So reading this had me thinking of a recent experience with a new vet. I had gotten good opinions on him and after much looking and my dog needing a vet I decided to go with him.

We visited and discussed one of my dogs (6 year old Dogue De Bordeaux female) and her 2 lumps (one being a lipoma, growing yearly in a bad spot for lying as she got older) the other we were unsure after aspirating so we decided to remove that too. In addition she needed a dental and we could see one fractured tooth on exam and gum overgrowth.

Got the estimate and scheduled the procedure. Mind you this is one of the most expensive general practice vets in my city. I do want what is best for my dogs and discussed his surgical processes and after her being cleared via senior blood panel and discussing anesthetic, her sensitive stomach and being brachycephalic I was comfortable. She had her surgery scheduled for 10am that morning. We dropped her at 8am.

By 1pm having heard nothing I called, she was still under and being worked on. Called at 3, still under. She had been under since 10:30am. At 3:30 the vet called while she was under having xrays (over 20 dentals total - aka bite wings) and we discussed the issues he was seeing and said he had removed the lumps, had 5 teeth removed including one of the largest molars and had more to look at still. He also informed me we were over the estimate (which had an $800 buffer) and would need to pay for more anesthetic, more xrays and possibly more teeth removed. I allowed him to continue reluctantly and after 6 hours of anesthetic and 8 tooth removals he called again. At this point I am feeling like she is on the table and I don't want to put her under again so I won't stop him but I am pissed off. Not as much about going over the estimate as the amount of time my dog was under.

So said and done he was $1000 over his buffer (top level) estimate. I wasn't quite sure where we were cost wise when he called to tell me she had woken up and what had happened. But I felt like I needed to ask for the extra anesthetic to be written off. We spoke for over half an hour my explaining my vast experience with surgeries, dogs etc and he was slightly offended about his ability and caring for my dog as he would his own etc etc. I stated plainly that had I given someone an estimate for a web development job (my profession) and it took me longer I would not ask the client to compensate for my mistake in estimating. Again and again I explained it was not his lack of care it was his poor estimating and ultimately the bill was lowered by more than just the extra anesthetic and the aftercare she got was wonderful (calls etc) and our recheck assured me that our relationship was still good.

All in all however this was a "complication" he did not see in advance and ultimately while I am capable of paying for the bill I felt it was so far off that I felt he made a bigger mistake he had to be accountable for.

What you experience is very typical of dental disease. Your dog went in for 2 mass removals and what I assume was supposed to be a basic dental cleaning.

Unfortunately most dental cleanings on older pets turn into major dental surgery as the tartar is removed and xrays are taken revealing the disease. It is impossible to estimate dentistry correctly on an awake patient.

I always explain that to clients and give a range of estimates before a procedure. Then I have them state their wishes ahead of time if unexpected disease is found. They leave me a phone number (or 10) but if they cannot be reached they can have us a) stop the procedure and send the pet home with disease or b) carry on with extractions and be responsible for the additional cost.

Perhaps your vet did not communicate this clearly before the procedure, but when he realized that he was going to go over your estimate he called you mid-procedure. In my opinion he fulfilled his obligation and when you consented to continue you should be held responsible for the cost.

Dentistry is one of the most time-consuming things we do at our practice. Removing that many teeth takes hours and as a result costs the clinic money. Unexpected extractions also throw the rest of the days schedule off and often other paying appointments are cancelled or rescheduled to accommodate the dental surgery. Some clinics will wake the patient up after the scale/polish and xrays, then make the patient come back for further work. This increases the cost to the client.

Your vet did you a favour by treating your dog like his own and getting all the work done in one go. He called you to communicate the increased cost before the work was done. And after you agreed to the work and after the work was competed, you argued about your bill. Your vet sounds like a keeper, you on the other hand sound like a client he could live without.

So Meghan you can leave the piss and vinegar response for one of your clients that you can't afford to lose but want to lose because you can't grasp that when you make an estimate with a $800 margin in it and then have my dog under on the table what do you think I am going to do? Argue about my bill and the lack of estimating properly?

