We commonly ask people to visit with their pet in an exam room.  This is mostly because there is very little room in the treatment room to manouver, and when things are busy it can be a little loud.  The exam room gives the family a nice, quiet, peaceful visit.  I often leave the exam room door open when I go to retrieve the pet so that mom and dad can see where he is coming from and that we have nothing to hide.

If an animal is critical and cannot be moved then of course we let people sit 'bedside' for awhile a couple of times a day.  The staff then tries to co-ordinate visits with our quieter times of day and give the family some space.

Some animals are better off without their people for procedures.  I know one hound that will take your face off if you get too close to his mom.  Separate them and take him to the treatment room for a procedures and he is very manageable. 

Some procedures look worse than they are and owners may not be understanding of restraint etc... (like feline jugular blood draws and cystos etc...) so I will take the pet to the back.  Most times I do procedures in the room, and if the owner insists on watching for the more difficult procedures then I explain carefully what I'm going to do and let them watch.  Once.  If they freak out, or accuse me of being rough or incompetant (this has happened) then they aren't allowed to watch anymore.  If that is a problem for them they can go somewhere else.  Owners that hover, and stress, and criticise do NOT help the situation.  Thankfully these owners are rare.

I am good at what I do, and my assistants are gentle and kind.  We would never be anything less than proffesional whether an owner is watching or not.

Meghan RAHT October 16th, 2009 11:46:54 AM

I can't watch pets having surgery on Animal Planet without breaking down.  I would be a total nuisance in the operating room.  My pet will do much better without me present in those circumstances.  If it's a procedure I can't hold my pet for, then they usually do better having a "stranger (vet tech) hold them. 

Tammy in SF October 16th, 2009 12:00:42 PM

thanks Dr K for a great article....

I have never been into watching procedures, mine or my pets'.... And you hit it on the head when you said unless you were of the vet profession, you understood that it's like   what are they hiding....

I have no qualms about handing over my standard poodle, Agadore, to my vet for treatment.   He's so laid back and aloof, he takes everything in stride.

Beaner did, too, until his TightRope ...and now even at his regular vet, he skaes, crawls, and is just stressed to the max. 

Before his surgery, I took him to the hospital three times to get him used to th staff and surroundings in a positive atmosphere.   And afterwards, he's been several times with no treatment...we just walked in, sat a minute, and walked out after getting treats.   He's better, but still frightened of things that never bothered him before.  

I would jump at the chance to just lay my hand on Beaner while he is put under...I know my calmness would give him comfort. I'm not the foo foo fussy type...and I know my general vet knows this.....then again  I've neevr had any problems from him being put under at my general vet...

I truly believe that the pain had something to do with Beaner's reaction at the surgical hospital...which is another stickler....and my general vet knows and trust me enough that when Beaner has a procedure, they let me take him home that day.  Comfort and home go a long way to reducing the stress and pain of many procedures. I provide around the clock care one on one, and he does much better.   So do I.   ; )

Thanks for an informative post.

agadoresmama October 16th, 2009 12:43:25 PM

I've been really grateful when vets allow me to watch (or even participate in) my pets' procedures.  Most striking was that the surgeon operating on my horse's hooves to debride a nasty, deep infection allowed me to stand IN the OR and see the whole thing.  Really fascinating. And I *know* it was exceptionally kind of him to allow it, and I tried to convey to him how much I appreciated his generosity.

I've also been lucky to have a couple of vets believe us about my cocker's resistence to sedative/tranq, and allow me instead to hold him for things like stitches.  Again, I know it was generous of them to allow me to participate, but it was the best option for him, and I'm so glad the vets in those cases were willing to listen to and act on my input. 

I love vets who listen.  I love it when situations are such that I can watch more involved procedures.  I know each time it's because the vet was kind enough to allow it.

Galadriel October 16th, 2009 12:45:57 PM

I can't say I've ever wanted to be in the room for procedures with any of my pets...  While I think it could be a very fascinating experience, I just really wouldn't want to watch while it was *my* critters on the table!

I did have a cat that had to be at the vet for an extended period, and they would let me go back to the kennel area and sit with her when I visited.  (I think it was just easier because she had an IV at the time, and it was a pretty big room so I wasn't taking up much space.)  I wouldn't have minded if they had sequestered us in an exam room, and wouldn't have questioned it either.

I certainly wouldn't expect to be allowed in the OR if a relative was having surgery, and I wouldn't expect it for my pets either.  I'm perfectly happy to let my vet team do their thing on their own.

Cindy October 16th, 2009 12:49:48 PM

I understand that some owners can cause problems, but blanket policies that do not allow owners to be present during procedures drive me crazy, and I firmly believe they are not in the best interest of pets.

I know for certain that my dogs are better off with me present than with me absent. They will be well-behaved and relatively unstressed as long as I'm there, but terrified if I am not. How can it possibly be in their best interests to force them to be handled by strangers without the comfort of knowing that I'm there?

I am careful to stay out of everyone's way. I don't ask questions, make objections or otherwise interfere. I'm just there so that my pet will feel better. My own vet will vouch for me. I don't insist on being present during surgery, just while my pet is awake. Yet time after time, I'm told that this blanket policy cannot be violated.

There is no one size fits all policy that is best for all pets. Ignoring what is best for my dogs is not in their best interests. I have reached the point where I will decline to see a specialist if it means I can't stay with my dog. My feeling is that if their policies are more important to them than my pet's well-being, then how can I trust them?

One of my dogs had emergency eye surgery a year and a half ago. While I had a good relationship with the ophthalmologist who performed the surgery beforehand, I was unable to convince her to let me stay with my dog while she was anesthetized. I could tell from the vet's behavior afterward that she realized she had made a mistake, but I am unable to forgive her for it, and it has affected my level of trust in her, plus I still feel guilty for letting my dog down when she needed me. It haunts me that she had to be so scared when it was completely unnecessary.

