Vet P.O.V. How to say no to your vet: Rejecting claims of vet-imposed guilt

Yesterday was a tough day for this vet, news-wise. It was my day off and I’d been working on getting my ducks in a row for next week’s Thanksgiving festivities. Part of that necessarily includes prepping my future posts so that my holiday in New York isn’t unnecessarily fraught with last-minute Internet nightmares. This invariably includes scouring the news, interesting emails and other tidbits that come my way.

That’s how I found this infuriating article from Slate.com (reprinted in part in the Dallas Morning News on November 4th). The writer, one Emily Yoffe, scolds veterinarians for our willingness to impose our aggressive care tactics on pets who don’t need them and/or on pet owners who’d rather go without. Her title? "But, Doc, the dog's already dead. How to say no to your vet."

Floored. Insulted. Disgusted. Offended. There aren’t enough appropriate adjectives to describe my reaction to the news this writer brings us. She cites examples of an Akita owner too shy to decline CPR on his dog’s behalf, unwanted tests foisted on our clients via unethical guilt tactics, and, most outrageously, comparing her own daughter’s congenital heart murmur (for which she’s happy to forgo evaluation at her pediatrician’s behest) with our over-the-top cardiology recommendations.

Too bad she didn’t call me first. I could have clued her in to brain surgery, allergy vaccine protocols and root canals—all of which I’ve seen clients guilted into this week.

Exasperatingly, this person is a pet writer. In fact, she’s written a book on how she became a reluctant pet lover—will the ironies never cease! Note to self: back-shelf that publisher’s freebie. Clearly she has far to go when it comes to understanding the mentality of most pet lovers I know—not to mention the average vet’s position on the subject of client compliance and choice.

Sure, she makes an interesting point as to the psyche of pet owners and how easy it can be to feel cowed by the likes of any professional—especially one who wields a brand of specialized knowledge liable to intimidate the average person. Are there vets who take advantage of their clients’ guilt? Sure, ruthless, manipulative people abound in every profession. Ms. Yoffe’s approach to this issue, however, amounts to a wholesale condemnation of the modern veterinary service industry.

How would she have us offer our services? “I don’t want to make you feel guilty, but there’s this great treatment…”

Vets are trained to offer choices, a list that admittedly gets longer every year—so much so that clients often stop me dead in my tracks to ask: “What’s the best, Doc?” or “What’s the least expensive?” My clients aren’t shy on either front. When they express frustration at their inability to pay for the best (often) I support their choice by referencing “family responsibilities we all have.” Then I conclude with a hearty, “I respect your choice.”

So much for the Machiavellian vet in me.

In her effort to vent her obvious frustration, Ms. Yoffe’s not just wielding a wide brush, she’s brandishing the PowerPainter with wild abandon. Her language suggests that just because we vets have so much to offer, we’re invariably putting our clients in a bad spot. Her view isn’t just grievously myopic, it’s an unfair indictment of the complex and varied multi-expectation environment we have to practice in.

So the next time she decides to write a glib article with pithy observations and minimal references, I’d like to offer her myself as a worthy source. I’d inform her that most vets get into trouble when they offer too little, rather than too much. I’d cite the rising tide of lawsuits we’re treated to when we fail to inform our clients of all their options. I'd point to the legions of pets ill-treated by their owners who languish without care. These owners clearly know how to say no to their vet. And, sadly, they comprise the majority of this country's pet owners.

Finally, I’d invite her to read this blog, where she can get a taste of the “damned if you do, damned if you don’t” realities inherent in practicing modern veterinary medicine.

November 17th, 2007

Add Comment46 Comments

"Don't ever assume your client can't afford a treatment" is what we're being told repeatedly in vet school.

It is a vet's job to offer choices and the client's job to choose what they can afford. I've been in the position where I've been unable to afford a procedure for my pet that I would have liked to have done and I know it can be painful, but that's just the way life is sometimes.

There will always be a limit for most people, whether it's shelling out for a root canal or flying a pet to a specialty hospital for a week of hemodialysis. We do the best we can and hope it's enough.

abc November 17th, 2007 09:10:00 AM

I thought her article was way off. My husband showed it to me a while back. I posted my opinion to it - and read through a lot of the opinions posted. The majority of the opinions I read were that she was full of it. Don't let idiots like that bother you.

Jenny November 17th, 2007 09:12:00 AM

As usual, Dr. K. has hit the nail on the head. While I feel and empathize for pet owners who are unwilling or unable to handle the costs that are associated with high quality medicine, I don't feel that blaming the veterinarian is realistic or appropriate. As I have mentioned before, I don't know any veterinarians who get discounts on supplies, rent, electricity, computer equipment or medical equipment simply because they treat animals.