What do you think a software design client of mine would do if I were to say "oops didn't know this was going to take so long mid stream and say you can have it half done or pay me double to finish"? Not quite a real business-like attitude is it?

Now veterinarians are businesspeople and they forget that all too much. It is their job to be realistic with their estimates and if he needed to give a larger gap, he should have. Same goes for me when I estimate a non-medical job. There is no difference really when it comes to money for services.

You remind me of those who I do rescue with who get very bitter about their lives dealing with people who in your opinion "just don't understand" - it is your job to educate them so playing victim and dumping clients because you didn't estimate properly (ie your fault) isn't going to "cut it".

FYI UC Davis in the MULTIPLE surgical procedures I have had done there have NEVER gone over their estimate and neither has any other vet in the over 18 years I have had dogs.

I don't do web design, I have no idea how one makes estimates for that type of work. I have a feeling though, that dealing with machines is not quite the same as dealing with bodies.

I do know that there is no way we can accurately estimate dentistry before the animal is anaesthetized,a comprehensive oral exam is done and dental rads are taken. Veterinarians are not psychics.

I agree that your vet did not communicate this beforehand and that is bad for business.

It sounds like the "dental cleaning" was added on to your dogs procedure as an afterthought. Like "hey we'll just clean his teeth while he's out". That's something vets do to save their clients money. Apparently this was bad idea because your vet ended up discounting the procedure because of the disease he found.

He estimated you correctly for the mass removals and dental cleaning but he didn't estimate you for the extractions that he didn't know would be necessary.

If you were designing a web page and halfway through doing so the client changed their mind about what they wanted, resulting in 30 hours more work for you, would you charge them for it?? Or would you revise their estimate mid-design and ask them if they wanted to continue??

Wow you are really full of it aren't you? You didn't even read my post where the vet identified a cracked tooth on oral exam and expected to take xrays and do more than a cleaning. In fact extractions were part of the estimate.

What is wrong with saying that he was wrong and didn't estimate correctly and that if it were your dog on the table you wouldn't take the time to dispute the bill while a man's hands were in your sedated dog and would wait until afterward to discuss. That would be being a foolish dog owner if you ask me and not looking out for what is best for my dog.

There is a big difference between one tooth and eight. And I won't say he is wrong because, as I said before, he estimated you for the disease he suspected. Which was not what he found. To say that he was wrong undermines my whole post. Which says, to summarize, that estimating dentistry is not an exact science and is often full of surprises.

And you did not need to dispute anything while your dog was anaesthetized. You needed to understand what was going on and make a decision about how to proceed and how much money you could spend. That is the responsible thing to do.

Authorizing the work, then disputing the bill is a bit shady. The vet can't take the work back now can he?

Indeed the process is time sensitive but I'm sure if the vet had concerns about how your dog was doing under anaesthesia he would have woken him/her up and finished the dental surgery another day.

Oh, and my clients don't get any piss and vinegar. They get open communication including education on the unpredictable nature of dentistry and a BIG range of estimates. They get phone calls mid procedure if necessary to keep them informed and a long discharge appointment explaining everything that was done. Rarely are there disputes about the bill.

I save the piss and vinegar to communicate my point in anonymous internet posts ;)

Meghan, I know you are a conscientious person. I have to tell you though, marathon dentals make me way nervous because of blood pressure issues and related potential for kidney damage. I'd much rather bring them back for part 2 than have them under for 3+ hours. Yips. My vet knows this, she gets them done as fast as possible. She also knows I'm a traumatized vet client, so I think she takes that into account and appers to exercise an additional measure of both caution and communication with me.

It is too bad the Pain In the A*s clients cannot match up with the Pain In the A*s Vets so they can drive each other crazy. Then those of us who do listen well, to the point of taking notes while our vets are explaining the condition and what can be done, and what can be expected and who try to do what's right for our pets and our vets would be left with the good caring communicative vets who deserve them.

Like you said, you knew who you were dealing with. I am surprised you didn't just refer him to the specialist and be done with it. Those types are the ones who deserve to pay the higher costs a specialist will charge him and who is prepared to deal with and will charge accordingly for his rude behavior! (Really to complain to you his summer is ruined because his dog is sick and not healing well!! What an ingrate!! Poor dog.)

