I know. I know. It wasn’t long ago that I wrote my “Dogs are not small humans” blog. But a few additional good lessons can be learned from my interaction with a client yesterday. This client had an appointment for later in the evening, but my receptionist encouraged her to bring her sick dog in before noon after hearing a description of the poor shape she was in. Apparently the dog was running a 105 degree fever this weekend and was unresponsive to stimulus from the owner. If you’re wondering why she didn’t bring the dog to an emergency clinic while all this was going on, you’re not alone. Rather than calling any one of the several nearby emergency clinics, this owner decided to take the following action:
- She diagnosed the dog with sepsis, based on her observations and the dog’s body temperature (This client is a nurse and works in a doctor’s office.)
- She gave the dog aspirin to reduce the fever.
- She gave the dog an antibiotic that her other dog was being given for a different unrelated condition.
When we measured the dog’s body temperature it was normal. I think the owner wanted a pat on the back for being resourceful and reducing the fever without needing to seek the advice from a qualified professional. Our conversation was both aggravating and comical:
“Why did you didn’t you have the dog examined yesterday?”
“You were closed. How can I ask you for advice if you’re not here to answer the phone?”
“There are emergency hospitals that are open 24/7. They could have helped you, and I assure you not one of them would have advised you to give the dog aspirin, especially since she’s already on prednisone.”
“I didn’t want to call the emergency clinics because they all would have forced me to come in. None of them would have helped me over the phone. All they want is money.”
“Well, that’s just not true. Either way, if you continue to play doctor at home, you’re eventually going to kill a patient.”
“I only gave 161 milligrams of aspirin. There’s no way that can be dangerous.”
“Actually it can be, but that’s not even my point. The point is, we cannot have a relationship where you play doctor at home and come here only to validate what you’ve done. That’s just not how it works.”
We went back and forth a few more times with the end result being her walking out of my office and refusing to allow me to examine the sick dog. Of course she left the office after [again] blaming me for botching her dog’s medical care because my office was closed on Sunday. I feel bad for the dog because obviously something was wrong, but I can’t continue to enable this sort of dangerous behavior at home. This was not this client’s first time self medicating …or pretending to know more about pharmacology than me. There are three distinct things that a doctor (be it veterinarian or physician) does on a regular basis that require a medical license: diagnose disease, prescribe medication and perform surgery. This one client performed 2 of these 3 on a regular basis at home.
So what are the key learning points we can take away from this situation?
- If the owner’s description of the dog’s symptoms were accurate, this was a medical emergency that required the care of a veterinarian. Period. If you are dead set against going to an emergency clinic (for whatever reason), they WILL help you to the best of their ability over the phone. I confirmed with employees of one local emergency & critical care center that on a busy night, the emergency doctor will speak to and consult with 6-10 clients on the phone.
- Prescription drugs are not meant to be shared. Even if this dog was septic as the owner thought, the drug she gave would have done little to solve the problem. It even could have caused other problems.
- Over the counter human drugs can potentially be dangerous (even deadly) to give to a pet, especially when they are concurrently receiving prescription drugs or have other chronic health conditions.
- Common sense should always trump any medical knowledge or training you have.
- Unless you have a personal physician/veterinarian on your payroll, you will never have access to them 24/7/365. Having a life outside of their medical career is what gives them enough personality to interact with you on a human level.
September 23rd, 2009 - 12:09 am
I’m mostly with your client on this one.
1. You confirmed with ONE of SEVERAL. AND they said they said how many of those 6-10 end with advice OTHER than “bring the animal in”? I’ve had several of those phone consultations with Vet ERs and every one ended with “bring the animal in because I can’t tell you anything without putting my hands on the animal… potential liability, yada, yada, …”
2. Hooey. The problem is how many drugs we restrict access to in the US. Other countries trust their citizens with access and we used to do so here too. When I had a nice stockpile (or a 24/7 pharmacy), I could consult with a doctor (human or animal and my very own, not some stranger I don’t know and have no reason to trust) by phone for a small fee and proceed until the patient could be seen during normal office hours.
