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What would you do in this situation?

Discussion in 'Pre-Veterinary' started by haloschief, 03.15.12.

  1. haloschief

    haloschief

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    My dog passed away two nights ago and I feel that my vet took advantage of the situation.

    Anyways, it started Sunday morning when I noticed my dog has less energy than usual. I was able to take him for a walk that morning but he wasn't moving around like he normally does. He did eat a little bit less, but I thought nothing of it. He did his business as usual during the walk. Come Monday, his energy dropped again but he was still able to move around and was still eating. Again, I thought it was just something that he would get over so I left for work. I came back that night and I go outside he isn't moving at all. He's lying on his bed barely moving. He doesn't touch food I give him, but he is responsive to me. Now, I'm a little distraught and decide to bring him to the vet.

    I brought him on his bed to the vet a couple miles away and they have me fill out some paperwork. They do an examination on him while I'm outside in the waiting room. The assistant brings me to a room to meet with the vet. Vet basically says he is in poor condition and they need to run some tests on him.

    I haven't seen my dog since I brought him in and the vet doesn't know whats going on with him other than he has stomach pain. Gives me a page full of tests: x-ray, ultrasound, cbc, chemistry, urinalysis which totaled to around $600. I'm reluctant to do all these tests and I'm thinking of just doing 1 at a time. Also, I can't throw down half a grand right now for all these tests so I ask her which one I should do for the that would cover most of the bases. Says I should do the x-ray, but it's best if I agree to all the other diagnostic tests as well. Now my judgement is clouded and I'm upset that my dog is so sick so I just tell her to do the x-ray then without thinking about what the costs would be for treatment. I mean wasn't even able to throw down the full $600 for all the tests.

    20 minutes later she comes back to inform me the xrays didn't tell her squat and NOW tells me my dog isn't going to make it through the night and that he is twitching and becoming unresponsive. Says he's anemic when she turns him on his back his gums turn white and that there is possible a tumor. I ask her he is in pain and she says no. I tell her I want to bring him home and let him pass away there. She refuses and tells me its in-humane to do that. Asks if I would want him to be twitching and gasping his last breaths before he dies. Finally takes me to see him and his condition is horrible and convinces me to euthanize him. I say okay and ask her to give me some time with him. I'm just thinking f-ck this guy has been my buddy for more than a decade and grieving.10 minutes later he gives out.

    After some time, its time for payment. Now, I can't help but feel cynical in that they withheld information from me and I tell the assistant I'm not going to pay for the x-ray. The assistant brings back to vet. Vet goes on a rant about how there's no way for her to know anything and that because she is in medicine she would never try and cheat people. Well I believed her and ended up paying for a damn useless diagnostic test.

    So I ask you pre-vets, what would you do in this situation? If you were the vet, what would you tell me? Someone who is distraught isn't going to be thinking rationally which I wasn't. Would you just tell them to do these tests without informing them of what the next step would be after these tests? She knew I was short on money. Would you convince someone to run these tests knowing that treatment would probably cost thousands of dollars? Was information withheld from me so that I would order these fruitless tests?

    Was it right of her to tell me euthanize my pet and that taking him home was inhumane? Should I have taken him to vet on when I first started noticing these symptoms?

    From a few posts down "The situation has already passed and I'm not looking for medical advice per say. I'm curious in how pre-vets/vets think and come up with their reasonings and your responses to a dilemma such as this. I come from the pre-medical forum and we typically see ethical scenarios pop up everyday so its intriguing to me to read constructive posts about these scenarios. In medicine, the focus is always on the patient and care comes first, but I'm not sure how it is with veterinary medicine. How do you balance the situation of the owner and welfare of the animal?"

    "As I said earlier, I had no intention of demeaning the profession at all. I just feel that the vet could have explained things more clearly to me which she was not. I'm not judging the field, I'm just judging ONE vet based on that visit. "

    TL;DR- I lost my pet. Vet didn't explain situation clearly to someone who isn't thinking straight with their dog's life on the line. Convinces me to euthanize pet instead of taking him home. Pet dies before euthanization. Gets a couple hundred dollars from me for a useless test...
    Last edited: 03.16.12
  2. ursulamajor

    ursulamajor Junior Member

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    I'm sorry for your loss. It's so hard to be placed in a situation where your dog suddenly becomes gravely ill and difficult decisions need to be made quickly. Your best bet is to call the vet you saw and discuss your concerns with him or her after you've had a few days to mull things over.

    SDN is not for medical advice, so I expect the moderators will come along soon and close this thread.
  3. ANY2003

    ANY2003 UC Davis c/o 2016!

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    First of all, I'm very sorry for your loss.That's terrible and I know you may be suffering a great deal right now.
    Unfortunately, I don't think you are in the right forum for asking for advice in this specific situation. We are all pre-veterinary students that really lack the education and experience to give you the answers that you need. However, I will address some common misconceptions that may or may not apply to you. As a vet assistant, I see situations like this every once in a while. A pet will come in in poor condition, and we try to run tests to save it, but unfortunately sometimes the pet doesn't make it. I don't think that the test was "useless" as a negative x-ray can definitely rule out some conditions and narrow done the possibilities. As far as not telling you the next step, well that's sort of impossible without knowing what is wrong, which is why diagnostics are recommended. Unfortunately, even if the pet doesn't make it, there's still a bill that needs to be paid. The vet and his staff spent time with you and your pet trying to figure out what was wrong, even if your pet was unfortunately not saved. It's really a difficult situation when owners are in a financial bind. The job of veterinarians is to recommend the best medical care. This is often mistaken for "being taken advantage of."
    I REALLY REALLY cannot comment on your specific situation because I wasn't there. I don't know what was going through the head of your veterinarian. I just wanted to comment on some *general* misconceptions about veterinary medicine. The bottom line is that if you don't feel comfortable with your veterinarian (even if the reality is that he/she is honest and talented), it's best to find one that you can trust. Again, very sorry for your loss.
  4. lailanni

    lailanni c/o 2012

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    I am also sorry for your loss :(

    >>Would you just tell them to do these tests without informing them of what the next step would be after these tests?

