Professional standards and gui...
Code of Professional Conduct

Client relationships

guiding principle veterinarians must act reasonably to protect their clients' privacy and communicate in a way that educates and empowers their clients to make informed decisions about their animals section 1 veterinarians must interact with clients in a way that promotes effective communication and trust this includes listening to clients, respecting their views, responding to their concerns and preferences and treating them with courtesy not exploiting a client's lack of veterinary knowledge treating all client information and information related to the provision of veterinary services as the private information of the client except in circumstances where the client has given consent for the information to be shared; or the information is disclosed in accordance with the privacy act 2020 ; or disclosure is required under the veterinarians act 2005 understanding section 1 trust is essential to a positive client veterinarian relationship clients trust that veterinarians are competent and honest veterinarians' knowledge and training allows them to potentially influence clients' decisions because of this, veterinarians have a greater responsibility to be trustworthy veterinarians must not abuse this position or exploit a client's relative lack of knowledge by encouraging them to undertake veterinary treatment or make healthcare decisions that are not in their or their animals' best interest communication veterinarians must be able to communicate effectively with clients this includes listening to clients and identifying their concerns finding out from clients what their veterinary needs and expectations are explaining treatment choices and options in a way clients can understand most of vcnz's expectations around the quality of veterinarians' communications with clients are set out in its competency standards and performance indicators for veterinarians docid\ anejoinyjlrzbvheo2tc7 this section of the code focuses on the ethical aspects of communication including consent issues and the confidentiality of information confidentiality veterinarians must ensure the privacy and confidentiality of information collected and stored during the provision of veterinary services veterinarians have professional responsibilities under the professional relationships docid\ g7umy1lhaknz5u4kno yw section of the code to share the relevant information they hold with other treating veterinarians or those who need to know however unless it is an emergency situation or there are valid grounds for disclosure, clients have the right to decide/consent to who should have access to this information the privacy act 2020 governs how personal information must be managed privacy principles 10 and 11 place restrictions on how organisations can use or disclose personal information privacy principle 11 provides guidance on when it is acceptable to disclose information without client consent for example when asked to disclose information about a client or their animals as part of an investigation by a recognised and authorised investigator into alleged breaches of the animal welfare act when required to provide information to vcnz as part of a complaints assessment committee investigation further advice can be sought from the privacy commissioner's office, 0800 803 909 section 2 veterinarians must obtain the client's informed consent before proceeding with a proposed treatment or course of action, including post mortems this includes making sure clients have enough relevant information to make an informed choice about treatment options giving clients the information they need in a way they can understand checking clients' understanding of the information, and ensuring they have the ability and authority to give informed consent ensuring the informed consent process is adequately documented understanding section 2 informed consent while veterinarians are obliged to obtain clients' informed consent to a proposed treatment/course of action this may not be possible in an animal welfare emergency for example, when the client/owner can't be contacted and there is an immediate threat to the life of the animal, or an immediate need to relieve unreasonable or unnecessary pain (refer to the animal welfare docid\ gr85ichrvf w2r sspyy7 section of this code) informed consent is an interactive process between the veterinarian and client it's not just a single approval for a treatment plan or a signed consent form for example, further consent is required where the condition of the animal and/or treatment options change client understanding is enhanced when information is given in lay terms (without technical jargon) clients are given the opportunity to ask questions or request additional information clients can relay their understanding of the information given back to the veterinarian (where appropriate) clients are given enough time to make an informed decision ' enough relevant information ' means sufficient, relevant information being given to a 'reasonable' person in the client's position to make a considered decision on whether to accept or reject the recommended treatment/course of action in general a simple procedure involving minimal risk and using current well recognised options will require minimal detail a complex procedure will require detailed information, especially if less common/routine options are recommended and/or the risk is high or unknown the following information must be provided the likely diagnosis where appropriate and the reason for the proposed course of action treatment options including expected outcomes, risks, side effects, benefits and costs (this can be a range of likely costs) the veterinarian's experience and skills to undertake the treatment, where appropriate referral options, where appropriate post treatment requirements and likely costs a client's experience and knowledge can influence the degree of detail they need to make an informed choice veterinarians should not pre judge clients' ability to take in the information conveyed/treatment recommendations and should use appropriate questions to check understanding the process of obtaining informed consent is ideally documented by a signed, consent form attached to the clinical record sample