Today's top pet peeve: Specialist choices in veterinary medicine
Knowing me to be full of crotchety opinions in all things veterinary, a colleague recently asked me to enumerate my top pet peeves in vet medicine.
But like a foodie asked to list her least favorite dishes, I was reluctant to rank my curmudgeonly views on my own profession, especially since I do love it so, faults and all.
Still, I thought it would be valuable to pen a post on this, especially since one particular issue’s been bugging me lately. So here it is: a lambasting of veterinarians who refuse—outright refuse—to send their patients to specialists.
Veterinary specialists are growing in popularity all across the US. Among others, we have vets to cut things up expertly (surgeons), vets who deal exclusively in eyes (ophthalmologists), vets who dedicate themselves to pet behavior issues (behaviorists), and even some who spend their days irradiating tumors (radiation oncologists).
Yet there are no clear guidelines on how referrals should happen in veterinary medicine, as there are for the human medical profession. That's why some vets won't give you the choice of seeing a specialist when your pet has a condition better suited to a specialist's ministrations.
So why is it that some vets assume they can keep their patients all to themselves, refusing to let their clients know when more highly skilled, knowledgeable providers are available?
I’ll give you four reasons we sometimes refuse to refer:
1-The short-term financial health of our practices
Not referring to a specialist means we get to do more tests, hospitalize more patients, perform more lucrative surgeries, and make loads more money than we would have otherwise. In my experience, there’s no doubt this is the number one reason vets refuse to refer.
An example: In my area if there’s a surgical procedure a vet can’t perform, non-referring practices will call in a non-board certified “surgeon” to cut the case instead. Said surgeon will arrive with tools and tech in tow, perform surgery several levels below the area norm for a boarded surgeon, charge the hospital a sizable fee and leave it to manage the post-surgical case as best they can. The client will never meet the surgeon, but they’ll have been told that a [presumably board-certified] surgeon has performed the necessary procedure.
Sounds shifty, right? It is. I should know. I used to work for one of these non-referring hospitals. I was fired for insubordination, i.e., referring patients to boarded specialists and refusing to allow clients to go through surgery in-house without informing them of their broader choices.
2-Our client’s good opinion of our skills
“If she’s referring me to a specialist it must be that she has no clue what she’s doing.”
That’s what we sometimes fear our clients will say about us on their way out the door. And maybe we worry they’ll never come back if we don’t exude the confidence of a James Herriot-style vet, one who can balance the entire animal kingdom on her shoulders. Why risk referring when we can try our best and hoard our clients’ good opinion of our work?
3-Our colleagues’ opinion of our skills
Every time we refer our patients to specialists we set ourselves up for potential disappointment in our own skills and for perceived condemnation of our skills by someone who knows much more than we do.
Here’s an example: A couple of months back I referred a patient for a cruciate ligament repair and it turned out to be a bone tumor. Embarrassing? Yes. A cruciate is typically an easy diagnosis for me. I wouldn’t have begrudged the surgeon his right to think less of me in this instance.
But what was my alternative? Perform unnecessary surgery (as must happen often in hospitals with strict no-refer policies). And that would’ve been worse. In the end, it was a “no harm no foul” situation that left me a little red-faced but otherwise none the worse for it. Ultimately, the patient was well served by my referral.
4-We think our clients can’t afford it
Sometimes there’s nothing more going on than some veterinarians’ belief that you can’t afford more expensive, specialized care. In these cases, “there’s nothing more we can do” translates into no more treatment. I’m convinced pets die this way every day.
Yet YOU are the only one who can decide what you can afford for your pet.
In all these cases, YOU are the final arbiter of your pets’ healthcare decisions and you MUST be informed of your choices.
In lieu of being handed these choices on a platter, you need to learn to speak your mind, ask questions, and seek out the kind of care you want for your pet:
Ask if the specialist is board-certified. Ask if you have a choice of specialists. What are the price differences? What do you get for these? 24-hour care, etc.? Ask if there’s a closer specialist, as some vets will often refer to those hospitals they don’t think “compete” with them, often to the detriment of clients and patients who need more immediate care.
I know this is a long-winded post, but it’s something I just had to get off my chest. And it’s something every pet owner should understand before their pet suffers the “there’s-nothing-more-we-can-do” syndrome too common to some less scrupulous practices. Remember, YOU are in control. All you have to do is ASK.