I think this is just a small part of a bigger problem in our society. We want (demand) that everything be safe and convenient, yet we complain when we have to pay more for that type of service. We get extremely mad at the Chinese for using lead based paint in children's toys, yet we refuse to pay a higher price for an American made toy or we refuse to find ways (i.e. taxes) to raise the monies needed for appropriate monitoring of our imports. By the way, the same argument applies to our pet's foods too!

At some point, the pet owners who feel that the veterinarians are taking advantage of them are going to have to grow up and make a decision. Most veterinarians that I know will offer several "levels" of care to try and help the owners. Example...ideally, canine parvo virus cases should be hospitalized in isolation at a 24 hour facility on IV fluids, antibiotics, and have serially blood counts done routinely. BUT...some pups may do ok on fluids at a non-24 hour care center and, heavens forbid, we have even sent some home on subcutaneous fluids. We looked at the WHOLE ANIMAL (the four legged one in distress and the two legged one paying the bills) and helped to craft a solution that had reasonable chances of success. Not all of the pups that went home survived, but some did. AND, the owners knew the risks going into it.

Anyway...getting off the soapbox now and returning you to the wonderment of Dr. K!

Tomcat1765 November 17th, 2007 09:26:00 AM

I think it definitely depends on the vet and the clinic. My current vet is very good at laying out all of the options and costs, but the last clinic I went to always recommended the most expensive option. We ended up spending about $400 on blood tests and x-rays when one of my dogs had a cold. Of course, I could have said no. Of course, there are definitely times when I want the heroic measures. When my 3yo terrier slipped a disc, I wanted to know that there was a chance that she could walk again. But when my 10yo bully mix had strange liver test results, I didn't want to put him through a biopsy and I'm glad that we took the more conservative approach. I definitely don't agree with the tone of the article, but I do think that if your vet is suggesting too much, you should tell them your constraints an possibly look for another vet.

Jen (SLC) November 17th, 2007 10:31:00 AM

Jen. I'll second your sentiment on the grounds that some practices are naturally geared towards a clientele that wants the best no matter what while others are geared to clients that typically can't afford much at all. Finding the right mix for you in the right hospital and the right vet are half the battle. Letting your vet know that, whether you have a lot or a little money, there's a limit to what you think is a reasonable use of your resources, is the other half. Most pet owners are smart enough. And most vets aren't bullies. When you get the flip side of those coins and put them together...well, that's when you get abused pet owners.

Dr. Patty Khuly November 17th, 2007 10:53:00 AM

This is the same woman that wrote an article about stuff she saw at the exhibitor's hall at the AVMA annual conference as if the AVMA annual conference was nothing more than a giant marketplace and served no other purpose. I can't take anything she says seriously, and I feel sorry for the pets she so reluctantly loves.

Julia November 17th, 2007 10:57:00 AM

We used to go to a clinic that had several vets. I dreaded getting the New Vet. She was always wanting to use the newest drugs, newest this, newest that, regardless of whether the old this or that was up to the job. I am not cheap in regards to vet care but I would prefer to reserve new expensive treatments for when the old treatment is not working, or when the new treatment is definitely superior to the old. Often the expensive treatment was presented as the only treatment, and it was like pulling teeth to get her to actually lay out all the options. This vet reminded me of those people who always have to have the newest, fastest computer model, and she was pushy about it. I can easily see a less savvy pet owner being intimidated by her into spending more than was necessary or their budget would allow.

Nightmare November 17th, 2007 11:24:00 AM

One of the things that consistently amazes me here, no matter the topic Dr. K addresses, is how many pet owners/guardians give their vets a hard time about the care of their animals. When I first started reading these posts, I was shocked, and now I'm just deeply sad for the pets.

Part of considering adoption is reviewing your finances and considering if you can afford most of the reasonable costs associated with it, particularly those treatments that you know come with old age of your cat/dog. If you are going to nickel-dime your vet over every blood test, pain med, or exam, maybe your priorities need to change.

Let's state the obvious: I, and many pet guardians, are *not* veterinarians, or even vet techs. We can't pretend to have the knowledge that they have, and must rely on them for advice/expertise. That doesn't mean we blindly nod and hand over the credit card. It does mean as responsible people that we get a decent book on pet health, read up on our pet's particular health issue, and then confer *with* the doctor on the options. Can you say partnership? If you haven't done your homework as a guardian, then I don't think it's fair to just accuse the vet of taking advantage. Maybe your pet does need that expensive test in order for the vet to gather the necessary information in order to treat him or her. If you honestly can't afford it, that's understandable, but if you don't trust your vet or don't want to spend the necessary dollars because it's "just" an animal, don't be surprised or blame the vet if your cat or dog suffers.

My husband and I just went through a long, three year season of illness with our cat. Our vet was absolutely the best there was for him. At every step, she discussed options with us, and when the cat became hyperthyroid, *we* asked her if she'd be willing to coordinate the pricey radioactive iodine with the local clinic, as opposed to the regular Tapazole pills she was going to prescribe. I'd read up on hyperthyroidism and for our particular cat, this truly was the better choice. We've since adopted another cat, also hyperthyroid, but for her, the pills are working fine. By doing the homework beforehand, I was prepared for the typical tests required, risks of different treatments, and could ask intelligent questions. Wouldn't you do that for any family member?