I'm sorry for sounding so strident, but this is a huge issue to me. It is unfair to punish pets because some owners cause problems. The best vets will make such decisions on a case by case basis, not have blanket policies for their convenience.

Mary Straus October 16th, 2009 12:54:47 PM

I try not to make life difficult....well, too difficult...for my vet, other than being a pest with questions. But I am NOT squeamish and there are times when my presence would go a long way to calm a frightened dog. My bulldog was notorious for struggling valiantly when she did not want something done. Once, when the vet needed to do a needle extraction of urine and Lucie was being particularly difficult, I sat on the floor in the back room, held her in my arms belly up and made comforting noises at her, and the vet got right in and out in no time. But I can see how you have no way of knowing in advance whether a client will be a hindrance or a help, unless perhaps it is a fellow vet. It's a tough call.

Susan October 16th, 2009 12:56:40 PM

I try not to make life difficult....well, too difficult...for my vet, other than being a pest with questions. But I am NOT squeamish and there are times when my presence would go a long way to calm a frightened dog. My bulldog was notorious for struggling valiantly when she did not want something done. Once, when the vet needed to do a needle extraction of urine and Lucie was being particularly difficult, I sat on the floor in the back room, held her in my arms belly up and made comforting noises at her, and the vet got right in and out in no time. But I can see how you have no way of knowing in advance whether a client will be a hindrance or a help, unless perhaps it is a fellow vet. It's a tough call.

Susan October 16th, 2009 12:56:59 PM

I've never wanted to watch any procedure my pets have needed.  However, if my elderly cocker had to have surgery, I would remain in the waiting room during the procedure because of his age and fragility.

Several years ago I talked to an elderly man whose cat had surgery.  He actually hired a pet sitter to watch his kitty at the clinic at night after the surgery was completed.  I've never forgotten his devotion to that little creature.

Carol October 16th, 2009 01:13:51 PM

One of my dogs has some pain issues and some fear aggression issues, and I will never let him be handled unless I'm either doing the handling, or at least there to hold his head (and yes, He's muzzled for most things beyond a vaccination).  Sadly, a couple times in the past, I left him for surgeries, and while I wasn't told he had or caused problems, I knew by the tone of techs/vets voices and body language that things didn't go well.  He got worse after these incidents, and I realized after the second time it could have been avoided.  I've gotten him better, but still, there's not enough reason to mess up his trust of me to let him out of my sight before he's under for anything either, so if a vet won't let me be there for the anesthesia, I'll find a vet who will.

The same applies to my male greyhound, who really has 'not smart' fear issues.  I'm not trying to be funny or mean, but he's 'not all there' and if a tech tries to take him back without me, even just to weigh him, he panics, and has actually peed in fear.  My female grey is pretty good about walking off with others, but my female mix is inclined to be growly (nowhere near as much of a problem as the first dog mentioned), but I try to stay with her for almost anything too.

Perhaps it's because I've worked in 4 different clinics, and been involved in treatment of many different animals at several other clinics, and I've seen what sometimes happens, that I'm so concerned, but it's hard enough to find a great vet and staff that I don't want anything to go wrong - on my (and my dog's) part or on theirs.  I don't want any of my dogs to bite or piss off (or on) anyone and start a chain reaction that could lead to problems.

KateH October 16th, 2009 01:19:07 PM

I'm under the impression that some states have laws regarding the sanitary conditions of the room where procedures take place, and this is why some vets won't let you go in the back. 

zandperl October 16th, 2009 01:58:12 PM

@Mary Straus: I know, I find the policy a tad restrictive at times. Case in point: I had to bring Pria to our local emergency clinic, and they brought her into the back for triage, without allowing me to come along. I could hear her yowling away, even though it was just a routine exam. The techs did mention that they had a hard time restraining her. (she's a strong, slippery cat). When it was her turn to be seen, they took her back again, solo, and again with the loud meowing. I can understand not letting people in for surgeries and such, but this was just to determine if she did in fact have a urinary tract infection, and to get antibiotics! I find that they caused my kitty a lot of stress for what should have been a minor issue... Then again, my vet lets me hold my cats while he's giving them shots, etc., and they have no issues with going to that clinic.

Mitsu October 16th, 2009 02:12:31 PM

"policies like these are the norm"  They used to be the norm in human hospitals too, along with VERY limited visiting hours, no children above the first floor, etc., etc.  It's now known to be counter productive to healing.  In addition, a living being should have the right to have their advocate present to observe ESPECIALLY when they cannot speak for themselves (babies and young children) or will be unconscious (surgeries and procedures).  While recognizing there may be issues to be dealt with, there are certainly other ways to deal with them.  Maintaining sanitation and space it very simply resolved by installing a viewing window onto a hall or adjacent room and it's simple and not very expensive to do.  Vets may think they are the animal's best advocate but that really is the owner's obligation and right.  As to it making the vet nervous?  Get over it.

Day care centers used to have a "not past the door" policy too.  BAD policy.  The only way to ensure bad things aren't happening in back rooms is not to have a closed door policy.  And how many issues and questions would never be raised it the owner had been able to see or at least had the option?  They might not know the technical details but they certainly would have the observed facts.

After having my Shiba injured the last time she was left alone with the vet for a procedure, guess what the chances are she or any of the others will be left alone in the future!  She wigged on waking up.  THAT would NOT have happened if I'd been present!!!  They brought her to me still knocked out the second time and, because I was present, she immediately settled down from the fear/fog of anesthesia awakening.

