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Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom.

 

Prescription policies and how veterinary clients can be great big meanies

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March 30, 2008 / (14) comments


There’s been some stress at my place lately, most of it taking place in the waiting room or on the telephone when clients let our receptionists know exactly how they feel about our prescription policy.

No, our policy has not changed. We still require bloodwork yearly to renew heartworm medication scripts, every six months for most of our chronic medication cases and even more frequently for some diabetics, Cushing’s disease sufferers and those with other specific conditions. Physical examinations must be conducted at least yearly for all.

We’ll happily write prescriptions for online purchases and prescription food—no problem. We accept that some clients will refuse vaccines altogether in spite of our liberal three-year vaccine schedule. And we’re pretty free about sending our clients to a nearby hospital should we happen to run out of something.

All in all we’re pretty easygoing by most hospital standards—I think.

Nonetheless, some clients can be great big meanies with the reception staff. They raise their voices. They accuse them of very personal things. They rail against the policies and demand medications immediately, implying that we’re holding their pets’ health hostage by withholding medications.

This scenario plays out most often with heartworm medications. In this case, owners will swear  up and down their pets have never missed a month, yet our records indicate no scripts written and no meds purchased. When asked where they bought their meds, sometimes they can’t remember.

So you know, the standard of care requires a heartworm test for dogs having missed more than a month of meds. That may seem self-serving but research has indicated we all take this tack as a result of some meds’ adverse reactions with larval forms of the disease.

We try to be careful with our patients. We try to be compassionate with owners, too. We bend over backwards, offering house calls for those whose pets can’t easily be brought in for a simple physical and blood draw. We don’t charge office calls when a simple blood draw is all that’s needed. We’re really just looking out for the best interest of the pet.

But not everyone sees it that way. A minority of our clients stands vocally in opposition to such “money-grubbing” ways:

“Stella needs her Rimadyl! Are you saying you’d rather see her suffer when I’m wiling to take on any risk the medication might pose?”

Ouch!

“Scooby needs his phenobarbital! It’ll be your fault if he has a seizure.”

Double-ouch!

In cases like these I’ll sometimes extend a prescription for another month or two, explaining to clients how critical the labwork is and offering just the basics. Come on, a $45 liver panel and a $20 phenobarb level is all I ask! Just standing out here arguing with you is worth more than that!

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COMMENTS (14)
1
by mary on 08/12/2009 07:41am

Try Tristate Veterinary Hospital on Merrits Creek Rd in Barboursville,WV, they won't write a prescription for Heartworm medicine! They expect you to buy it from them ONLY. How money grubbing is that?! I understand why our pets have to have yearly heartworm check, doesn't bother me! BUT for a vet to refuse to write a script so you can buy your meds from anywhere you want shws that they are demanding your money and being wrong.

2
by agadore's mama on 04/04/2008 08:41pm

WOW- YOUR clinic seems EXTREMELY reasonable! I don't mind the yearly heartworm bloodwork, nor do I mind the fact that my vet wants to see my guys at least once a year for a checkup. What I hate is that I go in, and even tho I have made an informed decision NOT to overvaccinate my dogs, and I have paper to back it up from the Colorado Vet School and Dr Jean Dodds, I am STILL lectured. Now, I'm not saying never vaccinate, but not every year.

So I think yor clinic is WAYYYYY ahead of the curve and if you weren't such a drive-about 15 hours- we'd head your way!

3
by Jen on 04/03/2008 08:58pm

Most of my pets have been so-called "pocket pets" like hamsters that it's an absolute nightmare to get blood from. I'm all for blood tests in principle, but in the case of tiny pets with tiny veins and arteries, I wish there were alternatives to drawing blood. I'd happily pay for a hair sample to be tested if that would reveal the same information as blood.

4
by Caveat on 03/31/2008 08:30pm

My old dog has right-sided heart enlargement and is also on Rimadyl. He's a battle-scarred (seriously) old mini-Dachshund.

He takes Fortekor, Lasix, Vetmedin and Rimadyl - 1/4 tab of the latter a day keeps him dancing.

He gets a full blood screen at least once a year, sometimes an x-ray and additonal bloodwork if he's coughing a lot at other times.

