3. Professional relationships

guiding principle veterinarians must communicate effectively with colleagues in a way that fosters respect and professionalism in the interests of clients, their animals, and the profession understanding the guiding principle where more than one veterinarian is providing services to the same client the general principle is that the veterinarians concerned, with the client's consent, liaise and share relevant information even where there is no overlap of professional responsibilities veterinarians should make contact with each other to maintain and promote effective collegial relationships isolation from colleagues is a barrier to maintaining professional competence veterinarians need to develop and maintain good collegial relationships veterinarians starting work in a new place should make contact with other veterinarians in the area; and continue to communicate effectively and regularly with their local colleagues where good communication and relationships exist between veterinarians, especially between veterinarians in neighbouring practices, there is a greater chance that any issues or conflicts will be resolved easily and professionally where there are disputes that aren't easily settled, veterinarians should consider seeking external help to resolve the issues (for example nzva or a mediator) section 3 1 veterinarians must share relevant information with those who need to know client consent is required unless it is an emergency or there are valid grounds for disclosure understanding section 3 1 veterinarians are required to share relevant factual information with those who need to know this is to ensure (either generally or in individual cases) the welfare of animals; the promotion of public health and national biosecurity; the integrity of certification; the advancement of veterinary knowledge and/or maintenance of public confidence in the profession client consent must be obtained to share this information unless it is an emergency or there are other valid reasons for disclosure refer to section 1(c) of the 2 client relationships docid\ p6wia0fafesys5dtjw 9p section of the code for detail on the legal grounds for disclosure as well as legal grounds, there may be other circumstances where disclosure without consent can be justified for example, where the ownership of an animal has changed, the new owner has taken the animal to their own veterinarian; and the previous veterinarian is unable to contact the former owner for consent to release copies of relevant records in this case the former veterinarian should be able provide the treating veterinarian with the information that is important to the future health management of the animal; while noting in the clinical record why consent was not able to be obtained clients have the right to use more than one veterinarian the requirements around professional cooperation exist to ensure the best outcomes for animals and their owners when different veterinarians provide services to the same client/animals there is potential for overlap if the veterinarians don't communicate, there is an increased risk of conflicting or concurrent treatment programmes compromising animal welfare/safety there may also be increased risks of residues in food producing animals and it will be harder to ensure the integrity of certification section 3 2 veterinarians who provide a specific and limited range of veterinary services to client/s (for example consultancy services) must ask the client who their usual general veterinary practitioner is ask the client for consent to contact this veterinarian and share relevant information while treating the animal(s) only authorise the use of restricted veterinary medicines for specific clinical matters they have consulted on arrange for 24 hour emergency care in relation to the matters consulted on understanding section 3 2 most clients will have one veterinarian who they consider to be their general veterinary practitioner over time, this veterinarian will accumulate veterinary records on the herd/flock/animal/s, their husbandry and their environment this clinical information could be invaluable for the future health management of the animals concerned in situations where some of that care is provided by different veterinarians it is in the best interests of the client and their animals for the client's general veterinary practitioner to be kept fully informed about the veterinary care provided where veterinarians are planning to provide a specific and limited range of veterinary services they must first find out from the client who their general veterinary practitioner is and seek the client's permission to contact them the benefits of communicating with this veterinarian should be explained to the client a client's decision to decline permission does not prevent services being provided, but this should be noted in the clinical records after permission is gained, veterinarians should advise the general veterinary practitioner of their involvement and the scope of the services to be provided the veterinarians involved should cooperate and share necessary clinical information that will improve the veterinary care of the animals involved and/or manage treatment risks where veterinarians provide veterinary services to a geographically distant client, there is a greater need to communicate with the client's general veterinary practitioner this communication also helps with follow up veterinary care that the general veterinary practitioner may need to provide sometimes clients may choose to use the services of a number of different veterinarians to provide the regular veterinary care for their animals the client may not have a general veterinary practitioner communication between the veterinarians is still needed, but because the total veterinary input is fragmented it may be difficult to achieve the best possible veterinary care outcomes for the animal(s) and the client where a veterinarian is providing a specific and limited range of veterinary services (for example consultancy or artificial breeding techniques such as embryo transplanting), any restricted veterinary medicines authorised for use will relate to those specific services restricted veterinary medicines should not be authorised by this veterinarian unless an appropriate veterinary consultation has taken place to gather sufficient information to support prescribing these