    I just want to point out that without doing any tests, it's near impossible to tell a client what may be needed. Similar to walking into a human ER with abdominal pain, they won't be able to tell you what's going on without running tests.

    All tests tell you something - even if that something is just the absence of an abnormality. It's a helpful rule-out.

    Also, the following treatment will depending heavily on what the tests do or don't show. You need step A to make an informed decision about step B.

    >> If you were the vet, what would you tell me?
    Something along the lines of - I can't tell you what is wrong with your dog unless I run tests. I won't be able to offer a solid treatment plan unless I know what is wrong. If your dog is extremely ill and appearing to de-compensate, euthanasia may be the best option. I would also discuss the various CPR or DNR options before initiating any test or treatment.

    The veterinarian and staff still used their time, resources, and knowledge to address your dog. This is not free, regardless of the patient outcome. It is this way in human medicine as well.

    I wasn't there and I can't judge how your vet handled the situation. From your post it sounds like you're in an emotional state. It might be helpful for you to give it some time and then perhaps later talk with your vet about the situation for closure. I can tell you cared a lot about your dog and this must have been extremely difficult to go through - again, I am sorry for your loss.
  5. haloschief

    haloschief

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    Thank you both for your responses. The situation has already passed and I'm not looking for medical advice per say. I'm curious in how pre-vets/vets think and come up with their reasonings and your responses to a dilemma such as this. I come from the pre-medical forum and we typically see ethical scenarios pop up everyday so its intriguing to me to read constructive posts about these scenarios. Maybe its because of the MMIs for medical school or how the field demands those who can think critically/logically... I'm quite unfamiliar with how veterinary schools do their admissions. In medicine, the focus is always on the patient and care comes first, but I'm not sure how it is with veterinary medicine. How do you balance the situation of the owner and welfare of the animal?
  6. moosegp

    moosegp KSU CVM Class of 2016

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    I am so sorry for you loss. This is a sad story that is many times inevitable for pet owners and veterinarians. I know what it feels like to grieve over a lost pet, and even though I am a pre-vet I still hold grudges against vets who I think did wrong by my animals. Sometimes you just need someone or something to blame and that role can often times falls on the veterinarian. Again, I know I am only a pre-vet, but you did address this to us so I am going to give you my opinion. Whenever you walk into a doctor's office wanting a diagnosis tests have to be run, I don't think the vet was wrong by requesting this. She could have definitely gone into some possible results and treatments that would be needed but there is no guarantee. However, I do not think ( and again I probably do not know all of the logistics that go into this) that it was right of the vet to demand you allow her to perform euthanasia. Euthanasia is an option, and yes a much more humane, less painful was of going, but I don't believe it is a requirement when you walk into the vet's office. I believe you had every right to ask to finish your appointment and pay for her time and services performed. However, looking at the situation and knowing he passed away within the next 10 minutes it might not have been the best decision to leave. Again, I am so sorry for your loss and I hope this does not detract you from owning pets in the future and certainly not from taking them to the vet. However, you have every right to go to a vet whom you feel comfortable with.
  7. moosegp

    moosegp KSU CVM Class of 2016

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    I also wanted to note that I do not think this poster (?) was seeking medical advice. They were simply asking opinions that everyone in our shoes should be able to develop. I think the conversations in these posts are healthy and valuable. Its ok to have an opinion even though it might change someday. Its how we grow.
  8. lailanni

    lailanni c/o 2012

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    That's a really excellent question and difficult to answer.

    In school, they teach us to offer the highest standard of medicine. This is what would ideally happen if money was no issue and the patient's welfare was the top priority.

    Realistically, it's rare that a client can afford the recommended tests and treatments. It then becomes a very tough balancing act. I have seen one too many case of a sick animal coming in and the owner saying "I have $50 (or some small amount). If you can't make him better, I'll just drown/shoot/etc him."

    What can do you for $50? Give him antibiotics and fluids and hope that helps? Or run tests but not be able to afford the fluids? Or do you cave and use your personal money for a test and have the owner pay what they can for treatment?

    There's no easy answer for cost vs care. Really it comes down the the individual owner. We will try to present the best care possible, but it is up to the client to decide how far they want to go with that.

    I have seen many instances where an animal is diagnosed with a cancer. Some people will go for chemotherapy and radiation. Others will elect for euthanasia. Is one owner right or wrong for picking that treatment? No. And that's what makes it so difficult. One owner may be angry if you didn't offer chemotherapy for treatment. Another may be angry that you did.

    Contrary to the belief that we're just in it for the money, most veterinarians I know have (at one time or another) used their own money to supplement for a test, or a treatment. Some veterinarians have even used their own money to get an animal sent to necropsy just so they could better understand why they died - and to help prevent things like that in the future.
  9. bayarea15

    bayarea15 someday super vet

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    Please accept my condolences on the loss of your dog. :( I am very sorry.

