A veterinarian can’t be all things to all people (I’ve said this before many times and many ways on Dolittler). And this little ditty rings especially true on holidays.
We’ve all been there…a sudden bout of vomiting…a lacerated leg…a cat bite abscess that rears its ugly head…or, in today’s example, the recognition that her back is horrifically painful again…on a major holiday.
The prospect of a crowded waiting room and an unfamiliar hospital…an unknown veterinarian who might well have the bedside manner of a succubus (to match the financial lifeblood-draining ways one would expect of their ilk)…and the possibility that your credit cards may all be declined anyway…it’s all in your head. But what’s the alternative?
“I know,” you say to yourself, “I have the cell phone number the vet gave me after Maggie’s last surgery. I think I’ll try that first.”
Next thing you know you’re leaving a message you hope sounds both urgent and respectful…and hoping—against all hopes—for a call from your trusty vet.
Meanwhile, your vet is in another city…perhaps another state…busily preparing a lavish meal for ten…in no way thinking about her professional duties. When the phone rings she misses your call, up to her elbows in turkey brine as she is. When she finally finishes her cadaverous task she washes her hands and checks the number: unknown.
Luckily, your message is sufficiently frantic to merit an immediate return call. But, truth be known, she thought twice about stepping away from a room full of happy family noises and the diversions of the kitchen to answer your call. After all, she knows there’s only so much she can do for you from afar. And she knows you know the way to the local ER. But she did forget to record her “I’m out of town” greeting on her voicemail. So you win. She calls you back.
After you explain the state of affairs, she agrees that this is almost certainly another flare-up of Maggie’s disc disease. She’s already been given the standard pain relievers and muscle relaxants, you explain. And it’s not enough this time. She needs an opiate like Tramadol, your vet agrees. But that’s not an easy drug to access.
Your vet knows there won’t be anyone physically at her hospital until morning. She also knows that no pharmacy will dispense a controlled drug on a call-in basis. She’s got to provide a physical prescription—and she’s at a loss as to how to do this remotely (she certainly doesn’t travel with a prescription pad so she can fax in drugs while on vacation).
In the end, your vet communicates with the ER vet and manages to have him agree to see Maggie briefly to confirm her diagnosis so he can legally prescribe a drug for her. So you know, unless he performs an exam there’s really no defensible way for him to dispense a drug based on another vet’s “I said so.” And because Maggie needs a drug deemed “controlled” by the DEA there’s no way her regular vet can call it in. Off to the ER you go—but at last you know what to expect.
Yesterday I received three such calls. All were semi-frantic. All merited attention. But in every case the pet’s owner could have gone straight to the ER and received perfectly appropriate care—more appropriate than anything I could manage over the phone.
Still, there must be something about having your regular vet’s cell phone number on speed dial that makes these things easier: “Can I wait?” “Do I need to go to the ER?” “Can you talk to the ER vet for me?”
It’s true, having your regular vet speak to the ER vet personally makes things go so much smoother. But I still can’t help but think: He’s getting paid (at least) $100 an hour to be there. Meanwhile, I’m making diddly as I run back and forth between my family and my cell phone.
Give me a choice, though, and I’ll choose my day over the ER vet’s—even it means I’m missing out on a double-income day…even if it means I still have to take your calls—gratis. As long as I get my break and my four days out-of-town I think I can just shut up and stop whining…for once.
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Dr. Khuly, Your client will be forever grateful and that is really a "Thanksgiving". As in a past post, I shared how a friend carried a personal note written by her veterinarian, while she departed for extended vacation, "just in case" her elderly Scottie needed immediate euthanasia. She too, was frightened of the prospect of a "strange place, unknown vet, and burdened with the additional emotional factor of a seriously declining & loved elderly pet". This was based on my direct 'scam' experience with my dying dog here in New Hampshire, and she lives in an adjoining state.
Just that phone call to the ER makes this a "referral" bound by ethics & AVMA guidelines, and not a "walk-in" with no allegiance. Of course, this only works for client/patient benefit when both are "upstanding & honest" rather than the flip side, of conspiring to deceive for each of the other's benefit.
The other advance thought, is to have a small quantity "on-hand" of possibly needed medications for a chronically ill pet. Actually, in the above cited blog case, having a bit of prednisone is a must, for just such a flare-up.