I'm sorry to get on my high horse, but I am angry that this writer took this attitude. She has a responsibility as a reporter to be careful what she says and how she says it, and clearly she failed to be objective. Yes, maybe there are some vets who take advantage, but most of them are doing the very best they can, and should be applauded for that.

Debby November 17th, 2007 11:41:00 AM

Although I agree a vet should lay out all the options, I am actually thankful that my vet is up on the newest/latest stuff. Some examples:

When she does dentals, I like the fact they use a digital xray machine. For one cat this pointed out an early stage FORL that needed to come out and another cavity too. For another it showed that what looked like a FORL wasn't one so she cleaned up the area, cut back the gum some and the tooth stayed.

I like the fact that she is aware of the TAMU protocols for Cobalamin (B12)/Folate/PLI/FLI tests as well as giving SQ B12 injections. I have an IBD/pancreatitis cat and the tests are good tools in evaluating malabsorption or an aid in diagnosing pancreatitis. As a member of a feline IBD forum, I am suprised on the number of members that are educating their vets on this! And SQ B12 injections given as TAMU indicates has helped many cats on the forums, regardless of whether they opt for the TAMU test or not.

I like the fact that she has done some research on SAMe (denamarin) being used for pancreatitis. We are not sure whether we will use that treatment or not yet, but I am glad she is presenting it as an option.

I like the fact that she suggested Mirtazapine for my cat when he had a flare up this past summer. I'm not sure how new this treatment is, but I believe it is not as widely used as Cyproheptadine. My cat responded very well to Mirtazapine, receiving a very small dose one time per week over 4 months (the typical dose is two times per week).

So, back to the point...I think the vet should present ALLl the options, including the latest and newest, as well as the old options.

Jenny November 17th, 2007 11:42:00 AM

Hi Debby. I agree pretty much with what you say. We as pet owners have an obligation to take care of our pets and provide the best care as financially possible. I know someone though who just does not take proper medical care for her cats. For the most part they are healthy, although one mysteriously went blind. Recently they all her cats got a virus and she was very slow to get care for them. Because the cats aren't vaccinated, all three got the virus and it lasted for about 4 weeks. (I know vaccines are another topic). I keep telling her she should do routine screening for her cats (CBC, urinalysis, blood chemistry panel) - but I know she never would. What really annoys me is she does all this stuff for her dog 'because he has such odd issues' but not her cats! One of her cats routinely urinates outside of the litter box too.

Now here is my point...although I think she is not giving them proper medical care, the cats overall are in OK health, even the one that went blind. If she gave them up I am pretty sure they would be put to sleep. So, sometimes in some instances poor care is better than death as long as the cat isn't in pain or suffering.

Jenny November 17th, 2007 11:50:00 AM

I wouldn't line my litter box with that article and truthfully I find it disturbing that someone would have to be persuaded to see the value in loving an animal anyway.

Part of the solution to not feeling pressured, imo, is having a good, long term working relationship with your vet so you know what to expect from them and they know what to expect from you. Mine know me and know that I am willing to spend whatever money is necessary IF there is hope of restoring them to a comfortable baseline. Yes, I have coughed up over $2,000 in one sitting on my very old dogs teeth. When it comes to extrordinary measures however like amputation for osteosarcoma we will decline and instead go for palliative treatment. I appreciate my vet for presenting it as an option but also know enough about that nasty disease to know the end result is always the same.

Also as with human medicine you need to be your own advocate! This means taking some responsibility and doing some research youself to make sure you are comfortable with the choices. Believe me I know this is difficult when faced with a life threatening crisis but still necessary.

Jules November 17th, 2007 12:01:00 PM

I'll be the lone soul who will say it...

I think a lot of vets use guilt or their position to wrestle unknowledgeable owners into performing tests, giving meds, etc, etc, that are not necessary. At least in this town- I do.

I've been a vet tech, albeit a fledgling one, I've been on the rescue scene for the last 10 years now (Oh, I'm getting old), and I've dealt with everything from newborn kittens to exotics most vets won't touch with a 10 foot pole.

My advice to people- whenever I see them, glowing with the love of a new puppy or kitty, "GET A VET YOU TRUST". Period. If you don't feel like you can talk to your vet- go to a new one. If your vet takes your pet to the back for exam/vaccines/the words- and you aren't comfortable with that- get a new one. If your vet talks down to you- get a new one. If your vet does not answer your questions- get a new one. If your vet is trying to foist procedures upon you without properly explaining the pros, cons, and everything in between- get a new one.