    I am pre vet as well...but if I was your veterinarian, the first thing I would do would be to listen to heart and lungs, get a temp, look at your dogs gums, and get as much info from you as possible. Animals cannot tell us what is wrong or where the pain is, and they hide it, its their nature. Any clues the owner has are the starting point. I would make sure your dog is stable, and ask about his diet, is it normal for him to eat things like socks, etc, when was the last time he was outside, when were his last bowel movements and urination, is he drinking a lot, etc.

    If it appeared that this was a time in which we need to act quickly, I would draw up an estimate, and discuss what would be best, and possible later choices. I would first suggest blood work, and an xray. Depending on the results of these things, I may afterwards suggest ultrasound as the next step, or medication, or surgery. Again, I would explain the why of these things, as well as the cost.

    I would opt for the most logical treatments, and would give you the option to decide. I would also offer you to visit your dog, no question....

    As for euthanasia...if it was apparent that the end of life was near, I would offer euthanasia. But, if you preferred to have him pass at home naturally, he is your dog, you know him best, and I would counsel with you on some pain medications for the dog, if you were to choose a palliative/hospice type treatment. But, if your dog was suffering a great deal of pain, I would gently explain that to you the best I could.

    Paying for the bill after the loss is always hard. But everyone does what they can. If no one pays, then as a vet I wouldn't be able to keep my practice because I would need a job to support myself...maybe there would be no veterinarians anymore if no one paid...I really don't know. I do know everyone has to eat.

    I am very sorry about the whole matter. I have exp this similar event myself...I would have preferred to pay right then so not to be reminded by a bill in the mail...

    The xray and cbc were not useless...they just were not helpful in determining a diagnosis. Cbc came up normal I'd imagine, as well as xray. Next step, ultrasound...dog can't tell you where or what...its a guessing game, and prolly similar to human pediatrics...

    Hope this helps :(

    Sent from my PC36100 using SDN Mobile
  10. bayarea15

    bayarea15 someday super vet

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    Ps

    Not attempting to provide medical or nursing advice, just was trying to explain how its a step by step process in vet med...

    Sent from my PC36100 using SDN Mobile
  11. krist

    krist

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    Why would you not have to pay for an x ray that was taken before your pet died?? And how would you expect a vet to know what's wrong with your very ill pet without running any diagnostics. A radiograph is hardly a useless test, it is used to diagnose fluid in the abdomen, masses, enlarged organs, gdv etc. which are all likely possibilities with an ill animal. Just because it came back Normal does not mean it was useless...and you're going into human medicine?? When I went to see my gastroenterologist for vomiting upper gi pain etc I had about a dozen different imaging, labwork and endoscope diagnostics performed and guess what, they all came back normal! And yes, I paid for them.

    My grandpa was in the hospital for almost a week before he died (in the hospital), and yes, that was paid for too...
  12. Peperoncini

    Peperoncini VMRCVM C/O 2016!

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    OP - First, I just want to give my condolences to you for your loss. It sounds like you really loved your pet.

    Second, just a *loooong* comment on what I bolded above (surely I will get scolded for this) - making decisions on diagnostic tests (rads/ultrasound/cbc/chemistry/urinalysis/etc) is a whole lot easier when the patient's pocketbook is deep thanks to medical insurance. Having worked in a shelter environment for years now, I understand that many owners do not have the financial means to perform every diagnostic test a vet may ask for (we get many animals surrendered to us every month just because clients can't afford diagnostics for their pet, much less treatment). I haven't worked in private practice (or a corporate ER) yet, but our shelter vet tells me when she is making decisions on diagnostics and treatments at the shelter, she treats the shelter as a client that has a small budget.

    In a world where the actual cost of medical care for humans is greatly subsidized by insurance (or if you will, subsidized by the healthy insured), where people have the expectation of "I don't care what it takes doc, just make me/my wife/kid/etc better," it seems horrible that client budget has to be a primary consideration in this field. It just sucks, but that is how things are. There is no "Obamacare" for pets (and I would not advocate that either, although I think pet insurance is a good investment).

    I bring this up because it pains me to see people say the profession I want to get into routinely rips off their clients and makes a commission on the suffering of animals. I pay a $20 co-pay for x-rays, $20 for cbc, $20 for chemistry, $15 for an office visit at my doctor, but I understand these are not real world costs. My insurance more than makes up for the difference because I see my doctor 2-3 times a year tops, but I accept that the excess from my insurance goes to cover the costs for those who use their insurance on a more frequent basis. I think many people are just misinformed about how the whole process works, and then get upset at the vet office because bloodwork costs $150, not realizing that their $20 CBC actually costs their human doctor much more than $20.

    OP - Again, I'm sorry for your loss and please don't take this as some sort of personal attack (I'm not - I don't think that would be productive). I'm just taking the opportunity to point out how unfair the thought process of the general public is towards the "greedy vet".
  13. krist

    krist

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    And what information do you feel was withheld from you?
  14. haloschief

    haloschief

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    Yes, it was rash of me to call it a useless test. I'm not disagreeing with its utility. It's a tool to rule out what the problem is or isn't. However, in the context of this situation and its outcome, I feel that it was a useless test.