Sheesh, I'd be happy the damn cancer was gone and more concerned about helping puppers heal than blaming my vet because it wasn't. When we rescued our oldest cat she had, apparently, been draged by the tail on the road. Her front paws were a mess. Our vet explained that even with surgery the outcome might not be good. We listened, decided to go ahead with surgery and were just happy she could walk on them. He was happy with the first surgery, which removed a lot of dead tissue, but, thought he could clean them up a little more. The problem was, as he explained, they would need twice a day bandage changes and she needed to be limited in walking, scratching in the litter box and no running or jumping. We had to listen to what he was saying, we needed to follow directions or the money we paid for the surgery would be wasted. People who don't listen, or who don't hear what the vet is actually saying shouldn't have pets!

You said yourself it was a really bad spot...sometimes there ARE reasons for specialists and reasons we shouldn't touch things even with a 10 foot pole.

Yes, but a specialist is much more expensive and some people won't pay that or can't afford it. Perhaps that was the case here?

call my vets doc khuly and I am sure they will be happy to tell you how bad I am. I only tell you this so that you can without doubt tell your current client that even *I* think he is being an ass about the wound

Even the simplest surgery can have complications. One can rarely anticipate anything and everything that can go wrong.

It sounds like Dr. Khuly did everything possible - including saving the dog's life.

I would much rather be inconvenienced by helping a pet to heal than to go through the heartbreak to losing them unnecessarily. Sometimes things just don't go as smoothly as we want.

The client is a jerk.

Do you like your job? Seems like you are always complaining about something or someone. Why not use your education and experience to "educate" pet owners in a more positive manner?

Hi Doc, Yes you hit it on the head, the client is probably angry at the universe. And it sucks when it is directed at you. But that is what happens when you are in that role of doctor.

Sometimes at huge emotional times like this, it is impossible for the pet owner not to "go there"... that horrible place , a ball of mixed up emotions, pain, sorrow, fear , feelings of helplessness, all the classic signs of grieving.

it sounds like you did all you could to "prepare" your client, you informed her of all that could go wrong...

so I think this is where the veterinarian needs to put on the "therapist" cap.

Sit them down, tell them you understand their anger at the situation; tell them the emotions they are feeling are common (sometimes people , when feeling anger, don't understand that it is not anyone's fault... they are not used to the powerful emotions that grab at their throats and hearts... and thus feel they need to blame someone)

SO sit them down; tell them you understand; but also ask them , did you as a vet tell them this, tell them that... i would list all the things that you did warn them of.
At times like this, they just need a reminder to pull them back to earth, away from that dark world of fear and anger.

In human medicine we have to read and sign lengthy documents with all kinds of detailed warnings about unlikely but possible complications. Sadly, I suspect veterinary medicine will ultimately utilize similar releases.

Regardless, some folks simply want you to wave a magic wand and cure their "beloved" pet without any effort on their part. If this had been a human child, would the pet parent have been complaining about having his summer ruined?

In every profession there are clients that make our lives and jobs a pleasure, and those that we'd not miss if they went elsewhere. Hopefully the good clients outweigh the difficult ones!

It is well documented that one's ability to hear and process the information conveyed directly after bad news is given is often severely impaired. So why is it unpleasant to think that providing a document specific to the situation, one listing available specialists in the area, the recommended treatment, details about the procedure and what to expect in the healing process as well as suggestions about things to consider in dealing with bad news is a good idea? Many people are often overcome with the fear and sadness of a poor diagnosis and a document to which they can refer and which can augment the many missing pieces of a dialog with the vet of which studies suggest that only roughly 46% is retained after the initial bad news seems like the minimal amount of consideration in both human and canine care. I doubt anyone is suggesting that generic HIPAA documents should be the norm, but certainly written detail about what is being communicated verbally seems more than appropriate. Odd to think that the concept of improving communication in a field such as healthcare in which poor communication is a leading cause of failure could be viewed as undesired and inappropriate but true enough, to each his own. For me, I want the document so when I regain my composure, I can review the materials and develop an appropriate response other than whatever I may or may not have agreed to in my moment of grief during which I likely heard very little.

