Yes. Yes we can afford to spay and neuter our shelter pets using a cap and gown and sterile instruments. And if we can't, we need to find a way to do so.

Cloth caps and gowns can be bought and sterilized again and again and again. And good instruments, though very expensive to buy, are well worth the effort of fund raising and the expense of buying them.

The part of the guidelines that covers this is pretty bare bones minimum. I'm a little disturbed that all vets *aren't* already following them. Including in shelters. I worked in a shelter and subsidized clinic for the past couple of years and we found ways to do this. Other shelters need to do so, too, if they aren't already.

Yes. I had some difficulty finding the article online when the link didn't work but I finally did.

I have not read it word for word yet, but skimming it, I can tell you as a consumer that we consumers ALREADY assume that these things are being done.

If they are not, then I think the vets who are not doing this have a moral responsibility to tell their clients exactly what precautions and monitoring etc. they are NOT taking and go over the risks associated with that.

In my review of State Disciplinary Decisions, I see a lot of spay deaths, most of them clearly preventable. Actually, all of them preventable -- boards don't act unless that's pretty evident.

Dr. Khuly, exactly what elements of these guidelines are onerous for regular practices, and exactly why?

What things in this document don't you do at your practice?

Tara, thanks ! I read the guidelines and am wondering what is usually missing from these routine surgerys? Some equipment used to monitor the patient(s)?
The article allowed for a lot of discretion and variations in protocol. I did note, that not 'forbidden', but highly discouraged was the use of "masking". But what I viewed as the message was: aseptic technique, comfort, stability, and safety of the patient, and identification methods to prevent error.

I am really curious as to what hads been recommended that is often not part of "normal, accepted procedure"?

Sorry about the JAVMA link--it's still not working. Here's a direct one:
To view entire doc, scroll down and click on FREE Special Report after following this link:
http://avmajournals.avma.org/toc/javma/233/1

did i read this right? Sometimes spayings are performed with the same instrutments that were used on another surgery? and no gowns? I thought that was basic procedure . i mean gee isnt that like inviting infection?

Guidelines are not mandates. If we lived in a perfect world we would not have to cut corners on any patient at any time. But the reality of paying bills and doing surgeries at a loss necessitate this. You cannot stay in business doing many spays and neuters for less than $100 if you followed all the guidelines word for word. I am starting to get tired of the common perception that Veterinarian's fees are the cause of the pet overpopulation problemand that the problem would go away if we just lowered our fees. I did a free spay day on a weekend a few years ago and only had 8 show up and 5 were regular clients who would have probably done it for my regular fee anyway.

Hmmmm...how much does it cost to use a fresh gown cap and mask and instruments on each case? Add about $10-$15 and that's about right. For each cat spay you can then add the following: Blades, gloves and suture? $15-$20. Anesthetics and pain meds? $25-$35. Staff time? $15-25. Overhead? Miscellaneous costs? Maybe another $40? It costs us at least $100-plus to bring you a cat spay--and that's at a pretty bare minimum.

Stefani,

there is a common assumption that vets that "care about quality" as you put it will use everything available to ensure a professional standard of operation - fluids, gowns, sterilised kit, dedicated monitor person and monitoring equipment. If every client was prepared to pay the actual cost of these services it would be great, and a perfect world, and I'm sure most vets would love to work like this. However, in reality, vet practice is driven by market forces. Clients shop around for a cheaper price. If you offer a cheaper price you must offer less optional extras to stay in business. Therefore lesser protocols are often used, eg no fluids, no fancy monitoring units, less frequent monitoring, no gown, etc. This does not mean these practices are negligent, just not the gold standard. An analogy would be the type of car people drive. Just because you drive a cheaper one doesn't mean it is too unsafe to justify the benefits of having a car.
In my experience most vet clinics would happily operate at gold standard if the client was happy to pay the $600+ or so to cover a cat spey. To me the issue is about informing the client, however it is often exceedingly both difficult and time consuming to explain the medical benefits of every part of surgery to a client with no medical knowledge. Clients do not realise the true costs of medicine.
With feral animals, I believe it is completely moral and justified to perform proceedures in a basic but effective manner, so long as pain meds are used, as the benefit of preventing future offspring far outweighs the risk to the individual animal.

I think the topic is getting a bit confusing, mixing a "normal client/pet spay" with that of shelter/feral spays in "bulk". I don't think we are trying to compare a $35 spay to that of market price (that varies in different regions). Actually in NH, shelter s/n are reimbursed at about 80-90 dollars.

Since I have a recent itemized invoice: a tumor removal was $389 w/o dispensed meds, lab work, x-ray, or histiopathology and does not include the teeth. What 'basics' should I expect for this? As stated, everything went well w/o incidence.