PJBoosinger October 16th, 2009 03:36:07 PM

Wow, it never even occurred to me to ask to be in the room when a surgical procedure (or any other 'back room' procedure) was being done.  I would assume that I would be in the way.  I'm pretty sure I would be one of those panicky pet owners who can't take the gore/drama anyway.  I trust my vet so I'm ok with that.

Sonya W. October 16th, 2009 03:47:15 PM

This hit a nerve.  Sorry to repeat this story.  I am still so angry and sad.

I believe my cat would not have to have been put to sleep the night I took him to the ER vet if only they would not have taken him away from me as soon as I walked in the door.  They knew nothing about him. 

I did tell them he had never been away from me but they were only supposed to take his vital signs and bring him right back.

In addition to being 17 y/o with kidney disease and a heart murmur, he was hyperthyroid.  From what I read, hyperthyroid cats are particularly sensitive to stress.

I brought him in dehydrated and 10 minutes after sub-q fluids and leaving he was such distress and he couldn't move so I turned around and had him euthanized.  

If only I could have stayed with him to get him aquainted to these new strangers and surroundings I believe the outcome would have been different. 

I also am suspicious of the tech.  She said he'd have to stay overnight and I told her I was taking him home.  What the "know it all" didn't know is that my own vet would not keep him overnight.  She was angry with me and I hope she didn't take it out on my cat.  He was fragile.

I believe we should be able to stay with our pets as much as possible, not necessarily for surgery or dental procedures or true emergencies but when the stress can alter the outcome.   

C October 16th, 2009 04:29:59 PM

If I had a problem with being present on a particular procedure, I would be the first to say so!

I echo PJB. Why don't vets get used to video cameras & two way mirrors and/or windows? That would be ideal. It wouldn't take any time at all to forget all about them. I should know, we have them in every postal facility and it hasn't put a zip on anyone's lips yet!

I've been present for lots of things, growth removal from an eyerim, C-section, x-rays, bladder pulls, wound debride, and pre-anesthetic.

How ever, I did not want to be present for Dottie's eye "injection", not that it was offered--but that would have been too much for me. Or maybe not.

Gees, did the vet know all of the above, when brutally killing Pocket in my arms? I doubt it. Wonder what someone else would have done in my shoes?

I'm starting to wake up again, access to your pet should never be unreasonably denied.

Barbara A. Albright/NH October 16th, 2009 04:43:21 PM

The more I think on this, the more I think that a new client/pet to a vet practice is exactly the one that should be allowed in the "back room".  True the vet doesn't know the owner client yet but also true the vet doesn't know the animal at all while the owner certainly does.  That would have been true even with the stray I took in less than 24 hours after finding her.  That's 24 hours of learning the vet didn't have; for my older pets that have lived with me for years, even more true.  I know how they respond and, while I may not be able to spell out generalities (let alone specifics, especially in the under 2 minutes the staff is going to grudgingly give me to do so), I'm going to be able to spot their cues and a vet certainly isn't going to catch the subtle ones.

PJBoosinger October 16th, 2009 06:44:58 PM

I don't mind not being present during dental work, surgeries etc. The only time I wanted to be back there was for an xray, because I knew I could get my dog to settle on her side, on a rasied table. My vet didn't let me at first and then Chloe was so worked up that she had to be sedated. I could have saved some money and time, but was denied. Next time I'll be back there for sure.

But what about when vet's want to take every animal to the back? For just an exam? We have to take animals that are for sale to the vet sometimes and some of the vet's do this. I have found another store vet that does the exams in front of us. I like to see the exam, ensure it's thorough, you know what I mean?  Just know what I'm paying for.

Sharon October 16th, 2009 07:19:11 PM

OT: Sorry, need to make a retraction of something I said on an earlier post.  Apparently, we do have some vets in Texas that are acting as vaccine and license police in Dallas and El Paso, where they get a kickback/fee from the City.  Now they're shooting for enforcement in Houston.  I'd never even heard the ordinance was on the books!

PJBoosinger October 16th, 2009 09:05:40 PM

PJ,

I've been checking your blog for a post on the Houston license policies....

I've lived in Montgomery county just about my whole life, and I've never heard anything about a license for cats or dogs in Houston!

Kara October 16th, 2009 11:14:00 PM

I mean this in the nicest way possible - if a client doesn't trust me or my coworkers or the doctor with their animal out of their sight, then we don't want them as a client.  Period.  Lack of trust/confidence between staff and owner is one of the biggest barriers to care, IMO, and the pet eventually suffers for it.  So if you don't trust me, go elsewhere.  It probably is better for your pet.

anna October 17th, 2009 12:06:06 AM

Interesting thread. I agree that the differences in human and animal medicine will need to be addressed at the level of these protocols. For complex surgery? I don't know whether that will ever change, but staying with a pet during hospitalization? Sounds like a bedroom scenario is on the horizon...if you're willing to pay for it. But given that most hospitalizations are more on the order of ICU for humans, I wonder about the feasibility of owner-intensive options when it's obvious that space concerns and close-monitoring issues will have to take precedence. Either way, I do see veterinary architecture changing to address issues like this in the future.

Dr. Patty Khuly October 17th, 2009 06:46:25 AM

Along the same lines, if the pet is in the equivalent of an ICU, then it really shouldn't be left alone at any time but I seriously doubt most vet clinics have someone at the office over night who is awake and observant at all times, let alone a doctor on the ward over night.  Perhaps we worry wart "parents" could be recruited to help out over nights or allowed to take our pets home to our very own ICU's.  Granted, that would be a "crib" by my bed but I know I'll be sitting by it or awakened at the least sound :)

anna, Trust is earned; not something you and your coworkers are inherently entitled to.  Why should a brand new client have that level of trust in you the minute they walk through your door?  Even now, I probably would leave my pets with my "go to" guy if it were really necessary but that's largely because he does so much with me in the room, hence earning my trust and maintaining it by his openness.