3. All the more reason to have continuity of care from one’s one doctor rather than a stranger as well as ready access to medications through a pharmacy rather than a vet’s office.
4. I agree wholeheartedly :)
5. When I was young, personal doctors and vets did house calls at all hours and were far more capable of interacting on a human level than I see these days. Maybe it comes from truly understanding one’s role as a “personal” caregiver. A doctor is not an interchangeable part. When my doc isn’t available but someone is on call for him/her, I know he/she trusts that person. “Go to the ER, pick one out of the phone book” or “it’s the only one in the area” doesn’t even come close.
Make a choice, either you want clients to depend on you, personally, or your profession (and most of us know better than that) OR you don’t. Why does the modern professional go into a profession that requires a higher level of availability and then whine about it? How about having a personal life that’s compatible with the job requirements?
Lawyers have to choose a field that fits their personal life. If one doesn’t want to get stuck doing emergency court orders in the middle of the night, one doesn’t choose one of the fields where that happens regularly. What is it with vets wanting to custom design their practices and cherry pick clients?
Maybe vets need to start playing vet again instead of following the lead of M.D.s who’ve completely botched the human medicine field.
And, finally, if you really cared about this particular dog, perhaps you could have exercised enough self control to have treated the dog before ass chewing your client. Priorities?
September 23rd, 2009 - 9:01 am
Nurses almost always come in with a chip on their shoulder and they think they know more than they actually do, but the self diagnosing thing is not just with them. A little bit of knowledge not only can be, but IS dangerous. The bottom line is that people are cheap and they want an easy way out. A pet is a luxury. You do not NEED to own a pet to live. Pets do make your life more enjoyable, but life will go on without them. That in mind, they will cost you money. Prepare for it! That dog should have been taken to an emergency clinic, period. With a fever that high the dog could have died. That owner played Russian roulette with that dogs’ life.
As far as the US restricting access to drugs… Seriously? If you leave it up to most people, they will kill themselves trying to figure out what drugs are needed for what they think they may have. That’s just dangerous and irresponsible.
There are vets that make house calls, and have house call practices. If that’s what you want, it’s out there. But guess what, they have hours that they are not available as well. Vets aren’t following the lead of MD’s, if we were we’d be a lot more wealthy. There are several emergency clinics in the area that are more than capable of stabilizing a patient until the morning. The patient can then be taken the their regular vet. This is not 1940’s Mayberry, there’s no way for one to be available 24/7/365 and still have any kind of life for themselves. There’s a reason that there are hours that we are not available, it’s called sanity.
I think Dr. Leon did, and does, care about this dog. That is why he was upset with the owner and addressed the issue with her. The own choose to walk out, chip on shoulder and figure of blame pointing, and not have her “beloved family member” examined.
Clients need a good ass chewing from time to time. It keeps the grounded :-).
September 23rd, 2009 - 10:26 am
@mark: no, we’re not in mayberry. we’re in one of the most populated suburbs in north america, surrounded by more veterinary ER’s than i’ve ever seen in any other metropolitan/suburban area in this country. as far as the dangers of self medicating, here’s a statistic for you: there are approximately 16,500 aspirin-related human deaths every year.
@pjb: i confirmed with one of two ER’s that i direct my clients to. and it’s the one closest to this client’s home. i never “ass chewed” the client -rather, it was the other way around. i actually did begin to examine the dog while discussing the client’s poor judgment. it was then when she told me to stop. and i asked to examined the dog again about 3 times before she huffed out the door. yes, my profession does require a high level of availability. that’s why i currently work 6 days a week, anywhere from 9-14 hours a day. how many times a week do i get home “on time?” never. i just hired another doctor so we could be open 7 days a week. but that still leaves this hospital closed for 116 hours during the week. this hospital’s relationship with a select couple of ER’s (open 24/7 and staffed with board certified specialists) ensures continuity of care for my patients. trust me, both ER’s have my personal cell number and i have taken a few calls at 3am or while out of town. lastly, are you, a lawyer, really accusing me of “cherry picking” my clients? hi, kettle -you’re black. this wasn’t a case of cherry picking. it was me being an advocate for the patient. i didn’t want him to be the owner’s personal science experiment.
