At the recent Society of Practising Veterinary Surgeons
(SPVS) and Veterinary Management Group (VMG)
joint annual congress held in January, I was fortunate
to be on a panel considering ethical dilemmas in equine
practice. The question “Should we accept referrals direct
from a complementary therapist/paraprofessional?” was
listed as a dilemma for the audience, but the healthy debate
that followed previous questions meant we ran out of time.
Hence, I thought it would be a good idea to raise it here and
put forward my view.
Firstly, being a regulated profession we must follow the
rules. Our regulatory body, the RCVS, is responsible for setting, upholding and advancing the educational, ethical and
clinical standards of veterinary surgeons and veterinary
nurses. Secondly, one has to do what “feels right” and act
in the same way in which we would wish to be treated by
fellow veterinary surgeons. Thirdly, animal welfare remains
our first and foremost consideration.
The Code of Professional Conduct for Veterinary Surgeons is a well-written and accessible document. The Code
makes it clear that veterinary surgeons have professional
responsibilities in the following areas:
• Veterinary surgeons must make animal health and welfare their first consideration when attending to animals
• Veterinary surgeons must keep within their own area
of competence and refer cases responsibly
• Veterinary surgeons must provide veterinary care
that is appropriate and adequate
A whole section covers the “Supporting Guidance on
Referral and Second Opinions”. This makes it clear that
veterinary surgeons should facilitate a client’s request for
a referral or second opinion. The guidance is crystal clear
that the initial contact should be made by the referring veterinary surgeon and the client should be asked to arrange
the appointment. The referring veterinary surgeon should
provide the referral veterinary surgeon with the case history. Any further information that may be requested should
be supplied promptly. The referral veterinary surgeon
should discuss the case with the client, including the likely
costs of the referral work, and report back on the case to
the primary veterinary surgeon.
Another section in the Code is devoted to communication
between professional colleagues, and is introduced with the
wise words “Overtly poor relationships between veterinary surgeons and/or veterinary nurses undermine public
confidence in the whole profession.” When taking over a
colleague’s case, although both veterinary surgeon and
client have freedom of choice, in the interest of the welfare
of the animals involved, a veterinary surgeon should not
knowingly take over a colleague’s case without informing
the colleague in question and obtaining a clinical history.
The Code would seem eminently clear: a referral should
not be made direct from a complementary therapist/para-professional. The referral veterinary surgeon should always
make contact with the primary veterinary surgeon in order
to obtain a full clinical history and, in turn, provide a full
report of what has been done to the primary care veterinary
surgeon. If the referral is taken on with no reference to the
usual veterinary surgeon, one could also see problems if
the horse develops an issue out of hours when the referral
veterinary surgeon may not be available and certainly not
available to provide appropriate veterinary care.
If the complementary therapist/paraprofessional feels
that the horse needs specialist veterinary attention, they
should communicate this to the owner who can, in turn,
take the matter up with their usual veterinary surgeon. This
would be the sensible and courteous approach.
I have recently had equine veterinary surgeons contact
me to express disappointment that a veterinary colleague
has attended a horse belonging to their client without
consulting them, requesting the clinical history or providing
information on what procedures they had performed. In
these three cases, the situation involved a direct referral
from an equine dental technician, but there are also reports
of similar situations with direct referrals from a musculo-skeletal therapist.
As responsible veterinary surgeons, it would seem wise
to follow the guidance on acting within your area of competence and refer cases where appropriate at an early stage.
As referral/specialist veterinary surgeons, we should have a
responsibility to follow the Code in the way in which referrals
are accepted. That way everyone is a winner and most importantly, we are doing the best for the horse.