Sunday, March 27, 2011

375. Sunday Case. Informed Decisions in veterinary medicine compared to real estate

Yesterday, Sunday, Mar 28, 2011, I saw the owner of the one-nose sneezing Miniature Schnauzer with his dog coming in for consultation with Dr Vanessa. I was present at Toa Payoh Vets from 9.30 am to 5.30 pm to help out and ensure that clients don't have to wait too long to consult Dr Vanessa who handles almost 100% of the caseload daily during her work hours. I would handle a case to shorten the waiting time on Sunday or if the client insists on seeing me.

The appointment system in human or veterinary medicine is not really efficient as clients don't come on time and vets can't complete cases on time too. Clients who make appointments and come on time may need to wait and they get angry.

I can't help them. Much depends on the complexity of the case and the number of clients and the need to force those without appointments to wait till the end of the day or to get lost as was a complaint to me by one client who went to a Chua Chu Kang practice without appointment! That is also not good for new clientele.

Now that I was stationed at the reception counter, I could see that some clients were quite annoyed at coming on time but having to wait. Yesterday was a busy Sunday for some reasons and I skipped lunch. My assistant Mr Saw needs to go out for lunch as his stomach cannot skip meals and so I manned the receptionist counter when he went for lunch. I would still be at the receptionist counter but Mr Saw would handle the payment if he was around. In this way, I could feel the pulse of the waiting room and supervise the associate vet as a licensee responsible for my licence to operate a veterinary clinic.

Some vets issue a ticket number and make sure that clients with no appointments are attended to last. But this is not practical as there are clients with appointments coming late.

3 incidents on this Sunday were memorable. I shall mention one here as I have not much time this Monday morning 7.28 am.

This was a matter related to INFORMED DECISIONS as related to real estate and veterinary medicine and I shall show the comparisons. I am studying the REA course (minimum 75% attendance at class of 12 weeks, 3x/week) which, if I pass will license me to be a KEO (Key Executive Officer) of In other words, a licensee to operate a real estate agency. Presently all vets with over a year of practice experience (supervision) can become a KEO or licensee when they want to open their own veterinary clinic or hospital. No exams are required. To be a KEO of a housing agency, the person must have 3 years of experience and handles at least 30 real estate cases. If not, he just become a salesperson after passing the RES examinations.

In real estate, the URA has mandated that the developers do the following:
1. Developers to issue price listings 2 days before a property launch. A price list 2 days before a property launch.
2. Developers to issue transacted prices weekly (compared to 2-6 weeks previously). Weekly transacted price list.
3. Developers to give accurate depictions of show flats (compared to fanciful and incorrect floor areas, knocked down walls to con the buyers).
4. URA extends control over web advertisements of developers.
I may get an exam question about the above in the REA exam in late May 2011!
1. Vets to issue a price list of common operations and procedures. This is mandated by the AVA. A list is displayed on the reception area. But no need to issue price list 2 days before the operation or consultation!

2. Vets don't have to show a price list weekly as regards new operations! A quotation is usually given by me.

3. Vets don't have to give accurate depictions of surgeries to be done! I do some illustrations and drawings of certain operations or refer some clients to my webpages for those operations so as to give them INFORMED DECISIONS.

4. Web advertisements by vets? This is a matter that is being studied by the AVA to the best of my knowledge. There is the code of ethics which the AVA may adopt from the SVA but I don't have the full details yet.
Informed decisions are the best way to build up the trust of the client. In the case of the one-nose sneezing Schnauzer, the owner first consulted me in Nov 2009 after he had been to a brand-name vet practice which had been too expensive for him. He had been to Toa Payoh Vets around once in 2 months to treat the sneezing or runny nose (one-sided).

I said to him yesterday again: "You know, a surgery to remove the infected fungal lump at the back of the nose will most likely resolve your dog's problem." He and his wife did not want the operation and after some days of anti-fungal drugs, the dog would recover. Then the dog would sneeze and a one-side runny nostril would be present. The brand name vet had quoted $4,000 for the surgery. In any case, his wife did not want the surgery and so, the dog comes in every 2 months from November 2009 to yesterday Mar 28, 2011.

I had given him an informed decision. It is up to the owners to decide. There is danger of the dog dying or getting infected from the surgery to open up the back of the nose and extract the fungal lump (seen on the X-ray from the brand-name Vet practice in Nov 2009) in one nostril.

Since he was well informed about the outcome without surgery, there would be no animosity or complaint should the dog fail to recover after some time on medical treatment as the fungal or nasal growth becomes enlarged. So far, he is satisfied and happy with treatment from my associate vet. I am happy for him too. For best practice, I ought to write down in the case sheet that I had spoken to him about the prognosis and surgical treatment.

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