products the veterinarian remains responsible for making provision for continuous emergency care in relation to the matters they have consulted on if the veterinarian cannot personally provide this, specific arrangements must be made with colleagues in the area to do so in situations where a veterinarian is providing services to a geographically distant client and is authorising and supplying restricted veterinary medicines for use by the client or a technician, they remain responsible for the subsequent use of these products unless veterinary operating instructions are used, the restricted veterinary medicines must only be authorised for use on animals under the care of the veterinarian the technician or client must be familiar with the correct use of the products if they are not administered under their direct supervision veterinary operating instructions should be used where necessary to control and manage the associated risks (refer to veterinary medicines paragraph 4 for further information on veterinary operating instructions) section 3 3 referrals, second opinions, and clients transferring to another practice, involve two or more veterinarians providing services, advice or treatment on the same clinical case in these circumstances the treating veterinarian must, with the client's consent, seek relevant information from the other veterinarians involved this ensures that all relevant clinical information can be taken into account when making treatment or management decisions all veterinarians involved with the animal(s) current care know who else is involved clients have the right to use the services of more than one veterinarian; to seek second opinions; and to ask that their animals' care be transferred to another veterinarian veterinarians must recognise clients' rights and, if appropriate, advise the client of them recognise when a case falls outside their area of expertise or competence and offer referral to an appropriately qualified colleague be aware of referral options and identify options to clients when referring to veterinarians with particular expertise, advise the client of the veterinarian's skills and experience and whether they are registered as a veterinary specialist be satisfied that consent has been given before releasing clinical information (except in an emergency situation) provide the relevant clinical records for the continued treatment and care of the animal when it is requested by the client or the managing or treating veterinarian not prevent or delay the transfer of relevant clinical records to a managing or treating veterinarian not try to discourage the client from seeing another veterinarian communicate with other veterinarian(s) in a professional manner veterinarians providing second opinions, treatment or diagnostic services as a result of a referral, transfer or request from a client must state their opinion about the case in a way which is respectful of the first veterinarian respect any past and/or ongoing relationship between the client and other veterinarians with the client's consent, obtain relevant clinical records from the veterinarians who have previously treated the animal if the client is returning to their first veterinarian, and that veterinarian organised the referral or second opinion, the second vet must provide a summary of their findings and recommendations to the first veterinarian if the client has sought a second opinion or referral directly, seek the client's consent and notify the first veterinarian of their involvement as soon as possible consider whether it is appropriate to provide their opinion and/or provide specific veterinary advice on a case if they have not examined the patient or reviewed the relevant clinical records if providing treatment, arrange for 24 hour emergency cover for their patients in relation to the matters consulted on understanding section 3 3 general requirements veterinarians are expected to know when to refer cases know when a second opinion may be appropriate understand and respect clients' rights to seek a referral or second opinion be familiar with their obligations under the privacy act in these circumstances when asked to provide clinical records about an ongoing clinical case to another practice, veterinarians must be satisfied that the client has consented to the information being released clients can provide consent directly to the veterinarian who holds the clinical records, or can transfer their right to access the information to their new veterinarian in the second situation the client's new veterinarian makes the request for the clinical records if in any doubt the veterinarian asked to release the clinical records is entitled to ask for evidence that client consent has been given consent may be given verbally or in writing if verbal consent is given this should be noted in the clinical records any conditions on the release of the information should also be recorded the provision of relevant clinical records ensures that all veterinarians providing services to the animal(s) have relevant historical clinical information to help ensure optimal clinical outcomes and patient safety keeps both veterinarians informed of each other's involvement and helps ensure the client receives consistent professional advice when this doesn't happen there is a greater likelihood of client dissatisfaction and an increased potential for complaints second opinions a second opinion involves seeking an evaluation by another veterinarian to confirm a diagnosis and treatment plan, or potentially to offer an alternative diagnosis and/or treatment options veterinarians may recommend a second opinion for a variety of reasons, for example in complex cases or where there are concerns the client may not accept the treatment recommendations clients may also decide to seek a second opinion without discussing this with their usual veterinarian they may be apprehensive about their veterinarian's proposed course of treatment or costs; unhappy with the care provided; or hesitant to request a second opinion in case they offend where veterinarians propose euthanasia on welfare grounds and the animal's owner does not accept the recommendation, owners must, on request, be given the opportunity to obtain a second opinion within a reasonable time frame this is a legal requirement under section 138 animal welfare act 1999 in situations where veterinarians are not confident