Thank you for sharing this. It is only too true, and explains the miscommunication of what is said and what is actually heard. The ability, as you point out, to be able to consult documentation, after bad news is given, is a great idea. So then when all the fog has cleared, and owners are able to think coherently, then they can make the right choice for them.

Yes, just what I was thinking, a piece of paper you can go home and read over and over and do research if you want.

Dr. K., while you said the lump had to come off ASAP, that's not really true. They tell human breast cancer patients all the time that it's not an emergency, that they have time to think about what they're facing and what the options are and make a decision, that it doesn't have to be made in the Dr's office upon receiving the dire news.

Paper needs to be sort of specific for the situation. And note made in record that client received it. Or get a signature that it's been received. I don't think you can ask for a signature requiring immediate understanding of issues on paper.

Personally I take a lot of notes, but I think most people don't do this. So they go home and remember.......not much.

Men just hate it when their play time is shortened. Poor babies...... Waaaaaa, Waaaaa, Waaaaaa. Needless to say, this guy needs to grow up before being responsible for another being.

That said, when dealing with these kinds of conditions, try to remind yourself:
Insist on a specialist. "I don't do these
surgeries."
Give written list of potential problems
and have client sign it. "We do this because
people get upset when their pets are in danger
and don't remember what we told them.
Warn client that summer vacations might be ruined,
but all part of being responsible pet owner and
you appreciate him/her for that.
Joke with him/her, "Don't forget I warned you."

Always do the very same things, so if ever questioned, you can say, "I 'always' do these 3 things: Give, Warn, Joke.

This is GREAT advice. You are absolutely correct about people getting "bad" news. They ARE upset and having to mentally process the information and decide upon a treatment is difficult, if NOT impossible, at that particular point in time. No one wants to lose their pet, and "instinctively" will agree to do whatever will keep their pet with them. I have many times gone with friends to a specialist (usually oncologists), so that "I" can be the unemotional information taker. I can then disseminate that information to the owner when they are better able to accept the facts and to rationally consider the options. And since we have a large population of specialists in our area, most are very good at again speaking with the client once they have had a little time to "digest" all the info. Sitting initially in that chair hearing a vet deliver unpleasant news, is overwhelming, especially for those more involved surgeries, or with a potentially terminal or severely life-changing prognosis. I think that most people, when given "bad" news that has a "potential" for treatment that "can" be successful...don't ever really "hear" the risks, regardless of the reality of those risks. I do also agree that vets, before doing a procedure, should ensure that the client DOES understand the "whole" situation. Consent forms should include the potential risks. And perhaps, at least in non-emergency situations, we should allow clients to have time TO "digest" the information, and not make "snap" decisions on the spot. A vet, wrongly or rightly, in a case where an owner is emotionally compromised, has the power of "emotional manipulation", themselves, should they so choose. This is why I always recommend that clients either receive a second-opinion, or at the very least, go home, and speak to friends/family/others that may be able to offer input. If nothing else, "sleeping on it" at least allows additional time to think about it more fully. And most surgeries/procedures easily offer that option.

Men just hate it when their play time is shortened. Poor babies...... Waaaaaa, Waaaaa, Waaaaaa. Needless to say, this guy needs to grow up before being responsible for another being.

That said, when dealing with these kinds of conditions, try to remind yourself:
Insist on a specialist. "I don't do these
surgeries."
Give written list of potential problems
and have client sign it. "We do this because
people get upset when their pets are in danger
and don't remember what we told them.
Warn client that summer vacations might be ruined,
but all part of being responsible pet owner and
you appreciate him/her for that.
Joke with him/her, "Don't forget I warned you."

Always do the very same things, so if ever questioned, you can say, "I 'always' do these 3 things: Give, Warn, Joke.

I would like to add that today's economy has the majority stressed, and it isn't going to get better any time soon, so you may encounter much more of this kind of behavior.... People feel like they have no control over their futures and are scared. They lash out where and when they wouldn't otherwise.

