HOW TO WORK WITH VETERINARIANS
Note: The author has had no veterinary
or medical training. She has merely documented her experience with her
dog's health problems. Use your own judgment on working with your vet.
The goal is to get a good working relationship.
HOW TO SELECT YOUR PET'S CARE-GIVER
WHAT YOU SHOULD EXPECT
HOW TO MANAGE THE CARE
WHEN AND HOW TO FIRE YOUR VET
Getting the most out of your relationship with a veterinarian involves selecting shrewdly, managing expectations, handling the care, understanding your own responsibilities, and knowing when it's time to change vets.
For the most part I have been impressed with the caring and concern vets have shown for Amie and her problems. I am appalled, however, at some of the things said or done or not done that defy common sense, human sensitivity, and ethical or service-oriented business practices.
Most veterinarians just know what they've been taught in school and are doing what they can. I don't mean to be hypercritical, but I do think you should be well aware of what you can expect and what options you have. "Doctor, fix it" is an attitude of the past. You need to be pro-active, educated and an advocate for your pet.
The most important piece of advice I can give is to apply the same common sense you would use in your own medical treatment as you would for your pet. While many people treat their pets as they would their child, let's face it - most of us are not going to use whatever resources possible to save the life of an animal. Medical treatment for pets is expensive and as a culture we generally feel pets should be euthanized if they are in pain and are not expected to recover. Having a good relationship with a vet with whom you have confidence, and knowing you've done what you can will ease this decision when the time comes.
DO YOUR HOMEWORK
DO YOUR HOMEWORKMostly people need a veterinarian to administer shots, dispense heartworm pills, do routine check -ups. When your pet is ill, find the best vet you can get. Decide what is most important to you and factor-in all the variables.
GET A FIRST IMPRESSION
LISTEN AND NOTICE
WEIGH THE VARIABLES
Check the vet's history. What school did the vet attend and when? Call the office and find out the vet's background. I have tried to interview receptionist's about the philosophy of the vets they work for and they are no better at describing the vet or differentiating their services than the vet's themselves. It doesn't hurt to ask, though. Interview everyone and see what info you get.
Is the reception area and examination office clean? Attention to detail is shown in the site. Just because the patients are animals and the vet is busy are not reasons to let the place get dirty. At Purdue the dog hair from previous occupants of the examination rooms (and hallway) was so thick every time I was there that I asked them to at least clean off the exam table. Then I waited outside with my dog until the vet was ready to examine her. No harm done, but I didn't want Amie picking up some other dog's problem. It made me question the cleanliness of her boarding cage, for example. I was confident that the student interns took better care of an operative patient. But if this was a general practice I wouldn't have gone back.INTERVIEW
Are the office personnel well trained? I don't expect office personnel to be vets-in-training, but I do expect them to be competent at their job. Competent people surround themselves with other competent people, so if the office personnel are unconscious and unconcerned about being unconscious, take a good look at the vet.
How healthy does the vet look? How radiant is the vet? How much love do you feel in the vet's presence? Does the vet love the job? I have visited vets who smoke, who look consumptive, who look stressed-out. This does not inspire confidence.
Is the vet too busy? Does the vet rush into your exam room like a person jacked-up on high octane coffee, with places to go and people to see? Does the vet rush from room to room? Is the vet obviously impatient about the time? Does the vet have the attitude - this wouldn't be so bad if it weren't for the people... or the time?
Is the office well equipped? Beware of the "gee whiz" syndrome. If the technology exists, vets find a way to use it. And consider this - A well-equipped facility has to use the testing equipment to justify and pay for its existence. The worst vet I have seen had a ton of state-of-the-art equipment and Claudia is a single practitioner with not much stuff. Having a lot of stuff doesn't really matter. She's got the stuff she needs and I've never heard her say that she didn't have sufficient equipment. She refers when she needs to.
Does the vet act confidently? A good vet brings self-confidence and competence to the work. Trust your instincts. In the final analysis it really comes down to whether or not your vet inspires confidence. If confidence is lacking, it's time for a change. Is the vet arrogant and over-confident? I'd much rather wade in on a problem with people who know they don't know than with people who already have all the answers.
Any vet who is proficient and confident shouldn't mind being interviewed. In fact the vet should warm to the opportunity to tout successes.LISTEN AND NOTICE
Ask what the vet considers to be specialty trained in or interested in. My vet, Claudia Lewis, said up front that internal medicine wasn't her specialty or interest. Her specialty was dermatology. But she was eager to learn and that was most important and has made the difference.