    I paid for the tests. I'm not going to argue that. The reason I suggested withheld information is that within the 15 minute timeframe that the xray was done what changed her opinion to tell me after that your dog won't make it through the night? I guess that is a question that only the vet can answer.
  15. Wildlife woman

    Wildlife woman

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    So sorry for your loss. I know that being in your position it is very hard to be objective. I am not yet a vet but I can tell you that in my experience when an animal comes in that is that ill you try to perform as many tests as possible as quickly as possible so that you can come up with a treatment plan ASAP. From the symptoms you were describing it really could have been so many different things that could have caused it and while I do not know this vet I would assume that she was concerned about the welfare of your animal and your feelings as well because she wanted to do all that she could to solve the problem. I can see how you might feel that they would be taking advantage of you financially but I think that is because you cannot look at this objectively (I wouldn't either if I was in your position; I am sure). Most vets are not out to make a buck, otherwise they would have gone into human medicine. I understand how difficult this is for you since you obviously cared for your animal very much and yes there are people out there that are trying to make money but as far as vets go I think they are fewer and far between than you may think. For most of us on here I think it is very difficult to give useful advice without being there or having more information but I hope this gives you some solace. Again I am truly sorry that you have had to go through this
  16. Peperoncini

    Peperoncini VMRCVM C/O 2016!

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    This :thumbup:!

    OP, if you are genuinely concerned that the x-rays were useless, take ursula's advice. I know you are not looking to get your money back, but possibly something happened while your dog was getting rads that made the vet change the prognosis? Perhaps the fact she couldn't tell from the x-rays ruled out possibilities that she could treat without the rest of the diagnostics (and since the other diagnostics were not an option based on budget, she could not treat?). You won't know without respectfully asking.

    Also...
    I know a few vet schools do use MMI (TAMU and VMRCVM at least) and sincerely hope you don't think the vet field demands any less than those who can think critically and logically. Your statements make that... unclear at best (if someone wanted to, I wouldn't blame 'em for taking offense ;))
  17. TigerWillow

    TigerWillow UC Davis Class of 2016!!!

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    I don't think it's useless. Many animals can crash with ruptured organs/abdominal fluids etc. Same thing with people. If emergency surgery were needed, would you want the vet to just cut open blindly? I cant tell you the number of times that people were originally reluctant to do radiographs, vet finally convinced them, and it turns out that the animal has been sick for a long time (saw a whole bladder full of kidney stones!!). Just so happened the radiographs were inconclusive with your dog. There's no way a vet can know that before-that would make them mind readers. But SOMETHING was wrong.

    I am very sorry for your loss. It's awful to lose a pet. I do think it was wrong that she demanded you to keep the dog there. If it were me (and what do I know), I would explain that he IS in pain and it might be a slow painful death. Again, you were in an emotional state, but you are still in charge of what happens to your pet. You can't come back to the vet saying you didn't mean to do something. Poor emergency vets would constantly get yelled at! (and I'm sure do)

    But the same thing happens in human meds too. Things happen too little too late sometimes (back when I wanted to go med, I saw a dude die after months of not knowing what was wrong with him-freaked me out). So it's not an isolated event.

    To answer your question about our interview process, I've helped A LOT of my friends practice for their med interviews, so it's safe to say I know a comparison of the two. Vet interviews have A LOT more ethical questions, usually dealing with owner's ability to pay vs quality of care. With med, it's usually what do you think of obamacare, oregon's euthanasia law, and abortion. According to my friend in med school who helps interview, she hears a lot of the same answers over and over.

    Again, very sorry. I had a rabbit that I brought to the same vet I volunteer with. He wasn't eating, but seemed perfectly fine other than that. They thought a hairball was the cause. They had him there over night. The next day he died. I was so angry at the time but never brought it up. After volunteering with the vet, I know that they are really good and caring people. Bad things just unfortunately happen
  18. lailanni

    lailanni c/o 2012

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    A lot can happen in 15 minutes, especially with a critically ill animal. There's fine line to be crossed from being just barely ok to going into shock, or rapidly decompensating. You mentioned that your dog started twitching and being unresponsive - negative changes like this can happen quickly in an ill animal. Your vet may have also noticed changes in his vital signs - heart rate, respiration, gum color, temperature, blood pressure or pulse quality. Unfortunately, an animal can go from bad to worse in an instant. I am sure they would be willing to discuss with you their reasoning behind their prognosis.
  19. haloschief

    haloschief

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    Sorry, I had no intention of coming off that way. This was just my experience going to a 24hour emergency clinic. I know the field has vets who excel at what they do and I have friends who want to enter a career in veterinary medicine and are obviously smart :).

    Going back to the useless test. I just wanted to clarify that I'm calling it a useless test after the fact that my pet died because it doesn't serve a purpose anymore.
  20. TigerWillow

    TigerWillow UC Davis Class of 2016!!!

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    Let me try to understand - so if I had a sore throat, had a throat swab for strep, that turns out negative, and then I go home. Turns out I had swine flu and die.

    Would the strep throat test that costed a lot of money be useless? Im just trying to figure out the definition of useless
  21. Bill59

    Bill59 Member

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    Haloschief, I'm so sorry for your loss. As others have said, the best person to explain the specific details is the attending veterinarian.

    In general though, with an acutely ill patient and "stomach pain" (probably abdominal pain) not recommending abdominal radiographs would likely be negligent. There are many emergent, treatable conditions that abdominal radiographs can identify or rule out. Far from not telling "squat" I suspect the results ruled out many of the potential diagnostic considerations. With diagnostic tests, negative results are just as important as positive results.

    As for taking home a critically ill dog to die, in my opinion that is a much less humane option than euthanasia.

    The veterinarian's job is to recommend what they think is best for the patient and to inform the client of the risks and benefits of the recommended procedures. It is not the vet's job to perform a wallet biopsy and determine what the client can and can't afford. That's the client's responsibility -- to provide informed consent as to whether or not they want to comply with the vet's recommendations.

