold, where why did you go that way?Because we're coming from those kind of perspectives.We get it.So write, write down those.Is reasonings and the communications that actually have happened because, as well as managing the case.
Well, as mag said, it's also we all read each other's history.So I think it's a really valuable learning experience to.If you've actually said a really nice thought process out, then people learn from that.So that's really valuable.And then the third, most common complaint is around clinical management.
But that comes after those other two, which is perhaps reassuring to know.And I guess the message I'd have there.And that is that we know on the It's that there's no one way of doing things as a bit, even the 6 bed sitting on the board would probably do something all slightly different themselves.
So that's why I really what we're looking for.Is that logical, informed, kind of progression of thoughts and decisions.That's based on a contemporary knowledge and the guidelines that's a really good start.It's not about was that the right thing to do was it one that made sense?
Because what we're looking at is a professional judgment.Yeah.And that Kate takes Point around, you know, why you thought It that way and your your progression of what you did and your logical sequence of events is really important because it's a board.When we get the complaint, we already have the answer.
We've seen the whole thing.Yeah.Because when you're making those decisions is a clinician that first consult your making decisions based on your physical exam and your history from the client.Where as a board, we've seen the whole complaint from start to finish and we know what the end result is.So if you can show what your reasoning behind everything, you did at that point in time, It does make it easier but I will just say one thing about medical notes.
I hope I'm not stealing your thunder, Gerardo you can write too much as well.I'd love hearing that reason I say that is because if there's just so much information that there's no Sequence to what you're riding you just riding and riding and then there's no actually set plan or no no written communication as to what the client said or didn't say and what they consented to someone is not going to read it and that in itself lends itself to poor patient outcomes as well.
And there was a really good study in human health that and I think it took about this indicate the other day that actually people with chronic diseases.If a doctor shop along amongst the number of GPS, there's actually a worse outcome.Come to their chronic disease process because there's not that continuity of care.
And so, therefore, I think it's important that whilst histories need to be written in a way that encompasses everything from Clinical and reasoning and client communication.It also needs to be written in a way that somebody can actually read it and actually taking everything without having to read an essay.
Oh yeah, so it's this is this as well is going to come back to but mag so is true.So are submerged Avenues within the practice that I work in.We might consult for six hours.Surgery's prescribed and were things up for another six hours but then the next potentially six hours is riding history and notes, right?
And it's getting to the Crux of what is really required.What's required to the point where it's like actually you know what we're going to hire a virtual assistants and then allow our vets because because we are we just did a podcast of the day with the head.
Edgar of burnout in Australia, Gordon Parker and he goes in the medical profession.The thing that, like, one of the things that contributes to medical professionals burning out is the writing medical notes.And so, for us, it's like the things that are saved us in the past from Beth surgeon boards, enquiries, or should we say inquisition's as investigations investigations, Is it fiction?
I'm just poking the bear did.I didn't totally poke the baby the things that has saved us was the fact that we had complete records but complete records.What you know?Like, yeah, like roster.I can be records.Is six hours.Yeah.So what know what cost.
Yeah, cost ya.So Define it for us, what constitutes a fell.I'll put it in a more.Practical question that the thing about you have to literally write down everything.So let's say my animal comes in for A very obvious problem.Do I have to ride down there years of fine?
Check the throat rectal exam normal.No neurological exams on an American.Well, it came in for a cut on its yeah.You know what I mean, is that doing?What?What are the guidelines they died out there?Are guidelines and I guess, oh yeah.And each state has them slightly differently.
So you know, it's very hard to say.You must do this and is nice, but I guess the general term, the generals are divided, would be that if you looked at it and Made some sort of observation about it, pop it in there.You might be there, looking at a dog for its ears because that's what the owners told you at the time.
And you might notice that it's limping a little bit, but that's what I'll do about that.I really wanted to use fixed, but a week later, something is going on with that leg, and they say that bet, you know, that didn't even look at it.They missed it and that's unprofessional.If you've written down noticed, a limb own a?