And when I think of the many surgerys of my pets over the course of 30 years, ironically, the one "bad news" neuter was performed at the most "expensive" clinic over the border in Massachusetts. I mentioned previously of the 4 feral cats (young) we took to a completely altruistic vet in the late '80's that spayed or neutered for a flat fee of $15, including vaccines.

I don't think I'm buying into the "money" thing of shortcuts or cutting corners to "cheapen" the procedure.

Lis, Barbara and Stefani: Not misplaced trust. Not negligence. Not malfeasance. Just a recognition of the reality: There's a continuum in the standard of care that is acceptable for spays and neuters. Example:

A dog spay at the specialist's place includes IV fluids, complete labwork repeated on the day of surgery. Two certified techs to prep. Two to monitor. Two more to recover the patient. Air-warming blankets. Lasers. Linea blocks. Pre-op meds including medetomidine, hydromorphone, etc., intra-op meds, post-op meds, continuous EKG. Total price? $1,250.

My dog spay? It meets the guidelines...but only just. (It costs about $300. And that's a *steal*, considering it costs me probably $200-$250 to do it.)

See what I mean? It's not that we're promising the best and not delivering. It's that we're not capable of bringing you the best at the price you can afford. Is it typically way better than at the shelter. I think so.

The attention to the patient's individual needs are still there. The care with which I monitor their progress and provide the intangibles (gentle handling, pets, hugs and sweet talk, etc.)? I think that's priceless.

btw, I believe I should be charging about $600 for a dog spay. But I can't afford to charge my clients that.

Stefani, you asked, "Are they AWARE of the risks when corners are cut?"

I can't find anywhere that you asked, "Are they aware that corners are being cut?"

You say, "Wow, I just assumed it was standard protocol to put a surgical patient on IV fluids at any decent practiced. I just assumed that all patients were monitored for anesthetic plane and vitals at any standard practice. As cynical as I've become I'm still naiive enough to be surprised."

But the rest of your comment seems to presume that all those _other_ pet owners are aware, and are only uninformed about the _risk_ of that corner-cutting.

I have always assumed that corners are cut in shelter spays, with the emphasis after all being on volume. I have also always assumed that a vet in private practice, has procedures for doing surgery, and follows them. I try to choose good vets, on the basis of quality and not price, BECAUSE I want high standards for the care of my pets.

Dr. Khuly, I don't know what things cost you, except the few numbers you've quoted here. I don't know what things cost my vets, and can't assume that the numbers you've given are necessarily informative, given we're in not just another state but another part of the country. I assume that my vets, not being able to live on air, price their services with some regard to what things cost them, including theirown and their staff's need to be paid.

If they are charging less for a spay than it should "really" cost, I cannot appreciate that as you apparently think that I should, UNLESS I KNOW! And since I am not in their computer system studing their accounts, no, this is not magically apparent to me. If you want to feel aggrieved by the fact that I'm not a mindreader, go ahead, but it's not going to change the fact that I'm not a mindreader.

And if corners are being cut to bring the cost down, in order to charge what they ASSUME is all I'm willing to pay, and I'm not being told about it--how am I supposed know? Given that I'm not in there while they're operating? Magic again?

I'm a fairly educated person, and I've learned to be moderately assertive about asking questions. A background as a medical librarian has made me both more aware of some of the questions I should ask, and maybe more ready to understand some of the answers.

But it has never before occurred to me to ask if a good veterinary practice, with a generally high standard of care for its patients, was following basic surgical care standards when spaying my pets.

And apparently that proves that I'm stupid, selfish, and cheap.

Second attempt at trying to prove I'm not a machine.

Lis

From a Vet hospital employee standpoint, I don't ASSUME anyone is only willing to pay a certain price. All I KNOW is that MOST of the people walking through our doors ASSUME that our higher prices mean that we are gouging them.

They refuse to believe that the guy-down-the-street vet is doing anything differently that we are. And maybe he isn't, but it would be pretty hard for him to make a living if he is charging 1/2 as much for the exact same procedure. He must be cutting corners somewhere- by paying his staff less, by using old equipment, by hiring untrained staff, who knows? He certainly isn't shy about advertising his lower prices but I'm he doesn't advertise how he saves people so much money!

Some clients, perhaps pet owners like yourself, appreciate the time I take to explain why we charge the way we do and the safetly measures we include in our higher prices. Many people just stare at me like I am a used car salesman and I'm lying through my teeth. It is the second kind of client that we feel aggrieved by. It doesn't make you feel very good when you leave a conversation with a client doubting your right to get paid for your services.

I'm shocked by this-and I'm a vet student (but it's early years)! The vet practice I did my work experience at before getting into vet school covered all the basics mentioned here for the rescue dogs they were neutering (including clean gowns and instruments). I, too, would have assumed that the price I paid for my rabbits to get neutered was enough to cover basic operating procedures-and I would've paid a lot more for that to be the case, despite being a poor student. I am aware that I care more for my pets than a lot of people though, and I understand the reasons for vets doing this. But next time I'm going to check, and I will offer to pay more for services I regard as essential for my pet. But I would prefer in an ideal world just to be able to trust the vets.