Ask if the vet has ever worked on this problem before. Maybe this set of symptoms is new - but is the vet excited? Motivation should be weighed against experience.
Ask if there is a decision-tree plan for your pet's diagnosis or symptoms. After several vets threw up their hands not knowing the next steps to take, I found Claudia. She has a decision-tree which very carefully describes the procedures and treatment in proper order to accurately diagnose and deal with Amie's problems. For example, first rule out this, then this, then test for this, if negative, try this. If the vet doesn't have a written guideline, ask what the plan would be.
Ask about alternative therapies. Vets who scoff at the importance of diet and environment do not inspire confidence. This should tell you that the vet isn't going to be interested in considering what the vet doesn't already know.
Does the vet listen to you? Most diagnoses will be made simply by listening. Tests confirm what the vet already suspects. So if your vet is not listening to you now, the chances of a mistake are greatly increased. All good consultants listen. You don't want a vet who thinks it's all in YOUR head. The owner's insight into the problem and ability to work with the vet is a major factor in treatment. I expect the vet to consider my perception of what is wrong, and to respect my expert knowledge of my pet. When I report a medical emergency the vet should not respond, "Take two aspirin and call me tomorrow".WEIGH THE VARIABLES
Does the vet take more time explaining the billing procedure and costs than about treatment? Costs can be on a vet's mind in more ways than the obvious. An opposite experience I had was in a vet office where three vets shook their heads and said - this could get expensive, but wouldn't take the next step even after I had agreed to finance it.
Is the conversation more about the vet than about you and your pet?
Does the vet keep good records? Is it obvious that the vet is writing down what you have said? Are the records kept in a neat, readable form? Good vets keep good records.
Don't think that just because a vet has a sterling reputation, that this vet is the right one for you. You've got to go on instinct, not pedigree. I have one bias that looks for experience, but basically I think recently trained vets are more up-to-date, more eager to be successful, more motivated, and maybe more service-oriented. There are many trade-offs. Go with your instinct.
Choose a partner. Find a vet who will be your advocate. Maybe you will find a new vet who wants to learn. Will this vet be a good partner who will advise you and let you participate or is the vet someone who will tell you what to do? Does the vet refuse to discuss alternatives because you wouldn't understand them? Vets should know that a person who works with the vet to develop a treatment plan is more likely to stick with it. We can only hope that vets will realize that quality treatment does not lie solely in computerized diagnosis, miracle surgery or wonder drugs, but rests essentially on the interaction between vet and pet owner.
Select a vet who will have an interest in your pet and will work with other vets who have a narrow specialty. Going straight to the specialist probably won't work to your advantage because there may be other problems and you may need a team of specialists. Use your general practice vet to rule-out causes, do preliminary tests and to be your translator and advocate.
Look for a conservative vet. You want a vet who is medically conservative - neither pill-happy or knife-happy, who doesn't believe that taking action, any action, is better than waiting. Be wary of the vet who prescribes meds on the basis of a single test.
Is the vet sensitive to your emotions and needs? I wept when Claudia said she was in for the long term - through the day-to-day problems to the time we have to put Amie to sleep. I know she will grieve for both me and Amie. I like that in a vet.
Separate personality from pedigree. Said in another way, if your vet is an excellent technician, but you can't stand the personality associated with the skill, stuff it. If I needed a heart surgeon I would find one who does a lot of heart surgery and has a history of results. The vet may not be the nicest person, but I'm looking for good hands and good judgment. Put up with condescending looks, over-simplified verbiage, rudeness, lateness, broken promises, and agreements, etc. Your vet may be a prima donna. Don't feed it, but if you are seeing great results, don't change because you can't stand the personal style.
Everyone has the right to be treated
with respect and dignity.
Vets basically have not learned that they need to be good business people, requiring timeliness, tact, explanations, etc. Vets generally relate better to animals than humans and some haven't learned good human communication skills, but that is no excuse for not treating the customer with respect. The vet should never forget who the customer is. Why is it some vets do not know that they are in a service business? I pay their fee - I am the customer. I do not need to be intimidated or kowtow to a vet that works for me. It's a minor issue, but can you really feel comfortable with a vet who insists on being called "Doctor"? If your pet is as sick as Amie has been, you will spend a lot of time with the vet. Can't we keep it on a friendly and equal basis? And if you prefer to be called Robert, does the vet insist on calling you Bobby? If you want to be called Mrs Smith, does the vet call you by your first name?
