Vet P.O.V. Follow-up appointments and veterinary client responsibility...to their pets

April 7th, 2008  

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Well, I have a few things to say on this. (Are you surprised???)

1. Although most really besotted pet parents take better care of their pets than themselves (in terms of making sure they get routine screenings and prompt care), I would place missed followup appointments in context. What percentage of our own follow up appts do we humans miss? A lot. I'm afraid its a bit of human nature that when the perception of crisis is passed, we slack off. A lot like the person who feels better and therefore stops taking the antibiotics.

I am not making excuses for this -- I think perhaps its important to try to get it into a clients head what the consequences for not following up would be for their pet. Especially if their pet seems recovered, they probably don't "get it." As bad as it is (10%) I bet you these same people are running about 50% when it comes to their own follow up appts.

2. Re:

"Consider the case of the Tennessee shelter vet charged after video footage of his intra-cardiac euthanasias surfaced. Though I’d argue this vet deserves a professional defrocking (not forthcoming, I’m afraid), "

That I think that was the point. These people are allowed to continue practising and they shouldn't be. People who abuse their pets should NEVER be allowed to have pets again, and vets who are cruel to animals should never be allowed to practice again. But in both cases, that's not what happens. And it is a shame. Shame shame. We have to all work to change that.

However, I wouldn't equate missing a follow up appointment with giving heart shots to unsedated animals. Not in the same ballpark of uh, cruelty. I don't think the former is necessarily cruelty per se, although it is negligent, and the degree of negligence varies depending on what the followup appt. is for, how the pet is doing, and how serious missing the followup could be. What Baber did isn't negligence, it out and out cruelty.

3. I really notice that your clients have been getting on your nerves lately. Are you aware of the trend toward "bad client" posts lately? Stupid clients. Cruel clients. etc etc.

I'm sure these people exist, in droves, it comes with the territory of your job. But they seem to be getting to you big time lately, and my fear is that it will color how you interact with all clients. They will walk in the door and you will look at them and say:

"OK, which one is this? The stupid variety, the cruel variety, the deadbeat variety, etc etc etc."

I think perhaps a REAL vacation is in order. Veterinary retreats and meetings don't count, no matter how luxurious or enviable the locale.

Stefani April 7th, 2008 03:17:00 PM

Oh one more thing:

On the topic of Baber, he's not the only vet who gives heartshots to unsedated animals.

In North Dakota, another vet did this -- in front of a client. The client was so disturbed hearing her cat cry out as the vet moved the needle around trying to get the right angle on the heart, that she of course, reported him.

What is most disturbing is that in their findings, the board said that the vet needed to
come up with a "written protocol for in-room euthanasia with the owner present that meets
the minimum standard of practice" -- the implication being, there is nothing wrong with doing this so long as the owner doesn't see it. Or, the standard of practice only applies when there are witnesses.

Links:

http://www.vetmed.state.mn.us/portals/22/FoeltzOrd...

Stefani April 7th, 2008 03:30:00 PM

Garden-variety ignorant people shouldn't own a pet. If you have to bring it in for a re-check, then you need to do it, and if something comes up -- call in and reschedule. It's really not that hard. Same for people that miss their own appointments -- the smallest change in something can initially be catastrophic to your body and it's complicated systems. Even a small infection can poison your body.

ashleigh April 7th, 2008 03:45:00 PM

Stefani - as someone who deals with people on a daily basis, most folks are idiots who couldn't find their own bums with aid of a flashlight, mirror, and map. You add a little stress into the equation, and stupidity seems to increase exponentially. I'm constantly amazed by the lengths some people will go to, lie, cheat, etc, to cover their own rear's when they know they are in the wrong.

I've got no empathy for excuses with people neglected follow ups, esp when they are already paid for. I've got a busy schedule too, but when it comes to the health of my pet I make the time. It's called being a responsible pet owner. There's really no excuse other than sheer laziness and/or negligence. If you can't take the time, then you shouldn't have the animal in the first place. From my gleaning of this blog, Dr. Khuly is far more accommodating and considerate than I would be willing to be under some of the same circumstances.