"Lis: The trouble is that basic surgical standards are hard to assess--hence the importance of this set of guidelines. Nonetheless, it remains to be seen whether these guidelines will be accepted by the profession as a minimum standard of care for spays and neuters (that's how I interpret them but that's not necessarily how things will play out in real life)."

If it's hard for the profession to assess, how can it be the fault of the clients if they don't know what to ask for and what it costs?

"Do I believe that the profession is *mostly* adhering to these guidelines? Yes. But it's going to vary by region. Ultimately, our clients' expectations for better care will drive the profession to adopt better standards but it's going to be a sticky process, and some areas will always lag behind."

Do you think yours may be one of the areas that's lagging behind? Because I have to say, I don't know anyone who takes the "it's just an animal" approach to the medical care they want for their cat or dog.

"As to *expecting* that you're getting *the best* care at your local hospital: forget it. If you want *the best* spay you should be willing to pay a board-certified surgeon at a specialty hospital for ALL the bells and whistles available--including *the best* set of hands money can buy. Will you pay $1250 in Miami? $2500 in New York City?"

Probably not intentionally, but that's a cute bit of rhetorical trickery, there. I didn't say "the best;" I said "high standards"--but if I point that out, am I placing myself in the category of people who won't pay for good care for their pets because they're too cheap?

For some things, you go to your doctor's office or your community hospital. For other things, you go to Mass. General. No, I'm not using Angel Memorial or Tufts Veterinary for my pets' regular vet care, and I am not under the impression that my vets are _same_ as those distinguished institutions--but I do believe that they provide a high standard of care, and are knowledgable, caring, and secure enough to refer me if needed.

My current vets were recommended to me by my previous vets, when I moved. My previous vets were recommended to me by a bunch of attorneys who took their own pets there, several of whom did animal welfare litigation. They were unequivocal about that being the best place in the area to take your pets. The current vets were also recommended by other satisfied clients, and I did rude things like use my librarian skills to check disciplinary records.

I believe I'm justified in thinking that my pets are getting a high standard of care, from people who are responsible enough to tell me when something is beyond their skills or experience.

And I'm really having difficulty with the idea that caps, gowns, and sterile instruments are not basic for surgery, but some sort of gold-plated, diamond-studded "extra" level of service that I should know I'm not getting, or that the vet is providing only as a charity, when I pay only $300-$400 for a spay.

Is it me or has this conversation taken a personal tone? Let's not rush to tackle the messenger, OK?

"It's just an animal" is not in the vocabulary of most veterinarians and you should not assume that the bare-bones, cutting-corners approach to sterilizing animals to help lend a hand to the overpopulation problem applies to how we treat your pets. Nor does neutering my neighborhood stray cats on a kitchen table (as I've occasionally done) presume that I'm treating them with disrespect.

That said, it's true that some of us DO cut corners on some things--relative to the *ideal*, that is. But don't misconstrue that to assume I'm saying that your veterinarian is scamming you. We all make choices in our healthcare providers based on *trust* and I my goal is not to prove that trust is undeserved.

I work in specialty/er so we don't do spays and neuters but I have a similar experience with our "simple" surgeries, such as a laceration repair. Keep in mind I'm talking about larger lacerations that need several staples or sutures, not a minor cut that can get by with a clip and clean.

We offer pre-op blood work, full for an older pet or a pet with other issues, partial for a younger pet. We offer IV, gas anesthesia, fluids. If there is concern of a penetrating wound we offer radiographs. We offer at least one injection of IV antibiotics in addition to the oral meds going home with the owner. You get the picture...we offer everything that would be ideal for the pet in its specific situation.

Many clients balk at the cost so line by line we will try to get it down to what the owner is OK with. And the general response? "Gee doc, if you knew you could do it that cheap from the start, why did you even offer me all that extra stuff. Thief!"

Some things at my practice are non-negotiable, however. All pets do get their own laceration pac and new suture and pain meds are a must. We will always have at least a pulse ox on a pet and a tech is always watching what is going on (a tech is the best piece of monitoring equipment there is). Sterile gloves, of course, but honestly for a straightforward laceration we might not gown, cap, or mask. Longer procedures? Definitely.

Dr. Khuly---I LOVE this type of post!! We learn something & appreciate WHAT we learn! And thank you for your candidness, as Stefani was so astute to notice. That's the "most" of what we are afraid of : the pretty 'front office' and 'dirty back room' !(in more ways than one--)

I never questioned s/n for years, had the "cheapest" & the "pricey"--the latter being the only bad one.Finally, after being present for a C-section---I stupidly thought that a spay was done the same way, except shorter time. Noooo, it isn't & learned about the anesthesia, recovery, etc. and why intubated for teeth. Ok then, I don't think fluids were involved for my young pets.

