college connection
LEARNING IN PRACTICE
Members of the veterinary profession have a responsibility to uphold standards to ensure the public has access to safe , quality veterinary care . When those standards are compromised , the College responds . Every veterinarian can learn from these situations and publishing the details of complaints received and resolved is intended to support that learning . The example below is taken from an actual case and is offered as a self-reflection tool to improve practice across the province .
MEMBER GIVEN GUIDANCE ON PROFESSIONAL OBLIGATIONS
CASE SUMMARY
The member examined an older spayed dog with concerns of lethargy and pain . The member ’ s assessment included a finding of a cardiac arrhythmia .
The next week , the member again examined the dog who had a new growth near her right ear . The member recommended surgery to remove the lump , which was suspected to be a mast cell tumour . The client had concerns about general anesthesia with the dog ’ s cardiac disease and sought a second opinion prior to the surgery . At the second clinic , a fine needle aspiration was performed which confirmed the mass was benign and no treatment was required .
The client submitted a complaint with the allegation the member recommended surgery without discussing options available for sampling and diagnostics to determine the nature of the mass , instead relying on visual observation and clinical experience . Surgery and anesthetic both posed risks for the dog . CASE OUTCOMES
The panel decided the nature of the allegations did not warrant a discipline hearing and that educational advice for the member would be more appropriate .
The member was advised of a veterinarian ’ s responsibility to exercise appropriate professional judgement in all circumstances , regardless of any personal challenges he / she may be facing . The member was also advised of the panel ’ s concerns regarding patient health assessments and subsequent diagnostic and treatment options . CASE CONSIDERATIONS
In consideration of this complaint , a panel reviewed the material provided . As is standard practice for investigations , the panel considered previous proceedings against the member .
In the complaint , the client alleged the member inappropriately recommended surgery to remove the dog ’ s mass without first discussing diagnostic options to determine the nature of the mass .
The client said she asked the member why a biopsy had not been done before recommending surgery . According to the client , the member was sure it was a mast cell tumour based on experience and visual inspection . The client cancelled the surgery and sought a second opinion , which averted an unnecessary surgery in an older dog with a heart condition .
The member explained he had been experiencing some serious health concerns at the time and was distracted . The member noted when he realized the error , the client had taken the dog elsewhere for a second opinion . The member apologized for being distracted and for giving poor advice . After realizing the error , the member changed his opinion and said he would not have put the dog through surgery .
In addition , the member said a visual inspection of a mast cell tumour was a mistake in judgment . The panel agreed with the client and the member that it was an error to diagnose a mast cell tumour in this manner and the panel concurred .
The member acknowledged the error in judgment and the panel took into account the member ’ s explanation of being distracted with serious health concerns . While the panel was empathetic , it appeared the member permitted personal issues to distract him from his obligation to provide care in the best interest of his patient .
The panel was concerned the dog may have undergone an unnecessary surgery which would have exposed her to risks associated with surgery and anesthesia . For this reason , the panel offered the member
advice concerning his professional obligation . The panel expects that if the member was experiencing medical issues that clouded his professional judgment , he would have taken appropriate measures to ensure his patients were not placed at risk .
The panel also noted the member had a serious enough concern about the dog ’ s arrhythmia to recommend a referral to a cardiac specialist . However , during the following visit , the panel could find no documentation of the dog ’ s arrhythmia in the medical records . The panel was concerned the member did not follow up on the arrhythmia or take it into account when making a decision about surgery to remove the dog ’ s lump .
In the panel ’ s opinion , it was the member ’ s professional responsibility to re-evaluate the dog ’ s arrhythmia at this appointment particularly in view of the fact that surgery was scheduled . The panel reasonably expects the member would have taken into account the risks associated with surgery for a patient with a pre-existing cardiac condition .
Veterinarians are obliged to have the best interest of patients as their primary concern at all times . In situations where personal circumstances are such that professional judgment may be clouded , veterinarians are expected to exercise appropriate discretion in limiting their practice in the interest of providing patient-centred care . When proposing a plan of care , the member should have recognized other options besides surgical excision under sedation .
The member should also have taken into account the specific situation of his patient , such as the dog ’ s cardiac disease , and should have considered the risks associated with performing surgery versus performing a fine needle aspiration with no sedation versus monitoring the lump .
6 / College Connection