1044. Veterinary surgery report will be recorded for every surgical case in the following format

A veterinary report will be recorded for every surgical case with the following format and filed on the discharge of the pet:

Date of Veterinary Surgery Report:
Name of Veterinary Surgeon

1. History & Complaint
2. Presenting Sign & Symptoms
3. General Examination
4. Tests done & significant findings of tests
5. Diagnosis - tentative and confirmed
6. Treatment
7. Anaesthetics, Surgical procedures, Sutures & No. of packets used (Record No. )
dates
8. Date admitted: Date discharged:
9. Clinical outcome 3 & 14 days or later - Follow-up dates:

Signature of Veterinary Surgeon
Date of this report

Attached and owner has acknowledged receipt:
Blood tests given to owner
Urine tests given to owner
X-rays given to owner
Ultrasound report given to owner
Histopathology report
Sterilisation Certificate No. given to owner
Others given to owner
Anaesthetic & Surgical Record No. ....................
Ear Scope
Skin scraping
Opthalmoscopy
Urinary stone analysis report
Others

Comments by Dr Sing K Y

1043. The cat bit his tongue - need for thorough exam of the mouth

Two cats fought on the ledge of the 7th storey HDB flat. Both fell at 10 pm yesterday. The stray cat died. The home cat came for treatment as she has blood stained chin.

Simple case. A horizontal lacerated wound. Stitched up 3/0 nylon for chin lacerated wound. 5/0 nylon for tongue vertically lacerated wound (lower and upper area) . I advised nylon instead of dissolvable as the area was infected due to trauma and cat fight.

After the surgery, I took some pictures and saw the lice running around the face. Also tartar in the teeth of this 3 year old cat. I phoned the owner to advise dental scaling and he said OK. During scaling, the vet noted a big laceration of the tongue. The owner was phoned to give permission to stitch up. I advised 5/0 nylon and 3 simple interrupted stitches on top and 2 below the tongue surface.

Always examine the whole mouth from end to end as vet medicine springs surprises.

1042. Failure to keep a proper record: $5,000 fine for senior cardiothoracic surgeon

Straits Times Jun 20, 2012
I showed the article to Dr Daniel and Dr Vanessa to illustrate the importance of meticulous recording to protect against litigation.

The cardiothoracic surgeon of the National Heart Centre was fined $5,000 by the Singapore Medical Council. He was censured and to give an undertaking that he would not repeat the clincial error and pay the cost of the legal proceedings.

What he did not do:

1. Failed to keep a proper record of his discussion with a patient's operation. Fined $5,000 for professional misconduct.
2. Failed to note the patient's consent to the operation (lobectomy).
3. Needed to maintain a higher standard as a senior doctor of 22 years so as to be a role model for junior doctors.

The Committee said that keeping proper medical records is part of patient treatment and these records avoid disputes between doctor and patient. The patient had given his informed consent but the surgeon had not recorded the informed consent given in this case. This is different from not obtaining informed consent.

FOR VETS
1. Patient to sign the informed consent form
2. Vet must record in writing that the patient has given informed consent (time, date).

The practice is usually to get the informed consent form signed by the pet owner.

      

1041. Follow up: Beagle with bladder cancer (adenocarcinoma)

Today, June 21, 2012 I was surprised to see the Beagle, Male, 14 years old so alert and able to control his urination (in the daytime). It was a great joy to see the happy couple as I did not expect this old dog to survive the 2-hour surgery to remove his bladder cancer. But here he was today at 10.30 am with the happiest client. They had made an appointment with Dr Daniel who is their vet surgeon. I come to Toa Payoh Vets for the past 10 days at 9 am and so am able to manage my "trust and audit" of the associate vets.

The complaint was that the dog cried when the wife wipe the left hind hip area after bathing. As for the bladder, there was no complaint now. No more leakage of urine with blood. I checked the op area. The dissolvable stitches had fallen off. The lower part of the body was stained yellow and the owner confirmed that he could not control his bladder when he sleeps.
HISTORY
Beagle, Male, 14 years. Haematuria and urinary incontinence. 
May 13, 12. Blood in the urine. Can't control the bladder at all. X-ray of bladder done but not so clear. I thought there were sharp stones. Blood and urine tests done.  Case report written.
May 14, 12. I removed most of the bladder tumour near the neck of the bladder in with Dr Daniel assisting. A 2-hour surgery. Histopathology of bladder tumour: a moderately differentiated adenocarcinoma.
May 16, 12. Went home.
May 17, 12. Paraparesis. He had bolted from his confined space at home and a luggage fell on his back!