My old, old gal? Well, she was so edemic when I picked her up, I hardly recognized her & she didn't drink water for 2 days. My girl last week or so? Well, it states a charge of a liter of fluid, but that can't be---she would have swelled to a beach ball. (this isn't a complaint being registered)

I do notice that a shot of penicillin & followup ab isn't routine, and kind of wish it was--especially if a catheter is needed.

This verifies that an "educated consumer" is your BEST consumer. You techs should hang in there, your speeches will pay off with patience!!

Lis, I'm with you!! And you are very lucky to have the recommendation that you got--it is my belief that the ultimate quality & good sense lies with the "human". A good PC vet is going to be the "first" to tell you when referral is needed and WHO to go to!!

Circe posted while I was writing this and she said it way better than I do below. Sorry for the bloviating :)

Circe: “Clients do not realise the true costs of medicine.” I absolutely agree with this 100%. Underline underline star star star. IMHO this is the basis of the whole tension between “unrealistic” owners and the perception of vets as money-hungry and cruel. If we compare how much our own health care actually costs, it’s pretty shockingly expensive, but most people never see the bottom line and people are generally entitled to a basic level of care regardless of ability to pay, which is subsidized by the government and the state. Vets have no such social support.

Barb: “I mentioned previously of the 4 feral cats (young) we took to a completely altruistic vet in the late '80's that spayed or neutered for a flat fee of $15, including vaccines. I don't think I'm buying into the "money" thing of shortcuts or cutting corners to "cheapen" the procedure.”

Unless you yourself work for free, I find it insulting that you equate charging enough to cover the bottom line and pay your employees to selfish behavior by vets. Perhaps your vet had his/her own personal reasons for charging so little money, but I can guarantee that those ferals did not get the fluids, bloodwork, one-on-one monitoring, intubation, inhaled anesthetic, pain meds, etc etc etc that a clinic charging more could afford, at least, not a clinic that wasn’t headed for bankruptcy. Luckily they were young and presumably healthy and the procedures went well.

Stefani: “Wow, I just assumed it was standard protocol to put a surgical patient on IV fluids at any decent practice. I just assumed that all patients were monitored for anesthetic plane and vitals at any standard practice. As cynical as I've become I'm still naiive enough to be surprised.”

Why would you assume this? For a 5 minute neuter, IV fluids aren’t necessary, likewise for a young healthy spay. It’s a medical decision to be made by the doctor, not the client, although of course the client should discuss their concerns with the doctor and the doctor should default to “more care” whenever it could possibly be needed. And the definition of “monitored for anesthestic plane and vitals” can vary greatly, from a tap of the eyes every so often, a mere pulse-ox on the tongue, to a dedicated anesthesia tech. I am curious why you consider this elevated level of care to be standard? Do you have similar views on what should be standard in human medicine as well?

“I know I am preaching to the choir, but when you say you can't afford to charge your clients the "real" cost of the spay, I have to wonder: Can pet owners afford NOT to pay for these kinds of measures?
Are they AWARE of the risks when corners are cut?
Do they understand the problem created when there is not an IV line in a patient and they get into trouble?
Not intubating?
Not monitoring or monitoring with staff that aren't adequately trained? “

I find this a completely unrealistic idea. Would you expect your human doctor to explain to you that you’d be getting more care or better care if only you had private insurance and weren’t on Medicaid, and then list all the things you won’t be getting? As far as I know, most places have a written consent form stating that all surgery carries a risk of death. As the guidelines state, vets should determine which patients are too fragile (elderly, sick) or otherwise risky to have “basic” spay/neuter surgery and should advise the pet owner about IV fluids, bloodwork, etc. If the owner declines this, they document it in the chart. Most healthy animals will do fine with surgery. It’s the percentage who don’t (and this is not always predictable) who may be better off with more of the “extras,” but in general, there’s a bell curve and most animals fall into the middle section.

There should be some basic logic to the idea that a very low cost spay/neuter will not have the “nice to have but not NEED to have” extras that a $400 spay would. Unless a clinic or shelter is subsidized by a city or donations, it’s patently impossible to stay afloat on $35 alterings, even if you do 100 a day. There is risk to all surgery and even those patients with the IVs, dedicated techs, intubations/gas, warming blankets, etc can still have exactly the same complications that the $15 low-cost spay/neuters can have. The difference is that you have more eyes actively monitoring and more preparation (IV fluids, pre-anesthetic bloodwork, etc) but for the majority of the general public their pet will not need this level of care and most people won’t pay for what they probably won’t need.

“I realize that you are saying these things don't go on at your practice, but it sounds from general commentary here like they do go on at lots of practices, and that the steps the vets take to make themselves "cost competitive" have risks associated with them that may not be known by the client.”