Chip April 7th, 2008 04:01:00 PM

I'm going to have to comment as a two-parter, because I am bring my elderly Dottie for her 3rd or 4th "recheck". I can't agree with you more that a recheck is important for certain conditions. According to the news, this man claimed that he was not told to bring the dog back for a recheck. The news never did a follow-up on this story.

Do I think that "veterinary cruelty" is rare? Well, I certainly hope so---I was very unprepared to deal with an obvious "pre-planned" scam in my state of grief and helplessness. This amounts to the lowest of lows, over a hopelessly dying pet. Did I expect my dog to be euthanized in an inhumane fashion? He-- no! It is against the law, unethical, cruel---how many other words are there? Did this clinic inform me that they do not possess a schedule 11 license?? Who would ever go to them for anything??!!

Every vet in this entire country knows about the clinic I refer to, unfortunately, not every potential client is privvy to the same information!! And I am willing to bet that a lot of techs and support staff know like-wise.

If the subscribers are curious and doubtful, I can only say this: #1 , though not "rich" by anymeans, I have assets worth losing #2 I drive around with "signs" on my vehicle & in front of my house #3 I have blogged, posted, published everywhere I can think of

gotta run----appointment--

Barbara A. Albright/New Hampshire April 7th, 2008 04:18:00 PM

Stefani: I'd love a vaction! Have a time-share in Costa Rica you'd like to offer me? ;-)

Dr. Patty Khuly April 7th, 2008 04:28:00 PM

Dr. Khuly, re: Costa Rica. Don't I wish! :)

Stefani April 7th, 2008 05:00:00 PM

Dr K wrote: "We vets have to be compassionate towards owners who don’t always completely understand us..."

Yes, and I'd like to point out that it might be helpful to stress the "no fee for the follow-up" when it applies. Sometimes clients presume there will be an additional fee, and sometimes that's a factor.

M April 7th, 2008 05:26:00 PM

Barbara and Stefani need to let go and move on with their lives. The entire veterinary community is not out to kill their pets just for the fun of it.

Sheesh.

Snoopy April 7th, 2008 07:31:00 PM

There is a charge for the follow-ups I go to.

I shouldn't have taken this "personal", just because it was my statement. The subject addresses the difference between a pet-owner, who may be :stupid & clueless, of limited funds, or uncaring. The veterinarian is :medically educated, experienced, bound by ethics & law, and licensed by the state as a "privilege".

Sort of the difference between parents with morbidly obese children and a pediatrician prescribing the wrong treatment ---like "feed the kids 3000 calories a day" to solve the weight problem.

I don't intend to "vet bash", I've named numerous good and successful examples. Over the course of 30 years, I can name dozens more--- and have never, never had an animal inhumanely "euthanized".

For a while after this incident, I seriously considered not going for vet medical care at all. But that would have made my remaining dogs suffer---I would have been just as bad and unethical.

For the longest time, the deafening "silence"on this blog suggested to me that perhaps I was viewed as a "nut". But the silence is truly the opposite, the veterinary professionals know that this exists & are hearing up close via the net, just how hurtful it is to people.

Change is coming, legislation, hopefully professional groups and associations are going to say "no more, no more part of this" and become courageous and weed out their "bad apples".

It happened, my name is real, my photos are real, my blogs are true, my web site is for all to see (published May 07) , I don't want anyone else and their pet to experience this horror. Why this state has allowed this for YEARS is unfathomable to me.

How can there be so many lawsuits and still pay $300/yr. for mal insurance? A pet has virtually NO value by law.

Barbara A. Albright/New Hampshire April 7th, 2008 08:50:00 PM

Correction: I have never had a pet inhumanely euthanized "prior" to Pocket.

People need to know "how cruel this is to animals & people". It took a LOT of silent people to accomplish this---desk help, technicians & animal care personnel, owners/vets, other vets on the premises, and every single professional outside that "knows" and enables it to continue.

This state is so SMALL, I could draw a tic-tac-toe of all the related "big-wigs" in the universities, politicians, big law firms, and on and on.