CONSULTATION ON June 21, 12 for painful left hip area. Dr Daniel extended left hip. The dog wanted to move away and yelped. There could be arthritis of the left hip as he had difficulty getting up immediately. 

I was more interested in his bladder. "He looks younger," I said and had some pictures taken of him. A 14-year old looking like a younger Beagle. I palpated his bladder while he was standing on the consultation table. I could  feel a bladder the size of an orange. Yet when Dr Daniel and Min went to collect urine

"No more drinking lots of water like before," the husband said. "Now he drinks around l litre, not 1.5 litres or more."

1040. Executing my vision to be top 5 vet practice in Singapore

Yesterday, June 20, 2012, I stopped consultations and had another talk with Dr Vanessa and Dr Daniel seated opposite me to the left and right respectively, in the consultation room at around 12 noon. I know it is extremely difficult to get vets to buy into my vision to make Toa Payoh Vets a top 5 veterinary practice in Singapore.

It is always difficult in any business for the leader to execute a vision because each employee or associate vet has his or her own agendas.

1. "First Impression Counts," I said to Dr Daniel. "If a vet can be bothered to shave, it gives the impression that he can't be bothered to take good care of the customer's pets." I looked at Dr Vanessa's feet and said to Dr Daniel: "Wearing flip-flops and clogs to work is not permitted and a vet had done this in Toa Payoh Vets for some months."

2. My.hints and advices are ignored. "If vets don't accept hints to change their mindset to improve their standard of care, I will be frank. If vets bring down Toa Payoh Vets to the bottom 5 practice in Singapore, I will not hesitate to fire them. Simple as that. I will just close down the practice when I am unable to work. I don't believe in passing the practice to the next generation. I don't believe in leaving my legacy to the next generation. Dr Daniel will have to earn his stripes.

3. Practise evidence-based medicine and know what to do. For example, the rabbit came in with a jaw abscess and there was no advice from the vet to get an X-rays done to check the extent and location of the impacted and infected roots of the cheek teeth. This will not be tolerated by me. In this case, the owner was very knowledgeable about medical practices and was agreeable to the X-ray being done. But the associate vet did not even mention this. This should not be happening again nowadays when litigation and complaints are getting more common.
4. There are around 50 vet practices in Singapore. Why should the client come to Toa Payoh Vets if the practitioners are mediocre and cannot produce excellent clinical outcomes?

It is very hard to execute a vision to be top 5. Failure of associate vets to adopt best practices need to be monitored. Associate vets who don't meet my standards to implement my vision will have to go. It is no more open a practice and clients will come as in 20 years ago. A practice must be sustainable and not losing money over the years as operational costs keep escalating while fees are kept low due to competition. It is quite easy to lose money if the vets are not of a high standard to perform and so it will be better that they work elsewhere.

5. Working in a corporation. Employee and associate vets may feel they are independent contractors and don't take instructions from the licensee. In real life, the licensee is held accountable and if associate vets dress what they like and bring disrepute to the practice, it is best to fire them and just be a small surgery with good referrals and profitability rather than be a multi-doctor practice.  

 

1040. Follow up: Rabbit's hyphaema. Bleeding inside the eye.

Jun 20, 12

It is a rare case of bleeding in the rabbit's eye.

BEFORE TREATMENT




2 DAYS AFTER TREATMENT

FOLLOW UP ON JUNE 20, 2012
Thanks for the trouble to give me the feedback today to say that the rabbit's eye is now normal and that the bleeding has disappeared 3-4 days after going home. Much appreciated.

1039. Follow up: Hypoglycaemia & Atypical lymhphocytes

June 20, 2012
"The Jack Russell X is normal now," the wife came in for more antibiotics for the urinary tract infection and was most happy. "I consulted a lady who can communicate with my dog. She graduated from overseas. My dog told her he is going soon when I ask whether my dog should take chemotherapy."

"I am open-minded," I said. "Your dog is on prednisolone which is a form of chemotherapy without the toxic side effects and so he is feeling much better now.".