I volunteered at a low-cost spay/neuter clinic. I am not a licensed vet tech. The clinic relied on donations from fundraising, and most procedures were between $25 and $75. The clinic carried a very small selection of antibiotics and pain relievers (the cheaper ones), there were few intubation tubes which were used mainly for spays, and neuters were performed by lining up the unconscious cats on the exam table and going down the row and neutering. The vet changed gloves between patients but not hat or gown, and did not change gloves between cat neuters. New scalpel blades were used on each patient but the scalpel holder was used for more than one patient. Animals recovered in unheated cages (covered with a towel but not actively warmed) with periodic monitoring by the “techs”, who were busy prepping patients for surgery. Complications were very rare. These animals would not otherwise have been altered if their owners had to pay for an increased expense level of care. As it was, people complained about the prices, and many owners refused even the cheap $8 vaccines. If we had to explain each and every risk and potential complication to every customer, and what their pet won’t be getting, I believe that many people would just get overwhelmed and unjustly terrified of surgery and their pet would just go untreated and unaltered.

I now work one day a week at a “standard” vet clinic and they do most of the things mentioned in the document. They will gas down some animals if it’s deemed to be needed, and they will box down really nasty cats. Gowns, gloves, etc are all changed between patients. IV fluids are offered for older or at-risk animals and every animal gets an IV put in before surgery, and every animal is intubated. The result is that our charges are significantly higher than competing practices, and we do fewer surgeries. Is it better to not do an alter rather than do a low-cost, bare-bones one? That’s the kicker.

There’s a balance between cost and standard of care. It exists. It may not be fair but there is the practical side that a clinic is a business and you cannot pay the rent with altruism. Until we have standardized mandatory pet insurance for every animal born, you’re going to have a trade-off between cheap and fancy. It may not be right or entirely ethical but since pets are essentially considered property, it’s going to take a LOT of change in the very fundamentals of how people view their pets before people start to see the value in paying a bit more for a bit more services.

Awww man, lost my comment!

I'll re-type an abbreviated version and I apologize in advance if it posts multiple times. This is going to sound jerky, but I really don't mean it that way. Tone is hard over the internet, sometimes.

Have most of the commenters here really read the guidelines, not just skimmed? I'm beginning to think not because they are really quite broad and permissive. For example, there are no requirements for:
* gowns during surgery (they're just recommended)
* monitoring equipment (this would allow the use of manual monitoring of things like jaw tone, palpebral reflex, etc)
*pre-anesthetic bloodwork
*IV catheters
*intubation (they say to weigh the risks vs the benefits, but recommend it when possible)
*withholding food from feral cats

I'm seeing a lot of comments along the lines of "Well, nobody can live up to the ideal! It would be way too expensive to use all the bells and whistles and most expensive things and intubate everyone and change your gown every time!!" But the guidelines don't even ask for that.

It's like everyone breezed through the abstract and went "Standards - yikes! I bet they're going to be really tough!" when in reality, these are broad, minimum standards intended to make clients and the veterinary community more comfortable with spay and neuter clinics. These are NOT the fancy schmancy specialty surgeon standards being referred to in some comments.

Translation: "The client is too stupid to understand our explanation (we have no obligation to learn how to explain things in layman's terms, after all), so there's no point in bothering. We just have to cut corners without telling the client, and if something goes wrong, it's the stupid, cheap client who's at fault--even though the client had no clue that we were cutting corners, or that there were any other options or something else that should be done."

PerfectWorld Retranslation: We explain the to the client the basics of the procdure (Fluffy will asleep with a tube down her throat, gas breathing for her, and she'll havea an IV in her arm in case a medication is needed. Running a full bloodwork panel ($140) and using Iv fluids during sugery ($30-$60) usually will need to be done at the time of the surgery and/or dental cleaning. We explain that the bloodwork can give a baseline incase anything happens later Then we start the warnings about the dental, that the aniamal will be anesthesized for a period of time, and teeth may need to be pulled. If teeth are extracted, the bill goes up, per tooth. Often, hidden dental problems require a much longer anesthesia event and can put the animal under much longer than a usual dental, which increases our anesthetic costs. We explain that we can't always predict how the dental (or spay/neuter, or any other surgery) ,will affect their recovery. We explain that there is always a chance that a technician might drop your pet on the way to the recovery cage, which will have warmers if needed. Also, a Yeti might walk out of the storage closet, requiring the staff to flee with the post-surgical patients to substandard accommodations outdoors.

A low-cost place would have to say "you'd be better off going somewhere more expensve, even though the shelter vets are very very good at S/N;" and have a list printed up to hand out of all the services they don't offer. I'm not a business major but the whole system sounds like it means fewer patients seen in a day, and people scared of the risks. I held a 17 year old intact miniature poodle iin order to draw some blood. As we put the muzzle on him, 2 of his teeth fell out into my hand. The owner said "I'm not paying to have HIS teeth cleaned. We never did that when I was growing up." That dog lived with a garbage mouth for another year. A year he could have enjoyed with less discomfort, anesthetic risks be damned.