Yeah, don't worry about it.That's Avant so it's not relevant to the problem that's been presented for.But if you saw it or measured it or observed it or heard it put it's good to put it in there because you don't know how it's going to become relevant in the future.
It's easier 20/20 vision, but I guess they're probably used it on a personal non-board level.I think there probably is a trend that I read about this not that long ago that we are probably going to go down the path in the future, just through lack of time and lack of vets and increased demand.
That pace that we know that meaningful.Work is absolutely core to engagement and motivation.And I thought someone said recently, I was saying, look, if you increase in this is not on the board wearing the board hat.But if you're improving your that processes, like using virtual, assistants Voice to Text technology, getting different people to do different work, that sort of thing.
You've got increase it that supports all of those sort of thorough findings, then that increase in processes.Increases your meaningful work because you're spending the time doing what you actually trained to do, which is problem solve and fix.So I think that's a definitely a really important thing to know that meaningful work is has to be core to how you do your job.
Well and one of the other things I think about making sure that you have the right systems and processes is having the right support around you.So if you have Veterinary nurses that are cleaning cages and walking, dogs all day and holding up, fine.
And we're not actually making the best of the support staff and with the shortage of gets, we really need vets to be doing what the legislation requires only vets to do, which in New South Wales is to diagnose, prescribe and do surgery.And so therefore, we really need to make sure that we have upscale our nursing staff so that they can assist our vets.
And then if there are things like nurses that are doing the majority of their workers things that an animal attendant can do then actually putting animal attendance in some of those roles to upskill, To allow announces to do more with our heads and then obviously may be increasing our customer service team.If you've got too much paperwork to do that, you actually have people that are taking that off, that's because there's nothing worse than vets feeling.
Like there's 10 people in the waiting room and you've got clients to see, but you're still admitting an animal in writing all the paperwork, I think gone.Are those days.Now, with the shortage of X, we have to just think differently and smarter about how we utilize our expertise in ways that are actually meaningful cake, but also effective.
And it's a natural sort of thing that when In that position, of course you're going to resent the board for putting this guideline in place that you need to write this ridiculously long history.But actually it's not just the board, is there for a purpose, the also needs to be the business management that supports it as well.
Can I quickly go back to something?You guys both mentioned a while ago, the clarity of consent and you both said it just a consent form is not enough.So what does clarity of consent look like so in my head to go?Well yeah, we've written it down.You've signed at the bottom that you I've agreed to treatment, how's that?
Not enough?What more should we be doing?I guess it plays out when they turn around and say, but I didn't know that if I did that, I signed.Yeah, that's my signature but I didn't know that I could have blah, blah, blah.So, I guess it does mean first and foremost knowing what the options are the benefits and the risks.
And again that stuff that you can record in your history and played that, you've discussed those specific things, And then depending on what your form looks like, things may or may not be on there and costs obviously a part of it, there's in, it's in Victoria.Now we have two levels of consent in our guidelines.
So we have the and that's specifically done to reflect human meds.And so, as they were trying to be more congruent with the world in general, rather than just living in a little bit bubble.And so, informed consent means understanding risks, benefits alternative options in terms of what actually happens to the animal informed Financial consent.
Is the second And often they'll be on the same piece of paper but that's about.Yes, I actually give consent for that amount of money to be spent in that outcome.So there's two levels of consent and I think if it doesn't all have to be recorded on that piece of paper and sometimes consent under our guidelines, doesn't have to be in writing.
Obviously it's easier to to prove but obviously, if you're standing on a farm and saying, look, you know, drain overlaid, who's their chances, do you want me to do it or not?You know, chances of survival.This turns the costing, this ongoing care of going to be this yes sir.No, you're not going to ride on a piece of paper necessarily there and then, but you've gone through all that same motion to say.
