A question of consent in vet medicine (or, No good deed goes unpunished)
OK so I did a bad thing last Saturday…a very bad thing.
A client I know well from years of stray cat care brought in a stray six month-old kitten so I could treat its ostensibly broken leg. Instead, I determined that a small abscess (probably from a bite wound) was the cause of his lameness.
Because the kitten was a tad on the wild side, I sedated him and proceeded to clean the area and debride the wound. While the kitten was out I had the bright idea of neutering him. To obtain proper consent I called the client to inform her of the slight alteration in our plans.
Unfortunately the owner was unavailable. I neutered the kitten anyway, figuring I’d sterilized so many of her cats already it’d be a shoe-in for consent. And it would be a shame to have to knock the kitten out again—or maybe not at all, since the wild guy might never go near a trap again after the current unpleasant experience.
At pick-up time the owner didn’t show. It was her daughter instead. Said daughter proceeded to berate me for the neutering transgression, arguing that she could have obtained the procedure more cheaply elsewhere and that she was absolutely shocked that I would undertake a procedure without express intent.
She was right, of course. Though offended at being called out so rudely (she could have been nice about it, right?) I apologized profusely and explained that I’d not only attempted to seek consent but that I hadn’t charged her for the procedure (since her mom was such a great client—and because I was looking out for the cat’s best interests, after all).
This attitude merits some explanation: Where I work we do things a little bit differently than elsewhere. Partly that’s because I’ve known a large number of my clients for well over twenty years—since before the world became such a litigious place.
For my thirty-something age I know that’s rare but this hospital has been my “home” of sorts since I’d started here as a volunteer at the tender age of ten. And I guess I’ve come to expect my long-term clients to always respond to my best efforts with the understanding and trust such a long-term relationship typically confers.
So it was that I finished up my Saturday with a bit of resentment. “I mean, she was such a bitch!” I explained over a late lunch with my also-vet boyfriend.
But if I was looking for any sympathy I was not about to get any from him. “You got exactly what you deserved,” he offered, “for not using consent forms.”
Though I fail to see how a consent form would have helped me out in this kitty’s case, I held my tongue. Yeah, he was right (mostly). Nonetheless, I fumed at my egg-white omelet for being berated, yet again, for my stupidity and naiveté… and for the frustration of knowing that consent forms are anathema to the culture of my place of work.
Our hospital has no consent forms and last time I tried to implement them (about five years ago) the staff and clients rebelled: “But I’ve been coming here for thirty years, how can you insult me with this legalese!” And that was the end of that.
But this last episode—though it might not have solved the problem in that instance—left me feeling creative. I would alter the estimate forms to include a consent immediately preceding the signature. And while the other docs might forego signatures on their forms, I wouldn’t.
So far it’s worked (yesterday went swimmingly). But I still can’t help thinking about the kitten and Saturday’s fiasco. Who doesn’t want a stray cat neutered? For free! No harm, no foul right? I guess what they say is true: No good deed ever goes unpunished.