PS: I don't know that I'd WANT to watch a complex surgery on one of my own although I'd have no trouble being advocate oberver for someone else's pet.  The human facilities who have tried it this way have found these third party observers to be a boon rather than a detriment; maybe that's the way to go.

Kara, turned out to be a rough week; 10+ hour drive to pick up a Shiba that was in a shelter; half the next day for the vet visit, rest of the week hovering over the pack while they sort out their new pack order without anyone getting hurt :)  Not quite what I planned.  But I have a collected number of updates that will likely be posted in rapid succession.

PJBoosinger October 17th, 2009 08:01:40 AM

You are ten months graduated and you have to perform your first caesarian for one of the practices biggest clients. It's a big chocolate Labrador. You've never performed a caesarian before. You are on your own...or at least that's what you think until the breeder informs you that the boss always allows her to be present. She even insists on raising the dogs vein. The pressure you are under is enormous. All goes well, that's good because she is watching you from across theatre. She has no idea you have never done this before.

I survived...but how many do not or make mistakes under intense scrutiny?

http://littlevet.blogspot.com/

LittleVet October 17th, 2009 09:12:47 AM

LittleVet: 5 years out of school and I did a C-section on Gloria Estefan's bulldog. The entire [extended] family was present and it was all on film. I'll never forget all that Cuban coffee I had to decline so my hands wouldn't shake. ;-)

Ten healthy pups. Whew!!

Dr. Patty Khuly October 17th, 2009 10:07:12 AM

Wow, Anna, the defensiveness of your comment is ... interesting.  Even though you say you're trying to say it in the nicest way possible, it's pretty vehement and sounds like someone who doesn't understand that the real 'biggest barrier to care' is lack of communication.  If a vet/tech takes the animal away for exams, vaccinations, bloodwork, etc. how is the owner going to be able to provide info and answer questions that ought to be asked during the process?  Saying that the tech/assistant gets all the info before the vet sees the animal is a recipe to problems, because questions can change, more information can be solicited/provided, and the owner can be educated better if he/she is there while the appointment is going on.  If they're not, then either information exchange is lacking, or someone has to go back and forth to keep getting that info.  When owners leave, feeling they didn't get enough info, whether bad things happen later or not, that's when the lack of trust starts.

If vets and all staff trust their skills (technical and communication), the only reasons for clients not being in the room for almost any procedure (except the actual surgeries/dentals), is for clients with aversions to needles, or who have pets who actually calm down when the owner leaves (and they are in the tiny minority).

KateH October 17th, 2009 12:51:46 PM

I can see the issue from both sides.

I have never had a problem with letting any of my critters out of my sight with my vets.  But then again I had developed a trust relationship with them over years, have never had a reason to mis-trust them, I never heard crying coming from my pets from the back, and none of my pets seemed stressed when they were returned to me.  I have been allowed in the back to visit my pets when they've had to stay there, and that choice was offered to me rather than me having to ask to be allowed to.

However, there are two exceptions.

One time I had to take my Megacolon cat to the specialist, who I did not know them or the staff. However they took their sweet time coaxing him and giving him the time he needed to come out of his carrier and handled him so gentle that I did not worry if he wasn't where I could see him.  And because of that the exams they did in the room with me, my cat did not give them one ounce of trouble at all.

Another time I had to take one of the cats to the ER last fall was a bit of a different experience.  I didn't know the doctors or staff either which made me more nervous than usual, although I'm not a hovering, in the way, worry wort, hand wringing, squeamish client either.

I'd never had to use an ER vet before and like any owner at midnight, I was a bit worried about my kitty's health, aside from the fact she's a Torti and can be a bit tempermental sometimes and I didn't want the staff hurt by her. 

I warned the staff ahead of time about my kitty's personality and that if they felt the need to muzzle her for their safety I did not have an issue with it.  My kitty was very good for the vet examining her, but he did have to gently scruff her though.

I was allowed to go in the X-ray with them at my request (mostly because I've never seen the inside of an ER hospital before).  They geared me up in lead and told me where to stand so I was out of the way. 

When they tried to get my kitty positioned for x-rays that's when her Torti personality came into play.  They were trying to be gentle, not get bit and yet still do what they had to do.  I offered again that she could be muzzled and they took me up on it.  I offered to put the muzzle on myself so they wouldn't be injured and they let me. My kitty gave me no problems doing so. 

After that they could get their x-ray without any problems and we removed the muzzle right after.  I think the staff was happy that they didn't have to fight her on the issue and they got a clean x-ray because of it.

So I can see the issue from both sides.

I think it's an issue of both the staff and owner being able to read the body language in the pet to know how it's probably going to react, and the vet and client being able to read each other (and trust each other) to know if the owner being present is going to be a help or a hindrance.

cl October 17th, 2009 01:01:09 PM

And if vets and all staff don't trust ther skills, then how can I trust them with my pets?  I understand a new vet/staffperson being nervous - even really nervous - but I'd want to know that their nervous and not think that they have something to hide because they were incompetent or unethical instead. 

I've seen a vet put dogs under for surgery, get a phone call, and leave, not doing the surgery, letting newbie assistants be there to deal with dogs coming out of ketamine by themselves.  I've seen kennel help hit animals for eliminating in their runs, and not clean it up until the next day.  I've seen a tech twist a dog's ear when it growled as it was lifted onto a table, and the vet did nothing.  I've been fired for trying to stop things like that from happening.  Maybe no one ever gets upset - either human or pet - at your clinic, and no one would ever do anything like that, let alone not tell a client, but it does happen, and not knowing, but suspecting something happened, is what makes it hard, if not impossible, for clients to trust what they can't see. 