The above situations, gratis, is what distinguishes "you" as true and worthy of the title "Doctor" placing patient above all else.
Barbara Albright
Pocket's Story from NH November 28th, 2008 09:48:16 AM
"Unlike most other opioids, Tramadol is not considered a controlled substance in many countries (the US and Australia, among others), and is available with a normal prescription. Tramadol is available over the counter without prescription in a few countries.[32] Sweden has as of May 2008 chosen to classify Tramadol as a controlled substance in the same way as codeine and dextropropoxyphene. This means that the substance is a scheduled drug. But unlike codeine and dextropropoxyphene, a normal prescription can be used at this time.[3] Tramadol is sometimes mistakenly classified as a non-opioid analgesic, because its abuse liability is lower than that of other opioids and because it has multiple mechanisms of action (including, but not limited to μ-opioid activity)." (medline google)
Couldn't help but be curious, since I have recalled unquestionably "controlled substance" medication called in to pharmacy for pet administration. But knowing and having your DEA license # is a must, unless written prescription is taken to a pharmacy unfamiliar with clinics and/or veterinarian's license.
Sorry, I'm such a "bugaboo" about this topic. My Pocket suffered a great deal physically & mentally because of this "important" ommission was never disclosed to me---B. Albright
Pocket's Story from NH November 28th, 2008 10:24:15 AM
You rock, Dr. Patty! I know there is a sense of "Just when I thought I was out... they pull me back in" :-) but having you return the calls even though you were on a much-needed and richly deserved vacation made such an enormous difference to those owners. I've had my vet call the emergency clinic before, when I was on my way in and it does a lot more than just make things go a little more smoothly. It changes the entire experience, from the way you are treated when you first walk in the door. And it can save a lot of valuable time in a real emergency too. Thank you for doing that, for being willing to go that extra mile. And thanks to all the other vets reading this, who have done the same thing. We pet owners just don't say "thank you" enough!
Barb November 28th, 2008 10:37:49 AM
Its a fine balance between willingly giving much of yourself and giving too much so you have nothing left to give. All of us must set whatever boundaries we choose for ourselves. I think what you did was great, but you must remember to take care of yourself as well.Every human is entitled to a life outside of work, no matter what their work is. We all need that time to regenerate.
Circe November 28th, 2008 01:07:29 PM
My darling veterinarian slipped out of a wedding to take my call on his cell phone one weekend. He was four counties and 400 miles away but he still got everything coordinated to help my dog. I love that man.
Gina Spadafori November 28th, 2008 01:22:25 PM
Barbara: I did not know this about Tramadol. Thanks! Will investigate further--the pharmacies around here are either serious sticklers or totally lax (and I don't recommend that my clients use the latter variety).
Dr. Patty Khuly November 29th, 2008 07:36:55 AM
Dr. K: Pharmacy laws may vary from state to state also, particularly regarding what is considered abused substances & subject to diversion. Obviously according to one country (Sweden), it is being reclassified.
I've had a lot of time to reflect about "pain control", although at the time, I was just about delerious from stress, as to not reason or ponder the subject, that my Pocket should have been administered a drug like this to control her pain caused by severe pancreatitis and peritonitis. Tramadol is relatively cheap, not too mention the $100 a "pop" charged for Dover VH's administration of the "special" anti-nausea drug, which I never heard of, authorized, or was informed of its cost. (sorry, couldn't help myself)
Anyways, the point of the blog is : grateful client, treated patient, makes for loyalty and satifaction === great Doctor!!
Barb Albright
Pocket's Story from NH November 29th, 2008 11:25:01 AM
I live in Georgia, just southwest of Atlanta. I am in Miniature Schnauzer rescue and our vet, who is in Atlanta, routinely calls in Tramadol for one of my puppy mill rescue girls who takes it regularly. I have had her do this with two pharmacies in town, so they obviously don't have a problem will filling these. I hope they don't start! You sound like a wonderful vet - wish to heaven we had some like you here where I live! Most are *very* impersonal, even after years of knowing them. And I have one vet I can call during off hours, but he insists that you bring the dog in and pay the emergency charge. Thank goodness I haven't had to do that but two or three times in 18 years! Keep up the great work and maybe more vets will "get it"!!
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AF September 16th, 2009 08:58:36 PM
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