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A veterinary blog for pet lovers, vet voyeurs and the medically curious...
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Yeah, I know this story will sound petty but it’s been burning a hole in my soul for the past couple of days so bear with me as I exorcise this demon here.
Some of you will remember an old post where I profiled a local hospital (nameless, of course) refusing to divulge the information of its former veterinarians after a falling out. Clients were upset after making appointments without being told of their vets’ departure. They left in droves after calling around and finding their preferred providers’ new location.
The same hospital offers a boarding service I’d often recommend to my clients—before the previous vets left. I don’t know the vets or the management now (the former hospital manager had also defected), so I thought I’d get to know them before recommending their boarding facility anew.
But some of my clients still go there, of course, having been referred there in years past.
When one reliable client didn’t show up for her regular yearly exam I didn’t notice (can’t keep track of ‘em all 24/7). But when she did come in a couple of days ago for a simple follow-up to her dog’s chronic condition, turns out the boarding facility/hospital had done my work for me—sort of.
A new medication had been prescribed and it was revealed that she’d received it after her last boarding stint. I asked about her yearly visit and she said all vaccines had been taken care of at that time, too.
So you know, this is a dog who normally gets vaccines on a three-year staggered schedule so she never gets more than one vaccine at a time. Her immune system-related chronic condition makes that a necessity. And she wasn’t due for any vaccines this year; none except the Bordetella (kennel cough), a vaccine that should be administered at least one week prior to boarding for maximum effectiveness (which wasn’t the case in this situation).
The hospital had told her she needed the vaccines before she could drop her dog off (though she was technically compliant even by yearly vaccine schedules as a full year had not quite passed). Of course she consented, not understanding that her dog wasn’t actually due for vaccines. While they were at it they did her heartworm test and fecal exam, too.
Moreover, on picking up her dog, she’d been informed of a new diagnosis for her dog’s condition and accepted a new medication. Something which duplicated one of the medications she’d already been using for three years.
Clients aren’t expected to be savvy about medical terms and prescription products. Clients are increasingly becoming aware of issues surrounding over-vaccination but they can’t always be expected to remember their vaccine schedules and the rationale behind them, much as we may explain it. Most good clients just do what they’re told. Excellent clients may go one step further but I don’t expect that brand of understanding from everyone.
So it was that I didn’t get into an explanation with this client over the vaccines, simply describing the duplication of the medication and leaving it at that.
But the hospital? They had our records on hand. They had no reason to fail to understand our policies and procedures. All our vaccines are approved for three years, save the Bordetella vaccine. Their oversight put a dog at unnecessary risk (albeit small), their lack of collegiality in performing tests and prescribing medications for a chronic condition was infuriating and I was going to have my say.
I called to speak with the hospital manager to describe the problem and ask that she check with us before administering vaccines to our patients. I was going to leave it at that.
Guess what I was treated to? No apology. No description of their policy for my information when referring new clients. No discussion of their vaccine protocols. Instead, I received a politely delivered admonition for failing to diagnose this dog’s condition.
“Seriously?” I asked. “You have the records. Read them.”
“Your client informed us that she had never received a diagnosis for this condition and when we asked if it was OK to give her the vaccines and medication she consented immediately.”
The implication being, of course, that this client was unhappy with my services since I’d failed to make a diagnosis (which I hadn’t and she apparently wasn’t since she’d just come to see me) and wished to make a change of hospitals.
Having the presence of mind to hold my tongue while angry, I hung up the phone after thanking her for “understanding my position for future clients of ours.”
For your information there’s an unwritten rule governing referrals of clients between veterinarians. The referred-to vet does not perform services the referring vet routinely performs without express consent. It’s considered rude and unethical.
If a client wishes to switch vets, the referred-to hospital and the referring hospital must confer. That may seem strange but it helps preserve collegiality on matters both financial and health-related. We all practice slightly differently so it’s important to preserve the continuity of our recommendations through this method—so that the administration of unnecessary vaccines and duplication of medications, as in this case, doesn’t occur.
Needless to say I won’t be sending any more clients their way. A quick check with the local vets I’m friendly with confirmed my impression of this hospital’s aggressive tactics. (I should have known, right?) But should I write a formal letter explaining my position so this might happen less often to others?
And should I discuss the problem with my client? Will it sound petty? Does she deserve to know that she received extra vaccines and that I had not failed to diagnose a condition? I hate to think she harbors any doubt the other hospital might have planted.
I haven’t decided. Perhaps I should just leave it like it is. Those of you more experienced in diplomacy…please advise.
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- Mohandas Gandhi
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If your patients are curious, you can just say that you'e come across a couple of cases where this was done and you didn't receive the records and you want to be extra careful to make sure that vaccines aren't being duplicated. And you can toss in a statement that should never let a kennel give these shots, etc.
That way you don't have to name the facility, you educate your customers and you avoid the liability that would end up on your plate if you were to give vaccines on top of the ones they were given by these bad vets.
And of course if they mention they use this vet for boarding you can always warn them about the vaccine problem or just gently tell them that you are now recommending facility X as your preferred boarder.