Since I still do not receive threads since February, anyone is welcome to email me with comments or questions at walnuthl@gsinet.net

Barbara A. Albright/New Hampshire April 7th, 2008 09:16:00 PM

I second Snoopy, although maybe not as harshly...Dr. K is not the only one w/trends evident in her writing. I would hope people would reserve their agendas, however warranted/deserved/good-intentioned, for their own blogs - and keep the comments here geared towards Dr. K's posts, as it is her blog. A simple link provided if readers are interested in your story further would be sufficient, I think. I mean no insult to the memories of your beloved pets, and as I personally have not experienced what you have, cannot imagine your pain or your want for justice...but anyone reading this blog often enough is aware of the cat who was given an overdose of insulin by someone who was not qualified and should have never been administering meds and the resulting cover-up...and of Pocket's story, too...

anna April 7th, 2008 09:29:00 PM

hey Dr K you write woderfully

If garden variety idiots couldnt own pets we wouldnt spend a few billion in $$, we wouild spend about ohh $24 ??

james April 7th, 2008 10:43:00 PM

"Snoopy" (clearly not your real name), and Anna:

My response WAS to Dr. Khuly's post -- in particular, as her post emphasized how infrequent cruelty among vets is, specifically giving as an example of this rarity, Dr. Baber.

I haven't referenced my own personal experience on this thread -- rather I have addressed Dr. Khuly's comments about the rareness of vets like Baber.

"Snoopy", to your comment: I never said all vets were out to kill our pets for fun. Clearly, you are misrepresenting my words in a hyperbolic way precisely to warp and give a misimpression about my actual comments.

When did Baber and the vet I posted about become "All vets?" Are they really All vets? Is that what YOU think?

I certainly hope not. I certainly hope -- among other things -- that Dr. Khuly is a living example of the majority of the veterinary profession who are conscientious. But for what its worth, I have read hundreds of veterinary disciplinary records in the last two months, and cruelty and some lesser but equally destructive behavior among vets are not as rare as they should be. For me, getting on with my life necessarily involves speaking out about that.

Dr. Khuly clearly is a tough lady and if she wanted only sycophants and yes men to post here, that's all there would be. Yawn, that would be interesting and lively.

Stefani April 8th, 2008 12:10:00 AM

rant on dr. khuly! i've noticed in the past that anytime you post more than one or two 'disgruntled' posts, you get a lot of people bleating that you're being too negative. then we dont get to read anymore (highly entertaining) stories about the stupid things clients do that bother the heck out of vets--things a lot of us are actually grateful to learn.

heck, as a groomer (not the one that called and yelled at your friend) i meet some of the stupidest people every single day (today a woman had a hissy fit because we don't send cards out to tell people their rabies shot is expired... i told her that cards sent out by VETS are a COURTESY, but it is really the owner's responsibility to know if their dog's vaccines are up to date. she huffed and puffed and stormed out). i LOVE reading your posts about your clients, the good and the bad.

as anyone in the animal care industry will tell you, we meet some of the best examples of pet parents, and some of the worst on a daily basis. we appreciate and adore our 'good clients' and love the people they refer to us. but at the end of the day, to be quite honest, you're more apt to remember the man who snarled "you people are the WORST judge of approximate time IN THE WORLD!!" than the sweet lady who picks up her dog and says "I know Snuggles is just awful, but I appreciate how patient you are with him!".

(the owner of Snuggles likes to tip an extra $5 for every hour over the 3 hour estimate because she knows her dog is an absolute monster who bites for EVERYTHING and cannot be muzzled due to his breed)

charity April 8th, 2008 01:23:00 AM

I say "ditto". I too, thought I was directly addressing the blog, especially since it was a past "comment" of mine mentioned. I felt it warranted a bit more explanation and certainly my opinion of the difference between a pet-owner and a "bad" vet.

Perhaps, I may be a bit "windy" on some posts, but certainly I have kept to how I viewed the topic, shared positive experiences as well and hope to benefit from others. I don't think I am exactly exclusive in a few "strays" dept. either.

Ok, so an "ugly" topic got some not so warm and fuzzy , albeit honest, responses. The sign on my car states "Public for YOUR pet's protection"----it is far too late to change the past for me or my pet.

I've submitted (what I view as) a good successful "alternative" for eye surgery in an elderly dog for the pet hospital----(coming soon!)