Yep.It's really about making sure that every step you treating owners, it's not an Us and Them, we are a team and just as you would talk to your team, whether your doubles tennis player and saying, right, you go for it, I'll go back or, you know, I'm going to do this, but it's the same with owners.You need to actually communicate about what you're doing so that they to appoint that and you do everything in your power, to make sure they understand.
So whether that means you might have to get an interpreter to Help or get an another person to come in or use handouts or diagrams are YouTube videos or any stuff that you like podcasts, they go help support anything you can do to build understanding because and it will repay you even you know, because what you're trying to do is never get to the board stage of course.
So that's the hard bit is we don't always get feedback on the good stuff we're doing and they get the hug, the bad feedback, which is bad.As The stress.Yeah, I think you're right.It's not just signing it form.But actually understanding the implications of the treatment that's been offered, all the treatment has been denied things like, you know, offering referral and then actually do mentioning, why the client declined referral, it's not about money.
Maybe it's actually about the fact that they can't travel, but then it becomes something that has been explained to the client.And again, like I said before, it's about the implications of not doing a procedure or not doing a diagnostic, You know, running the blood test or doing an x-ray prior to doing the surgery.
But again, it's, it's something that I think one things we need to also do, is talk the clients and seek clarification from them about understood.Get them to play back, what you said to them.So do you understand what I've said, you understand what's going to happen to your dog and the things that, you know, we're going to do today.
But also that's where, that whole, making sure that we've got a really structured way that you run your consults.And I ask open questions at the start of fiercely, to make sure that you've got.All the information and then seek clarification from the client.They understood what you're going to say?I still recall years ago.
Someone telling me when I first started that our client misunderstood but putting to sleep words.Thought the animal was going to be anesthetized instead of euthanasia.It's just the language you used but you know making sure you seek clarification from the client that they understood.And that's why I think just standing by a signed consent form is not enough.
It's about a risk.The implications really it's risk mitigation.And at the end of the The board is there to assist you in that, you know, the aviators there.They've got fantastic information on their website.About some guidelines.You can follow webinars podcasts.So has a vet board.
The vet board has some information for you and one of the great things about the board and even before I joined the board, as I used to in them all the time and seek clarification, not only on things like consent forms and things like that.But it was always about this is what's happened.This is a scenario that I am facing at the moment and they would guide you whether it's to a specific legislation or to someone from the Department.
The local government or whatever.So the board is there to help you pick up the phone and call them and no we're not scary and people that work at the board and scary and what they're trying to do is assist B to hopefully be able to work in a way that allows them to enjoy their work and not have obviously a complaint filed against them, do it.
But yet, because following on from that eggs, I think I think people do find sometimes it's fantastic.How many people do that's actually during the board that obviously, trying to do the right thing and trying to be really proactive, I think they might be you know sometimes a level of frustration that the vet star forward staff actually can't give specific advice so you can't ring up and say okay I've got this consent form and is this okay you can't give that advice even though you think well, isn't that your the people who regulate it?
You make a judgment on it.We can't give that advice.Because that's the thing we are.We have to be impartial.When a case that uses that consent form comes up in front of us.If we've given advice To say, yep, that's great.Then that doesn't, we're not impartial anymore.
So what we can do is nag said, is what they do is is do direct them to and that's why we have guidelines that are really quite explicit about what you need to consider how you actually enact it.That's one of the Privileges of being a professional is that you get to exercise your professional judgment.
There's not one right way, but we do direct you to resources that can help support that.The only other thing I would say is that the ABA guidelines can be fantastic as as a resource.But it's important to remember that they're not the guidelines that states regulate against so their recommendations their guidance to, you know.
And again you can say look this is what a demonstration of peer expectations but they're not the measure that we regulate by.So I think it's just important to remember that when you're looking at where your guidance comes from.So just on that those guidelines.Again this, this a Often people feel like if you had to follow the guidelines to the letter, it'll be quite onerous and not always that that practical are.
