2016 December - Referrals and the code of professional conduct
The Veterinary practitioners code of professional conduct (schedule 2, Veterinary Practice Regulation 2013) (Code) clearly sets out the responsibilities of veterinarians as we go about our daily practice. Breaches of the code are declared as either unsatisfactory professional conduct or professional misconduct and disciplinary findings can be made by the Board. The basic principles of the code are a primary concern for the welfare of animals and maintenance of professional standards.
Current standards of practice
A veterinary practitioner must maintain knowledge to the current standards of practice in the areas of veterinary science relevant to his or her practice and must base professional decisions on evidence-based science, or well recognised current knowledge and practice, or both.
Before undertaking practice in a particular area of veterinary science, a veterinary practitioner must ensure he or she has the knowledge and competence necessary to practice in that area. Where appropriate, a veterinary practitioner must utilise the skills of colleagues, by consultation or referral (clause 5 of the Code) and a veterinary practitioner must not refuse a request by a person responsible for the care of an animal for referral or second opinion (clause 9 of the Code).
With the ever growing knowledge base and advanced care that is now available to our patients there is an ever increasing need to discuss and offer referral or obtain second opinions in our everyday practice.
Specialists and referrals
As at 30 June 2016 there were 154 registered specialist veterinarians in NSW.
There are many areas of specialty recognised which can provide assistance for the management of a wide range of species, conditions and situations. All the specialty areas are listed at the AVBC site at avbc.asn.au/wp-content/uploads/documents/public/SpecialistRegisInfoAusMar2016.pdf
The legislation in NSW (Veterinary Practice Act 2003 (s 13)) is very clear that no abbreviation or derivative of the word specialist can be used by any veterinarian who is NOT registered as a specialist:
- An individual must not represent himself or herself to be a specialist in a branch of veterinary science unless he or she is the holder of specialist registration in that branch. Maximum penalty: 50 penalty units or imprisonment for 12 months, or both.
- Without limiting the ways in which a person can be considered to be represented as a specialist, a representation using any of the following titles, names or descriptions constitutes such a representation (a) the title or description “specialist” or any abbreviation or derivative of that word in connection with the person’s practice of veterinary science, (b) any title, description, words or letters implying, or capable of being understood as implying, that the person is a specialist in a branch of veterinary science.
Many veterinarians now hold further qualifications including certificates, advanced degrees, memberships, fellowships and diplomate status. Holding qualifications that may be suitable for specialist registration does not entitle the holder to call or promote themselves as a specialist. Only specialist registration in NSW allows a veterinarian to refer to themselves as a specialist. A searchable list of registered specialists in NSW can be found on the Board’s website www.vpb.nsw.gov.au/search-vet-hospital
The Board grants specialist registration on the advice and assessment of the AVBC. Application forms for specialist registration can be found on the Board’s website www.vpb.nsw.gov.au/specialist-registration
It is important specialists use their correct title as described on their specialist registration. For example, those who are registered in the area of Small Animal Surgery or Small Animal Medicine must not use the more general term Small Animal Specialist.
Primary responsibility rests with the individual veterinarian but all practice staff should ensure there is no misunderstanding by the public as to the qualification of the veterinarians consulting in a particular practice. Within a general practice you may refer a client to a very capable yet non-specialist veterinarian but both the referring and referral practice staff should ensure the client is not accidentally misled as to the status of the person accepting the referral.
What terminology can you use if you want to encourage second opinion cases in areas of extra training or skill that you do not hold specialist registration? “Particular interest in. …” is a problem free phrase and frequently used and accepted by the Board. “Special interest in…” or “expert” or “expertise in” are not acceptable terms.
The AVA policy on Veterinary referrals and second opinions provides a useful guide.
When referring a patient, the attending veterinarian should send the receiving veterinarian a detailed report and advice about previous treatment. This report should include relevant medical records, laboratory findings, radiographs or other imaging and the results of any other diagnostic tests performed as appropriate.
Upon discharging the patient, the receiving veterinarian should send the attending veterinarian a detailed written report and advice about the continuing care of the patient. If appropriate, the client should be advised to contact the attending veterinarian regarding continuing care of the patient. Maintaining good relations between veterinarians is important in promoting quality patient care, but each veterinarian’s primary legal responsibility is to the patient and client.
Clause 21 of the Code states: “A veterinary practitioner must not provide a referral or recommendation the request for which is accompanied by an inducement to the veterinary practitioner.” Veterinarians may be tempted to offer a “reward” to other veterinarians who provide them with referral cases - this inducement would pervert the normal referral procedure and would be a breach of the clause above.
The high ethical standards to which most veterinarians aspire would prevent base factors from influencing our referral decision making process. However it behoves us to be constantly vigilant, and always ensure that our decisions concerning referral and recommendation are influenced only by good, evidence-based medical decision making. In the modern world where savvy consumers are aware that inducements might occur, it is simple wisdom to record the reasons for a particular referral or recommendation in the medical record. Clause 21 of the Code patently applies to all veterinarians, not just specialists.
The Board is legally bound by the legislation to investigate complaints and complaints can come from anyone, including consumers of veterinary services, veterinarians or the Board itself.
If the Board finds evidence of any breach of the Code, the Veterinary Practice Act 2003 or Veterinary Practice Regulation 2013, the veterinarian will be asked to justify their actions and a disciplinary finding against a veterinarian can be made.