*Smile*

There are enough vets in our town that you can afford to be picky. I AM PICKY. Yet, I have three vets I love- one for my exotics (he is clear across town), one for my cats/kittens (she works at a top rate vet hospital and I adore her) and one for my dogs (although I use my cat vet for my dogs too, when anything serious occurs because I despise the head vet at my dog vet's hospital- confused yet?). But I'm picky about my pets' care. I also know when to say no and when to say go ahead with procedures.

I'll go read the article. And I'm sure it will be vile and one-sided because you, Dr. K, are the type of vet I'd love to bring my animals to. While our opinions might not be the same on every topic (like my exotic vet wants me to feed canned food to my exotic- I feed raw), you seem willing to listen and to learn. THAT IMHO is a sign of a brilliant vet.

Enough blathering :D

(PS- I also advocate owner education. PLEASE, know your breed of dog/cat. KNOW issues that go along with the breed. KNOW about pet healthcare and if you don't know- ask questions or if you are too shy to ask, go online and read, check a book out at your library, etc. There's no excuse for utter ignorance when it comes to pet owners and their OWN pets!)

Trish November 17th, 2007 01:25:00 PM

I am also a vet. My two cents: If you decide not to do the best reccomendation for your animal, that is no problem. Just don't blame ME for offering it.

I have to be an advocate for the animals, and I have to give the owners the option of the best possible treatment.If you can't, that is fine!!! We will try plan B. The only option of care I am opposed to is one that leaves the animal in pain or suffering. Can't afford a $3,500 root canal like one of my clients just had done? Just let me know and we can choose extraction as another option.

Don't just get mad at the vet or blame the vet--tell them your feelings and they will be glad to discuss!!! I know I would!

Sarah November 17th, 2007 01:45:00 PM

Trust me... Pet writers get to be pet writers because they are good WRITERS, not necessarily knowledgeable, or even GOOD, pet owners. Problem is that once they get published, they're generally viewed as "experts" in pets, not expert writers. The ignorance I've witnessed about everything from husbandry to health to breeds and breeding and (God forbid) training in pet articles is usually anywhere from disgusting to downright alarming.

There were so many things in this article which I found alarming it would be ludicrous to comment on them all. Let's just say that her comment about "... One is the increasing acceptance of the notion that pets are family members (thus the movement to change the word owner to guardian). ..." shows how ignorant she is about the state of animal ownership today. (The term "guardian" is something being pushed by PETA and their ilk, whose ultimate goal is to be able to a.) endow animals with human civil rights for the purpose of b.) enabling themselves to be able to remove our pet animals from our lives without the fuss of DUE PROCESS OF LAW. That in itself disqualifies her as an animal expert, in my opinion.

I mean, look at the lead story - her friend A comes home to discover her dog in RIGOR MORTIS. First thought: "Let's go the vet!" DUH. His remark to the vet: "I think my dog is dead." Uh, yeah - what was your first clue? My question would be, "And what would you like us to do about it?" But when asked if he'd like them to do CPR, rather than volunteer that the dog had been dead for at least an hour (more, if the dog really was stiff), the friend agrees.

How dumb is that? Whose fault was that? The author intimates several of this guy's thoughts, including that he wanted to tell them the dog had been dead for an hour and wanted to know how much CPR would cost. Really - the guy should have saved his $250 and invested it in a course of assertiveness training. I'll just bet his relationship with his vet isn't the only one in shambles due to his lack of communication skills.

Stupid is as stupid does, they say.

Tracy D November 17th, 2007 02:05:00 PM

I suppose that lots of people pay attention to Yoffee, but you shouldn't. If you do a search on her columns, you'll find that, even before her book was published, she wrote a column on how she dumped her dog because she and her family were too busy for it. Too bad she hadn't thought of that beforehand.

Margot November 17th, 2007 02:24:00 PM

I wonder, Dr. K, if you know that Ms Yoffe is contactable via email. I appreciate, respect and agree with your well argued stance on this topic and think you should send her a link.

Shannon November 17th, 2007 04:13:00 PM

Emily Yoffe has another lovely article titled "Why I Killed My Cat" which is about putting her cat to sleep when it repeatedly urinated in the house and several other articles dedicated to her gripes about her animals. Her sole purpose as an "animal writer" seems to be making true animal lovers angry.

Lisa November 17th, 2007 04:25:00 PM

Lisa, I was going to mention Yoffee's "Why I Killed My Cat" article; glad someone did. I am still sickened when I think of that article. You know, I had some sympathies with her upon reading it, but all in all, her writing it was more an attempt to justify her behavior than to impart any information.

Rita

Rita November 17th, 2007 05:28:00 PM

Anyone wanna volunteer to be HER vet? Yikes!

Marie November 17th, 2007 06:23:00 PM

As so many of the commenters both here and on Ms Yoffe's diatribe have said, it's all about choice. I don't want to die of something treatable myself - so I see a psychiatrist and take anti-depressants. Expensive? Yes. Likely to kill if I don't? Yes. I apply the same standards to my pets, and to the human members of my family when possible.

