Chapter One
On the Scent: Tracking Down the Best Veterinary Practice for Your Pet
You’ve decided to become an informed veterinary consumer, and this decision is
going to greatly benefit your pet’s well-being. The first step toward your goal
of ensuring that your pet receives the very best health care available is to
carefully select a veterinarian. Just as in every profession, there can be real
differences among veterinary practices. By learning what to look for (and what
to avoid), you will be able to make educated decisions with your pet’s
particular needs in mind. There are many excellent practices providing
up-to-date, high-quality medicine, and others that are unable to offer the same
level of care or have fallen behind. The key for pet owners is to possess the
tools to make an accurate assessment and choose wisely.
How do I choose the right veterinarian for my pet?
There are various times when you need to select a veterinarian. Maybe you’ve
just brought home a new pet (or two). Or perhaps you’ve recently moved and are
searching for a good practice nearby. If your pet has developed health problems,
you may suddenly find it more important than ever that she has the best care
available. You may even have concerns about your current veterinary practice and
be considering a change.
When you find yourself looking for a veterinarian-for whatever reason-what’s
the best way to go about choosing the right one for your pet?
If you’re like most people, you have some personal preferences that may
influence your choice. Maybe there’s a practice that’s in a particularly
convenient location or has hours best suited to your schedule. Perhaps you feel
your dog is more comfortable with a female doctor, or your cat is happier in
practices that handle only felines. There may be a local veterinary hospital
that your family has trusted for years, or that a friend recommends.
These considerations are indeed important, but you should also weigh some
objective criteria when deciding which doctor to entrust with your pet’s
well-being. If you have a choice of practices in your area, you want to use the
one that offers your pet the highest standard of care and avoid those that
aren’t achieving the quality of medicine you’re seeking. To help you in your
search, I’ve compiled a list of questions that will enable you to evaluate
various aspects of each veterinary practice you consider. The areas covered
include patient care, equipment, staffing, philosophy, and how up-to-date the
facility is. Using this checklist, you will gain the ability to more
knowledgeably oversee your pet’s health care.
THE CHECKLIST
The checklist is divided into two sections. The first contains questions about
the veterinary practice you’re considering that can be answered over the phone
by a staff member. The second section contains topics that are best evaluated
during an appointment. There are two worksheets at the end of the chapter where
you can record the information you gather.
One option when you’re evaluating a new practice is to schedule an appointment
to take place without your pet. This will allow you and the veterinarian to
focus on your concerns and have enough time for an informative discussion. Also,
since your pet won’t have been seen at the practice, you may feel less awkward
if you decide not to return. Be prepared to pay the normal fee for the
appointment, even though your pet is not present. Don’t feel hesitant about
letting the veterinarian know that you are trying to pick the right practice for
your pet; many parents interview several pediatricians before selecting a doctor
for their children, and you, too, have every right to do some investigating.
If this suggestion is not convenient or affordable for you, you can evaluate the
practice during your pet’s first visit. You probably shouldn’t expect to be able
to stop by a practice your pet has never been to and speak to the veterinarian
without an appointment.
What if I am too shy to ask these kinds of questions?
We all sometimes find ourselves losing our voice: at the doctor’s or
veterinarian’s office or even the hair salon. We don’t want to annoy or impose
upon anyone, and we feel embarrassed to speak up. Keep in mind that veterinary
practices are there to serve you and your pet. You are entrusting them with your
pet’s well-being, and you are paying for their services. You certainly wouldn’t
buy a car or choose a vacation spot without asking plenty of questions and
having a sense of what to expect. I bet you feel more strongly about your pet’s
health than either of those. So ask away!
I appreciate clients who care enough to ask questions; they allow me to practice
the best medicine. Always remember that a veterinarian should value a client
like you and be gracious in addressing your concerns. If not, you may want to
consider another practice.
What if I have concerns about my pet’s current veterinary
practice?
You can use the checklist to help you evaluate your current veterinary practice
and perhaps pinpoint the cause for your concern. I’m surprised by how many pet
owners stay with a practice despite being uncomfortable there or dissatisfied
with their pet’s care. They may not realize that there can be significant
differences among practices, or they may feel awkward about leaving,
particularly if they are long-term clients. The truth is that veterinarians are
accustomed to clients coming and going. As professionals, they see this as a
normal part of doing business. Like any other relationship, there must be a good
fit between you and your veterinarian; if it doesn’t feel right, it is perfectly
natural to consider a change. Your pet’s health must always be your top
priority. Your decisions should be made with that responsibility in mind.
Sometimes people are unsure about how to diplomatically go about shifting their
pet’s care from one veterinarian to another. If you decide to try a different
practice, simply ask that a copy of your pet’s complete records be mailed to
you. You don’t need to indicate the reason why you want the file, or that you
have decided to take your pet elsewhere.
How can I narrow down the practices in my area?