Barbara A. Albright/New Hampshire April 8th, 2008 01:25:00 AM

While lots of sycophantic comments would be boring (sorry Dr. K, I don't see that EVER happening, people are very opinionated when it comes to their pets) I find Stefani's comments to be continually acerbic, predictable, and sharpened, as well as offensive at times (I am thinking of the time that she went after Dr. Patty (I believe she was ranting about Vets and said something to the effect of 'yourself included' - meaning Dr. Patty) and then noticed AFTER her post that it was a guest blogger, a lawyer. Not Dr. Patty. And yet she still commented that her 'comments still stand'.
http://www.dolittler.com/index.cfm/2008/3/20/pet.v...
I think her tone of anger, righteousness and 'she knows better' are just something we will ALL have to live with as she comments here, as this is a free country. She views this blog, that is Dr. K's, as her personal therapy session and forum. Talk about 'yawn'.

Creature of Habit April 8th, 2008 09:18:00 AM

Time to step in. All comments are welcome and appreciated. I also appreciate the sentiments of those who feel a bit put out by the frequent negativity evident on both sides of the "Add comment" line.

Nonetheless, I think it makes for a continuously lively exchange. I also appreciate the defense but long gone are the days since Thing One (remember him/her?) could make me cry.

I take ALL your comments in stride without discounting how you feel. Ultimately, I know you all love your pets and want whats best for them. I don't mind the sometimes personal criticism as long as I believe you have the best interest of animals in mind.

Dr. Patty Khuly April 8th, 2008 09:50:00 AM

I do have a question about the heart-stick "euthanasia" vet.

My own profession is unregulated. I am a dog trainer. There are those of us who maintain high standards of professional practice, seek professional certification (or in my case "endorsement") based on our hands-on skills and demonstrated knowledge through our professional organizations. This is voluntary, more like board certification or AAHA accreditation. There are others who hang out a shingle without any knowledge or skills to justify it, and do things that are neither effective nor humane. And there are still others who spend all their time calling everyone else an animal abuser. (If you can't provide effective training for your clients, your best marketing ploy seems to be claiming that everyone who can is a dog-beater.)

The last group, predictably, calls for regulation, "just like vets." Often they call for regulation <i>by</i> vets. (A bit like lobbying for all schoolteachers and tutors to be required to work under medical command.)

If a vet who routinely kills animals via a clearly inhumane and outside-of-any-practice-guidelines method can't lose his license to practice, can't lose his membership in the AVMA or the state VMA, then <i>what is the point</i> of having licensure, board certification, codes of ethics and practice guidelines?

Are there any teeth to these things? Does anyone ever lose his license for malpractice? What about malpractice in which the suffering of an un-owned animal (or many of them, as in the heart-stick vet's case) is the primary or only violation? Or does it require a ripped-off, PO'd owner to get any action?

I'd never thought about this before, and really am curious.

H Houlahan April 8th, 2008 11:03:00 AM

You're right Dr. Patty, diversity in your readership is great, and I do apologize for my rant Stefani. It's just that, while I think it's great to ask for clarity, dispute topics respectfully and offer more info, sometimes the consistent tone of condemnation affects then stream of comments (especially when it's one of the first) and the initial intention/message is lost or muddled. It gets frustrating after a while........

Creature of Habit April 8th, 2008 04:42:00 PM

This post is for H Houlahan ( I would have emailed a private reply but there is no email address).

You asked:

"Does anyone ever lose his license for malpractice? What about malpractice in which the suffering of an un-owned animal (or many of them, as in the heart-stick vet's case) is the primary or only violation? Or does it require a ripped-off, PO'd owner to get any action?"

The short answer is YES, a very few do lose their licenses. However, this only occurs after repeated severe and serious violations over years and years, usually ones with very dire consequences (death). So, when you ask, "does it require a ripped off, PO'd owner to get action" -- just one PO'd owner won't do it. It must be many PO'd owners over years and years. And often by that point there are vets in the community urging action too.

Having said that, a Board is more likely to revoke a license for instances or patterns of drug related violations than for instances or patterns of cruelty or malpractice.

As for owned vs. unowned animals, I have never seen a revoked license where the animals affected were all unowned, but that doesn't mean historically there have not been any.

