I went to a human doctor today (a doctor that treats people) because I have been sick for over a week with flu-like symptoms. My excellent and thorough physician went through the options after the exam: viral infection, low-grade flu, complicated by an asthmatic-like condition.
We went over possible diagnostics and treatment options, just like I do with my clients, all day, every day.
My doctor offered chest rads to rule out low-grade pneumonia and asked if I wanted to do bloodwork. I asked her for her opinion. She seemed more concerned about making me go out of my way to have the X-ray taken. I, for the first time in a long time, was actually concerned about the money! I said, “Well, since I changed my insurance to a high deductible to save money, do I have to get the X-ray?”
“I don’t think you have pneumonia,” she said. “And I don’t want to waste your money. Why don’t we wait and see if the antibiotics help over the weekend. If you’re not better, we can always get the X-ray.” We had a plan.
The point of this story is that my doctor and I, based on mutual trust, discovered my probable diagnosis and, based on my symptoms, her diagnostic skills and money, came up with a plan. And this is exactly what you should feel comfortable doing with your veterinarian.
So the first piece of this client-veterinarian relationship is the matter of trust. Let’s hope you have some experience with your vet, but even if this is a first visit, you need to feel good about the exchange. If somehow you don’t hit it off with this doctor, you need to ask more questions before you decide on a treatment plan for your pet.
What if you’re not comfortable with the initial exam and diagnostic options? Figure out why. Maybe it’s just a matter of personality or communication. Maybe the vet is a shy person. Or maybe he’s too gregarious. Maybe she thought she explained herself adequately. Maybe he’s “just not like your old vet.” Maybe he’s too old, she’s too young, he wears the wrong shoes, she’s not wearing any shoes (kidding). Who knows? We’re all just people, and we need to communicate.
Sidebar: Many years ago, it was a first-time visit for a client I’ve now known for 15 years. She had just moved to the area. She was a nice enough person, and it was a fairly straightforward exam of her cat. I welcomed her to the practice, bladdah, bladdah, and, well, it was uncomfortable. She just stared at me a little too long. Kind of a benign smile with apprehension.
“Is something wrong?” I asked.
“No. It’s just that my last vet was so good looking. I used to just like watching him sit on the end of the exam table.”
Well, a sigh of relief for me! I was an okay-looking thirtysomething mom, and she wanted Brad Pitt on a table! Thank God it wasn’t my attire or my bedside manner or my teeth or my knowledge! It was simply my gender.
Picking Your Practice
Feel comfortable in the practice. Do you like going there? Do you love the easy access and somewhat sterile atmosphere in a shopping plaza, or do you prefer a more suburban practice? Do you want a high-tech-looking hospital that offers full boarding, grooming, etc., or a warm and fuzzy “All Creatures Great and Small” kind of place when you walk in the door?
How many vets are in the practice? Do you want a 10-doctor practice with Sunday hours but no guarantee you’ll have a primary vet, or a smaller practice where everybody knows your name (no humming the Cheers theme, anyone).
Does a practice limited to cats have an appeal? (I considered this but would miss dogs too much.) Then again, having your heaviest pet of the day be under 20 pounds is a nice thought. Any of you with cats over 20 pounds, shame on you.
Clients and veterinarians share two ever-present concerns: the welfare and hopeful healthy outcome of the pet, and the cost of this veterinary care. The rising cost of veterinary care in a struggling economy causes grief for both of us. This is the truth.
First, put yourself in the position of your veterinarian. Let’s say she’s an associate, meaning she is employed by a hospital and not a practice owner. Her only job is to do the best job possible for your pet. However, in order to do this, she has to tailor her plan to your economic concerns. Immediately, this complicates her job.
Now what about you? Of course you’re at the vet because something has you concerned about your pet, but for many of you, that ugly question is burning: What is this going to cost?
So, the next step is for you and your vet to come to a happily agreed upon plan.
This is just like when I was at my doctor’s and we made a plan, right? Wrong. There’s a significant difference. I could tell my doctor when my symptoms began, how they progressed, my exact history with respiratory illness, and how good or bad I felt. I can tell her I have a headache or not. Nausea or not. Mild aching, etc.