that the owner will follow through on obtaining a second opinion and the animal may suffer, they may put a time limit on gaining the second opinion after which an animal welfare/spca inspector will be notified when veterinarians recommend a second opinion they should help clients by recommending one or more veterinarians with the appropriate expertise the first veterinarian must provide the relevant clinical records and should contact the second opinion veterinarian to notify them of the possible client visit second opinion veterinarians must be careful not to discredit the first veterinarian when second veterinarians know the client has sought a second opinion to clarify or confirm the first veterinarian's diagnosis and/or treatment options, they should, after providing the second opinion and providing they are in agreement with the first veterinarian, encourage the client to return to the first veterinarian if, after obtaining a second opinion, clients choose not to return to the original clinic, or to have the treatment/investigations carried out at the second opinion clinic, first veterinarians must respect this referral referral involves handing over a case to a veterinarian with particular skills in the appropriate discipline clients should be told whether the referral veterinarian is a registered specialist; if not, the client should be given details of their particular skills, training and experience the purpose of referral is to obtain a diagnosis and carry out treatment with the expectation that the client will return to the referring veterinarian if veterinarians offer referral but the client declines, this should be noted in the clinical record consideration should also be given to including this information in consent forms veterinarians should be familiar with the referral options available to their clients and consider offering referral early in appropriate cases referring veterinarians must provide relevant clinical records to referral veterinarians if documentation can't be provided before the appointment, referring veterinarians should phone referral veterinarians to discuss the case referral veterinarians must provide referring veterinarians with detailed reports on diagnoses, treatments and prognoses for referred animals if clients are provided with a written report, the original veterinarian should also receive a copy client initiated transfers and consents when clients transfer the care of their animal to another veterinarian their consent must be obtained before contacting the first veterinarian to request the clinical records (unless information is required to assist emergency treatment) in seeking client consent it is important that veterinarians explain the benefits of having access to relevant clinical information about the animal(s) when clients don't consent to the second veterinarian communicating with or obtaining clinical records from the first veterinarian, the second veterinarian must consider whether they are able to provide services the previous clinical records may contain important clinical information without this, outcomes and patient safety could be compromised veterinarians must exercise their professional judgement in deciding whether to proceed, balancing the code's expectations against the best interests of the patient the welfare and safety of the patient should be of primary importance in making this decision when a client refuses permission to communicate with the previous veterinarian, and the second veterinarian elects to treat the patient, it is strongly recommended that this refusal is documented, preferably with the client's signature confirming the appropriate process and discussion has occurred with the client's consent, second veterinarians must try to notify the first veterinarian before providing treatment or advice this demonstrates professional courtesy, and helps ensure optimal clinical outcomes and patient safety if this isn't possible, the first veterinarian must be told as soon as possible afterwards open and honest communication between veterinarians leads to better communication between the second veterinarian and the client and reduces misunderstandings and the likelihood of complaints accessing, providing and documenting client information for second opinions referrals and transfers clinical records belong to the owners of the veterinary practice however the information in them is the client's unless there are legal grounds for withholding this information, veterinarians must release copies, or summaries, of relevant information from their clinical records to clients on request (or to the client's new veterinarian with the client's consent) when veterinarians obtain client consent to access previous clinical records, they are acting as the client's agent and are entitled to seek relevant clinical records from the first veterinarian this veterinarian does not need to contact the client to confirm their permission to release the records, but if in any doubt can ask the second veterinarian for evidence that consent has been given clients have the right to limit how much information second veterinarians are authorised to obtain from first veterinarians for example clients may authorise second veterinarians to obtain clinical information relating to the case but not allow the transfer of financial information it is recommended that veterinarians clarify with clients what information they are authorised to access second veterinarians need to document that the client has given consent to them to obtain the clinical records of their animal(s) (including any limits set by the client on the extent of the information to be provided) ideally a written consent form tailored to the circumstances should be signed by the client and kept on file if a signed form or emailed consent is not possible, a note must be made in the patient's clinical record at the time consent was obtained clinical records should be sent in the format requested if there are initial time pressures, records can be provided in the most appropriate way (depending on the urgency of the situation) this could be verbally providing the details, or faxing or emailing them if it's not urgent, posting the information may be sufficient veterinarians are expected to use their professional judgement to decide what is acceptable and appropriate in the particular circumstances the patient's welfare must not be compromised