September 24th, 2009 - 12:01 pm
@Mark: I agree that some nurses have a chip on their shoulder. But I also feel that it is nice to have an educated client to speak to that understands (or in this case SHOULD HAVE KNOWN BETTER) the medical issues at hand.
There are responsibilities that come with owning a pet that people don’t realize. I find that most purchases are an impulse/emotional buy. When you buy a pet you buy love first and not responsibility. It drives me insane. But as vets we should perhaps educate owners on their first visit? Maybe it is something the pet stores aren’t doing?
@PJ: There is absolutely no way that a person can get through Veterinary school without compassion, drive, and love for animals. It is a constant day to day struggle to give yourself up 100% and still have the energy to remember who you are when you get home. We need to sleep, shower, eat, hug our friends, family, kids, watch our favorite movies too. I am human first, companion second, Veterinarian third. Until you have done after hours emergency calls or watched a patient you give everything to die, you have no right to say anything.
Dr Leon did the best thing he could for that pet. The owner was wrong in giving NSAIDS with steroids. She was “playing” Dr. A little knowledge is dangerous. She had no IDEA what the complications could have been. Here’s where it gets very dangerous: she might not have told Dr Leon the medication she had given. Unknowing, Dr. Leon could have prescribed a fatal medication. Our job is to be an advocate for the pet first, the owner second. The owner was just plain wrong. And the pet will suffer for it.
By the way PJ, how many hours a week do you work? And can I call you at home when I have questions?
September 24th, 2009 - 4:31 pm
hi adam. welcome to the blog.
in defense (kinda) of the client, she did understand the potential risk of mixing steroids with nsaids. the word “prostaglandin” even left her mouth :) but when i explained the dangers of mixing and the low tolerance for aspirin among dogs in general she said “BS! i don’t buy that!”
we take calculated risks in medicine all the time. in fact, most medical decisions come with some sort of risk-vs-benefit analysis. the problem in this case was that the owner used her limited knowledge to prescribe a drug without doing any risk calculation.
September 26th, 2009 - 10:12 pm
Adam: @PJ: There is absolutely no way that a person can get through Veterinary school without compassion, drive, and love for animals.
Say what??? Try that one again—perhaps you need to visit badvetdaily.blogspot.com to aprise yourself of a sampling of those wonderful vets that graduated & became licensed. Better yet, click on my name & gander at my website for awhile—took FOUR bad vets to pull that off on my defenseless pet.
You assume that a nurse has a chip on her shoulder, why? Because she is not an MD? That would be like saying vets have chips in a hospital setting, wouldn’t it?
I have a hard time relating to the work ethics today. Since I am “older” than most, I remember when any medical field person simply felt duty to the job and patients: that included hospital personel, doctors, dentists, and yes siree vets too.
September 26th, 2009 - 11:37 pm
@barbara: i agree with both you and adam. i think it does take a great deal of compassion, drive and love for animals to pursue a career in veterinary medicine. BUT that does not mean that every veterinarian practices with those 3 ideals in mind. there are plenty of bad veterinarians out there (as i pointed out in a previous blog) who are more motivated by financial gain than anything else. and certainly there are physicians who fit the same bill.
i don’t see too many issues with my own work ethic. i work my butt off when i’m at the hospital, and i almost always stay late to get all of my work done. i am without a doubt a workaholic, but when i’m home, i want to be at home, relaxed and enjoying the company of my own pets and loved ones. all work and no play …well, you know how that one goes.
