Delegation and use of staff:
I will delegate as much as possible to staff. I assume there are adequate staff to load exam rooms and be there for patient restraint, perform TPRs and collect data needed for wellness care or for medical appointments. Staff should be able to discussed your hospitals heartworm and flea/tick preventatives as well as describe your typical vaccination schedule and similar client education. There should be staff in the hospital to collect and run blood samples, place IV catheters, run anesthesia, take radiographs, monitor sedated or anesthesia patients, etc. I can do most of these technical tasks but I will not be as efficient which could lead to overtime fees if well booked.
I recommend estimates be used for wellness and visits for medical reasons. I recommend staff be able to prepare estimates. I will tell staff what I need on a medical estimate but translating that into your software can be tedious. Since each hospital has their own way of invoicing, a temporary relief doctor will not be used to how you like estimates prepared. This may lead to missed charges or overcharging. If staff using your software for months to years is not able to prepare estimates or charges, it would be inappropriate to expect a doctor just walking in to be so able. A technician should be much more efficient at estimate preparation.
I recommend your staff be able to discuss your hospital’s recommended flea, tick and Heartworm products, protocols and policies. These vary so greatly between hospitals it is difficult for me to share the information you would like clients to know about the products you recommend.
Records:
I tend to write complete records. I practice with the idea that I can support how I manage each and every case. I try to make my records so another doctor can readily take over the case when I am gone. I tend to not get behind in records. That means I generally finish with my record before I start the next case unless there is pending blood/rad results or a true emergency. Normally if there is at least 20 minutes per appointment and there is adequate staff I keep up without having owners wait unless there are too many medical cases in a row or multi-system medical cases. I am familiar with a variety of softwares, too numerous to count now. However, each hospital uses software differently so please be prepared to have someone give me assistance to start if needed.
Prescriptions:
I can normally recommend prescriptions from your pharmacy selection. If a needed drug is not available, I usually can call a prescription in. If you have an online pharmacy I will always support that instead of using an outside service. I do not carry prescription pads so will need to use hospital supplies for written prescriptions. I am DEA licensed and MA registered and will follow the state rules for dispensing.
Anesthesia:
For anesthesia, I prefer a good selection of medications to allow balanced anesthesia protocols which supports hydration, blood pressure, oxygenation, thermal support (before and after anesthesia) and pain management. I do expect technicians to use the doses I have determined, or authorized. Technicians should not change my doses, but may question them. My preferred opiod is hydromorphone but can use buprenex, morphine, torb, etc. Surgeries will only be performed with adequate pain management.
I need the opportunity to examine a patient before anesthesia and ideally the patient should have been recently examined. I recommend a blood profile in advance. There are patients I may not allow anesthesia without a blood profile or other diagnostics which will depend on their signalment, history and healthy status. IV catheters and fluids are my standard of practice. For thermal support, warm water blankets or Bair Hugger blankets and similar are my standard. Heating pads, rice or water bags are too risky and may burn patients. They are unlikely to be supported by AVMAPLIT if used and are not to be used in cases I am responsible for. Please insure there is proper thermal support protocols.
Surgeries:
Surgeries I do include spay/neuter, gastropexy, GDV surgery, laparatomy, gastrotomy, enterotomy, intestinal resection/anastamosis, analsaculectomy, cystotomy, lumpectomy, laceration repair, etc. I do declaws but I use the Resco trimmer method and I have specific requirements for the equipment and for the patient and the timing. Please ask before scheduling surgery or procedures. I prefer to have a good selection of suture materials such as trade name or generic Vicryl, PDS and Nylon. I prefer Swedged-on or Swaged packs of suture. I reserve the right to not perform any particular procedure or service if I do not consider the standards would protect my license. I do not crop ears. I will not give prophylactic antibiotics to elective sterile surgery patients.
Dentistry:
I prefer not to complete dentistry services unless the hospital is well equipped with dental radiographs, a high speed drill and has an ample selection of appropriate drill bits and of well cared for hand instruments. I will regularly use perioceutics such as Doxirobe or Clindoral. If staff are not well trained I can easily position the sensor for the radiographs and do not mind helping train staff to learn. I have an interest in dentistry and will recommend the service to all patients in need. Teeth will not be extracted without radiographs on cases I am responsible for.
USDA Certification:
I am USDA certified for dogs and cats in WA and FL. I will need time to research or verify requirements if I am asked to complete international health certificates. I recommend not scheduling international HCs for me unless you are committed to paying for the research time. Please be aware I am unlikely to sign acclimatization statements. In a similar vein, I am unable to sign any documentation about a pet’s good behavior or if they are an emotional support animal.
Behavior of Patients:
I am not ‘fear free’ certified which I consider a marketing ploy. But, I adopted my own techniques for handling patients with as little restraint as needed decades ago and I believe the marketing ploy developed from the same. If requested I am willing to become certified at your cost.
I reserve the right to not work with any animal that I deem is too dangerous – Safety First. With owner acceptance and acceptable restraint items and techniques, I will work with behaviorally challenged dogs or cats. If an owner cannot apply a muzzle to a dog and I think one needs to be on, I will not continue with service for them for everyone’s safety. I will readily prescribe medications typically used for a ‘chill’ protocol’ for patient to make future visits easier for all. Cats can similarly be rescheduled and sent with gabapentin or can be sedated for handling.
If I am the only veterinarian in the hospital, pets in for tech services will also need to be relaxed and compliant. If not, they will be offered medications and rescheduled. The AVMAPLIT has found that the veterinarian is liable for the pet and there is greater risk of CCL ruptures, etc if pets are struggling.
Vaccinations:
I prefer to use or offer 3 year vaccines where appropriate. If your policy is for yearly vaccinations for viral diseases, please have staff prepared to answer clients questions about that as I will have a hard time supporting that if products are warranted for 3 years by the manufacturer.
Please do not ask for me to give partial doses of vaccines.