I work in a "high-risk" field for rabies, yet I choose not to have the pre-emptive rabies shots myself - not only because of the cost, but because of the pain/discomfort involved. If I get bitten by a probably-rabid animal, I will have the post-exposure treatment at a higher level of both pain and cost. Hasn't happened yet, in more than 3 years. Yet I keep my anti-tetanus shots up to date, because of the higher likelihood of getting tetanus from all sorts of sources. With a young animal, I happily pay for all the vaccinations and preventative shots because they are at a higher risk. After that, I choose not to vaccinate yearly - having discussed that with my vet. When I adopted a dog who might have been exposed to parvovirus, I vaccinated the whole family immediately.

If I think back over the last 30-odd years of vet treatment that I remember as being available to the family pets, the same period of human treatment, and the options that have been available to both, what I can give to my cats and dogs has progressed far more than what I could offer my parents if/when they have similar ailments. And, above all, I can offer my pets a pain-free death with dignity before it costs us all our home...something that is very seldom offered to us humans.

I want - and can afford - the best care for my pets. Along with that, I want my vet to advise me on what she would do for her own most-loved animal, taking into account all the quality of life, probable outcomes, impact on the rest of the family factors. I don't feel bad about refusing radiation for my sweet big-dog after he'd had a mast cell carcinoma. But I would be bitterly resentful if that option was available and my vet didn't offer it to me. I didn't want my Twiggy dog to die from advanced lung-cancer a month after I adopted her - but when it was diagnosed, I was glad that we could know what was wrong, and euthanase.

As a wildlife rehabilitator, I am opposed to the term 'guardian' being applied to our pets. For better or worse, humans are the dominant species on earth. As such, we should view ourselves as guardians of the planet for all of us - human, pet, food source and wildlife. We need to accept that responsibility along with the benefits we assume so easily. In Ms Yoffe's case, she is happy to watch her cat die slowly. She is happy to ignore her child's heart murmur. She is happy that she can "save" her dog, yet not treat the orthopedic injuries. I guess for all of us, it comes down to where one draws the line between dollars, the care/knowledge available, and the honesty to acknowledge that what you are choosing to do is NOT what is either right or 'caring'. Just don't try to make anyone else assume guilt for your personal choices.

jcat November 17th, 2007 06:29:00 PM

OK I usually agree with everyone here....maybe I am a tad cynical and jaded...
I thought the article was hilarious.... Is she an educational writer, or does she write to entertain? She reminded me of the late Erma Bombeck. or even Bill Cosby...who used to say he brought his kids into the world and he can take them out. It struck me more as creative license.... I thought she was exaggerating her stories to get a laugh. I mean, does anyone here truly believe someone would take a stiff dead dog to the vet?
I agree that SOME vets are exactly what the article is about--OVERKILL. But they are a small minority. But good vets aren't good copy...same reason you never hear the stories about GOOD pitbulls... you only hear the hype that sells.

If I thought this writer was trying to educate me, I'd have to say she's focusing on one tree instead of the forest. But truly-- I thought she was intent on a humorous, exaggerated, cynical article.

And trust me....my babies are my babies....not livestock. But I see the humor in what I believe is her story she is telling.

AGADORE'S MAMA November 17th, 2007 08:14:00 PM

Christie wrote about this piece over on our <a href=http://www.petconnection.com/blog/2007/10/27/veter...> Pet Connection blog</a> a while back.

Gina Spadafori November 17th, 2007 09:41:00 PM

The woman is an extremist. I'm glad that my vets perform full exams on my pets. I'm glad that my cat was referred to a cardiologist when he developed a murmur. Most clients aren't shy about refusing services that they find too expensive or unnecessary, and a good clinic gives the client an estimate of the charges. The times are hard for many economically and it's tempting to lay blame haphazardly. The best care comes with many options and an expensive pricetag. We can always say no, but the lives of these family members are too short in the best of circumstances, so many of us choose instead to try whatever we can to make them healthy again.

P.S." If your vet takes your pet to the back for exam/vaccines/the words- and you aren't comfortable with that- get a new one"?!? The back isn't a torture chamber! Many nervous pets do MUCH better without their nervous owners watching, and we are trained to hold in a way that no one gets bitten. If you trust your vet and the staff, you should not be afraid for your pet to go to the back for a few minutes.

Sarah November 17th, 2007 11:11:00 PM

THANK YOU. I like Emily Yoffe as Prudence but that article was ridiculous. Beneath Salon, really, which is a shame.

They should let you pen a rebuttal, for reals.