KateH October 17th, 2009 01:04:06 PM

KateH: Thanks for saying what I was thinking, and a much better job of it.

A year or so ago, I would have been a lone poster bashed to smitherines over my comment, with a list a mile long of people admonishing me for suggesting "lack of trust". I see above, I have more company.

Anna: Providing care for my pets over 35 years gave me that level of "trust" you talk about--how else would have all those surgeries/spays/teeth cleaning/extended diagnostic work have been accomplished?

Sadly, that trust was misplaced regarding one of my pets, for sure. But how is anyone to know otherwise? You can't answer that question and neither can anyone else. Bad people don't wear a certain kind of face or attire.

Think for a moment, the number of employees that worked in a facility knowing that controlled substances are unobtainable?

What would you be wondering, if in my place? Would you wonder what happened to your pet before and after death , out of your sight?

Would you wonder how many other places engage in this behavior, unknown to the patient/client?

After all, to exist in business like this, took a heck of a lot of cooperation from both within and on the outside, and STILL does! Why would 500 or so NH veterinarians allow this drag & shame?

What kind of licensed professionals place themselves above state & federal laws? Well perhaps, we will find an answer to that.

Pocket: 5/22/95-10/18/06

suffered professional abuse & cruelty

Barbara A. Albright/NH October 17th, 2009 05:11:52 PM

We allow owners in the back room on a person to person basis.  If the dog or cat is better with the owner present then we try to do simple procedures in the exam room.  I've given SQ fluids several times in front of the client in an exam room.  If it's something like a radiograph we have the owner come in back, help us get the animal settled then have them step out quickly for us to take the radiograph.  The only people we allow to stay for surgeries and anesthetized procedures are the few clients we have with large animals (in most cases, alpacas) and that is because they are much more skilled at handling those animals as they go under and wake up than our technician staff.

I can understand the staff not wanting owners present during certain procedure though.  Surgical procedures and dentals extractions can be brutal at times.  I would not want to be present during a dental extraction if it were my pet if only to avoid the noises.  Like I said, we allow owners to be present on a person to person basis.  For example, the woman that insisted that we not shave her dog for the spay inciscion or the IVCatheter because she wanted to protect her hair coat probably would not be allowed in the back,

Jes October 17th, 2009 07:08:45 PM

I have stood in the surgery suite while my dogs leg was amputated.  My vet never had a problem with clients being there if they asked.  She also had a viewing window so they could stay out of the suite, but still see what was going on.  I actually worked there so I was allowed to be in with him the whole time.  I even took pictures! I held him while the cath was placed and held him while he woke up. I wouldn't have done it any other way!

His other 3 surgeries were done at the specialists office and I was not allowed to be there even though I worked in a vet office.  I didn't take offense to that but would have liked to be with him.  I understood because he was in the ICU area and there were many other pets back there.

I actually work at that specialists office now and totally understand that if we have a patient that is coding or needing attention we can't have other clients back there to visit.  When they are hospitalized and can't visit in a room we always let them visit in the back, but they may have to wait if something else is going on.

I have been on both sides of the counter and understand that it is hard on the staff and clients. 

stlrsgirl October 17th, 2009 07:27:59 PM

I'll cop to the defensiveness - it's hurtful and insulting to be distrusted by default. 

anna October 17th, 2009 09:52:22 PM

I don't distrust by default but I do make a judgement almost instantly based on how the cats  are treated from the start. Our local vets and their assistants handle the neurotic PrettyCat quite well. They're gentle and she doesn't freak out. That goes a long way to earning my trust.

I don't trust the internet ratings/reviews of vets and clinics, there are too many nutcases out there either gushing or ranting.

Will October 17th, 2009 10:56:58 PM

Will: There's a lot of frustration in the vet community on the issue of online ratings for the reasons you cite. Interestingly, however, it does bring in the clients for our hospital in particular. We have a set of very dedicated clients who work together and they seem to have decided we deserved a thoughtful review. I believe these reviews work for us because our clients took the time to write positives and negatives about us (our space is very small and very dated and our front staff can get surly when overwhelmed). 

Dr. Patty Khuly October 18th, 2009 07:44:06 AM

Patty:  Once upon a time I knew a world-renowed heart surgeon.  He had a death rate generally higher than others in the same specialty.  He, of course, was getting the really terrible cases, many of them pediatric cases invariably doomed to die previously.

If the internet and Google were around then (The net was, but not available to the general public or even most academicians) Googling his name would have produced all sorts of "He killed my baby" stories.   However, we insiders had detailed information and good stats on conditions and outcomes and could make reasoned decisions if we had to.

With veterinarians or clinics?  There's not much available besides personal experience and anecdotes unless things are so bad the professional or legal systems get involved. 

I don't have any good answers.  I trust my intuition and experience to know when I'm seeing and hearing competence but I don't know how to translate that to general rules.

Will October 18th, 2009 10:59:11 AM

Will: Check out tomorrow's post. I've taken your comments to the next level. I hope you don;t mind if I quote you. ;-)

And thanks for the topic inspiration.