If you would like any other information on this, feel free to email me privately. I have been reviewing 2007 vet board actions from about half the boards in the country over the last 2 months and some prior historical records for selected states, so that is the basis of these statements.

Stefani April 8th, 2008 05:33:00 PM

H Houlahan: That's a great point. I can't say I have the answer except to say that I'd agree--if vets like Tennessee dude can't get their licenses yanked then what's the point of all this hoop-jumping they make us do?

Dr. Patty Khuly April 8th, 2008 05:37:00 PM

I also gently support Snoopy and anna's comment towards Barb and Stefani. Since others have echoed what I have been saying in my mind for the last couple of weeks, I feel compelled to agree.

I keep typing and retyping what I'd like to say, but the general message comes down to the following:

I hope that Barb and Stefani can heal their pain and move on. They both have such good observations and comments about the topics Dr. Khuly presents. Let's focus on bettering the veterinary industry and let their beloved pets rest in peace.

Michelle Schwab April 8th, 2008 07:09:00 PM

re: "Let's focus on bettering the veterinary industry and let their beloved pets rest in peace"

??? I wasn't talking about my cat. He hasn't been mentioned once in this thread.

And, by speaking out about my quality concerns with respect to veterinary care, I believe that I am doing something to help better the veterinary industry. When I criticize my country, its because I want it to be better. I believe this country's critics do much more to improve things and keep us to our ideals than the gazillions of nationalistic cheerleaders who suspend their critical faculties whenever hail to the chief plays. Similar concept.

Stefani April 8th, 2008 07:22:00 PM

Thank you Dr. Khuly. As I mentioned before, I wasn't sure what a blog was meant to be & did make the assumption that it was a forum to share opinions, ideas, and experiences on a given topic.

Straying from the thread H. Houlahan asks about licensing boards. The way it is set up in NH, is that a complaint is received and voted to rise to the level of investigation. Guess what, all "rise to that level"---this "seals" completely, what the complaint was, who the person(s) involved --both parties, forever!! The only statistics that can be gathered are any form of official disciplinary action.

In essence, I will never know, nor will others, if the clinics or vets were ever in past receipt of complaints. The licensing boards (all professions in NH) do very "little". This is where legislation comes in (such as Colorado's House Bill 03-1260) specifically states "CONCERNING CERTAIN DOMESTICATED ANIMALS IN THE ORDER CARNIVORA THAT ARE USED FOR PURPOSES OF COMPANIONSHIP, AND, IN CONNECTION THEREWITH, IMPOSING CIVIL LIABILITY FOR ANIMAL CRUELTY AND NEGLIGENT ANIMAL HEALTH CARE PROFESSIONAL PRACTICES AFFECTING COMPANION DOGS AND CATS, AND ESTABLISHING SPECIFIC STANDARDS OF VETERINARY PRACTICE INVOLVING INOCULATIONS FOR COMPANION DOGS AND CATS."

This change will provide more "teeth" by making a lawsuit more feasible financially for both lawyer and client.

Thank you again, Dr. Khuly for the opportunity to exercise "Free Speech"

Barbara A. Albright/New Hampshire April 8th, 2008 07:31:00 PM

"After all, some clients simply suffer from garden-variety ignorance. And as they say, you can’t legislate common sense. "

Absolutely true! I think if everything possible has been done to clue a client in to meds/follow-ups/signs to watch for, then there's nothing more you can do.

Along that line, clear instructions written in lay terms (1 pill given twice a day, once in AM, once in PM) rather than "BID per os", an offer to make an appt. for that follow-up right now, stressing it's part of the fee already paid and will be no extra charge, perhaps even a free sticker for their at-home calendar (if anyone still has one not on computer!) for that appt date. I wouldn't go so far as to call the client a day ahead of time to remind them, but it seems to be popular with medical Drs. as I guess people just plain forget appts. all the time, especially if they're weeks in the future.

Oh, BTW, I find the comments about garden variety people not being fit to own pets both silly and offensive. There is no perfect home. Some people are just naturally space cadets and don't operate well in the real world. Or hear any science terms and their heads start to spin. If pets were to be only allowed in perfect homes I don't think there would be too many.

CathyA April 9th, 2008 08:34:00 AM

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