I have a 18 yr. old, no way will my Boy go under the knife. Cancer will spread, went open to the air....... ( FACT ). Thank God my Boy is in good health, But my Mom's Bubba, at age 6, was allow to pass away during his operation, colon cancer. Our Doctor Bless Him, call me while Bubba was on the table....It was hard I just lost my Mom. Doctor Khuly....Some Folks, just have to blame someone...if he would have came to you sooner, He would have had a better out-come. Let The Truth set you Free.

Papillon One hit it right square on the head! "It is too bad the Pain In the A*s clients cannot match up with the Pain In the A*s Vets so they can drive each other crazy."

I don't think that humans react any differently to veterinary issues and advice, than they do to a physician's. Human nature, fortunately AND unfortunately, applies to clients AND vets. AT least if they are both human!

Any procedure carries "risk". ANY AND ALL! Now, the vet is there to advise regarding those "risks" and the odds that exist in a particular case. Animals are not widgets. They are not manufactured equipment. They are living creatures, and therefore, not GUARANTEED in any way, shape, manner, or form. No two are alike. Far too many owners expect their vet to be perfect, and because they are a vet and have medical training, that NO harm will ever come to their pet. And far too many vets, either don't advise their clients fully, or are not experienced enough to perform certain procedures, or perhaps, even offer knowledgeable advice about a particular procedure. This is a highway to hell. ALL PROCEDURES HAVE RISK, regardless of how statistically "safe" the are. A vet should know the risks, and know the odds. But nothing is 100% safe. A vet that advises a procedure or treatment being COMPLETELY safe, is untruthful. Every client DESERVES to know the risk/benefit...and the potential adverse possibilities. The client deserves the "whole" truth. Good and bad. And a client who is not willing to process that "truth" in the event that something doesn't go the way it was "hoped", or in this case, even anticipated...lies with the client. After all, the final decision lies with the client.

Reality is that there are clients who are a*holes and vets that are a*holes. I left many a practice that had vets who were a*holes. And my current vets, deal with a*hole clients all the time too, I'm sure. That's just a fact of life. But in this case, Dr. Khuly, I think that you have done exactly what you should. You probably already know that I want a vet to be up front, and to share everything they know, and even what their personal opinion would be...but in the end, the decision...is the mine. And some people simply won't (or in some cases, can't) accept the responsibility for their decision.

For the record, my old Pug, had a mast cell tumor on her back, right above the base of tail. We found it very quickly, and since it was not large, and there was plenty of tissue allowing for very safe margins, she healed quickly and with no complications. That was three years ago, and she turned ten in April of this year. But, now I am now "mast cell" paranoid, and every time a bump comes up on any of the dogs, we run to the vet, and I tell him it's a mast cell(and it never is ). Which is quite obviously, why I have a vet!

Just as the patient (owner) must carefully listen to, and try to understand, the vet's instructions and prognosis, the vet must remain fully connected to the owner's emotional state.

An older Golden suggests that this particular dog has been in the owner's life for many years and the bond that forms almost immediately between man and dog grows stronger as years past. AND, the word Cancer has an equally terrifying reaction whether the patient is a human or a human's canine companion.

Cut the guy some slack. He's not the steady professional he's the terrified owner of the Golden. He knows that he needs to keep the dog quiet and inactive but he really doesn't know how (I don't care what age the Golden may be - he still wants to please his 2-legged companion and will still actively pursue his lifelong habits).

You feel you have done your job by curing the cancer but you actually only did half of your job. The rest of your job, and any vet's job, is to be the go-between from the companion to the dog back to the human companion. Kennel-side manner is as important as bed-side manner.

You stated that you would have liked to remind the angry client of the risks you told him of prior to the surgery, but did not. WHY??? I do not understand why vets are so reluctant to be up-front and honest, and tell it like it is. Is it because you do not want to hurt their feelings? Is it because you want them to remain ignorant? Is it because you don't want to lose future business?

It's your job and duty to help sick and injured animals, and sometimes it is necessary to face your clients (whether they're jerks or not) and speak up! Who does it serve when you hold your tongue? Certainly not you, as you're writing an entire column about it. Not the pet, if the owner's potentially taking their frustration out on them. And not the client, as they're upset and will continue to be so until the situation is resolved - whether, as in this case, the wound fully heals, or perhaps if he is reminded of the details you told him prior to the surgery.