Dr. Patty Khuly October 18th, 2009 11:37:02 AM

Will, You point out one of my big gripes with on-line ratings.  It really depends on the nature of the professional practice for starters.  If a professional only handles the easy cases and there's nothing but praise, that's well and good but doesn't inform that the pro is only taking the easy cases usually.  I'm suspicious of any rating that doesn't have have both positive and negative included as I prefer well rounded people and practices.  Trial lawyers are like that surgeon you mentioned, if one only takes the easy cases, the win/loss ratio is very high but deceptive.  On the lawyer side, one who takes 90% cases (those with a 90% chance of winning) is, IMO, not entitled to charge 40% across the board while I'm far more tolerant of that 40% for an attorney who takes 50/50 cases and who will also have that lower win/loss ratio.

PJBoosinger October 18th, 2009 01:30:36 PM

I'll cop to the defensiveness - it's hurtful and insulting to be distrusted by default.

It's arrogant, and damaging to the building of trust, to demand to be trusted ex officio, without being willing to take any steps to earn that trust.

Surgery is one thing; I would not expect to be present during surgery and cannot imagine any benefit to my pet from my being present during surgery, unless just during the process of being put under. I would not allow anyone to do surgery on one of my pets if I distrusted them so much that I would feel I needed to insist on being present during the actual surgery.

A parent or spouse would not normally be present during surgery, either, although in hospitals equipped for it, they might be allowed to watch from behind a window. I would not expect a veterinary hospital smaller than Angel or Tufts(to name the ones in my area)  to be able to offer that.

But there is really no sensible reason why an owner who does not stress at the sight of blood should not be present during a blood draw. There's no reason for the owner not to be present during x-rays. I would not do business with a vet who insisted on routinely taking my pet into the back to give an injection without me present. (There have been occasional instances when we were truly there for just an injection, and there was a choice of wait for an exam room, or let her be taken out back to have it done immediately--meaning in and out in under ten minutes. That wasn't a matter of not wanting me present while it was done; I had a choice of which way to do it, and I'd been present when these same people gave these same pets injections on other occasions. And held my pet while they did so.)

Lis October 19th, 2009 11:36:08 AM

While I agree that the standard policy of limiting owners' access to treatment and surgery areas of the hospital doesn't necessarily indicate anything nefarious going on, I also think it's as much a habit as it is a useful policy. I work at a 24/7 hospital with 25 doctors, and we have had an open access policy for 40 years. It is rare that owner interfere with our patient care activities, and it certainly improves both their confidence in us and the professionalism of our staff for the owners to be abe to be present with their pet at all ties. It may not be the ideal policy for everyone, but I think a lot of the fears vets have about such an approach are unfounded.

SkeptVet October 19th, 2009 12:19:44 PM

I not only watched, I shaved and scrubbed my (at the time foster, now permanent resident) cat for her spay.  I'm not a vet tech, just a volunteer.

I was amazed that I wasn't nervous during the procedure.  If it were a more serious procedure, or one done in an emergency, the circumstances would be different.  in such a case I would probably be more of a hinderence.

jen October 19th, 2009 01:01:56 PM

I have no desire to go back and watch surgery on my dog. Seriously- and I've always been grateful when vets let me come sit in the back when I had a dog who had to stay for ICU care. But I have a serious issue when ALL routine care (blood draw on a healthy dog who is completely managable, for example) is REQUIRED to be done out of sight of the client. If the dog acts up? Fine. (One of my dogs gets occasional nail trims at the vet's because she's better behaved for them than for me, and she's better behaved out of my sight- but they always try with me there first, then I leave when it doesn't work.) But ROUTINELY? It really, really bothers me.

I work very hard to have my dogs totally desensitized to handling. They both accept muzzling without any fuss, should it ever be needed (it isn't, but I don't mind vets doing it as a precaution, particularly with my smaller dog, who is kind of a punk, but DOES still stand politely for most routine care. (Nails are her bugaboo- everything else is fine.) I'm not opposed to letting the vet tech restrain my dog for whatever, but I just don't see any reason that shots should require the dog to be out of my sight.

Cait October 19th, 2009 01:26:15 PM

"I would not allow anyone to do surgery on one of my pets if I distrusted them so much that I would feel I needed to insist on being present during the actual surgery."

Lis - we're talking about the same thing, believe it or not. I don't mind owners coming to the treatment area to visit their hospitalized pets. I do think it's a bad idea to let clients in on surgery - sometimes bad things happen and they're not necessarily anyone's fault, and I can't imagine a doctor performing a surgery or a nurse running anesthesia trying to deal with a crisis with the emotional owner there, too. I have no problem performing blood draws, giving injections, setting IV catheters (rarely done with a client present unless it's euthanasia), nail trims, administering SQ fluids, collecting samples for skin scrapes, fecal exams, ear cytologies, etc., in front of owners. I do these things all day long - I'm competent and capable, and most times it's easier to simply perform these things in the room instead of shuttling the pet back and forth. There are two situations where I will take a pet from an exam room to the treatment area: 1) the procedure requires some measure of restraint and the owner is unable to adequately provide it, or 2) the animal is so aggressive, even with the owner present, that I know it will take me, a muzzle, and a few of my coworkers' help to get the procedure doneSAFELY and quickly.

What I don't care for, and what I was trying to communicate with my earlier post, are owners who have had the opportunity to watch me interact with their pet prior to these procedures being done (through general interaction, previous appointments, temperature-taking, preliminary examination, etc.), with pets who fit one of the above situations, still eyeballing me as if I'm going to take their pet to the back and beat it into submission if they let it out of their sight...when no such conclusion is in any way warranted. And some of those clients have their own hang-ups that have very little to do with how their pets have actually been treated.