    Consider the alternative. Would you want the doctor to decide what level of care you want? "This patient really needs some x-rays and bloodwork. But they're expensive and this guy looks like he doesn't want to spend a lot of money. So let's just skip all that and hope for the best."

    If a veterinarian or MD treated me like that, I would be pissed.

    You've just lost a loved family member and you're grieving. A natural part of that process often involves some anger. After you've had a little time, if you still have concerns or questions about the treatment, I would contact the hospital and give them a chance to address those concerns.
    Last edited: 03.16.12
  22. bandierose

    bandierose

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    Hello,

    The doctor had no right to refuse you your pet. That said, I have seen cases where the animals are truly suffering and gasping for breath and they truly are at peace when you let them go (euthanize them). If it had been me I would have definitely suggested you euthanize. The other option would be to take him to an emergency vet, but you would have to be willing to shell out minimum of 2 grand, just to figure out what the problem is.

    As to the tests, when a dog is in tha condition it is really tough to decide what tests are important and delaying by only doing one test at a time can mean the difference in life or death in a situation such as yours. So, yes, I do believe that you should have paid for the test. That said, the vet seemed totally unprofessional to me and should have explained the situation better.

    All things considered I think you made the best decisions you could with the resources you had.
  23. nordicat

    nordicat Mizzou c/o 2016

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    Maybe you should have tried to learn how things are done in veterinary medicine before you judged your vet? IMHO, vet med requires potentially even more critical thinking and logic than human med. Human doctors don't have the option of euthanasia on the table to offer their patients. None of the vets I work with would offer euthanasia as an option if it were not logical based on the patient's test results, quality of life, and prognosis. One cannot make a judgment about what to do next without some diagnostics. As Peperoncini (I think) said, someone may get offended at how you worded this. I certainly did.

    Many pre-vets and vet students have spent YEARS just applying to the 28 vet schools in the U.S., and each school only takes somewhere between 50 and 175 (depending on the school) students per year. Do the math. Vet school admissions are HIGHLY competitive, and the ad coms assess applicants' science GPAs, overall GPAs, some schools look at the last 45 credit hours and the GPA earned therein, GRE scores, we need hundreds to THOUSANDS of hours of experience in many different areas of vet med, and most schools use an interview process to narrow the candidate pool. Many schools use behavior-based interviews to assess an applicant's thought process and logic. We learn to treat more than one species, generally pay more for our education than med students, and will make less money than most human doctors throughout the tenure of our careers. Human medicine is some pre-vets' "Plan B," and I have seen several pre-vets turned pre-meds on here...but far fewer pre-meds turned pre-vet.

    Don't go into your vet with an angry, judgmental mindset. Your vet will probably pick up on this and be on the offensive.

    It's only logical.
    Live long and prosper.
  24. haloschief

    haloschief

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    As I said earlier, I had no intention of demeaning the profession at all. I just feel that the vet could have explained things more clearly to me which she was not. I'm not judging the field, I'm just judging ONE vet based on that visit. I was in a stressful situation and I had expected more sincerity/empathy here. I would have appreciated a clear explanation as to why, instead just being told: "your pet is ill, sign here to run all these tests" and "your pet won't make it through the night; its not humane to take your pet home, euthanize him". Instead, looking like a clueless idiot in front of her staff, I have to ask her the whys behind her actions/suggestions.
  25. haloschief

    haloschief

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    Exactly. Lets say you tested for swine flu, result came out positive just as you died. The information is there, but you're dead anyways so whats the point of having the diagnosis other than for knowing what the cause is for. Hence it was useless.
  26. TigerWillow

    TigerWillow UC Davis Class of 2016!!!

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    Ok, I understand. But the way you previously stated our profession made it sound like how every med student makes us sound: the B team.

    Next time use caution with how you word things. I've learned that as a very important lesson with others in here, and I believe it will help in future events. Obviously the vet made that same mistake. You are going to someday be in the vet's shoes with how you carry yourself. I don't think you meant it, but I'm sure it angered a few of us!
  27. TigerWillow

    TigerWillow UC Davis Class of 2016!!!

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    Yes, but you can't start TREATING for swine flu unless you know you have it!! It could have been strep throat! A very bad case of it! Perhaps you took in the pet too late where nothing could be done :-/
  28. NStarz

    NStarz Ohio State c/o 2016

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    At the point the test was done, it was not useless. Your vet did not know, at that point, that your dog would eventually pass. Just because the outcome was not as you would've hoped does not mean that diagnostics were not warranted.
  29. nordicat

    nordicat Mizzou c/o 2016

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    That being said, you have the right to be told everything that is going on (which,yes, would most likely require diagnostics). I don't think I would have said, "no, don't take your dog home!", and I don't think it was right for the vet to judge your wishes like that and call you "inhumane" (which, btw, you CLEARLY are not). I can totally understand why you would be upset about it all. I would wait a bit until you've had some time to cope with the loss of your dear friend and then address the situation with the vet, either in person, by phone, or via e-mail. If this was a vet you have been taking your pet to for a while, they should be able to give you some more insight. If they were a new vet you saw for the first time that day, though, I personally would just e-mail (if possible). I'm assuming you won't be using that veterinarian again after this. At the very least, you'll get the point across that he/she should try to be more forthcoming with information and less judgmental of a client's wishes.
  30. haloschief

    haloschief

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    I'm agreeing with you. It was not a useless test at that point, thats why I signed for it. I'm saying that the information it gave me was useless because I can't do anything with it since my dog passed. The information would have been useful were my dog still alive.
  31. Fireflysushi

    Fireflysushi CSU c/o 2016!