Those guidelines are do this or else?You got to be in shit when things go wrong or is it?Look, these are that's what you should strive for but it's not necessarily.If you don't meet those, you falling short, you're going to be in trouble.Absolutely.I think it having just jump in here just because we just finished doing this has been immersed in guideline think, and how we actually put this together to reflect that over the last.
A couple of years at the end of the day, the yardstick is exercise, your professional judgment.That's what all of that is about.And what the guidelines are there to do is to help you understand what that might look like in the kinds of considerations that you need to think about.
So it's kind of a prompt.It's certainly not a rule book hours of actually moved right away from the old prescriptive type of you know, there used to be one in there about how to do a cesarean.Like it was incredibly, you know, specific and prescriptive and That's not what we're about.What we're about.
If the guidelines is empowering people to be able to layer all those different factors.And I think we all understand that there's a lot of it's very easy.To say, You must put the welfare of the animal at the center of all your do, which is absolutely what it's all about.But putting we know, we had a lot of discussion and debate about how do you word that in a way that reflects?
Then that you also need to prioritize human safety.So you can't say, well, that animal needs that, but I'm going to get my vet in my nurse are going to It completely mauled by trying to do that.That's okay.To say, you know what, I'm not going to do that.So there is a real work in of all the different layers of things and it's not just our legislation that you're trying to follow.
It's also a whole range of other things.Have said, medicine poisons, Animal Welfare, act Fair work it's quite difficult to navigate.We've tried to put in hours references and cross-references so that it's easier to see where things link and we can find other advice that you might have to consider.
And I guess sitting over all of that.As now have professional behaviors, really other sort of key things, that underpin it all with, okay?If you're in this situation and you're going well, here all the guidelines around these things.I'm trying to balance all of that, taking it back to.
Okay?The behave is that would reflect professionalism in this situation which are also outlined there are there things be quite straightforward things like respect Integrity, all of those sorts of things.Then bringing that into any scenario is really what we're talking about is a Is no one right way it wrong.
You don't live or die but by following a guideline, really?Yeah.And as I've said there are so many different legislations that we as veterinarians work under and some of them, you know, you need lawyers to go through and explain them to you.
And some of them we Face everyday, you know, the local government acts and how to deal with stray animals and things like that.We operate under so many different legislations and Prevention of Cruelty to animals act, is another one.And the most important thing is that everything we do Should be looking at code of conduct as veterinarians.
I'm making sure that we abide by that.And I think it's really important that our behaviors.We are a profession.We're not an industry.We work with very profession within IT industry.But we are professionals and is professionals there is, you know, a code that we should be held to account for because they are professionals.
Oh, that's such a tricky thing, right?Because remember, once posted something on social media about us as an industry and someone someone takes me like replied.I believe that we are profession and it just blew my mind and ever since then, I'm like, yes we are profession, we are professional.
What is it mean?What are the actions of our professional professional ears as opposed to?I'm just the bet, I'm just a bit nurse, right?It's okay.So now you just see the trigger point.Well, I think we are professionals working within a large industry.There's so many other Industries within the pit and animal.
I guess, pits and animals like a massive Industries around us, but as a profession, we legislated or is a lot of other parts of this industry aren't, I can't really be held for two account because they're not a professional that has a professional body.That's actually able to investigate them.
The question I have is punishment punishment.Okay, because I thought I thought that me and my interaction with the board was like dumb.That's it.I'm gone.My bought, like, Mom lights is gone and all of a sudden.Now, I will have to work as a librarian.
I was a librarian before I became a veterinarian, but what does the level of punishment?Because my understanding is that if you is something just happens, it's not that you could just let things happen, accidentally, but if there's, if there is an actual purpose for misconduct or something, then that is an issue.
But I didn't know that I thought that I did.And my reputation as a veterinarian, all those kind of things, most taking the board and I got there, we talked about it and then the level of punishment was like, yeah, hey, I get that that was reasonable.So what levels of punishment are there?