Which brings me back to what you hadmentioned...ifa client distrusts a veterinary team so much that they insist on being present for every procedure, why in the world would they keep coming back? That's what I meant when I said we don't want those clients - they apparently assume the worst from us, and that's no way to be treated on a regular basis. If that sounds defensive or arrogant, so be it...but it's the truth.

anna October 19th, 2009 04:32:45 PM

Anna - I still have a question. You say: "There are two situations where I will take a pet from an exam room to the treatment area: 1) the procedure requires some measure of restraint and the owner is unable to adequately provide it, or 2) the animal is so aggressive, even with the owner present, that I know it will take me, a muzzle, and a few of my coworkers' help to get the procedure doneSAFELY and quickly."

If you have a dog that is so aggressive that you think taking it in the back so the owner won't see you muzzle it and have extra coworkers restrain it is necessary, do you not see two very obvious problems?  1) Why can't the dog be muzzled and extra help come into the room with the dog and owner?  Do you think they don't know the dog is difficult to handle?  Maybe they should actually see the range of behavior their dog exhibts under stress so they can make arrangements for training, or... 2) Why don't you discuss with the client - or have the vet do it after the client gets to see how stressful this is for the dog - the perfectly reasonable idea of a touch of chemical restraint.  To insist that heaping handfuls of physical restraint to an aggressive (most likely fearful)dog - away from its owner - is better than a small dose of tranquilizer and another of 'wake-up' chemical is just ... mean.

KateH October 19th, 2009 05:34:51 PM

I'm glad to read the above posts. For awhile in recent times, I was letting my pets be taken "out back". There has never been a need for it, my one old tough tomatoe is deceased. And even she became so easy-going once weakened by loss of sight & hearing, that I felt even more compelled to be with her.

If a vet or tech has an issue with a request, I'm reasonable. For instance, I used to request "jugular pulls", but once informed that the doc felt uncomfortable with that--it was a-ok by me. Of course, it is more important to feel proficient than bend for an alternate "method".

Barb A./NH October 19th, 2009 06:12:14 PM

KateH -1) First, our exam rooms are tiny, and the tables in the treatment area are larger and at a height better conducive to restraint.  Second, the hospital is legally liable if the owner is injured on our property, even by their own pet.  Third, some pets behave worse with their owners present, and some owners inadvertently worsen their pet's behavior with their own reactions. 2) We've got no problem using Telazol if necessary, and we have some patients that have "*Telazol" by their file name, indicating that the owner and vet have agreed to always tranquilize the pet from the get-go - but there are certain things we can't do under chemical restraint  - like vaccinate (what would happen if the pet had a reaction?).  And let's not forget the 100-lb. lab who isn't stressed but simply very boisterous and not very well-trained?  Trust me, they're strong, and it might take two or three people to get something accomplished.  Again, there seems to be this idea that we basically take a dog into the back room and mimic WWF wrestling techniques, complete with elbow-smashes to the head, etc., to rough-house a pet into submission. And that's not true, and I certainly wouldn't work at a place that used those techniques.  And you're right - it would be mean/cruel/inhumane...which is why we don't do it in the first place!

anna October 19th, 2009 06:13:08 PM

Anna - I don't know why you brought up the issue of the owner being injured - that has nothing to do with them just being in the room, if others are doing the restraint.

I have worked in tiny exam rooms, and had 5 people restraining a dog for treatment for an infected anal gland, and the owner was still able to watch from the doorway.  If the space is so small and the tables are so badly situated - well, right there, I wonder at the sense of not installing a viewing window into a bigger room.  Yes, I know you work for Banfield and can't change those things, but you can see why people might wonder if it was designed so poorly, what other things are not up to snuff there, and be less inclined to blindly trust what happens there.

And I know very well that some pets are better behaved away from their owners - and some owners don't help and actually hinder, but those situations are such a small minority and shouldn't be used as a blanket excuse (not that you in particular are, but some places do) for taking pets into the back.

As I mentioned, I have seen WWF type things happen to pets in the back, and that's why I never want to put my pets into a situation where their less than perfect actions might trigger those responses.  You, yourself, may never have done those things, but everyone has a bad day/breaking point (even me, although it was a 'just' a loud verbal growl) and I don't want my animals to be there, out of my sight, when it happens.

KateH October 19th, 2009 06:42:04 PM

My personal fav....

Clients who's pet is snarling, growling, hackles raised for a simple blood draw for a heartworm check in the room.  While requiring heavy restraint to hold them still so they don't blow the vein, the owner steps forward and puts hands/face right in the dogs face and speaks with soothing tones, which to the dog says 'good dog please keep struggling'. 

No matter how many times you tell the owners to step back, that the dog won't look to see who's face/hands it's biting, they seem shocked and offended to think that their own beloved pet would dare bite them. 

Happens far more often than one might think.  And I have seen the owners get bitten/scratched when they refuse to listen.

clientsdon'tlisten October 19th, 2009 07:11:14 PM

Anna, my position is that I should be able to e present, at a vet clinic, for any procedure for which I would reasonably expect to be present for my human child at a human hospital or clinic. Do you agree? If not, why not?

Lis October 19th, 2009 07:57:13 PM

I am not saying that owners should get in the way - they should be away from the table and not putting their hands/faces (and that goes triple for their kids!) near a dog that is struggling/growling/trying to bite - unless they are the very tiny minority of owners who really could do a better job with that animal than veterinary staff (and they should sign a release if necessary).

It was two different jerk clients who physically interfered with my holding their dog who 1) sprained/dislocated my right forefinger (major pain for weeks) and 2) 'helped' me take his dog off the table and caused the dog to hit the wall of the exam room and then complained about me such that I was fired, so trust me, I understand where 'clientsdon'tlisten' is coming from.  Yes, some clients don't have much common sense, but, especially with those clients, taking their pet where they can't see what's going on, isn't going to help them learn not to worry. 