Cassandra November 17th, 2007 11:53:00 PM

'I regret I couldn't make Goldie happy, but since he's been gone the feeling of dread I lived with for years has been lifted. My other animals are a joy. I'd even say since Goldie's demise they've been on their very best behavior.'

this woman is the little abortion that got away

charit November 18th, 2007 05:38:00 AM

That article has to be one of the better examples of shoddy journalism I've seen lately. First off, her vet source is a man who is only allowed to operate on a limited license due to a lack of oxygen in the clinic, no presurgical exams, etc.
She also seemed to completely remove the client's responsibility from the situation. As a vet, you are responsible for presenting the best course of treatment (the Gold Standard of sorts) regardless of your impression of the clients ability/willingness to pay. Not only is it good practice in terms of offering the best medicine, is also good practice in terms of the cover your rear theory of life (especially when documenting treatments that are offered but declined) As a client you are responsible for weighing the cost and deciding if you can afford that, then asking about alternatives. Yes it may be possible to treat Fluffy's CRF and extend his life, but do you want to put him through it? As the owner you know your pet best. Will the treatment be worse than the disease (the inevitable wrestling the cat to give pills, etc).
Placing all the responsibility on your vets shoulder is a cop out. It should be an open dialogge between vet and owner. If you feel bullied, find a new vet.

Alli November 18th, 2007 08:46:00 AM

Here's a fellow pet writer weighing in (that would be me, who feels like she's never going to know enough about animals)...

First, I'll point out that Slate likes to get in your face--Jon Katz and Emily Yoffee are NEVER going to be feel-good writers. Than, I'll repeat Christie's excellent questions:

"So my question to all of you is not, how far would you go? My question is this: How much information do you want about what can be done?"

My answer would be: it depends on the vet who's telling me, and how he or she's telling me.

The place we used to go to had apparently studied at the Advanced Graduate Center for Panic and Guilt. It was clear, as we cycled through different vets, that they had learned to tell us the worst case scenario first, and encourage the most expensive treatment. It was sometimes a subtle thing, sometimes a not-so-subtle thing. Is that a crime? No. I have some sympathy for these folks (their rent is unbelievable, they also housed a homeless man's dog on cold nights for years, they do animal rescue), but not enough to stick around.

The place we go to now, the vets take extra time to empower me. Starting with the head vet, they slow down, they explain carefully. If there's anything we can do to help our dog's health, as owners, they let us know. Here is the difference: They are calm and thoughtful, and they give us space to make our decisions. And I am sure that their rent is even more unbelievable (Manhattan, anyone?) than our old vets'.

The options for great care are multiplying. That's good news. They're sometimes expensive. That's not good news. If you are my vet, I want you tell me the options, and the price, and as much as possible, leave the guilt and the panic out of it.

Martha Garvey November 18th, 2007 08:56:00 AM

Since I wrote this I've been feeling more and more like I've been had. Could Ms. Yoffe's article simply be a giant joke in tremendously poor taste? Her primary source, one Dr. Busby, turns out to be not just a self-described "curmudgeon," but one whose practice has also been censured by his state board (that's not an easy feat, in case you're wondering). Here's a link to his protestations:
http://www.oldcountryvet.com/newsAndUpdates.html

Dr. Patty Khuly November 18th, 2007 10:47:00 AM

I grudgingly admit to having a vet very much like Dr. Busby - older, curmudgeonly, and quite upset about the direction in which the field of veterinary medicine is heading. I consider him an invaluable resource. I like having two different "styles" of vets - one is clinical and high-tech, the other is pragmatic and almost do-it-yourself. Each make the other type shudder, wince and scoff and scream "How can they get away with this?" Both have taught me much, both have saved the lives of my animals, both have alarmed me beyond belief. Each has their place. I'm grateful for the two approaches. Unfortunately, my old country vet probably won't be practicing much longer - recently diagnosed with Alzheimer's. IMHO, it will be a tremendous loss.

Hmm... perhaps an examination of the different styles of veterinary practice would make an interesting blog entry, Dr. Patty...

Tracy D November 18th, 2007 11:42:00 AM

Sarah, I'll defend my stance-
My quote, " If your vet takes your pet to the back for exam/vaccines/the words- and you aren't comfortable with that- get a new one"

Your quote, "The back isn't a torture chamber! Many nervous pets do MUCH better without their nervous owners watching, and we are trained to hold in a way that no one gets bitten. If you trust your vet and the staff, you should not be afraid for your pet to go to the back for a few minutes."

As a regular Joe Blow walking in off the street, I don't KNOW you. I have no BOND with you. I don't know anything about you except you are the vet who is supposed to take care of my pet.

When you whisk away said pet to the back to get his exam and vaccines- I don't see how you handle him. I don't know what's going on in the back and while, hopefully, it's benign- I have no way of knowing this. I wouldn't allow my 2 year old son to be whisked away by the pediatrician- I surely won't let my animals be whisked away by a stranger without my consent (and given that I DO know what can occur in the back of a vet hospital- namely a Cocker Spaniel puppy who was shy being strung up by his leash until he crapped himself by a head vet- I'm even more leery then Joe Blow).

