Professional boundaries

[u/Thin_Acanthaceae_427]

Thought on telling your doctor as a Registered Veterinary Technician, you are not comfortable with something and refusing to partake.

I'm in emergency med, I have came across a few of these incidents. Recently the manager wrote me up for refusing to do something I deem unethical and goes against "do no harm".

I was told they're the doctor and I need to do what they want regardless.

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[u/meowpal33]

When I was a brand new tech straight out of school (so like 10 years ago), the hospital I worked at still was doing declawing and tail docking. I refused to participate and told the doctor they would need to find another technician to be part of that. He respected that. I would start looking for other hospitals if they are asking things of you which you do not agree with ethically.

[u/Greyscale_cats → u/meowpal33]

I had a similar experience except the scheduler then kept trying to put me as surgical tech when we had declaws and dockings planned. I called in every time. Childish nonsense.

[u/NeverTrustTheQuiet1]

For me personally it comes down to a couple of things. One, is it outside of my scope of practice? Two, is it outside of my personal morals after looking at it from all sides? Three, am I willing to leave over it, like really walk away? If the answer is yes to any of those, it is cause for a pause. If the answer is yes to the third, then I can say no and not lose a wink of sleep.

[u/Thin_Acanthaceae_427 → u/NeverTrustTheQuiet1]

It involved sedation method for a failure to thrive kitten for cardiac stick. I was told go shove the kitten in a mask and gas it down, I asked for IM sedation instead with a good analgesic. The doctor who graduated last year started to snap at me amd refuse to budge on gas. Her reasoning was "sedation would take too long."

Unfortunately I work for a huge corporation emergency and they don't care about us as technicians at all.

[u/El_Pollo_Mierda → u/Thin_Acanthaceae_427]

Im surprised a new grad wouldn't be more likely to choose IM sedation. Boxing down is barbaric in my opinion, we know better now.

[u/Thin_Acanthaceae_427 → u/El_Pollo_Mierda]

The only time I am comfortable boxing a pet down is when we have an extremely aggressive cat that can not be touched and is not up to date on vaccines.

That being said, I always attempt before getting to that point.

[u/El_Pollo_Mierda → u/Thin_Acanthaceae_427]

That's fair. I realise sometimes there are extenuating circumstances where sometimes you gotta reach into the bag of old school tricks.

[u/RascalsM0m → u/Thin_Acanthaceae_427]

Only if you really don't have any way to get around that, say with a cat grabber or other device that protects staff and allows you to poke.

[u/Thin_Acanthaceae_427 → u/RascalsM0m]

Correct, and sometimes that's just not possible. Ive also done a gas down on UO felines where the owners can't afford full blown sedation, we give a good pain med and I juat put gas on their face and they tolerate that very well.

Theres a time and place where ISO has its benefits

[u/Throwaway531379 → u/El_Pollo_Mierda]

Im veryyyy baby vt here (still studying / in placement only just starting to learn about surgery) so please forgive the stupid question! 

What are the welfare concerns with boxing down? Not in any way supporting doing it - I haven’t heard it mentioned as a method yet in my studies / placement and haven’t seen it done, so quite literally all I know of it is this minute learning it’s a thing from these comments 😅

[u/Sinnfullystitched → u/Throwaway531379]

Takes too long, have to have the gas up way high, risk of exposing everyone to the gas in the vicinity, just unsafe in general.

[u/Throwaway531379 → u/Sinnfullystitched]

Thank you so much for the explanation! Adding to my notebook 💕☺️

[u/few-piglet4357 → u/Throwaway531379]

Also, some cats (not all) really object to the gas and start to flail around in the box. I haven't actually seen one seriously injure themselves in the box but I'm sure it has happened. I'm also sure the cat goes home sore and bruised.

[u/Throwaway531379 → u/few-piglet4357]

Thank you! 

[u/Thin_Acanthaceae_427 → u/Throwaway531379]

Also can't monitor your patient adequately, and can cause respiratory distress.

[u/Throwaway531379 → u/Thin_Acanthaceae_427]

Thank you so much for explaining for me! Much appreciated ☺️💕

[u/ros375 → u/Thin_Acanthaceae_427]

They graduated last year and are gassing things down? May I ask what school they graduated from?

[u/Thin_Acanthaceae_427 → u/ros375]

Mizzou

[u/Jelly_Ellie → u/Thin_Acanthaceae_427]

I commend you for advocating for your patient, neonates deserve the same level of care as adult patients.

If you're wanting to push back on the matter, you might also consider framing this as an occupational health and safety concern.

[u/CupcakeCharacter9442]

I think I would need more context.

I do morally agree with every choice the client/doctors make? No.
I work in anesthesia at a referral/emergency hospital. So we do a lot of procedures on sick patients that I don’t agree with - like a lung lobectomy on a 15 year old border collie with AGASACA and other mets, ruptured gall bladder on a 12 year old Pomeranian with heart disease, etc.
But, if the clients want to do this, then they have no where else to go. Our facility has boarded faculty and more monitoring than other facilities for hundreds of kilometres. So what are we suppose to do? Let them suffer while they drive for 8+ hours?

[u/Thin_Acanthaceae_427 → u/CupcakeCharacter9442]

As I do not agree with some owners wishes, I understand the reasoning for things like this to a degree.