You have the right to know your pet's
You should be able to obtain from the vet complete current info concerning diagnosis, treatment and prognosis in terms you can be reasonably expected to understand. This means you have the right to learn what is wrong, to know what medications your pet is getting and to be told what you should expect about the progress of the illness. I expect that the vet will make sure Amie is not allergic to the medication. I expect to be told about the risks, the chances of failure and any other options that may exist. Once you have all the information, you can weigh the risks. That is your decision, not the vet's. Don't be afraid to ask the "stupid" question or "waste" the vet's time.
The right to reasonable medical costs.
I have the right to ask about fees and any ancillary costs that result from the vet's decisions. Before the vet orders an expensive set of lab tests ask, "Are all of these really needed?"
The right to good judgment.
Even though you probably are not medically trained, the diagnosis and treatment should make sense to you or something's wrong somewhere. Amie seemed to be in slight discomfort and had involuntary shuddering below the waist after she ate. I mentioned it in a phone conversation with a vet. I expected the vet to look into some digestive tests. Instead, the young vet pronounced a diagnosis that Amie had epilepsy and wrote out a prescription. I knew she wasn't epileptic. Sometime later I learned that dogs should eat food at room temperature and once I began warming her food in the microwave, the problem went away. I couldn't believe the vet would make such a snap diagnosis and prescribe anti-seizure meds without even seeing her.
An example of good judgment was when Amie's heartworm test came back positive. Given that she is an indoor dog, I felt certain she didn't have heartworm. Claudia prepared me for the worst by telling me that Amie would have to have these awful and life-threatening shots, because this lab NEVER makes this kind of mistake. But Claudia suggested we retest Amie and, in fact, Amie was worm-free. Another time Claudia's thermometer read 106 degrees but I knew Amie didn't have a fever and confirmed it at home. Claudia called and said her thermometer was not reading correctly. I'm glad I trusted my judgment, rather than blindly follow her treatment recommendation.
If the vet seems quick to jump to conclusions or reach for a prescription pad or doesn't recommend X-rays or lab tests when common sense tells you they should be considered, then you may not be getting competent care.
You have the right to refuse medical
The day a vet urged immediate emergency surgery to remove Amie's bladder stones, I thought, gee, if this were me, I'd want a second opinion. She did not seem to be in pain and I couldn't understand the urgency. Fortunately we discovered she didn't have bladder stones. Had I known that Bactrum, an antibiotic, can permanently dry up tear ducts I would never have given it to her. You have the right to refuse prolongation of life by heroic means during a terminal illness.
Find out what the usual wait time for an appointment is.
You should be able to in to see the vet within two days, especially if your dog has been sick. If it is not quite an emergency but your pet is in pain or uncomfortable, explain what's going on to the receptionist and ask if you can be squeezed in.
Control the wait.
If you consistently wait more than 30 minutes to see the vet, call the office before you go to see if the vet is running on schedule. If it takes you 15 minutes to get there ask the receptionist to call you 15 minutes before the vet is expected to get to you. Believe it or not, some will do this! And don't be late. I try to schedule appointments first thing in the morning when the vet is fresh and appointments are not yet backed up.
Question the vet closely on every aspect of care. Ask the vet to explain and justify virtually every step. The sicker your pet is the more important it is for every medical choice to be rigorously scrutinized and evaluated. If the vet is vague about side effects, ask for the instructional insert and be alarmed that the vet did not know.
Ask "Is there anything else I should know?" It is surprising how this irritates some vets - they think I am needlessly extending the conversation. However, it gives the vet another opportunity to actually consider something that has not yet been communicated. You can find out a lot of good info if you keep asking.
Ask what will happen if no treatment is administered. Not only does this help discover some options, but you learn what the end-game is. For example, Claudia described to me what happens when you know a dog's kidneys have failed to the extent that the dog needs to be euthanized. Asking for worst case scenarios educates you regarding what you should look for and expect. Maybe the answer is - "It might go away by itself".
Find out how the vet wants to communicate with you.
Claudia takes Thursdays and weekends off. She wants phone calls on the half hour. She is very good at exchanging messages by phone machine and email. Don't demand some real-time contact if a message will work just as well.
Train your vet.
Teach your vet how you want to be treated - within reason, of course. If the vet has a father-knows-best attitude and won't explain things or is always rushed, tell the vet you need more info or offer to pay for two sessions in order to have time for you. Just saying "I'll pay for your time" indicates to the vet you really mean it and the vet may warm to your sincerity. Some medical people think that if you don't accept everything on face value, you are demonstrating a lack of confidence in them. Explain that you are a person who likes to understand. If you understand and are informed, you can better deal with your pet's medical problem. Change vets if you can't get the info you want. If you feel ill-treated by a vet, say so and why.