September 26th, 2009 - 11:40 pm
and in defense of any nurses who happen to be reading this, i do have plenty of RN, NP and PA clients who are wonderful people and all-around good clients :)
September 27th, 2009 - 6:43 am
Wow, seems like a good discussion going on here. My two cents for what it is worth….. I am one of those ER vets that Dr. Leon mentioned earlier. I field many phone calls during both day and night- offering as much hands-off help I can. Best type of emergency I see (or rather do not see) is the one that isn’t one (which I find out by getting on the phone and discussing the case with the owner in detail). That being said, there are several good reasons why ER docs are so inclined to tell people “To just come in…”
1. We always want people aware of our interest and availibility to see their pet. We live during a time ad area of exceptional medicine and ability to offer 24/7 care.
2. Regardless of how much info the owner gives about their pet, there is nothing like doing a true hands-on physical examination. Since our furry friends cannot talk to us, unless we truly place our hands on them, who knows what kinda of health or state their bodies are in. The last thing we want to do is tell owners to self-medicate their pets without a visit to either the ER or rDVM just to placate them so they do not think “Vets are only in it for the money.” We went to vet school to actually treat animals, not polypharmacy them over the phone to appease clients.
3. Unfortunately we have to be so concerned about litigation that we have to cover our butts. If it wasn’t for the lawyers looking to fund their multiple summer homes and lavish lifestyles, we would not have to have a disclaimer at the end of every suggestion, recommendation, etc. We might be more inclined to offer some more advice without seeing the pet.
In response to part of PJs post saying that the general practice veterinarian needs to be more reachable/able to see pets at all times: what was left out of this scenario is that during “older veterinary medicine days,” the general practice vet maybe would see the pet. After working their long day, they make that extra effort to see this pet. If it is sick, it gets hospitalized at the practice often without any supervision overnight. How is this better than going to a facility where an ER doctor is not extending their shift just to see this pet, is fresh minded and specifically tailored to addressing emergent situations, AND the pet is monitored at all times? To just dump the pet at the general practice is an antiquated way of practicing. Coming to work in the morning to possible dead animals in the cage is not acceptable.
And lastly……IMHO, people in the medical field in general make the worst patients/clients. That includes MDs, DDS, RN, LPN, DVM, LVT, etc. I include myself in that. How many of us in the medical field do exactly what our doctors tell us? Not many……
September 27th, 2009 - 11:25 am
Dr Friedrich:
“3. Unfortunately we have to be so concerned about litigation that we have to cover our butts. If it wasn’t for the lawyers looking to fund their multiple summer homes and lavish lifestyles, we would not have to have a disclaimer at the end of every suggestion, recommendation, etc. We might be more inclined to offer some more advice without seeing the pet.”
How on earth could you add #3 to your post? Litigation? That is so rare, even today, that it has allowed your malpractice premiums to remain at the paltry sum it is!
Lawyers taking cases to fund lavish homes? Again, lawyers willing to take a pet-vet mal case is extremely rare, because of the lack of “$$$$” to be had!
I wrote a lengthy post last night that didn’t go through.
A brief repeat here: What other profession has no recourse for accountability? What profession allows continued licensure & privacy for the most egregious of acts? Certainly not the human professions, that allow legal suits, sanctions, and loss of employment.
It behooves those of you to finally step up and speak out, because those ‘bad apples’ you have been silent about are dragging on the integrity and causing public mistrust and perception you do not deserve.
I happen to be in a system based soley on the preservation of public trust. The USPS does not hide, shuffle, or tolerate the unethical, criminal, or thievery. It is out the door, full prosecution, media announcement, and no sympathetic ear. Pensions are confiscated for retribution and the public is assured of no “second chances”. Sadly, this principle became so ingrained over my last 22 years, it was naivete and shock to discover otherwise, particularly among highly educated and licensed professions.
It is also fair to say, that what is tolerated may be based on region, and the individual clinics and/or clinicians principles.
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February 7th, 2010 - 9:53 pm
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