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    Just as in human medicine- seeing a doctor is no guarantee of better health or a saved life. Doctors are there to do what they can to improve the health of a patient, but this is not always possible. In humans or animals. When as an MD you lose your first patient to no fault of your own, I think you will understand this better.
  32. K9DANE

    K9DANE VMRCVM c/o 2017

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    My condolences as well to the loss of your pet.

    Just out of curiosity, where in your pre-med/med track are you?

    My opinion is one of someone that has spent 10 years in the human medical field and is transitioning to veterinary medicine. Do not be naive to think that all treatment on humans is "patient and care come first." You will find as you futher your experiences that that is not always the case. In addition, many procedures/treatments/surgeries do not always come with sufficient information to make accurately informed decisions. Legalities are also more of an issue, and will continue to be as long as animals are legally considered property.

    You are grieving, and anger, bargaining and blaming are a natural part of that process. My intention is not to belittle you here; however, I would like to point out that the statement was made that you waited approximately 48 hours to have your pet seen. Would having him seen earlier changed the outcome? Maybe/maybe not, but if not it might have at least allowed more time to find a differential diagnosis and allowed more time for decision making.

    As for negative tests (or inconclusive tests) being useless because they didn't provide a definitive answer, that's just ludicrous. It doesn't matter whether the patient is human or animal, a plan is put into effect as the patient presents in determining a diagnosis. If you had a patient with classic signs/symptoms of a PE but the CT scan was negative, was it useless? No. It effectively ruled out probable cause #1, time to move on, etc. More often than not in medicine, it's a hunt and find game.

    In the veterinary world, economic impact is usually of top priority. With the presentation of your dog, an xray could potentially diagnose an obstruction, tumors, heart failure/pulmonary edema, etc. Whereas a CBC might show elevated white counts (of which you still don't know the source), anemia (again, unknown source), platelet dysfunction, (again, unknown source.) A chemistry panel might point out liver/kidney issues but again, unknown source. In the end, YOU asked her (based on finances) which diagnostic would hopefully provide the most information based on the presentation of the animal. I agree with your vet that an xray would hopefully provide that info. (keyword: hopefully - there are no guarantees) Depending on the size of your dog, she might have been able to visualize the chest AND abdomen in one film.

    At the end of the day, we still don't know what caused your pet's demise but whatever the cause, he/she had been severly declining over the last 48 hours. It is totally possible that in those critical moments, your pet crashed.

    If I think an animal has some time left and pain meds would offer some quality in their last moments, then I will certainly offer my clients the opportunity for them to take their pet home. However, if the situation is critical, and in my judgement the pet is truly suffering (whether there's obvious pain or not), then I would do just as your vet did and highly recommend euthanasia. Our oath is to provide the best care to our patients, and do what is best for them (in our judgement.) While I'm not even in vet school yet, based on my experiences (both human and veterinary), I do not believe I would've proceeded much differently than your vet.

    Your pet was examined, and tests were performed. As for the bill, yes, you would be expected to pay for services rendered that day. In the human world, you would as well, only it comes in the form as a bill in the mail.

    I am truly sorry for your loss. Please discuss the situation with the vet, but don't go in gunning for bear. You will both be on the defensive and unable to effectively communicate at all. Remember, calm heads prevail.

    I wish you peace and good luck in your studies.
  33. sunshinevet

    sunshinevet

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    :thumbup: Thought this summed everything up beautifully.

    Just wanted to add a few things:

    You seem a bit perplexed that your dog was taken away from you at the start and you didn't get to see her again quickly. As someone who works at an emergency clinic, (which I think you may have gone to) I just wanted to explain why that is. (if its not apparent) as its a point that quite a few owners need to be talked through.
    Taking a really sick animal straight out the back for assessment is key for us. it allows us to have multiple staff members look at the animal at once, attach multiple diagnostic tools (ecg, bp, spo2 etc) at once without having to bring them up to the consult room, and have multiple vets assess the situation together and get opinions. Whilst the lead vet on the case goes up and does the "consult" with you, other staff members continue to monitor your pet, gain IV access, perform free fluid checks etc. Especially with critical patients, always having them near a source of oxygen and multiple staff members is a must.

    Also, patients can deteriorate within a matter of minutes - in a truly critical patient, 20 min is a long time. I have definately seen patients turn from "fairly sick lets keep our eye on them" to fully crashed requiring resus in less than 10 - there are numerous disease processes that can cause this. I don't think this vet withheld any information from you regarding course of action - I think your pet just deteriorated rapidly.

    I personally support the vet in telling you that taking your pet home to die is cruel. In some instances its fine - adequate pain relief on board and your pet is clearly not distressed - but that wasn't the situation you described here and so I feel the vet was well within her right to say "no, you can't take your dog home because it would be cruel". Here is Aus a vet can legally say that - I don't know about US? But at the very end of the day, the extreme pointy end of the stick, my responsibility is to advocate for that dog - especially in situations where the owner may be too distressed to advocate for their own dogs best interests adequately. And I personally believe that that was what your vet was doing.
  34. nohika

    nohika lurker status

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    I'm not a vet student, but I'd still like to say...

    While the vet could've maybe explained things better, would you rather them spend their time talking to you, or working to save your dog? Sometimes when such cases are so critical, the vet needs to be in the back working on the animal and really can't take that much time with the owner.

    I agree with the others about the X-ray being useful at the time - it's really not the X-ray or the vet's fault that your dog died. To me, this is not really an ethical question - it's more someone not understanding how things work in an emergency clinic.