Get everything in writing.
I'm always surprised that vets are offended by my wanting a copy of a report. As with humans, the physician owns x-rays, even though the patient has paid for them. Nevertheless, if I pay for a test, I want a copy of the report. This greatly simplifies matters if you are out of town and need a vet who is unfamiliar with your pet. It also helps when you have to summarize what's been going on for a specialist. You have a right to the essential information in the vets records. The paper is theirs, but the facts are yours. You should be entitled to see or get a copy of your records any time you ask and the copy should be delivered within a reasonable time for a reasonable copying and handling charge. Put your request in writing if necessary.
Get a second opinion.
If the treatment is going to be painful, involve surgery or consists of drug use, check with someone else. The Internet is great for checking on drug side effects and finding out about alternatives. Maybe the vet isn't doing a good job of explaining but if the vet doesn't further explain at your request, don't assume that the doctor knows best. Seek a second opinion. If the vet doesn't know an answer, find out who does. If the vet is unwilling to take the case any further, change vets. The great thing about Claudia is her readiness to admit she doesn't know. And she is willing to find someone who might. I was pleasantly surprised by her candor at what she knows and doesn't know and her willingness to explore other avenues. Other vets have shrugged and said, "Sometimes you never figure it out." - and then washed their hands of the problem. Claudia has done research and has contacted her Michigan State professors. Don't go to a crony just down the hall. Find a vet who will really take an objective look at your case, without regard to ego, fear of loss of control over the case, costs, or any other irrelevant issues to you. Get a second opinion before you start taking meds, have an operation, or alter the pet's diet markedly.
Consider a non-medical alternative.
Just like MDs (medical doctors), vets are trained to know about and prescribe medicine. Don't put all your faith into a vet whose only remedy is a drug or medical procedure and scoffs at any other option. Before we started the Elimination Diet to determine Amie's food allergies, people recommended we put her on Prozac. I'm not going to put down Prozac, but I thought she'd get on Prozac and still itch, but just not care as much. Find out what is in the pet's environment that may be causing the problem. Check the diet. What is a simple, non-medical solution?
Be awake regarding tests.
Avoid unnecessary tests. Schedule tests during the time of day your pet feels best. Ask the following questions:- What are the tests?
- What is the chance of an inaccurate result?
- How should we prepare for the test?
- How is the test performed? Will it hurt?
- Are there alternatives to the test or can you rely on the results of a previous test?
- How much does it cost?
- Who does the lab work?
- Is this test necessary?An acceptable answer would be: "We're checking her kidney function indicators in order to compare them to the last test" or "This will show if any other organ is abnormally functioning." Unacceptable answers - "This is a standard test we run" or - "Don't worry about it, I just want to make sure everything is OK."
- Will the result of this test influence the way you treat my pet's condition? If the answer is no, why take the test?
- What are the post-test side effects? Knowing that being catheterized might make Amie wet her bed could have prevented some post-test upset.
- Does my pet have medical characteristics that will alter the test results - such as being on certain medications? Claudia had the foresight to get Amie off antibiotics before doing a urinalysis.
Some of these admonitions apply to all
pet owners, but primarily I'm speaking to those with sick pets.
What to do if you need to go away and
leave your dog?
We have hired pet sitters and paid $15 for them to clean up her papers, feed and play with her three times a day. Then we were very fortunate to come across a student interested in becoming a vet who is conscientious about meds. He actually sends us thank-you notes for the opportunity to take care of Amie. We have recently found a bonded, professional pet sitter who has experience with sick and senior dogs.
Find out before needed what is an emergency
and what to do.
Find out possible side effects. Ask what is a dangerous situation and ask what to do about it.
Keep good records.
A study by the American Society of Internal Medicine (human) found that correct diagnoses are 70% dependent of what patients tell their doctors. Detailed and accurate records are invaluable when the vet says, "When did this start?" Since the animal can't speak for itself, it is even more important that you observe and write down what you can. I was a little embarrassed to keep such a detailed daily log of Amie until my current vet, Claudia Lewis, related her story. She was still in training and tending horses. No one could figure out what was going on with them, but her records noted that changes in weather were related to the horses' behavior. She encouraged me to keep detailed records and urged me to add weather-related data. I am always concerned about Amie's changes in urine pH. Why is it that she eats the same, exact, identical food and her pH can vary so much day to day? Claudia says it's because Amie is an animal, not a machine. Occasionally her pH really jumps or falls, and I have sometimes been able to relate it to severe electrical storms.