I guess it comes down to.Again, we talk about risk management, so with prevention, if we can.So we're looking at the seriousness of what's going on and in Victoria, we actually as a board have been quite explicit.In guidelines webinars about a single mistake in and of itself isn't necessarily.
Really unprofessional conduct so that aside we are looking at risk of whatever went on.So there's kind of two levels and I think New South Wales is the same here in terms of if things.So what happens is they go through that preliminary investigation process that we talked about before and then of those, some of them don't progress further beyond that because then we look at it and say, okay, that actually, now we know what happened, it doesn't look like we've come near unprofessional conduct there.
That's And at that stage, it's about two-thirds of them that go through that whole investigation process that don't actually get progressed into a hearing.So that's the first thing just because you've been notified of a complaint against.You doesn't mean that it's actually a two-thirds of the time you won't necessarily progress to hearing, but when it does go to hearing, you've got one of two levels of hearing and we're talking here about professional conduct.
We've also got complaints about Fitness to practice and that's a different story or to get, that's really based on health and substance dependency.So that's a only only 2% of of our complaints investigations in the last couple of years were actually get us to practice.So we're just talking about professional conduct here.
There's the invest the informal hearing or a formal hearing and the reason I'm giving you all of this is because that is the bit that's critical to going.What are the punishments or the?And they're not punishments all the time.Some of them are, as you say, are quite constructive.So at informal hearing level, and this may vary a little bit between States, but in Victoria the most common things, absolutely hands-down, the most common thing but we've got Determinations at after a finding of unprofessional conduct at an informal hearing, which by definition is conduct.
That's potentially unprofessional conduct, not of a serious nature, is the language under the act.So there are things like what we've been talking about often there.And again, it's all about risk.How much risk is disposed in terms of severity or likelihood.So that's how we determine which basket it goes into in terms of for the hearings and that then determines what are the determinations going to be?
So at Infinity, Formal hearing, we're looking at the most common, things are continuing education and counseling.So Counseling doesn't sound like you have.It's not you have to go and see a professional.It's us giving you feedback at the end of an informal hearing, which is, as you said Dorado it's much more like just a conversation.
You know.We're just you've got a clear set of what we're looking at in terms of allegations and it sounds really formal and scary like that.That's just the legal speak, we have to use but basically there's really key points that we as a board want to understand and Looking at it in terms of is this under professional or not.
So you know what you're answering and responding to and then we then provide Counseling in terms of this is where, as you said Dorado this is where you went wrong.These are the other options.You might want to have considered that might have led to a different outcome.So it's more explanation and future things to think about second things continuing education.
And that's the other really, really common outcome and that can look anything, like for it can be formal, we can be mentor.And it can be submitting clinical records for us to review and your feedback on so that you get a better when it's put in place those measures to make sure that we don't just say go and do this.
And we have no understanding as a board of whether that risks actually been effectively resolved or not the other two outcomes there, that probably carry more potential scariness in your head.And there the more I guess the deterrent side of the the outcomes is the caution and the reprimand.
So there you for outcomes that you can get from an informal hearing.And about just to give you an idea of the odds of that set of outcomes about 1 in 5 of Victorian complaints lodged over the last couple of years ended up in an informal hearing and about two-thirds of those found that in unprofessional conduct had occurred.
And as I said, most went to continuing education counseling a couple with reprimand and caution other end.The big scary end is the, you know, and that's just perception.Is that it is It is where we're looking at the, the more risky behaviors, and the more serious professional conduct.
So that's a formal hearing that's when there is legal represented representation usually occurs and it's allowed and the complainant can be there.It can be most often open to the public, so it's a more formal.We've got the court reporter and everything there.So for us, it happens on the board premises.
