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Feel the burn: Burnout in vet medicine and the pet sector (January 17, 2008)

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I don't think you did anything so wrong. My vet knows that if he cannot reach me he is to use his best judgment and do anything/everything he thinks should be done for any animal I bring to him. And I'd be happy to sign a blanket consent if he wanted one. If I didn't trust my vet, I wouldn't be there. I realize that in this litigous society release forms and consent forms are a necessity for CYA, but I think your client's daughter was out of line.

# Posted By Mary | 7/1/08 11:53 AM

Unfortunately, I'm on the clients side here. Granted, in this situation (stray kitty?) I'd certainly give permission, but where's the line?

I had a very sick baby ferret once -- he was a rescue, and god only knows what had happened before I got him, because within a few weeks of bringing him home he got very, very ill -- kidney stones & bladder stones. Worse, I'd just moved to a new city and (my bad) hadn't sussed out a new, ferret-friendly vet yet. So I took him to the local animal ER.

They diagnosed the kidney & bladder stones, took him in for surgery, and while he was out, neutered him. I was livid. He was barely 3 months old, and I don't fix my ferrets until they're at *least* six months old for health reasons. (Ferrets fixed later in life tend to be much larger, healthier, and live longer -- something I definitely thought this little guy needed since he was already off to such a bad start.)

In the end, the poor little guy couldn't handle all of the crap he'd been through, and he died when he was 5 months old. The neutering ended up being totally unnecessary, and just one more thing that his body had to try to recover from while he was already very sick.

Anyway. Client permission? Always a good thing. :)

# Posted By donna | 7/1/08 12:48 PM

I agree that the daughter was out of line. You know the mother well, you know the cons of repeated anesthesia, the kitten was already out - and it was FREE! I'm kind of wondering how she thinks she could have had the neuter done cheaper than THAT! As much as I see the importance of official consent for this day and age, I can't blame you at all given the circumstances - you know your clients and you had the best interest of the patient in mind, and you didn't even try to charge them for the extra procedure. Heck, if I was the owner, I would have not only thanked you profusely - I'd have insisted on paying for the operation if I could afford to (but that's just me).

By the way - has the mother called or come in and had her say in the matter? I'd be curious to know if she agreed with the daughter.

# Posted By Shiny | 7/1/08 1:44 PM

I'll beat her up for you. We LOVE you!!! You were thoughtful of the client and the well being of the kitty.

Wrong schwrong...please ... Incognito-ally yours...

No Name

# Posted By JANET | 7/1/08 2:08 PM

I am on your side here. Had you done that for one of my animals I would have been most appreciative for sure.
I trust my Vet completely to do the right thing for any of my animals that I take to her. If she felt that a procedure was necessary/warranted and I could not be reached I would expect her to do it.
In fact my Vet knows that if I am away and my dogs are with the pet sitter and require veterinary care that I trust her to make any and all decisions regarding their health care. I know that she will make the decision that is in their best interest. I don't think anyone can ask for more than that.
I have never signed anything to that effect but unfortunately I can see the day coming, even in Canada... <sigh>

# Posted By Elizabeth - in Nova Scotia | 7/1/08 2:47 PM

I could go either way. On the one hand, you definitely did the right thing and made the best decision you could have with what you knew about your client; OTOH, just the outside chance you might be wrong on such an irreversible procedure should have made you get the consent. It was a tough call...I'd also be interested to know what the client herself had to say.

Probably you're just stung mostly from the boot in the arse from her daughter. I've done things like that where I was in the midst of giving myself a pat on the back for doing this awesome thing only to be handed my head back to me unexpectedly, so yeah, it sucks. Chin up! :)

# Posted By Shasta | 7/1/08 3:30 PM

I'm on your side. It was a stray kitten and if that was me I'd want the cat neutered to help with pet populations - you knew the client and I'm curious if you heard anything back from the Mom? My vet knows (or at least I hope he does) that I give permission for him to do what's necessary but I have to admit if that was my baby (doberman pinscher) before he turned a year old I would have been upset.

I could only see the daughters reaction being justified if you had charged her for the procedure.