Can your pet do that? Not really. So your vet’s job can be a lot more difficult than your own doctor’s in some situations. And, unfortunately, you may have a lot more decisions to make to get to the real answer. Let’s look at two very common scenarios.
Young Dog, a Little Sick
Mrs. Wanna-do-the-best brings in Kirby, a 2-year-old Golden with bad ears. It’s his first ear infection. I do an ear swab to look at what type of infection it might be. I diagnose a very common yeast infection. Mrs. Wanna asks me what caused the yeast infection. Possible allergy, time of year, swimming, Golden Retrievers’ predilection for ear infections.
I go over all the options, and I’m getting the sense Mrs. W wants to do everything from A to Z on this first infection. Culture the ears. Maybe test for allergies.
I believe this is over-treatment at this point. I show her basic ear care and send the dog home on an appropriate ear medication, carefully scheduling a recheck. If there is a recurrence, we will definitely take additional steps. In this case, I actually recommended to the client that she save her money and treat conservatively.
Old Cat, Probably Real Sick
Mr. Fallen-on-hard-times brings in his 16-year-old cat and hasn’t been to see me in about four years. Lately, Sunshine has not been feeling so sunny. Losing weight. Maybe licking some food, not much. Drinking water, though — lots of water. Her abdomen is hanging a little funny. Sunshine needs what we call a work-up. Ideally, we should run bloodwork and take X-rays. Maybe we’ll need an ultrasound. Maybe she’ll have to receive IV fluids. What are we going to do?
This is not an easy plan to decide upon with Mr. Fallen because of his severely limited funds. We decide to take things a step at a time, doing the most important tests first, based on my highest suspicions. That way, with any luck, we can get some answers and save money to treat Sunshine. This makes my job much harder, but at least we have a common understanding.
This case has a reasonable outcome so far. Based on the bloodwork alone, I treated her medically for liver disease, and she is responding. But we don’t have all the answers, and there will definitely be more costs. But this client would have been very upset if I had given him no options but the most thorough (and most expensive) one. He had all the information and could make an acceptable decision. If I had given him a price tag completely out of his reach, he might have done nothing, or, worse, he might have euthanized Sunshine.
So, No Regrets?
I think a professional and well-trained veterinarian should come up with the best diagnostic and treatment plan available. He or she should explain all the options to the client as completely as possible and make sure the client understands. Then that vet should respect the client’s decision, as long as it is ethical and compassionate.
The best clients listen, ask questions, maybe ask for more information, and make an informed decision, knowing that the plan is fluid and can always be altered along the way.
If you don’t feel comfortable with and have trust in your veterinary practice, there won’t be a good outcome. Frequently, a client will bring me a pet for a second opinion, and sometimes it’s just that. They want to make sure that another veterinarian agrees with the diagnosis and treatment. I think this is valid. I appreciate if any of my clients seek a second opinion, not to mention the many clients I send to orthopedic surgeons, ophthamologists, oncologists, etc. for consults.
But too many clients come to me with complaints about their previous experience, saying something negative such as, “They didn’t do anything over there.” Or, “They charged me three hundred dollars for nothing.” These clients have buyer’s regret and are angry. I think it’s usually a breakdown in communication. Obviously, something “was done over there” and three hundred dollars was not “for nothing.” But the client expected something more and either didn’t ask for an explanation or it was explained incompletely.
Usually, “didn’t do anything over there” translates as the pet didn’t get better on the first round of treatment. And “three hundred dollars for nothing” usually means the first set of diagnostics didn’t yield an answer. But if the vet and client have a relationship based on mutual trust, there should not be regret or anger at this point. Just a re-evaluation of the pet’s condition.
After careful consideration of your feelings, if you’re not happy at your current veterinary practice, try someplace else. It could be a personality thing, a medical philosophy thing, the list goes on. I left a dentist’s practice once simply because I didn’t think they cared about me as a patient! No warm and fuzzy dental floss samples, I guess.
Seriously, I found a dentist’s office with a completely different personality and felt much more comfortable. This had nothing to do with the dentists, by the way. They were both highly competent.
Onward and upward for trust, compassion and understanding!