    I also would've supported not taking your dog home. Euthanasia is much more peaceful than gasping for breath and not getting it, imho.
  35. jradjsb

    jradjsb

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    I'm sorry for your loss. I actually had a similar experience. First my experience and what I gained: I had horse that fractured her leg. I called the vet to come out and look at her. He did a physical exam (PE)and very rudely recommended euthanizing her for the fracture. No xray, no bloodwork. He actually seemed mad when I wanted him to put a cast on it. 1 month and thousands later I get a 2nd opinion. This vet does xray, and bloodwork tells me that the bone isn't healing and the horse is starving herself. He gives the option of 10k surgery or euthanizing. I asked him to come out and euthanize her and he literally told me a bullet is cheaper. So how does this relate to your questions? 1st a vet doesn't have to be the one to euthanize your pet, she could have allowed you to take her home. You stated that 10 mins later your dog died, which makes me think that it was suffering and it would be in-humane to let an animal suffer, so this may be why she said no. 2nd (I am not speculating here just general info) After the xrays the dogs condition worsened, and the vet said it wouldn't make it through the night. This is where you feel info was not given? Xrays can be stressing on dogs w/o sedation, because they have to be held down. It is possible that the xrays exacerbated the condition and the vet performed another PE and realized there was nothing else she could do. This was my experience with the 1st vet, I was upset because no tests were run. Turns out that his diagnosis and prognosis was correct, and based on the 2nd PE by your vet her's prolly were too. How did your vet act, was she rude and to the point, or friendly and encouraging the tests? This is bedside manner some people are good at it some aren't. This is true for all types of med. human and vet, and can sometimes seem like they are trying to force something on you when really they are offering the best treatment when money isn't an object. In vet med money is almost always an object. True story: a guy comes into the vet clinic with a dog hit by a car. He tells the vet he has $10 what can he do. The vet literally told him to buy a box of shotgun shells. The fact is that vet med is a service and it has to charged for no matter the outcome, just like human med. If someone gets taken to the ER and dies, the family will still be charged for the ambulance and the ER visit, as well as continue paying any old medical bills the person had. Medicare actually tried to take my grandpa's farm after he died as payment. Its sucks but its life. As far as human med being all about patient care I will tell you that is far from the truth. That's what they tell you but in fact its all about money. I couldn't tell you how many useless surgeries, and tests I have seen performed. Last time I saw the stat it said over 70% of medical costs are spent on end of life care. If your old and have insurance the MD's will order a surplus of diagnostic tests everytime you get sick. From my 1st hand experience I see human medicine as a business and everyone has there hand in it trying to make more money.Sorry if ti turned into a rant, just my 0.02.
  36. squeegee

    squeegee

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    i just feel the need to comment on this; it is true that physically she could have 'allowed' him to take the pet home, but if an animal is unstable and potentially in pain (and clearly near the end, since it died 10 minutes later) then morally and ethically she had an obligation to convince him to not take his pet home. but as far as euthanizing by gunshot, that's something that is really only seen on the large animal side as an AVMA approved method of euthanasia. There are too many morphological differences in skull anatomy between breeds for a gunshot to be accurate and result in a painless death, and we have far better methods in a hospital setting that allow it to be peaceful and painless.
  37. jradjsb

    jradjsb

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    Squeegee I completely agree with you as I stated, "which makes me think that it was suffering and it would be in-humane to let an animal suffer, so this may be why she said no." I was trying to say that a vet is allowed to let a dog die peacefully at home, but to let is suffer is immoral and unethical. I didn't mean for someone to shoot this dog I'm sorry if it sounded this way, I was just trying to say that just because a dog is dying doesn't mean the vet has to euthanize it, if it is at peace it can go naturally.
  38. squeegee

    squeegee

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    ok sorry if i misinterpreted what you wrote. there's so much information out on the internet nowadays i wouldn't want someone to misconstrue what they read :) including myself apparently!
  39. yann

    yann

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    I agree with many of the posts here. It must have been a difficult and emotional situation for you (I can only imagine; my cat went though something similar 2 years ago), but from what you have informed us, I don't see anything particular that the vet did that stands out negatively. I've been working as an assistant for over a year, and I have seen similar cases like you where the animal was in a very poor condition and there were variety of possibilities (cancer always being the big one) and the tests we would often ask the client to let us run is blood work (Chem 6, 12 or comp plus CBC), x-ray and/or ultrasound. Not because all this will definitely give us the correct diagnostics, but because there are certain things that needs to be ruled out before we can proceed into treatment. Or, especially in your case, if it is too late and the animal is already dying, making it go through unnecessary and useless treatment will only prolong the suffering and would be inhumane, both for you and your dog. So in regards to the tests she asked to have run, I would have probably done the same...if looking at your dog's history and PE did not give me much information.

    Having said that, how the vet handled the financial situation with you was a bit off-putting. You had just lost your best friend and family a mere 10 minutes ago, and demanding payment from you was very insensitive. I don't know how other practice deals with this, and perhaps having to pay right after is the norm, but our practice does not force a client to pay right after euthanasia/death. We understand the client is in grief and needs time to mourn. Whether they can pay or not aside, if a client wants to leave, we let them leave without a fuss. If a client cannot pay for certain tests, we give them financial assistance. Sometimes, even though this is technically not allowed per head doctor because it hurts business, some of our doctors do x-rays and bloodwork for free, because they want to help the animal and do not want the animal to be neglected of proper care and treatment simply because the owner has no money to pay for it. I see the negative aspect of this, but at a situation like yours, or even worse where the owner has absolutely no money and will rather shoot the dog than have it treated, I have seen doctors give pro bono diagnostics anyways for the sake of the animal.