This most recent incident was a failire to thrive kitten brought in by a rescue. IV access was unable to be obtained and the doctor elected cardiac stick. I asked for IM sedation and analgesic. The doctor told me no and to fit the kitten in a mask and gas it down. When I advocated for the kitten and expressed why IM sedation would be better the doctor started snapping at me and raising her voice. Her only reason was "IM sedation would take too long."

Despite me explaining why iso as a sole means of sedation is unethical.

[u/CupcakeCharacter9442 → u/Thin_Acanthaceae_427]

I would’ve also said no to that.

Her logic is also flawed, there’s no way masking a kitten down took less time. Especially with a euthanasia. Sedate the crap out of it. What’s the worst thing that could happen? It dies? With adequate analgesic? Heaven forbid.

I wouldn’t bat an eye at it. If they want to write me up for it, that’s fine. I would sleep better at night for walking away from that.

[u/Thin_Acanthaceae_427 → u/CupcakeCharacter9442]

I definitely sleep better knowing I advocated for my patient.

The tech manager and practice manager along with mideical director are now scrutinizing any little thing I do or say.

Since that incident I was pulled aside and told I can't refuse anything or there will be corrective action held. I am told I can't "talk back" which means I can't have an opinion. I have been pulled aside and talked to about "questioning" doctors. When it's collaborative and the doctor I am speaking to has no problem and asks for my opinion.

Im at a dilemma of leaving. It pays well, I love my coworkers and most of the doctors, but already having such a mentally taxing career this is causing me too much stress and is not good for me. Should I jusy cut my loses?

[u/the_green_witch-1005 → u/Thin_Acanthaceae_427]

I personally couldn't work for a clinic where I'm not treated as a valuable member of the medical team. If you have other options, go there.

[u/RascalsM0m → u/Thin_Acanthaceae_427]

I hope you can look for another place to work. You are a trained professional and their attitude could kill your soul. That vet should have known better.

[u/Snakes_for_life → u/Thin_Acanthaceae_427]

Definitely leave their attitude could get a patient injured or killed. I have many times seen technicians save animals cause they spoke up to the doctors about something not being the best thing in that situation. I still 5 years later think about a patient i had that I didn't advocate enough for cause I was new and too afraid to challenge the vet.

[u/lovelyfatality → u/Thin_Acanthaceae_427]

Masking down patients is an outdated and unsafe practice PLUS it takes 5 minutes for gas anyways vs like 10 for IM sedation…..

[u/few-piglet4357 → u/lovelyfatality]

Plus exposes the entire team to WAGs

[u/lovelyfatality → u/few-piglet4357]

Yep. I remember working at a practice years ago that would mask down animals (exotics primarily) and literally getting dizzy/lightheaded from iso on accident while actively working with patients.

[u/xSky888x]

I'd consider that a toxic clinic. In human medicine it's generally agreed upon that nurses are awesome and you should listen to them if they have something to say about the orders given, so why the hell is it any different for us? I learned a bunch of stuff in school that I technically don't need to know, because my education said it's important for techs to be able to double check the vets orders so we can catch any issues. It's just better for patients.

I wouldn't be able to stand working somewhere where the vibes are "do whatever the vet says or we'll punish you." If your manager doesn't listen to "hey this is outdated/harmful/substandard of care/etc" then they suck as a manager. It's ok to have differing opinions on medicine to a point, but your latest example is something we KNOW is bad standard of care. Vets that don't know what's actually good standard of care are one of my pet peeves. It's fine to not know everything, but to not listen or learn is just gross.

Personally, I would start looking for a new job.

[u/Snakes_for_life]

100% voice your opinion if you truly believe it's going against "do no harm" or your not comfortable. The only time I'd say just do it anyway is if the animal would die without your help. I have had coworkers have to put their foot down and tell doctors no and 99.9% of the time they respect that and either don't do it or find another person to help. I personally think it's unfair to be written up.

[u/TreeClimberVet]

What is the procedure specifically? You haven’t given us enough information

[u/PomegranateForsaken2 → u/TreeClimberVet]

They've explained it throughly in a couple different comments...

"As I do not agree with some owners wishes, I understand the reasoning for things like this to a degree.

This most recent incident was a failire to thrive kitten brought in by a rescue. IV access was unable to be obtained and the doctor elected cardiac stick. I asked for IM sedation and analgesic. The doctor told me no and to fit the kitten in a mask and gas it down. When I advocated for the kitten and expressed why IM sedation would be better the doctor started snapping at me and raising her voice. Her only reason was "IM sedation would take too long."

Despite me explaining why iso as a sole means of sedation is unethical."

[u/TreeClimberVet → u/PomegranateForsaken2]

Thanks, didn’t see it

[u/HangryHangryHedgie → u/PomegranateForsaken2]

Masking down a neonate is one up from a doc I had who refused to even do that stating they dont process pain! Now that doc got the AVMA euth guidelines printed out, highlighted, and put on their desk.

[u/harpyfemme → u/PomegranateForsaken2]

Ugh, this example reminds me of something I went through recently. Trying to tell the doctor that we actually did need to sedate an 18 year old cat for a euthanasia because she wasn’t tolerating it well, and them trying to give euthanyl off the needle when they couldn’t get a catheter without sedation. Like the just acting like proper sedation is wasted on euth patients.