Next, we begin the speech oh how animals wake up from the anesthesa. Some thrash, some just wait a bit and get up, some recover etxremely slowly. Once recovered, the animal is offered some water and lounges on a towel in a cage until they're picked up.

Finally, we hand out a Patient Information Sheet about every instrument that will be used (with pictures), every medication that may be necessary that may have to be used, and the horrible side effects of spays gone wrong and what to watch for.

Now imagine having to say this to even 5 people a day. Not only will it take up all of your allotted time, you also don't know if the client understands the low-level of risk and the potential benefit that comes out of it. And most people would still choose the fewer bells and whistles approach with a young, healthy dog or cat.

Boston, re:

"Why would you assume this? For a 5 minute neuter, IV fluids aren’t necessary, likewise for a young healthy spay. It’s a medical decision to be made by the doctor, not the client, although of course the client should discuss their concerns with the doctor and the doctor should default to “more care” whenever it could possibly be needed. "

EXCUSE ME, THIS IS WHERE YOU ARE 100% WRONG.

NO DECISION INVOLVING MY PET IS YOURS.

Remember, you and your lobby keep arguing that my pet is my PROPERTY, every time laws are proposed to change that YOU fight them.

Don't you DARE presume that "clinicians" get to decide what level of care my pet gets.

I initiate these discussions with vets so that I know, BUT THE CHOICE IS NOT THEIRS.

This is the point I was making on the metacam debate. You do NOT substitute your judgement for mine. I deserve to be informed of the protocol to be used, AND THE RISKS. The risk-benefit calculation and consequent decision is always MINE to make, NOT yours.

PET = MY PROPERTY, NOT YOURS.

Get it into your head.

Stefani: 'Don't you DARE presume that "clinicians" get to decide what level of care my pet gets.
I initiate these discussions with vets so that I know, BUT THE CHOICE IS NOT THEIRS."

Number 1 question: why do you even GO to a vet at all? Given how cynical you appear about every aspect of patient care and cost containment, how can you possibly walk into their office ever again? I think you should apply to vet school now, then start your own practice with the very rules you keep pushing everyone else to follow. I'm sure it will Edenic.

I don't telll my personal doctor what she should do when I see her for a physical or for other reasons. I don't grill her about the side effects of the new drug I'm on. If I have a side effect I call back and get a different drug after reading the CVS precautions handout. If I had to have surgery I would assume that I would be in good hands and I would not waste my time grilling the entire surgery team about how clean their face masks are. It's a boundary that shouldn't be stepped over, IMHO. They do their job, you do yours. There's so much that I don't know about human medicine that I couldn't possibly presume to direct the staff around.

How can you be comfortable requesting treatment for your pet and making decisions on what you want or do not want done on the pet, when you as a lay person have not done the reading on every procedure, you have not performed numerous surgeries youself, and you yourself are not in the medical field? Do you specify the flow rate that you want going into your pet's IV? Do you watch the surgery to point out to the vet where he or she has stitched something a little crooked? At some point you have to give up control and let your vet do his job. What is your determination when you allow them to do this?

Anonymous,

I hire vets to provide their expertise, not substitute their judgement for mine. It is my expectation that risks and procedures will be thoroughly explained to me, and then I will make the choices. NOT that they will be made in my absence, UNLESS it is an emergency and I can't be contacted.

I do grill my vets . . . now. I have a good relationship with my vet, but she knows I am going to ask questions. Yes, down to surgical details. I tried to pay her extra to use sevo instead of iso but they stopped carrying it and I went ahead with the procedure but I told her I wanted them carefully monitored and I asked questions about it. She understands this. I confirmed that they would be on IVs. I confirmed that the tech monitoring would be licensed. I think it is good that she knows I care. I have never balked at the bill.

As for your attitude toward human doctors, I personally believe you place yourself at risk when you fail to ask questions. I work in an industry where I am exposed to knowledge about the medical error rate. Medical errors and quality of care issues abound in human medicine as well. More's the pity for you if you don't grill your doctors. I have also learned to do that with medical doctors, and I get 2nd-3rd opinions when something doesn't seem right. This habit saved me a totally unncessary surgery a few years ago, in the hands of an over-eager and fairly inexperienced doctor.

Both my father and grandmother were, in my opinion, victims of negligence. At 23 with no medical background, and a surgical resident and nurse in the room, I was the only one who apparently could see that my father had stopped breathing. Lotta good they were. I had to convince them that he was dying, which was apparent to me, but the medical professionals didn't want to slow down enough to really LOOK. Not until the monitors all started going haywire.

