Wednesday, May 9, 2012

Consent is the best form of defence

"The dog has been passing blood in the stools for 14 days. You don't just give a jab and ask the owner to go home, " I said to Dr Vanessa as the owner wanted treatment on the spot and no hospitalisation for the 13-year-old Beagle X. A gentle giant looking Beagle with a white face. I was also in the consultation room.
Should the old dog die soon, the vet may be sued."

"For negligence," the young lady asked whether the dog had colitis as there was fresh blood in the stools and I had said that the likely area of bleeding would be in the colon. This indicated a young lady with knowledge and the vet must be able to provide the standard of care expected by his peers in such situations.
"Consent is the best form of defence," the young fair lady in her late 20s said.
This case is more a standard and duty of care rather than (informed) consent (to specific treatment
as requested by the owner)," I said. "A dog that had diarrhoea for 14 days resulting in more frequency of diarrhoea and blood loss and loss of appetite is not a simple case of one injection and go home.    5%

Actually I can't figure out where "consent " comes into play in this situation. This must be a lawyer or legally trained owner. Later I saw her studying her book  placed on a brown table in the waiting room as she waited for the treatment of IV drip. I had instructed what type of treatment to be given inside the IV.
The 500-ml 5% glucose saline IV drip normally runs over one hour. So, I helped her to take the dog to the father's car. The father would drive the car closer to the front of the clinic. I would hold the drip set and she would carry the dog of 18kg. "Put the dog on the floor of the car," I said as the blood gushed back into the drip set due to the lack of gravity for the drip to flow. The front car seat was pushed forward. She would hold the IV line as high as possible in this small car and the drip droplets flowed again.

FOLLOW UP
I phoned today Day 3. Dr Vanessa had phoned earlier twice. The dog was OK.
"The dog can only be certified OK if he has passed normal stools," I said to Dr V at 2pm. "Due to the spasmogesic drug, he had not passed stools for 2 days. That does not mean he is OK." The lady returned my call at 3.30pm and provided the following feedback:
Day 1. Had diarrhoea for 14 days with increasing frequency of diarrhoea. Dog would drink but pushed away the food. Sought vet treatrment at Toa Payoh Vets. Bundled home with IV drip set in car as the owner did not want to leave the dog in clinic. According to the owner, vomited lst day, diarrhoea for one week 1-2x/day, then more and blood seen. last few days, dia.rrhoea 4-5X

Day 2. No stools. Ate plain rice and chicken.
Day 3. Ate plain rice and chicken. At 3 pm, normal stools passed. First pellet was firm, then semi-soft but no blood.

Blood test - Neutrophils 47%, L=17% but total WBCC normal.
Liver enzymes high.


Stools - Erythrocytes +. No leucocytes, ova, cysts, parasites seen.

Parvovirus test on faeces. Owner did not want it.  This was recorded.




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