Veterinary Notes

Controversy over exposing “rip off” vets April 25, 2009

Last month, a TV programme was broadcasted in the UK about veterinary treatment. I finally got to watch this programme, “Tonight”, on ITV catchup (online), which caused huge controversy within the veterinary profession.

The programme featured the presenters taking 3 healthy pets (a dog, cat and rabbit) separately to several different clinics. Each animal was presented to the clinics simply with the owner complaining that the animal wasn’t eating. Obviously, the vets in charge of the cases offered different treatment and diagnostic options.

The advice given varied from vet to vet. This included prescribing different medicines, recommending further work up e.g. blood tests , doing nothing at all/monitoring and one vet even advised for the rabbit to undergo a dental procedure (which was deemed un-necessary by the other vets).

The presenters then brought the pets to the “television vet” Marc Abraham (who had the benefit of knowing the pets were healthy), who then proceeded to examine the animals and inform viewers that no treatment was necessary in any of the cases.

The programme’s conclusion was that the veterinarians were intentionally opting for treatment/diagnostics with the purpose of making money. The programme also implied that it was wrong for a consultation fee to be charged for examining a healthy pet that required no treatment.

This programme created the impression that veterinarians were using their professional status to take advantage of owners, that knew no better, simply to make money under false pretences. Obviously, this caused an outcry in the UK amongst vets.

I think several points that the programme illustrated are worthy of further discussion. Firstly, one of the most important parts of the diagnostic work-up, is the history that the owner provides. Obviously, as vets, we place a lot of trust in what owners tell us. If an owner is sufficiently worried that their pet is inappetant, then it would be wrong of us not to take the complaint seriously.

Often, we may have a very good idea of what could be causing the problem just from the history. For example, an obese pet drinking a lot of water, eating a lot and still losing weight would be suggestive of diabetes.

Obviously, during a consultation, the pet is examined and if no illness is found, then several options are left to the vet:

1) Ask them to adopt a conservative approach and wait to see if any other signs develop which will help to isolate the cause of the problem.

2) Offer the owner the option of further diagnostic tests such as a blood test to check for any internal problems, which may not be detected from a physical examination.

3) Offer some form of mild treatment, which may help to increase the appetite such as a specific food or appetite stimulant (e.g.vitamin B).

4) Either not believe the owner’s information and keep the pet in the hospital and observe the appetite (may end up with false inappetance due to stress) or dismiss the owner and tell them that there is no obvious problem.

There is also the possibility of the vet finding something on clinical examination that may actually be unrelated to the inappetance but further investigation/treatment is recommended.

Of the 4 options above, I believe that any of the first 3 options is acceptable. The 4th option however, is the one most likely to lead to problems. The owner may end up going to another vet or worse still, the animal deteriorates rapidly and the owner complains that the pet wasn’t investigated properly. Inappetance is such a vague symptom that a number of conditions (including some serious ones) can be responsible.

I personally feel the best way of dealing with a case like this is to present your opinion and then give the owner the options to choose from. If they are sufficiently concerned and want to spend money on a blood test, then I most definitely am not going to dissuade them, in case something more serious is going on and then I have left myself open to litigation.

I always try to give a set of options with a different range of prices and discuss the pros and cons of each. I will also tell them what I would do for my own pet (as a strong recommendation) BUT I will then leave the owner to make the final decision.

A common example of this is with a pre-anaesthetic blood test. These tests help to check the functions of the internal organs before a general anaesthetic. Often animals can appear very healthy on physical examination and from the owner’s history. On paper, it would appear, that a blood test isn’t really necessary as the pet is “clinically healthy”. However, I can personally testify that there are times (in these “healthy pets”), when a disease such as leukaemia (cancer of the white cells) or a liver/kidney disorder is diagnosed.

This however does not mean that I recommend a blood test before every anaesthetic. Normally, I tell the owner the animal appears healthy and I would be surprised if the blood test comes back abnormal, but once again, I leave the decision to them.

The final point I would like to bring up is the charging of a consultation. Vets by nature are caring professionals and rarely value their own time. I know myself that I often feel guilty when a pet requires an expensive drug or procedure. A lot of vets and clinics regularly do charity/wildlife work.

In addition to this, I don’t know any vets that charge for giving advice on the phone (unlike lawyers!) or in the reception area. Surely, it is reasonable to charge a fee for our professional opinion and service during a consultation. Do you get charged for a perfectly good house to be surveyed, an MOT for your car or by the dentist for a checkup?

Although, naturally there will be unscrupulous greedy individuals out there, who are more interested in making money than the welfare of animals; it is wrong to taint all vets (the majority who are excellent) with the same brush!