Sometimes, when clients are dealing with a stressful and frightening diagnosis, they are apt to be particularly emotional and think they're hearing and comprehending information when told the first time, but are not. Having gone through STS with one of my dogs, I know this first hand.

In the future, please consider telling your clients "like it is" even if you suspect they may not appreciate it. I believe that hearing the truth - even if it's harsh - is better than saying nothing at all.

"Dehiscence." What a pretty term for such an ugly thing.

I feel sorry that his dog's summer is ruined but am unable to summon up much empathy for his summer.

I think for surgical procedures, it behooves both parties to receive something in writing to sign. Specifics for diagnosis, procedure, pros/cons , and recovery should be in writing.

Most of these procedures are performed numerous times. A basic form with an area to "customize" based on the individual patient would save a lot of heartache in the long run.

You warned the client, perhaps he looked at a more optimistic picture, or perhaps you weren't stern enough (which may have deterred him from the surgery completely). Or maybe, he is just unhappy to care for a horrible appearing wound.

To put it very briefly: no, I don't think the owner is right to be angry. He was told of the risks, recommendations and possible complications. Unfortunately, some people will always find something to be dissatisfied with, while others will be eternally grateful to you for just doing your job. It's more a matter of how they are than what you did. So don't lose any sleep over this jerk.

We can't control everything. And because of that there is the bumper sticker SH*T HAPPENS.....

Even when we do our best, sometimes things still go south. Or in this case, they just don't heal quickly.

IMO, the owner has no gripe. Nothing is certain in healing....and each animal does it differently. One may scar up, another may not.

Personally, I don't know how you put up with some of your clients' owners........wait..yes I do....good wine.

Personally I think both parties are at fault. The client for being unrealistic about what could happen and the difficulties in healing a wound. The vet for not firmly communicating the need to see a specialist and refusing to do the surgery. It is impossible to forsee any added expenses especially when it comes to dental. I don't think anyone can realistically expect that a vet can give a perfect estimate. Estimates are for a new set of tires or a addition to a house not my beagles health.

In this particular case, from the way you have described it, I would say no, he shouldn't be angry. The "unless" is -- if you really felt that this one was large enough that it would make a significant difference to have it done by a surgical specialty vet, you should have urged that. However, if you don't think it would have made a significant difference in the likelihood of this outcome (it's hard to tell from your post), then no, I don't think he should be mad at you.

This doesn't mean, however, that simply explaining that there may be complications in EVERY case means the owner has no right to get upset at a negative outcome. There are many vets who do a substandard, lazy, negligent job of monitoring under anesthesia and anesthetic protocols in general, who point to the fact that the client signed something with a small text statement about anesthetic risk, as though it is total absolution for their carelessness.

This does not appear to be analogous to your current situation. But just be careful about classifying "types" of clients. Sometimes we have a right to be angry when things go wrong. The simple fact that someone gets angry at a negative veterinary outcome doesn't make them wrong or a bad or troublesome "type" of client. I really does depend on the specifics of the situation.

Sometimes vets don't prepare owners as well as they could have. I have been extremely fortunate that my dog has not needed any surgeries beyond her spay. But she was sedated for xrays last year and I was badly frightened by her subsequent behavior at home for the next 12 hours or so. The vet did say she might be "a little out of it". But she was so out of it, knuckling over when walking, terrified of her familiar surroundings that she clearly didn't recognize, etc. that I felt I had been underprepared for her likely behavior while coming out of sedation. As I do like and trust my vet, I called the office-more than once! But I also felt a bit let down. At the very least, I felt I should have been warned to keep her crated and away from stairs and the like. (I did keep her crated except for very brief outings to allow her to pee because she was so disoriented, and I carried her in and out after the first uncoordinated, knuckled over attempt she made on her own.) I'm still not sure why the vet didn't beter explain from the outset what was normal behavior when coming out of sedation--perhaps she thought I'd seen it previously? But if I'd been told up front, I would have been much less distressed and my vet could have enjoyed her dinner and evening without my fearful calls for advice!