# Posted By Katrina | 7/1/08 4:02 PM

I could go either way too. You, in the end did right by the patient, but an owner has the right to decide if the "extra" procedure is worth the risk - granted a neuter is probably not a risky surgery, but complications do happen - and it would've really sucked if in your case something bad happened. Then again, if you hadn't have neutered him, then a nasty client could've argued, well gee, why didn't you neuter him while you had him down - you must be trying to get more money out of me by having me schedule another appointment! You're right, no good deed goes unpunished.

# Posted By lyn | 7/1/08 4:26 PM

You were not bad, your moives were pure and in the best interest of the pet. but I think you were lucky this has not happened sooner. I think this case is a poster child for consent forms. I implemented them years ago with the same concerns as your staff but received very little static. If a client protested we blamed lawyers and insurance companies. That usually placated them.

# Posted By Hobson | 7/1/08 5:14 PM

Unfortunetly in these days of every little thing being an issue, Consent forms are essential, We don't do anything without a consent form, if the client isn't present and premission has to be asked for over the phone we require the client to repet consent to a secondary person and both people must sign the medical record that consent was recieved. Maybe that seems overly paranoid however we have been burned repetedly in the past, just recently we have now had to have the client sign each page of the quote because we had a client claim that we switched the first page of a quote to add expenses.

# Posted By Erin | 7/1/08 8:13 PM

I usually am very vehement about the need for consent forms. Too often things are done to owned pets without the owners knowledge and consent.

In this particular case, I'm surprised the client was so upset. As the cat was a stray -- and you'd neutered cats for her before, it is a bit shocking how they reacted.

But there are other cases in which consent forms could be much more important, so perhaps it is good that you came to this realization in a relatively benign situation like this one.

And, FWIW, the consent forms will help you and your hospital in the future if issues arise and you are questioned. I am surprised they are not doing it. Failure to obtain consent has occastionally been mentioned in vet board decisions.

# Posted By Stefani | 7/1/08 10:17 PM

Your heart was in the right place. And because it is a rescue-work client, it made sense to go ahead with it. You may have thought differently, if it was a pet-owner & long-standing client and that is where I see a dilemma.

For years, I made lots of verbal "ifs" when in for a procedure to check this or that, and walked away with an "understanding". Absolutely, regular clients would view a "piece of paper" as insulting,or put off, if they have not been accustomed to it. But it isn't the same, as if you asked those same people, for money "up front". I would then be highly insulted about that, as a known & good client.

# Posted By Barbara A. Albright/New Hampshire | 7/1/08 10:39 PM

I just think it's really odd that mom and daughter weren't on the same page.

# Posted By anna | 7/1/08 10:48 PM

if I had been the client I might have expressed initial displeasure that another procedure had taken place without my permission--but upon hearing that it was FREE, no harm, no foul, right? i mean, who wants an intact male cat around the house (assuming they were trying to home it)? as expensive as spay/neuters can be, i think I would have ended up bringing in cookies or something as appreciation... or at least trying to tip you. can clients tip their vet? i live in Vegas.. we tip everyone for everything out here.

# Posted By charity | 7/2/08 2:42 AM

I just have to echo your final sentiment:

Truly, no good deed goes unpunished.

I'm reminded of this fact almost daily, as I try to do good deeds all the time, and still-surprisingly-frequently they come back to haunt me. When will I learn? ;-)

# Posted By Marjorie | 7/3/08 7:12 PM

Remember, Dr.Khuly that common sense is the least common of all the senses. The sad part of these events is that they destroy our innate nature to help others. Send it up; it will work out.

# Posted By Irene | 7/4/08 9:10 AM

Sorry - you were wrong to neuter that cat without consent. It's a very black and white issue.

# Posted By Faith | 7/7/08 6:25 PM

Faith: I think you're right.

# Posted By Dr. Patty Khuly | 7/8/08 7:52 AM

Sigh, this just happened to me today. A critically ill patient, a highly dynamic situation, and me. The patient needed an ultrasound, I needed authorization, and the owner was oddly difficult to reach. The radiologist gave me an ultimatum - his schedule allowed him to do the ultrasound in 5 minutes, or next week. This little dog can't wait until next week. I had to make a call ... and I applied my lofty principle of "when in doubt, serve the best interests of the patient.

Long story short, the owner later declined the ultrasound. I will pay for it out of my paycheck (another point of honor). In all, a rather low price for a big lesson learned.

# Posted By Dr. Cicely | 9/5/08 1:53 AM

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