KateH October 19th, 2009 10:32:05 PM

One local vet hospital has a solution: Video and glass everywhere. I hapen to like it. You can watch surgery without being in the room (but so can everyone else) and look out over the boarding area to see how the animals are kept and treated. But then, I like this because I happen to do everything in an exam room right in front of an owner and allow owners back for visiting (unless the floor is wet or there's a procedure happening and then they have to wait). If I believe the owner is making things worse in a room or back in the hospital ward (as sometimes happens), I've been known to ask them to step out for the good of the patient. Most people take that OK, though I'm sure they don't like it.

Still, I agree that there are a great many clients (about one a day on average) who are so clueless  they demand to hold their pets for blood draws and get in on the action (where they decidedly don't belong). But then, that's another post altogether.

Dr. Patty Khuly October 20th, 2009 06:54:59 AM

I work at a vet clinic that treats cats only and man you should see the looks on people's faces in the lobby when they hear a cat in the back yowling bloody murder.  It used to bother me terribly when I first started working there until I realized that only 1% of the time are the cats actually enduring any real pain.  Cats will scream wretchedly during the physical exam, during nail trimming, while being weighed, even when we are just trying to get them back into their carriers to go home.  At least where I work, clients should not worry about their animals suffering needlessly.  All painful procedures are done only while the animal is sedated.

Jen (future vet) October 22nd, 2009 07:01:12 PM

There's a lot of talk on this board about clients being upset that their vets don't trust them to be helpful and/or understanding of the procedures they might witness on their pets. We've also mentioned a lot about emergency situations and care at those hospitals. I offer up the suggestion that, has anyone stopped to think that your emotions might be a little bit different in the case of emergency care? I've dealt with a lot of clients at my university's emergency room who act a LOT differently than they would under normal circumstances. It's our policy to initially triage with the client (a quick, subjective assessment), but then to take the pet back to the treatment area to begin examination and treatment while simultaneously beginning an interview with the client if time permits. We don't separate clients and pets just to be cruel; we do it because clients are 99% of the time upset, afraid, nervous, or angry (maybe at a previous referral veterinarian) and that emotion spreads to their pet AND to us! That negative energy does not help calm their pet (who is also in a new situation and not acting itself due to injury or illness), as has often been suggested here. It's not that we don't trust clients, it's that we never know what we're going to get when we go out to meet whatever new emergency just walked in the door.... and we can guarantee that the pet will get faster and more efficient care when everything is performed by doctors and technicians without the client present.

Meagan, V'10 October 24th, 2009 04:01:14 PM

Meagan, I agree with you 100%. I think most of the posters were thinking in general at their own clinic.

Emergency? Eeek, of course it is highly stressful at that point, whether an accident, bloat, close to death---

The pressure on the client is tremendous--hoping to take the right action with the given information, because "time is of the essence".

Glad you shared, good comment to absorb into the memorybank.

Barbara A./NH October 24th, 2009 04:33:50 PM

Don't forget the patient themselves when having a 'no hand holding during procedures' policy.  The core of good medical care does boil down to what is best for the patient not the parent (aka owner).

Some pets can be more stressed out by having their significant other(s) in the room with them when they are already stressed out medically.  Pets worry about how owners feel and are very attuned to their stress and fear levels and we know they pick up on them very easily, and they think its their job to make you less stress or fear or upset and try and take on the role of making you feel okay about what is being done to them. 

I have seen this too often with my pets not to know that the bottom line to the decision should be the pets comfort and not what makes me feel better.  My dog undergoing chemo right now does 100% better during his IV chemo and blood tests if I send his blanket, a bowl of  cheese treats I make him that he will do anything for and allow him to disappear into the back of his own accord following the Vet Tech who holds his bowl of treats. 

The procedures turn out great for him, he is not freaked out worrying about me and happy with this new friend who ALWAYS gives him many more treats in a short time then mom would allow.  He is a big lovable dog and he wants nothing more then to make his family happy.  Just having us in the room for a minor check up stresses him out to where he cooperates with no one.  Separating us from the "vet stuff" makes it much easier for him to cope.

I would love to see what is going on back there but not at the cost of my dogs stress levels.

The other thing that is important to pets, I have found, is that they are happier if you are separate from the medical procedures.  Home and family are safety and comfort zones.  At home no one strange is going to poke, prod or stick him in the middle of the night and (except for oral meds we hide so well he does not know he is getting anything but a big cheese treat) nothing is done to him at home except for his comfort and helping him back to his regular schedule.

Don't get me wrong, your pet should not hate the vet and only love home, but their relationships with both being different help a great deal in their care and progress.  Any pet is much more secure when they know that in one place they can expect one thing and in another they can expect a difference.

And I don't advocate 'dumping and checking out' without visits in between dropping the pet off one day and picking up at release time without any visits even these should be handled so that the pet in not distraught by your comings or going.  A specific schedule of visits lets your pet know when to expect you and when to wait.   This also relieves them from having to be 'up' waiting not knowing when you will arrive to be entertain and cared for by them and instead they can rest. 

There are, of course, exceptions to this that even I will agree to accompany my pet 'through the doors' and the staff literally begs me two.  Perry (aka psycho kitty) greats everyone with claws and teeth except for me and if you try the cat treat routine you just get a dirty look.  Need to draw blood from this kitty then you better let mom hold him or your going need sutures.  The only place this cat is not stressed in his own bed, several of the rooms of the house and on mom.  Everywhere else is just a bad place (you get what you get when you adopt rescued pets) so there is no worry hear that he will confuse the home and vet or learn to love the vet.  In this case its pretty much a medical necessity that the owner be present if the cat is even semi conscious otherwise there is no way to treat the cat safely - for cat or the staff.

Pam November 13th, 2009 04:11:35 AM