One of the enjoyable aspects of working as a veterinary surgeon is that we frequently get to work as part of a team. Much has been written about ensuring the workplace environment is a happy one. But what about when we have to work with allied veterinary professionals?
The definition of an allied veterinary professional does not seem to be universally accepted. In New Zealand, their Veterinary Nursing Association states that “allied veterinary professionals include all persons working in a clinical capacity to provide animal healthcare under the direction of a veterinarian. This includes veterinary nurses.” In the UK, registered veterinary nurses work alongside veterinary surgeons to provide a high standard of care.
Farriers also seem to fall under the category of “allied veterinary professionals” and the Farriers (Registration) Act allows regulation of farriers through the Farriers Registration Council. When veterinary surgeons are working with veterinary nurses and farriers, it is generally clear where responsibility for the work performed by the colleagues lies.
More problematic is when veterinary surgeons work with musculoskeletal allied professionals and equine dental technicians. There are so many different organisations and individuals offering musculoskeletal therapies for horses it is difficult for veterinary surgeons to have a clear understanding of the skill level of the person they may be working with.
The Veterinary Surgeons Act 1966 stipulates that only vets are allowed to diagnose an injury and give advice based on the diagnosis. Under current legislation, a vet should examine the patient, make a diagnosis and decide on a course of action before any form of therapy is administered. If the proposed therapy is a “physical therapy”, it may be administered by any musculoskeletal therapist (regulated or not). By signing a consent form, you may be deemed to have some level of responsibility for any treatment administered.
Equine dentistry is one of the most common tasks performed by equine practitioners. Equine vets are more knowledgeable and better equipped than ever before. BEVA is keen to promote its members as the primary care dental provider and has introduced some online dental resources to help with the provision of good primary equine dental care.
The recognition of equine dentistry as a field of veterinary medicine is apparent. Nonetheless, some owners will still choose to use an equine dental technician (EDT). BEVA encourages members to develop good working relationships with appropriately qualified EDTs and has produced much informative material on its website that aims to ensure that vets can work appropriately and constructively with EDTs.
Many colleagues are still concerned about their degree of responsibility when working alongside EDTs, particularly if sedation is required. There is no easy answer to the question of “where the buck stops” if a vet agrees to a client’s request to sedate a horse so that someone else can carry out work on it. Much will depend on the individual circumstances.
The particular risks are from: injury to the horse caused by the person whose work the sedation is facilitating; and injury caused by the sedated horse, either to personnel or to itself. Below are some steps to consider taking in advance of becoming involved in this type of scenario. These should help to minimise the chances of veterinary surgeons becoming scapegoats if problems arise.
- Ask what procedures are proposed, to establish the duration and levels of sedation likely to be required.
- Warn the owner of the risks associated with sedation. A sedated horse can never be considered totally safe. It might behave unpredictably at any time. Sudden arousals can occur without notice or in exaggerated response to stimuli that would otherwise be tolerated.
- Define the limits of your responsibility with the client (and preferably with the technician), ie that you only accept responsibility for the sedation and in no way for the work of the operator.
- Advise the client that it is preferable that you remain with the horse for the duration of the required sedation. If you are requested not to stay during the procedure, ensure that the client understands the risks.
- Warn the client that it is against the law for an EDT to perform any invasive acts of veterinary surgery, including extracting teeth, other than the extraction of erupted wolf teeth.
- Provide the warnings and advice in writing and verbally.
The Veterinary Defence Society produces an Equine Sedation Risks Advice Note and is always happy to talk such matters through with any concerned members.