Give the vet accurate and succinct reports
about the symptoms.
Inform the vet of all medications the dog is on and an up-to-date shot record. Put it in writing. That way it becomes part of the file and doesn't rely on the vet's memory of everything you think is important. Keep a copy for yourself.
Don't tell the vet how to practice.
Meaning, don't demand certain drugs or treatments. The vet really does know more than you do or you'd be a veterinarian yourself.
Don't expect miraculous cures.
Level with the vet.
Withhold no info in order to avoid embarrassment or gain approval. If you are supposed to feed a specific diet and Billy, your 8 year old, has been slipping the dog leftovers, come clean. And train Billy to butt out.
Pay your bills on time.
Don't stiff your vet. Remember the adage: "Pay local debts first". Don't be a charity case. Negotiate the fees if necessary and be prepared to pay full price. If the vet knows the sky's the limit, that may be what you will experience. Have in mind a dollar figure you will not go above. It sounds callous, but a pet is not worth going bankrupt over or creating a hardship for or taking food out of your children's mouths.
Respect the vet's rights to leisure, private life.
Don't waste the vet's time.
Prepare for your visit. Think of the questions you want to ask and what you want to get from the visit. Bring your list of questions - don't rely on memory. Anticipate what information the vet will want. Arrive on time, a few minutes before your appointment.. Don't chitchat about irrelevancies.
Shut up and listen.
Having worked with the public for years I know that nervous or upset people can ask a question and instead of listening to the answer, they talk through the other person's response. You can't listen and talk at the same time.
If you don't understand the medical jargon, ask for a translation.
Learn about the illness.
Minor illnesses that are short-lived and don't recur needn't concern you too much. But many come on slowly, get progressively worse, respond only partially to treatment, and never really go away. Check the Internet for more info. Look under both human and vet links. Don't expect the vet to know everything. The more you know the better you can effect the treatment process.
Understand the medications.
One of the most crucial areas involves meds. A misunderstanding concerning what the vet said may be fatal. Review the meds your pet is on every now and then and verify if they are still needed.
Don't be concerned that the vet will think you're trying to capture the conversation for a subsequent malpractice suit. I am one of those nervous and upset people that needs to write down what the vet has said or I will forget or misinterpret it. I think of myself as being so aware, so on top of things, but when I read the notes I wrote at the vet's office I am very glad I took them, because my mind was racing. And if I hadn't written it down, it would be lost. This includes what the vet said in general, and very specific medication instructions and follow-up notes. Ask for written instructions. If absolutely necessary, tape record the vet's instructions.
Follow the vet's instructions exactly.
If your pet is to get meds every 4 hours set the alarm, if necessary, to do that. I would think it would be frustrating for a vet to try to cure a pet when the owner has a close-is-good-enough philosophy about treatment. It would be silly to expect a vet to care a lot if the owner has a casual attitude about following the vet's instructions.
If you find a good vet that is willing to work with you the way you find satisfying, tell everyone you know. Brag about your vet - or at least tell others about your experience. That's a service you can do for the vet and one that helps others. I was astounded that so few people I know have a preference in the choice of care-giver for their pet. They go to the vet they started with or that's closest. Their opinion is that vets are all the same, anyway. This is especially not true when you need more than routine care.
Does the vet have a father-knows-best attitude and is not a partner in your pet's treatment? Know-it-alls have nothing to learn.
Does the vet worship tests and drugs? I know being a veterinarian is a science, but it is also an art. Without intuition vets can make big mistakes.
Is it a hassle or a demeaning experience every time you see the vet? Who needs that? Some vets may be just too much trouble.
Can you get better care elsewhere?
you're asking yourself this question, it pays to find out.
Speak with your vet about your grievances. Sometimes vets aren't aware that they are in the midst of a deteriorating relationship until an owner tries to leave. This might just open the communication lines.
If you are still unhappy, your most
important concern should be continuity of care. Don't feel embarrassed
or guilty if you decide to change. Good quality vet care is your right
and responsibility to your pet.
BUT if you're reading this because your dog has serious problems, don't jump ship without the courtesy of informing your current vet. You owe it to a vet who has invested time and caring into your pet to express yourself. Maybe you can correct a misunderstanding or improve a bad relationship.