forms are available from the veterinary professional insurance society (vpis) through nzva when verbal consent is given this must be noted in the clinical record the clinical record should also include a summary of relevant discussions that took place to arrive at the treatment decision/s a client's decision not to proceed with the veterinarian's recommendation (for example declining a second opinion or referral) the veterinarian responsible for the case must ensure that informed consent has been given before proceeding delegating some or all of the process to other staff (such as a veterinary nurse or receptionist) may be appropriate when the proposed treatment is a common procedure, especially when requested by the client eg de sexing operations the staff have been appropriately trained and protocols are in place and followed the accountability for the process remains with the veterinarian in charge of the case and there must be the opportunity for clients to talk with the veterinarian if they have expressed any concerns or request it veterinarians should consider how to best communicate information to the client it can be helpful to support verbal explanations with written information, use of white boards, anatomical atlas to illustrate procedures etc this is especially important for post operative home care information veterinarians are expected to exercise sound professional judgement in determining who is able to consent to treatment the client may be the owner of the animal, someone acting with the authority of the owner, or someone with statutory or other appropriate authority if the person providing consent is not the owner, and has not confirmed their authority to act on behalf of the owner, procedures should only be carried out in exceptional circumstances if there is any question about the person not being the owner or being an authorised representative, this must be documented if the owner is less than 16 years of age or has limited capacity to provide consent, veterinarians should consider whether someone else can assist in providing informed consent a person under the age of 18 (a minor) can provide informed consent to the treatment or procedure however, the veterinarian should assess whether they think that person is competent to make such a decision, taking into account factors such as the complexity of the procedure and their apparent level of understanding the agreement to pay for the service (procedure or treatment) should be treated as a separate process to obtaining informed consent an agreement to pay for the service may not be legally enforceable if the person is under the age of 18 years, even though it is acceptable for them to provide consent to proceed veterinarians will need to consider whether someone else can assist when setting up arrangements to pay for the work this could be a parent, guardian, employer or friend if the owner is less than 18 years and cannot pay for the service at the time and if an older person is not available to take responsibility for payment, the veterinarian will need to make a judgement on how to proceed taking into account the animal's welfare questions which the veterinarian might need to consider include, for example what is the minimum amount of treatment needed which addresses the welfare of the animal at the time eg treating a fracture with a robert jones bandage, sedation and analgesia? would the spca or another animal welfare charity accept responsibility for payment or part payment? depending on the circumstances should euthanasia be considered? is the practice prepared to take a risk to cover the cost and proceed on the basis that they believe the owner intends to pay? it is recommended that the practice develop a policy setting out how their veterinarians can deal with these situations in discussing alternative treatment options veterinarians must not tailor the discussion because of their evaluation of the client's financial status failing to inform clients of reasonable medical alternatives (for example referral) breaches the code part of the discussion to obtain informed consent should include how the veterinarian can contact the client during the procedure to discuss unexpected outcomes veterinarians should also gain the client's agreement to act without further consent if it becomes necessary in the interests of the animal section 3 veterinarians must respect clients' rights to use the services of more than one veterinarian seek a second opinion or referral decline or choose an alternate course of action to the one recommended by the veterinarian, provided the animal's welfare is not compromised understanding section 3 clients are entitled to use the services of more than one veterinarian or to seek a second opinion or referral clients may also choose to use multiple veterinarians to provide different and particular skills in order to meet their specific veterinary needs for example reproductive services, nutrition, and herd health consultancy when it is known that a number of veterinarians are involved with the same client, the veterinarians concerned have particular responsibilities to communicate with each other as set out in the professional relationships docid\ g7umy1lhaknz5u4kno yw section of the code when clients decline, or choose a course of action to the one recommended, veterinarians must be satisfied that animal welfare requirements are met (refer to the animal welfare docid\ gr85ichrvf w2r sspyy7 section of the code and sections 10–12 and 138 of the animal welfare act ) section 4 veterinarians are not obliged to accept new clients, continue to provide services to existing clients, or provide a requested treatment, providing animal welfare and professional standards are met understanding section 4 as long as animal welfare isn't compromised, veterinarians should use their professional judgement, and take into account all relevant circumstances, when considering whether to provide a particular requested veterinary treatment (surgical or medical) undertake any requested diagnostic investigation veterinarians can end their relationship with a client as long as this decision doesn't conflict with any animal welfare responsibilities under a current treatment plan veterinarians should notify the client in writing of this decision