by the decision on how to provide the clinical records clinical records should contain all relevant information including case notes, x rays, lab results, drugs used and treatment details point 4(a) of the 5 veterinary services docid\ qytt vobkfxdyhtxlemcb section of the code requires a patient's clinical record to contain sufficient detail for another veterinarian to take over the management of the case at any time it is not acceptable to delay providing the information because the first veterinarian is not available veterinarians/practice owners have professional and legal responsibilities to release relevant clinical information in a reasonable timeframe to ensure there are no delays, clinic staff, acting on the authority of the first veterinarian, must be delegated the authority to release the required clinical information to the second practice similarly, staff can, on the instructions of the second veterinarian, notify the first clinic that the animal is about to be seen or has been seen, and request previous relevant clinical records guidance on charging for the provision of information (based on privacy commissioner guidance ) individuals have the right to access the personal information held by veterinarians about themselves (including information about their animals) when veterinarians respond to a client's request to access the clinical records of their animal(s), they must ensure they only provide the requested information and do not inadvertently pass on information that relates to others veterinarians cannot charge for collecting, collating, sorting or redacting (obscuring or deleting) personal information veterinarians may charge clients for the reasonable time spent copying the clinical records where this exceeds 30 minutes copying costs where the number of pages exceeds 20 refer to the ministry of justice's charging guidelines for official information act 1982 requests these guidelines are relatively generous and the privacy commissioner has stated that a reasonable charge in some circumstances will be considerably less that these guidelines permit professional obligations and courtesies second veterinarians are not obliged to provide the original veterinarian with information on their planned treatment of the case or details of the treatment provided (apart from referral situations) however, in the interests of maintaining good professional relationships this information may be shared with the client's permission veterinarians are expected to communicate professionally and not hinder the ongoing management of cases the patient's welfare and the public perception of the profession must not be compromised by poor communication between veterinarians veterinarians must not contact clients to try to discourage them from seeing another veterinarian however conducting a professional 'client exit interview' to establish the reasons for switching to another veterinarian may be appropriate as a tool for learning and business improvement if carried out in a way that is not perceived by the client as pressure to return to the first practice; and takes place at an appropriate future time section 3 4 veterinarians must treat colleagues with professionalism and respect; not making malicious or unfounded criticisms that may undermine the public's trust or bring discredit to the profession understanding section 3 4 veterinarians are expected to settle any personal dispute with colleagues privately they must not publicly criticise other veterinarians in a way that risks bringing the profession into disrepute refer to the social media docid\ owsota jolvsej1qj3b2n guide for further information veterinarians who are asked to provide their opinion or veterinary advice on the clinical management of a case which is still under the care of another veterinarian must consider carefully whether it is appropriate for them to do so, if they haven't examined the patient or reviewed the history while it may be acceptable to provide general comment, veterinarians who choose to provide specific advice on the particular case must with the person's consent, notify the first veterinarian of their involvement limit the extent of their specific advice to what is reasonable given the limits of the information they have reviewed state their opinion in a way which does not discredit the previous veterinarian veterinarians should distinguish between providing specific veterinary advice about a case and giving general advice specific veterinary advice is given when a veterinarian gives their opinion on how a particular case should be managed for example a veterinarian at a party tells another party guest that their dog, which has been hospitalised with a broken leg, doesn't need surgery because the fracture can be satisfactorily managed with a splint general advice about a case is given when a veterinarian provides information about treatment options and refrains from making specific recommendations for example in the same party scenario, the veterinarian might explain that there are various treatment options for broken legs and the most appropriate option will depend on a number of factors including which bone/s are fractured, the nature of the fracture and the age of the dog section 3 5 veterinarians must ensure that veterinary colleagues within the practice are appropriately supported, particularly those who are newly registered or inexperienced understanding section 3 5 newly registered or inexperienced veterinarians may not have had the opportunity to fully develop their skills all veterinarians in the practice must ensure that inexperienced practitioners are appropriately supervised and supported at all times regular practice meetings, seminars and performance feedback/review meetings together with formal induction of new employees helps ensure that practice values are adopted and professional standards are maintained when a veterinarian is subject to council's competence and/or health processes, their employer is expected to provide them with appropriate support this includes cooperating with all reasonable council requests that allow the assessment of the veterinarian and where necessary reassessment or monitoring when veterinarians start working at a practice, the relationship and accountabilities should be clearly defined and agreed, in a robust and fair contract or employment agreement failure to do so can lead to difficulties and disputes