When my grandmother died, apparently after choking on her own vomit while recovering from pneumonia, they told my mother that someone had put a DNR on my grandmothers bed. WELL, no one in the family had put a DNR on my grandmother. An autopsy showed that she had been allowed to develop sepsis from a kidney infection likely due to not being kept clean in the nursing home, and her friend confided that they were both in abdominal pain constantly, but my grandmother was probably afraid to open her mouth.

You need to be your own advocate, when you are dealing with human medical staff. YES, studies SHOW that you need to ask them to wash their hands before they touch you if they don't do it. MRSA is rampant.

And, we feel that we need to be advocates for our pets as well, I know I do. It's nothing personal -- but neither vets nor doctors are all conscientious, nor always at top form, etc.

Anonymous in Boston:

Here is what I suggest: 1) Veterinarians provide a xeroxed copy of this surgery report and give it to the pet guardian. 2) An itemized list and price of everything that is offered by the vet. 3) LET THE CONSUMER decide what he/she wants for their pets.

My pet DIED three days after he was released from the diplomate surgeon. I am still waiting for the surgery and anesthesia reports that I asked in March. HE REFUSES to release them to me. . .
I never bargained costs, and most IMPORTANTLY, I TRUSTED HIM! The sad part of this story is that there was NOTHING WRONG with my pet! Two attending vets, a PHD internist, an emergency vet, and the surgeon all MISDIAGNOSED my pet. His wrong treatment (surgery) cost me more than $5,000.00. No specific risks were mentioned by the surgeon other than "There are always risks with any surgery but your pet is fairly healthy--will be OK" I was naive and stupid not to ask A LOT OF QUESTIONS, but his status (diplomate surgeon, dimeanor, fancy mouthing) never let me doubt the outcome of the surgery. I paid very dearly my trust to these vets.

Barbara--Sorry! I didn't think you were disagreeing with me; I was just struck by the "an educated consumer is your best customer" line, because of the Sims ads, wihich I assumed were in the back of your mind because the phrasing was identical.

Dr. Khuly made a comment earlier about the tone of this discussion getting a little _personal_. By which she appeared to mean that I and others are saying mean things about vets. Part of what I said in my Ghost Post that failed to actually post SEVEN TIMES before I finally lost it altogether, is that she might want to try rereading this comment thread from the point of view of the client.

There's an awful lot of condescension and contempt for the client being expressed here. We're being told that our pets in surgery are not getting some things we thought were BASIC--like sterile instruments. We're being told that the reason they're not getting them is because we're not willing to pay for them--even though we've never been asked, and WE'VE never asked because we took sterile instruments for granted. And we're being told that we can't even be told about these "choices" because we wouldn't understand the explanation, and would certainly believe that the vet was trying gouge us, and so the ONLY POSSIBLE CHOICE is to leave us in ignorance, and cut corners, and blame us for being ignorant and cheap if something goes wrong.

"Anonymous in Boston" (gee, I wonder why?) says that if we DO ask questions, insist on answers, and insist on making those cost/benefit risk-balancing decisions ourselves, then we shouldn't even be bothering to go to the vet. That the only correct way to relate to the vet is the same way my grandmother related to Dr. W of revered (by some) memory: She told him what symptoms she had. He told her what prescription or other treatement would be done. She said, "Yes, Doctor," and did what she was told without any questions.

It doesn't work that way anymore. If "Anonymous" has ever received medical care, and has bothered to look around the doctor's office, or the hospital waiting room, it will have noticed the signs for Patients' Bill of Rights, patient advocacy, people to help "translate" medicalese if you don't understand what the doctor is telling you.

Humans have laws and standards committees and patient advocates and the ability to ask questions. Our pets have US, and that's all. Pets are property, and as far as medical rights go, pets have the same property status as a toaster--and veterinarians bitterly resist any effort to change that.

So the only protection that pets have in the vets' office is those owners that "Anonymous" thinks should just shut up and not ask any questions.

A GOOD relationship with a veterinarian, as with a human doctor, rests on trust. But it shouldn't be a blind trust, and there should never be a DEMAND for blind trust. The pervasive, unconscious, unexamined condescension and contempt expressed in this comment thread undermines that trust--and any vet or vet tech like "Anonymous," who DEMANDS blind trust, should be drop-kicked six ways from Sunday, and then dumped, gagged and blindfolded, in a hospital emergency room, to experience without explanation whatever care, or, um, "care" the ER team chooses to practice that day.

Wow, Lis, this was perfectly said:

"There's an awful lot of condescension and contempt for the client being expressed here. We're being told that our pets in surgery are not getting some things we thought were BASIC--like sterile instruments. We're being told that the reason they're not getting them is because we're not willing to pay for them--even though we've never been asked, and WE'VE never asked because we took sterile instruments for granted. And we're being told that we can't even be told about these "choices" because we wouldn't understand the explanation, and would certainly believe that the vet was trying gouge us, and so the ONLY POSSIBLE CHOICE is to leave us in ignorance, and cut corners, and blame us for being ignorant and cheap if something goes wrong."