I had a related experience with my dog at a boarding facility within a vet clinic over 15 years ago, and I'm still ticked about it. We had to travel unexpectedly and couldn't take our dogs. Our normal kennel was full. I don't recall how we chose this place.
When I picked up our dogs, they presented me with a computer printout of a list of recommendations -- food change, further diagnostics, semi-annual exams, I don't know what-all. Turns out they had done an "Older Dog" exam on my dog without my permission and -- obviously -- without me present. I don't recall whether they gave him any meds. Poor pup. He didn't know any of these people, and he didn't like exams. He didn't deserve to have that done to him at all, to say nothing of in the absense of someone he trusted by his side.
I was extremely upset about this (mis)treatment and never used them for kennelling again -- or anything. I let them know what I thought, but they acted as if they had done me a favor. So, every friend and client of mine who had pets learned that this clinic had poked and prodded my dog (and took blood, as I recall!) without my permission.
Interestingly, the vet sold the practice and moved. I moved too, later on, and recently found that he's practicing nearby. Oh goody -- a whole new opportunity to educate my local friends and clients -- and the humane society also.
I think a curt letter to the vet/boarding facility is in order, since you have referred past clients to utilize the facilities (no appreciation for that obviously!!). Of course you could formally register a complaint of AVMA guidelines with your state association too----since you have pretty much stated exactly what the written ethical guidelines are (I've read them too!).
Will you sound petty to the client? It would not appear that way to me, but is the client kind of a dim bulb? Sorry for lack of better description. I only say this, because it would occur to me immediately that something "not right" was up with all these "included tests" for a boarding stay. The vaccine issue, I would mention your position on the issue (that is now backed up by all research, including the AVMA)
Lately, I have been pondering the cruel "referral scam" that Pocket and I were subjected to. And it is my belief that not only was I scammed, but the referral hospital was scammed also. This does not in any way excuse any of the unethical, cruel, and fraudulent vets involved from what they did. Every individual is responsible for their own actions, including the "silent support staff "
Hmmm, I believe the above sounds pretty restrained, since I truly am in a "simmering & stewing mode" , since my old gal's peaceful and humane death that flies in my face to remind me of the incredibly cruel one I'll never forget. This blog is about ethics----
For the readers, I have learned that federal guidelines for all states Attorney General Dept. are mandating "transparency in government" and easier access to FOI (freedom of information). A search on the "new website" here in NH (and you have to use multiple searches to find the buried info) has disclosed "some" of the complaints filed starting in '06---no details except the name of the clinics (I'll be updating my web site hopefully this week)
I think this is a moral issue. Take the "you" out of the situation and deal with it from afar as though it had happenned to another vet or pet owner. Then make your decision. To me, this is an ethical situation.
They suck!
People are just plain FED UP with scams, blatant incompetance, deception, disrespectfulness everywhere they go. Legal reform is taking place, government reform, accountabilty, because the public is demanding it! The majority of Joe Q. Public is reasonable, expects mistakes to happen, looks for the courteous and ethical transactions----but can no longer accept the mentality pervading the business/service world. Changes are coming! Bad business will fall and fail, as it should be.
As for your announcement taht "the State of Florida is moving towards publishing more visibly " -- this is good news. Earlier this year I wrote a public records request to every state in the country requesting disciplinary records for the veterinary board for 2007. I didn't hear from Florida -- until just this past week, and the letter was sent in late January. They said my request was mis-routed. I don't disbelieve them, but now must write them again to get the information I originally requested, since they say so much time has elapsed that they aren't sure I still want the information.
Many states make the records of veterinarians as well as other health professionals available on their websites. I don't believe Florida does. My state of Maryland does not either. However, Virginia, Colorado, Connecticut, and a whole bunch of other states have.
It is incredibly expensive to fulfill public records requests when this is not done. I have been informed by several states in the country that it will cost me hundreds, and in some cases, thousands of dollars to obtain the public records associate with veterinary discipline for 2007. Clearly, this is exhorbitant. Some states charge 25-50 cents per page (NOT inclusive of staff time, for copies alone), when the Kinkos right down the street from their office charges only 8 cents per copy. From a consumer standpoint, this seems like an attempt to withhold public records in spirit. Technically, it's available. Practically, its unaffordable in SOME cases.
Also, how much less expensive must it be in the long run for the state to simply do what Virginia has done, and make the decisions readily accessible online? No staff time is involved. True, it's an up front investement to build the database and website, but after that -- no more copying costs, no more research time costs, it all goes away.
Anyway, it's good news about Florida, and I wish they would hurry up and implement.
http://www.aahanet.org/PublicDocuments/AAHAReferra...
THen I would write a letter to that boarding place and tell them they broke the "code" between referred to and reffered by, and you do not appreciate their aggressive money-hungry tactics, and you will not be referring anyone to them again. I would also add a sentence saying something such as "last year I made 127 boarding room references" so you think about the long-term financial impact of your short-term financial aggressiveness. OK OK, I'm not saying exactly what I mean, but I think you get the main point... Love your blog!