It's not out in a courtroom or anything, but it is still a more formal proceeding and the same for outcomes are possible there.But then you've also got it.The range and that's with your conditions limitations or restrictions to practice and that can include things like not working with access to our sites, for example, or something like that.
So those things are designed to again, prevent with not just the animals but also to have how you practice so that you're doing the best.You can finds legal costs of the hearings altering or can suring canceling, a specialist endorsement or suspending or cancelling the registration.
Now again, To give you some sort of perspective with that.There are only so about 1 in 14 of our complaints lodged.Actually ended up at a formal hearing of a couple of years ago.So it's not a high number and all of the findings that that those formal hearings in 2019-20, there are four formal hearings held of those.
All four were asked to pay legal costs.Received a reprimand and had to do continuing education.Only one of those had their registration suspended for a period and it's not a long period in that case, I think it was six months and one had their their ability to re-register, they weren't allowed to do that for a period between, so I delayed.
So it's a really, it's I think three percent of complaints lodged actually end up having one of those two things suspension or cancellation.So, it's a really low risk.Yeah.So in New South Wales, we have a subcommittee of the board that is the Complaints committee.
And there are two vets and one consumer member, and there are others on that.If required, we collect all the information, everything else and get the information back from the vet they get to respond.The client gets to respond.We as a board.We don't technically have those hearings before the board KN like in Victoria, but we do have the power to summons a person to appear before the board to provide more evidence.
And then that committee makes a recommendation to the board but the board has to determine the Some of the complaint, but once a decision is made seventy percent of our complaints are actually dismissed.And most of the complaints up to 70% of complaints are actually a, when the patient is a dog and 17 percent of cats and I'm betting the horses.
And the reason I say that is because it's really interesting, you know that's obviously the majority of its practicing in major cities with small animals and that reflects also the number of complaints.So when you think about it we've had more complaints over the last year.But we've also as well had more dismissal of Complaints.
So those complaints that end up with unsatisfactory, professional conduct or professional misconduct.We as Kate said, we there's a reprimand or a caution for the vet, we can impose fines, we cannot require that pace and costs we can impose conditions on their registration and we can also ask them to undertake further education.
And really it's around trying to reduce risk into the future.There are at times we have the New South Wales civil and administrative tribunal, we can actually ask The tribunal to take that on for a finding after the boards made a recommendation and the MCAT can also be asked by the veterinarian who the complaints being made against to review the findings made by the board.
So obviously most of our complaints around conduct but there are also Health complaints as Kate said, so that's our process.But the most important thing is that, you know, the likelihood, you're going to kind of complaint one in twenty five seventy percent of dismissed.And I guess with the others, if they are Unsatisfactory, professional conduct there are the recommendations made there may be fines imposed or conditions placed on your registration.
But as I said that, the majority of them are dismissed.That's great to hear.That's reassuring because it's just my opinion.And this is how this all started.Because I'm of the opinion that people could testify as a little bit.You know, this this thing that we worried about that really like you never actually happened and when it happens, it's actually not as bad as we fear.
It will be I think if we can just flip that around and go let some it's not that the big scary Boogeyman out to get us.That's it is, as we, as you can see, it's Unity for reflection really like, in terms of say, okay, it stopped, and that's something that I'd say that in terms of advice, in terms and managing their complaints and trying to try to flip that headspace around from being against the wall feeling too.
Okay, I recognize that I'm stressed and I've got all this energy going on.How can I channel that constructive?Glee is providing some sort of reflection and and in your response back to the board doing that, providing some sort of reflection on what's occurred.And if there are things that you've identified either together as a on your own, that could change pop that in there because that stuff that we're looking at because again it comes down to risk.
So if you've taken those steps that's fantastic.And to um so yeah I guess it is dumping it all as a really valuable exercise in seeing how we can, how we can be better.I think one of the other things that the we Or remember is that you can feel isolated when you get a complaint?