Ditto and bravo.

OK my last post defended vets in general, but anonymous has said a few things with which I have to disagree.

First, the vet giving thyroxine to a cat not diagnosed with hypothyroidism was WRONG. That is negligent behavior. He should have offered to let this client pay for a full thyroid panel even though his suspicions of disease were low. Then IF the numbers were off, treat appropriately. This client was probably confused and read symptoms of hyperthyroidism which IS common in cats and though they fit her animal. If this were human medical care, he could be held liable for any bad consequences.

Second, I don’t think other posters are saying they want control over every last detail, but to be reasonably informed about the choices being made and why. Informed consent is an important part of human medicine and needs to become an important part of veterinary medicine as well. If you think that makes me a control freak, fine – I’ll find a vet that is confident in their choices and willing to explain them to me. I do appreciate the experience of my vet but that doesn’t mean I need to trust them blindly. I don’t expect that out of my own patients.

If you don’t ask your doctors questions, that is your mistake. Hopefully, you will not pay for it too dearly. In life, we are our own advocates and that of our pets. Yes it can be frustrating when people find bad info on the internet and I have to explain why my recommendation is better. But I’d rather deal with that patient than the one who takes no personal responsibility for their health. They don’t ask questions, they don’t listen to explanations, they just wander blindly through life and expect me to wave a magic wand over their head once a year to heal them. Asking questions and doing your research is part of responsible pet ownership.

When my 14 week old puppy was diagnosed with renal failure, I was given a bag of Purina NF and told maybe I’d get a few extra weeks out of him with that food. I did my research. In the end, went to a homemade low phosphorus diet, subq fluids, occasional IV flushes, meds for various symptoms and bought him several months of quality life. When his phosphorus levels were high, I started him on binders (again after my own research since no suggestions from the vet). At this point, I’d seen three different vets in town and they all still thought kidney failure diet was about protein not phosphorous. When abnormal calcium levels started showing up on the labs I was requesting, I figured out the appropriate testing for diagnosis and the appropriate dose and frequency of calcitriol to treat his secondary hyperparathyroidism. I found a good vet and stuck with her even though she was not up to date in treatment of his disease but she was willing to work with me. I was not condescending to my vet. I recognized that while she had trained properly, she hadn’t used this info in years and was rusty. She was also too busy to spend hours each day researching for my animal. I shared this info as politely as I could by bringing in printed info with the important stuff highlited (so she could skim read and not miss the important stuff). She reviewed what I brought in and gave me her opinion on the matter. We made the final decisions about what to do with his treatment together. If I wasn’t his advocate, he would have died. Yes he was in the small 1%, but he still mattered.

My parents 10 year old Yorkies need their teeth cleaned. I called around local vets asking questions. I know by the estimates that they are not providing the level of care I am looking for so I’m looking for a vet that has the other services available since we are willing to pay extra for proper care. I’m having trouble finding an office that can provide everything we need under one roof (labs, x-rays, intubation, good anesthesia protocols not masking down, and monitoring equipment for the anesthesia). If I didn’t ask, they wouldn’t have said anything. I’m not blaming them for this, but I don’t think I’m going overboard by asking what they plan to do with my animal.

It is hard to take you seriously when you are willing to say inflammatory things and not even use your first name.

If you use the same spay pack on 3 cats, aren't you possibly infecting healthy cats with FIV or FeLV or something of that ilk?

Lis, I haven't watched TV in so long, I FORGOT which commercial it was, thanks for reminding me!! You expressed advocation just right, illustrating the "pickle" we are in as pet-owners.

Shannon, I am thrilled to have your viewpoint, having spent a solid 5 years wrapped up in a family member's stage 111B post-diagnosis (recently deceased) and my pets' triumphs & failure. (see my name link-web site) It has been the human medical professionals (also loving pet-owners) that have been my best supporters in my state. On previous blogs, we have all hashed out how we view human/animal medical care comparisons.

I defer to the kind comments of your "rusty" vets that failed to inform you of options and treatment for probably the most "common" diagnosis of renal failure (in both cats & dogs) . From my standpoint, "I cynically" presume that they may have presumed that you'll just "get a replacement".

Fotini (hope I spelled it right): I am truly sorry for your experience and loss. I can say with all truthfullness, I know what you are feeling, my email is on my web site

>At what point does 4 years of vet school have any value when up against a client's beliefs?

What on earth gave you the idea that four years of veterinary school gives you the right to make decisions for your client, instead of using that education and expertise as it should be used, to explain the range of options so that the person who makes decisions for your patient is operating from a point of informed consent?

It's not the client's "beliefs" you should be concerning yourself with, doctor. You should be behaving in a professional manner to help that person make a decision for the animal in their care based on information that includes your expertise.