Expected complications and/or sloppy work in pet medicine: Who pays and how?
When you take your pet to the veterinarian for a “simple” spay and the incision requires multiple follow-up visits as a result of its obvious superficial infection, should you pay for follow-ups?
When your vet “misses” a diagnosis and you have to go see the [expensive] internal medicine specialist only to figure out it’s something simple your regular vet should have caught in the first place…do you demand a refund?
When the bandage your vet placed on your cat’s tail causes it to slough off, should he pay for its necessary removal?
If, year after year, your vet fails to inform you of your dog’s high liver enzymes and she eventually ends up at the ER with a ruptured bile duct, should your vet pay for the expensive intensive care she requires?
When your cat’s ability to get at her sutures after her spay means a $1,000 trip to the ER after dripping intestines exited her surgery site, should your regular vet pay?
If your son’s orthodontist failed to account for an obvious, incoming permanent tooth (which you questioned him about two years ago) and your son now needs another round of braces just to accommodate said tooth after the fact, should he comp the treatment?
This post is something of a corollary to a popular post I penned a couple of months ago on the issue of unexpected pet death in an animal hospital setting. I’m also offering it up by way of a response to some of the comments following Wednesday’s busy post on multiple pet discounts (in which I possibly allowed my indignation in response to a client’s comments to get the better of me).
Complications will happen. After all, pets are not cars. The machinery of automobiles is uniform and its repair predictable. The same cannot be said for any living organism, much less a complex mammalian version.
Medical complications may be seen to fall into two categories that are not always easily distinguishable: 1-expected, routine complications and 2-those that arise out of sloppiness, lack of skill and/or poor protocols.
In a court of law (though seldom employed), sorting out the two is usually the rub. And it’s not easy to do. Any given practitioner’s track record for poor outcomes is not always available for the world to see, nor is its corollary: the excellent care this clinician might typically provide.
Having said that, complications are not always viewed in the same rational light by laypersons. They’ve suffered a loss of some sort in the aftermath of a complication. They have to pay more to the ER, they have more home care to do to solve the problem, they have to pay for antibiotics, their pet might need another anesthetic procedure, or, God forbid, the pet may even die.
Vets have to be capable of comprehending the understandable frustration, the irrational anger and/or the bereaved emotions that follow. They need to address client concerns in a responsible manner that respects these inevitable feelings—regardless of where the fault lies.
Even if the owner is clearly “at fault” for failing to provide proper follow-up care (E-collar placement, antibiotic administration, exercise restriction), veterinarians must nonetheless acknowledge their clients’ point of view and work to resolve the potentially trust-breaching gap that ensues, though they're (ethically speaking) free to choose whether to charge or not for complications that are not their fault.
To that end, many veterinarians will head off these issues with a list of possible complications, including anesthetic risks, suture line issues and other common malfunctions. Others will also build in free rechecks and let their clients know that any procedure will receive any necessary follow-ups from any complications at no charge.
Such discussions acknowledge the possibility of complications in an up front way. Some vets will even ask their clients to sign documents that specifically address the vagaries of anatomy and physiology and legally free them of blame for a list of common complications.
Now back to the list that led off this post:
The last example (the orthodontist) is one I’m currently dealing with. Another round of braces will cost me $3,000 dollars more and lots of time invested in orthodontic visits (time is money, too, you know)—not to mention the pain and discomfort my son will endure.
So should my son’s orthodontist find a way to acknowledge my concern? Well, he did, sort of. He discounted the extensive procedure 10% after I explained the problem and pointed out his mistake, which he did not disagree with or apologize for.
To the point may be that orthodontists don’t expect parents to know how to interpret dental radiographs. It may be that they’re not used to acknowledging complications.
Because of this, my son's orthodontist may not understand what many vets know well: Whether your clients are right or not, making concessions is part of the pact. And when your clients are right and you know it (and even if your clients aren’t aware of your mistakes) compensating clients for complications that are the direct result of your sloppiness is the ethical approach. And apologizing for your lack of attention is often even more appreciated.
When complications could have avoided with more judicious intervention and assiduous care—with careful protocols and attention to early client concerns (reference the liver enzymes example above)— compensating your clients to the tune of your mistake seems only fair.