You are trained to hold a pet- correct- but you can hold that pet in the exam room with the owner present, in most cases. Now, there are the few that put up such a fight that it's best for everyone involved that the animal be removed from the owner, but for the most part- you can give vaccs and full exams with the owner present.

Trust is built through a relationship with your vet- not simply by walking through the front doors or any given vet hospital.

I stand my ground- if as an owner, you are not comfortable with the vet taking your pet out of the exam room for shots and the vet refuses to do the vaccines/exam while you are present, you need to get a different vet. We are not talking about special circumstances- we are not talking about the cat you cannot even touch without risking losing an eye- we are talking about vets who routinely remove every pet from the room for exams and vaccines. It's not necessary and if the client is not comfortable, they should be more then willing to perform those services in front of the pet owner.

Trish November 18th, 2007 08:46:00 PM

My vet always does the exam and vaccines with the owner in the room. They do take the cat to the back room for taking urine or blood typically. I prefer to be in the same room, and in fact we sometimes help to hold the cat to make them less stressed. I don't think I would be comfortable either with a vet that does the whole thing in the back room. There is typically quite a bit of back and forth with the vet while she does her exam. I think it builds a much better relationship as she can tell you what she is finding while she is checking.

Jenny November 18th, 2007 10:27:00 PM

i'm in my final year of vet school - and so, when i found this article posted on VIN, i actively tried to take myself out of that mindset and sympathize (if not empathize) with the author. however, by the time i finished reading the article, i was sickened. i'm glad others are as offended as i.

homeless parrot November 18th, 2007 11:47:00 PM

Tracy D: I work with two older vets. One has a very progressive style in terms of technology. The other is more basic and pragmatic (sort of like your curmudgeonly vet but in no way like a Dr. Busby with no X-ray and modern anesthetic setup) but progressive thinking on holistics. the two different practice styles are not completely incompatible but it has nonetheless been a source of stress and tension in this place for years. I don't tend to write about it because it's a bit of a raw nerve in my place of work. Hidden among these comments I feel like I'm a litle safer (I don't want to offend anyone or pick sides) but it's still a tough issue for me to tackle.

Dr. Patty Khuly November 19th, 2007 09:00:00 AM

Tracy D: By the way, I've learned a lot from both. I can't say theat either one has been any more of a mentor than the other. And that says a lot about balancing styles and how different ways of practicing your art and science can be equally valuable to the next generation.

Dr. Patty Khuly November 19th, 2007 09:02:00 AM

Thanks for the reply, Dr. Patty... I understand. And I sure wouldn't want to be in the middle!

Maybe someday when you find yourself in a different situation....

Cheers...

Tracy D November 19th, 2007 09:17:00 AM

Please, let us not contribute to the enthusiastic endorsement of yet another damaging false dichotomy here. Here is an assortment of facts and experiences from my own life, after 40+ years of loving, taking care of, making difficult decisions about, and losing (from a variety of Partially-Treatable, Completely Untreatable, and Impossibly-Expensive-to-Treat conditions), many remarkable and greatly beloved cats.

Some of my cats died years ago of things that were not treatable at the time.
Some of those are treatable now, but would cost so much I could not possibly pay for them; some still aren't treatable; some are but would mean a regimen I would not care to put an animal through regardless of cost.
Some of my cats have been saved, or kept alive for a long time, by treatment that was a stretch for me financially, but I made the sacrifice because it made sense in terms of what I could reasonably do, financially and so far as care and nursing required.
I may not have the same views of what should or shouldn't be done for/to an animal as the vet; this doesn't make either of us intrinsically Bad.
I once had a vet who was a very good vet, but whose practice I left because ABOVE ALL, he would ALWAYS not just inform me of the existence of, not even just recommend, but practically insist on, THE most expensive option available for EVERY condition presented to him.
The vet I see now is good at letting me know what options are available, and at communicating about things I might take into account in making decisions. He's willing to consider my well-being, the cat's well-being, the possibility (and likelihood) of success, and even what constitutes success, in his counsel to me. He doesn’t try to influence me to treat a cat who has already suffered a lot and probably won't ever really improve in any significant way, just because a treatment exists.
I could go on and on. Like about my Mother, who died recently of Parkinson's after many years of suffering. That one would be a book. Could she have been "pulled through" that last illness, had we decided she should go to the hospital instead of staying in her own room, to be comforted to the best of our (and Hospice's) abilities until she died a week later? Possibly. But "pulled through" into what? More suffering and a continuing life of being able to do nothing at all, of pain, of increasing dementia, and so on? Why?
And so sorry, you may assume if you wish that I must not really love my cats to say so, but after all we went through with my mother, I will say it: cats are NOT human beings. I will never make decisions about them in exactly the same way, with the same considerations, as I would for a person. And even with a person whom you love above all others, there is a time when doing all that CAN be done becomes a travesty of love. A denial of death, not a reverence for life.