Considering that I'm spending quite a bit on meds, I certainly have no problem with the blood screen - even though he comes up 'so normal he's boring' according to my vet, year after year.

They do renew my scrips without worrying about lab work because they know they'll see me fairly often anyway. I get about 6 months worth of Rimadyl, the others in two-month refills.

As for heartworm, I've always had my dogs tested annually, although some vets around here say every two years is fine. The way I see it, what's the harm in doing an annual test? Why wouldn't you want to do that since it's easy, painless and a quick way to put your mind at ease? We take the meds from the end of May/beginning of June to the end of October here in southern Ontario.

I figure if I knew as much as my vet does, I wouldn't need her but since I don't, I always take her advice. She's the one with the degrees after all.

Stick to your guns and don't worry about the whiners - they've read a little and think they know a lot.

5
by Lis on 03/31/2008 10:25am

Cats and dogs do age faster; a human twenty-year-old has barely reached full adulthood. And I'd just love to know in what way humans are more complex, medically, than cats or dogs. Other than being able to come up with more inventive rationalizations, that is.:)

Okay, fourth time typing the letters in the little box, to prove I'm a human being. How about the computer proves to me it's a computer?

Fifth time.

Sixth. Losing my sense of humor.

6
by CheriCat on 03/31/2008 09:40am

I don't mind the bi-annual heartworm tests for my two big dogs, if that's all the vet clinic would be satisfied with. But they charge the regular exam fee, plus put on a very strong up-sell for all kinds of other tests, ect. The reason i was given the vets insist on doing a complete exam, panel of tests every six months is that "dogs age a lot faster than humans. . . " I am changing vets. I told them last week i'm already "old" and humans are a lot more complex than dogs and cats, and my doctor asks me to come in for a complete physical only once a year, and that's all my insurance company pays for! Once my dogs are over eight years old, i don't mind the bi-annual everything. It is almost $1,000 for two dogs for complete exam, plus blood work every time. I wish i could afford for them to have better medical care than me but i can't.

7
by Stacy on 03/31/2008 07:08am

Gotta love adult temper tantrums. It makes one wonder how the children of these adult act when heaven forbid they are told "NO!"

My vet and her staff go through this scenerio several times a day. While all the them are the the most compassionate people I've ever known, they've grown thick skin to these trantrums and just roll their eyes. My vets medication protocol is just like yours. They too will also write scripts for online ordering, send a client elsewhere if they don't have something, ect and yet this people still pitch a fit over a yearly heartworm test which also checks for Lyme Disease. My vet could just as easily charge for second office visit and test just for that. I'd rather just pay once minus the second office visit. She even takes things a step further and gives discounts on office visits if a pet are pets are seen within 2 weeks apart.

I'm sorry you have to deal with the trantrums, but if these people weren't having a fit about those things it would be over something else. Can't please people 100% of the time and half of those can't be pleased period.

8
by Robin on 03/30/2008 10:27pm

Sounds like they are getting their cue from human medicine - many doctors just keep writing out prescriptions without a further examination to determine if they are still needed. Also the feeling that if you do not leave the surgery with medication or a prescription, you have not had the attention needed.

9
by Sherri on 03/30/2008 06:52pm

My dad grew up on a farm in the country; they didn't really have pet dogs, but a lot of the kids would feed scraps and love on 'strays' that they considered their pet, even if the parents didn't. So many years later my dad's living in the big city, and about to start working nightshift. He's worried about us, so he decides to get a guard dog that's going to be mostly a housedog with a locking doggie door so we can keep the dog inside to protect us at nights.

We were inexperienced at having a pet dog, but our neighbors would give advice. So after a few years our boxer gets a cough, and the neighbors said it might be heartworm, which was bad, so get him to the vet. My father took King to the vet, he was a good vet that explained that King had a pretty bad case, and if he gave him heartworm medicine now, that most of the heartworms in Kings body would die all at once, which would most likely clog his heart (or was it arteries, I don't remember now).

So dogs with as many heartworms as what King had would have to stay in the vets office a few days so they could slowly kill off the heartworms while closely monitoring King. I forget how many days King was gone, but it seemed like forever to use kids.