    I am so sorry for your loss and only hope you will feel better soon.
    Last edited: 03.18.12
  40. yann

    yann

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    I'm sorry, I may have misread your original post. I was under the impression that the hospital/vet demanded payment, but was that not the case? I re-read it again and it seems like the vet was just trying to explain why she did the things she did to help you understand. If she or the hospital did not demand payment from you, more just wanted you to understand why the x-ray was felt necessary, than I believe the vet handled the situation professionally and ethically.
    Again, all depends on her attitude towards you too...
  41. sunshinevet

    sunshinevet

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    I think the difference is though that this happened at an emergency clinic. At my emergency clinic (and i'm enclined to think all emergency clinics) we insist on payment at the time of consultation. It might seem harsh, but its nessercerry to us - in general we have NO previous client relationship with them and actually have no idea if they will pay their bill later. So we bite the bullet and get payment then. We always settle the account before the actual euth so they can just leave straight after, but payment is nessercerry for us.

    As far as free tests/dropping bill prices and whatnot goes, I strongly disagree with that too, and I think it's really harmful to your business. It costs us roughly ~$70 to run an idexx general panel, I can understand bosses getting angry about people giving that away for free!

    I know as someone who's worked in general practice for a long time, that what emergency clinics might demand might seem heartless and uncaring at times, especially since their dealing with distraught people. However, they do deal with people they have no client bond with and regularly have severe cost restrictions, so they really have to make the best of what they've got. We make people leave a deposit here, of the lower end of their estimate, and I know that must seem harsh - but every time that step gets overlooked, it always goes spectaclarly wrong (client refusing to pay anything, client disappearing off the face of the earth etc).
  42. lostbunny

    lostbunny

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    I just wanted to add that we used the exact same policy at an emerg clinic I worked at in Canada. Anyone could easily just put a fake name and promise they'll come back tomorrow with their credit card after a $6000 procedure.... We've got no way of tracking people, and I think at one of our end of year meetings the clinic was a few hundred thousand dollars in debt just from unpaid bills.

    I think we made exceptions for people who were regular clients of ours, but randoms had to pay up front/lower end of the estimate if the animal stayed over night.

    Although we didn't offer financial help from the clinic itself, we did have a payment plan from another insurance company that the client could sign up for on the spot and pay them back over time.

    So yeah it seems harsh, but there's really not much leeway in terms of the financial side.
  43. moosenanny

    moosenanny UC DAVIS class of 2014!!!

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    But where do you draw the line? So now you know the dog needs surgery based off of the pro bono diagnostics. What does the vet do? Pay for that too? Does the client suddenly have money to pay for surgery that they didn't have a minute ago for diagnostics? Does the pet walk away? I think that last option would make the vet feel worse - they used their own money to be able to discover what is wrong, but can now do nothing about it. :confused:
  44. DVMDream

    DVMDream Grrrrr! Gold Donor

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    I am very sorry for your loss. I know it seems that the x-ray was useless because now your pet has passed away but any test that is done whether or not it actually gives an answer is not useless.

    About a year ago, I took my older border collie mix in to the vet because he was acting really sick; not eating, would not lay down, walking around like he was in pain. We took x-rays and discovered that he had a splenic tumor. We also sent out bloodwork to make sure that nothing else was wrong with him. The bloodwork came back normal and he had surgery to remove his spleen and the tumor. After the surgery, he did ok for about two days; he did not want to eat, he would drink but he really seemed uncomfortable. On the second day I noticed he was pale white so I took him back in and they put him on IV fluids. He never got better. I took him home that night with the fluids (I worked at this clinic so they trusted me with the pump and fluids). Overnight he was no longer able to walk, he stopped producing urine, he became almost completely unresponsive. The next day I took him back to the clinic early in the morning. We had all decided that it was time to let him go and have him put to sleep; he was suffering and we could not let that happen. I dropped him off that morning and then had my own doctor's appointment. My dad went in a little bit later that morning to be with him. The vet came in and told my dad that the pathology report had come back showing that the splenic tumor was not cancerous. The vet then stated that maybe he got some form of infection and suggested trying more IV fluids and some heavy doses of anitbiotics. My dad agreed. The first thing they did was run some more bloodwork and that showed what was truly going on. My poor dog was in massive multiple organ failure: both his liver and kidneys were shutting down. There was nothing we could do for him. So we made the decision to just let him go. It was a very rough 5 days from the time he got sick to the time he finally passed. I could look back and say that all the x-rays, bloodwork, surgery, IV fluids, etc, etc were useless since he is no longer with us but that is not true. Everything done including the initial bloodwork that showed he was healthy was helping to make him better. I understand how hard it is to lose a pet especially when you have no answers. Why did my healthy dog that simply had a splenic tumor go into massive organ failure after surgery? Nobody knows. But everything that was done was not useless it was a step used in attempting to make my dog healthy again.

    Again, I am very sorry for your loss and the x-ray taken may seem useless especially since your pet is no longer with you but in reality it wasn't. It sounds like your dog was really sick and probably got even sicker very quickly. It is horrible seeing owners bring in pets that had been happy and healthy and then they are all of a sudden stuck with a severly sick pet that is dying. My condolences to you it is not an easy situation to handle. I only hope that as you grieve you can look back and realize that the vet was probably trying to do what was best to help your pet.

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