None of these facts, alone or in any combination with any other ones, leads me to the either/or conclusion that I must be either a) Willing to seek a second mortgage on my house--or lose it entirely--to treat absolutely any condition, expected to be fatal or not, and without regard to either the suffering entailed to the animal or its age and previous medical history, to the ultimate degree and expense possible given all the advancements in veterinary medicine available, both locally and in far-away places; or b) I am a thoughtless, heartless, irresponsible, unloving, degenerate jerk who doesn't deserve to have any animal, no matter what its fate might otherwise have been had it not come into my admittedly resource-limited home.

The article cited may have been ridiculously extreme, but that doesn’t mean there aren’t vets who do use emotional manipulation of clients not for the benefit of the animal, but of their own financial well-being. There are. That should make a vet with more integrity and compassion angry at those vets, not at the person who points out the existence of such tactics.

And to close an already-way-too-long post, I’ll just say that anyone who thinks people unable to spend thousands and thousands of dollars on all the readily-available, high-tech tests and treatments out there should be barred from having a pet, be prepared for millions more unwanted and homeless animals.

Judy November 19th, 2007 01:06:00 PM

My sentiments are similar to Judy's.

If my pet had cancer or a brain tumor, I may be able to afford to spend thousands of dollars to treat my pet, though I would have a hard time justifying it morally. Billions of people live in complete poverty. In most US cities there are homeless youth. I feed my dogs high quality kibble and locally grown grass fed meats, they get plenty of exercise and quality vet care. I am comfortable with that, though I know I spend more on them then some very poor families in poor countries live on, because I want healthy, happy furry friends.

Still, I like to donate money to groups working to improve the world. If my pet develops a complicated chronic illness, I may choose pain management and eventually find another pet in need of a new home. Unfortunately, we live in a world of finite resources, and decisions have to be made. A friend told me choosing whether to save her pet or her child would be a difficult choice. That would not be a tough choice for me.

I hope people think these things through before the time comes to make a decision. It is too bad people feel guilt for making different decisions. People should judge themselves, and help others, not judge others for making different but well considered decisions. Life is tough enough.

Erich Riesenberg November 19th, 2007 02:39:00 PM

BTW.... I worked at an overnight emergency clinic for 8 years as a receptionist. Having people bring in animals that were really, really obviously dead was not that uncommon.
Although 90% of the practice was emergency treatment (and as the receptionist I needed to often make the snap decision to interrupt the vet to assess the new patient right away)....I don't recall any of the vets ever being nasty to someone whose pet had obviously died as it was being rushed to the vet, or of them ever treating an animal that was very clearly way dead.
But there were a good few that I really wished we could bill for their idiocy - and the presumption that we were just as dumb. As in...the ones that made it clear that they were not there by choice, that brought in animals that had gone past rigor by a good few hours but who insisted that the animal was 'fine until you made me fill in that form', and a few more kind-of-obvious categories. Although we didn't ever, sometimes it would have felt like just rewards to hit them in the wallet when their hearts were clearly not involved.
Not saying that there aren't opportunistic vets around who do charge for unwarranted treatment (and I have had experience with a couple), but I reckon they are far less common than the many vets I know who will tell the client compassionately when enough is enough, and it's time for Fluffy to be helped to go peacefully.

jcat November 19th, 2007 05:18:00 PM

IN MY OPINION ONLY MYSELF CAN GIVE ME A GUILT COMPLEX.
I'M IN CHARGE OF MY FEELINGS. PRIDE IS WHAT MAKES GUILT COMPLEXS IS WHAT I TELL MYSELF.
MY VET IS VERY CARING LIKE MOST VETS. THEY LAYOUT THE OPTIONS AND I'M TO USE WISDOME.
I DON'T KNOW OF ANY VET THAT IS A VET SO HE CAN BECOME RICH.

CAROL FITZGERALD February 2nd, 2008 03:25:00 PM

Her article shows no proof that the vets pressured anyone into getting treatment for their pets. The medical advice was given and it was up to the pet owners to decide 'yes' or 'no', or ask if there isn't a less expensive or easier way.

When my dog was diagnosed with cancer and needed a major operation to remove her uterus and the huge growth on her chest, I told the vet I couldn't afford the $1200 bill. He kindly gave me the option to pay in 3 instalments. Surely, any vet would be willing to help their clients in such situations, especially if they have been their clients for many years.

My vet is great. He's given me options in the past. We'd try the less expensive option first and go through the list until a solution was found. Unfortunately, this time there was no choice but one other than to put her down. My vet truly cares about the animal. In the case of the person who balked at the vet's suggestion of providing CPR, it's evident to me that he was willing to do whatever he could to try to save the life.

By the way, we only have her word that the dog was stiff as a board. And if the owner felt so positive the dog was already dead, why did he approve the treatment? In all my experiences with vets over many years, I've always received the best advice with options. Her article discredits vets and their dedication to saving pets' lives, even if it's only for a few months. It's up to the owner to make the ultimate decision and not blame the vet for giving them that option.

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