And I certainly in my time not just on the board, but prior to that and within my own organization that I play a role in now, having your peers help you been able to talk to them about the complaint, been able to get some help around, maybe drafting some of your responses back, it really does help.
Don't feel like you're isolated are so many people that can help you and one of the things that always helps when something goes wrong and I know this sounds funny but somebody else I'd say I that happened to me.It actually does take that, it's not just me because you do feel like when you have a complaint that, oh my God, something's wrong with me.
Like I said, it's not a purse.People do take it personally, but I think if we can shit and help each other leaving your team with that complaint, it does take a lot of that load off that bit.They're coming back to your four-year Point.Why we started this conversation in the first place and the fact that we've talked about different ways of doing things and being quite aware of all the guidance and guidelines around there.
And one of those is as we've talked about practicing within your capabilities and giving informed consent, which actually also means telling the client about what your capabilities are.But The key bit here, I guess, in terms of we're trying to encourage a growth mindset across the whole profession.
Merely because that's how we all get better.So recognizing the guidance to practice within your capabilities is one thing.We only get better by trying new stuff and taking on new challenges.So the board's really?You know, I think people can sometimes I know I've heard particularly graduates and things say, okay, I, but if I'm not good at this, I haven't done it before.
I shouldn't be doing it.The thing is, is it seeking those appropriate?Support.So that's having it.Your supervision and your mentor and making sure you've got informed consent learning from them.The stakes aren't unprofessional.They're human and actually, I guess recognizing that that's a fantastic growth opportunity and learning from.
It is really what we're about.That's right.And I do single people practicing defensively because they are scared.I know you mentioned that yet all it's about being scared about a complaint.And that really does detriment of your ability to grow, like Kate said.Because one of the Things about being a vet.
When you graduate is, you can do everything in terms of their ability to do surgery, anesthesia all those sorts of things.But again it's about developing those skill sets so you are confident.The only way you can be confident in something is to do it and to do it again and again and I do believe that having the right mentorship and being able to be supported in your first few years.
So you have those learning opportunities means that you hopefully will be able to stay in the profession which is what we're in trying to achieve here is that we don't lose Is really good people in the profession because they are scared of aboard.Complaint, excellent.I think that's super useful and I hope that we achieve our goal of making people feel a bit more reassured and a little bit more happy and less scared at the best.
Censor board is not the Spanish Inquisition and if you're if you're too young to know what that means, it's like you're stood in front of seven people with muskets and yet.No, no, just kidding.Making it up a bit.So going to drop that out.Supposed to be stuff out like, always.
All right, guys, thank you very much.
All right, I promise you that I'll tell you more about the stainable bit curious, I'm a bit biased yet to be honest because I've been helping Kate with putting together, some of the marketing material for a sec.But the only reason I'm doing that is because I think that as we see is onto something really good.There are a lot of people and organizations working, very hard at the moment to make the way profession a better place for those who work in it, which is very exciting.
Do you ever feel a bit overwhelmed?Like, okay, so, which resources should I use and and who's going to pay for it?Which is where is we see comes in SPC is not offering content or courses or training or anything like that.Instead, SVC aims to do research into what is needed, what will be the most effective changes we can Implement and what the proven best resources are then they'll put them all in one place so you don't have to spend a scaring the net and then do more research to measure the impact and adjust what's on offer based on the best data but here's the best part.
I once heard this quote a dream without a plan.It's just a wish SPC has a dream but they also have a plan.The core difference with SVC is a unique funding model.We've had customers will pay a small levien drug purchases which will be collected by the drug Distributors and then managed by ncpc to help those in the profession, pay for the resources, we mentioned before, which as I'm sure you know, can be a huge, stumbling block for many people in the profession, go and check them out at sustainable Veterinary, careers dot org, to check out what they're up to And while you're there, please do the survey.
It step one in the research that we need towards better.And while you're there, please do the survey.It step one in the research that we need towards better.

Dr Kate Clarke

Dr Magdoline Awad