The vet called and said King was ready to come home, and he gave us the daily heartworm pills. King loved them and thought they were treats. The vet explained that if we ever forgot the pills, or went off them for any reason, that we'd be exposing King to the same thing as what happened the first time, and he'd most likely have to be put back in the vets office for a slow kill off again, so avoid that by always giving the pills.

Daddy would get up in the early afternoon (still on nightshift), make himself breakfast, and before eating it, give King his heartworm medicine 'treat'. King was smart and quickly learned routines, so he'd be by the medicine bottle waiting for his treat as soon as Daddy started putting the breakfast stuff away. Daddy never forgot to give King his heartworm medicine, because King wouldn't let him.

After they came out with monthly pills, the vet asked Daddy if he wanted to give those to King. Daddy said no, because King would be mad about not getting his daily treats.

I remember a few times people complaining that their vets wouldn't let them start back on heartworm meds after missing a few months. Since I knew why, I'd tell them about King, then they understood and didn't complain again (and also probably didn't let it lapse).

I would think I'd forget to give a monthly pill more than a daily pill. If we ever get a dog, I'm going to see about giving daily pills because I'd remember better.

Does your receptionist explain this to people upset that they have to bring their dog in for a blood test?

10
by Cait on 03/30/2008 04:55pm

I'm glad you'll write it- and your prices sound fantastic! A general blood panel at my old vet is $180 plus the $50 office visit and heartworm testing is $60- and she won't write scrips. I love my new vet- he's much more reasonable.

11
by barri on 03/30/2008 01:33pm

Sorry to see what you guys have to go through, but I see it all the time with medical, and it's getting worse.. People are coming in for one problem, and it turns out to be one problem plus, and they don't know why you can't do their physical while they are in, and have to pay a copay for the problem that needed to be addressed.. or they are overdue for their physical, and their meds need to be renewed, but they are feeling fine, and don't see the need to come in.. ughhh
Barri

12
by CommOddity.us on 03/30/2008 01:17pm

I had this conversation with my father the other day. After his vet explained to him that it was necessary to test for heartworm in order to renew his dog's prescription he asked her whether there had been any heartworm cases locally. When she told him that she was treating two dogs at the time he kept his disbelief to himself, thank goodness. I explained to him that heartworm was, indeed, common and that the medication can harm an infected dog.

I think that if more pet owners were aware of the pervasive nature of the problems that can be avoided by blood testing they may be able to reduce their resistance to a wince.

13
by Lis on 03/30/2008 12:12pm

It's my theory that, anytime my vet suggests, hints, or looks like she might be thinking that blood work might be a good idea, I should go for it. Yes, it's not cheap, but it's not _that_ expensive, and if nothing else, it rules out a bunch of problems.

My own v/e/t/ doctor insists on six-monthly blood tests for the medication I'm on; my two cats and my dog are a lot smaller than I am, and potentially a lot more sensitive to low-level toxicities.

14
by Stefani on 03/30/2008 11:01am

If they realized how dumb it is to not test blood when your pet is on potentially hepatoxic or nephrotoxic drugs . .. but I'm sure you have told them that.

I can't even fathom not regularly testing an animal on rimadyl. eeek.

Tough situation though, when they call you when they are LITERALLY OUT of drugs. I can imagine then the owner would be in a pretty agitated, desperate state of mind because then it really is a case of potential withdrawal causing a seizure in the case of pheno. So, it's good that you sometimes give them a grace period.

I hope most of them ultimately realize how important it is to have regular bloodwork done on these kinds of drugs.

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About fully vetted

Patty Khuly, VMD, MBA

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Dr. Khuly is a former petMD blogger and small animal veterinarian in Miami, Florida, where she practices medicine at Sunset Animal Clinic and serves on the board of the South Florida Veterinary Medical Association. She is a graduate of Wellesley College, the University of Pennsylvania School of Veterinary Medicine, and The Wharton School of Business.

As a significant sideline, she writes...a lot. She authors pet health columns for USA Today, The Miami Herald and Vetstreet. She also writes a popular monthly column for Veterinary Practice News and serves as regular contributor to Veterinary Economics, The Bark, and the Veterinary News Network.

Dr. Khuly lives in South Miami with her brood of hens, goats, dogs, cats...and humans.

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