You can start by finding out which practices are accredited by the American
Animal Hospital Association (AAHA). Participation is voluntary, and whether or
not a practice has chosen to be evaluated by the AAHA can be an indication of
its commitment to providing a high level of care. AAHA accreditation involves an
on-site evaluation to determine if the practice meets all the standards
established by the association, and then periodic reviews to ensure that it
continues to meet those standards. The practice is graded in many areas,
including the facility, staff, equipment, and patient care. Only veterinary
hospitals that meet the rigorous AAHA standards receive accreditation.
You can look for accredited practices on the AAHA’s website (www.healthypet.com)
or in the phone book, or by calling local practices to inquire about their
status.
TIP Another good way to find a practice in your area is to get a
recommendation from an equally concerned pet owner. Ask your friends, neighbors,
and colleagues for the name of their veterinarian and how they feel about the
practice. But be sure to ask specific questions, such as the ones that follow.
It’s wonderful that your neighbor loves her dog’s doctor, but you need to make
sure the practice provides the level of care you are looking for.
CHECKLIST: BEFORE YOU MAKE AN APPOINTMENT
To see if a practice meets your needs, you can ask the following preliminary
questions over the telephone. A staff member should be cheerfully willing and
able to give you this information. If the person who answers the phone can’t
supply all the answers, ask to speak to the office manager or medical director.
Explain that you are looking for a veterinarian for your pet and that you would
like to learn more about their practice. It is perfectly acceptable for them to
request to return your call if they are busy.
1. How are patients in the hospital monitored during the night?
If your pet should ever require overnight hospitalization, you must be confident
that he will receive adequate care. Some pets are hospitalized primarily for the
purpose of cage rest-for example, an animal with a bandage, splint, or fracture
who may suffer further injury from too much movement. In situations such as
this, the pet doesn’t necessarily need to be observed during the night.
A pet who is ill or recovering from surgery, however, can benefit greatly from
being monitored overnight. For example, the animal will be able to receive
necessary medications and intravenous fluids throughout the night. Patients who
are on IV fluids should receive them continuously, and this must be closely
supervised. And if something serious happens, such as bleeding, severe
discomfort, or deterioration of the animal’s condition, overnight monitoring can
prove crucial and sometimes lifesaving.
The degree of overnight care provided varies widely among veterinary practices.
Some practices are unable to provide any type of care at night; some have an
employee who intermittently stops by to check on the patients or administer
treatments. Other practices have one or more veterinary technicians and/or
doctors treating and monitoring the patients throughout the night.
A practice that does not provide overnight care may suggest that your pet be
hospitalized at another facility until she is more stable. Some practices have
an arrangement whereby the animals are transferred to an overnight care facility
during the night, and then returned to the practice during the day. This can be
cumbersome for owners, who are generally the ones transporting their pets back
and forth, but it does provide a safety net. In any case, the situation you want
to avoid is one in which your pet is left alone overnight when doing so may
threaten her health or comfort.
Many excellent veterinarians practice in situations where the cost of having an
overnight employee is not warranted. Naturally, some smaller practices are not
as equipped as larger animal hospitals to deal with very ill or postoperative
patients. What matters is that the practice handles these situations
appropriately by referring patients to another facility when needed. It’s
crucial that the practice recognizes that the need for overnight care can arise,
and that they have established a plan ensuring that such care is provided when
necessary for the patient’s safety, whether at their office or at another
facility. Avoid using a practice where sick or postoperative patients are kept
alone at night.
Questions to ask:
How do you handle overnight care for your patients?
Is there an overnight employee? If so, is she monitoring the patients
continuously, or does she stop by periodically?
Is the overnight employee either a veterinarian or licensed veterinary
technician?
2. Does the practice use adequate and modern equipment?
Veterinary practices vary widely in their equipment. Still, certain types of
equipment are so essential, I recommend you select a practice that has them on
the premises. These four examples can be used as benchmarks to help assess
whether the practice is well equipped and up-to-date.
Blood pressure equipment: Just like in people, many health
conditions cause animals to develop perilously high or low blood pressure, and
this relatively simple equipment can make an enormous difference in your pet’s
care. For example, animals can have high blood pressure that leads to a stroke
or blindness (especially those with kidney disease or hormonal disorders), and
animals who are under anesthesia or very ill may develop dangerously low blood
pressure. You might be surprised to learn how many veterinary practices do not
have this basic item and cannot measure their patients’ blood pressure.
PCV centrifuge: A PCV centrifuge allows veterinarians to quickly
measure an animal’s red blood cell level using a small blood sample called a
PCV, or packed cell volume. This equipment can be lifesaving for patients who
are anemic or have blood loss. For example, during surgery, an animal may lose
enough blood to require a transfusion. With a PCV centrifuge, the patient’s red
blood cell level can be measured immediately, instead of waiting for a blood
test to be sent out to a laboratory. Without this equipment, it is difficult for
a practice to safely handle such situations.
Pulse oximeter: A pulse oximeter is used to monitor an animal’s
oxygen level. This is critical for patients under anesthesia as well as for
those who have difficulty breathing, such as pets with pneumonia or heart
failure.
Radiology equipment: Most veterinary practices have radiology
equipment, but not all of the equipment will be of the same quality. For
example, older machines require the X-rays to be developed by hand; newer
automatic processors for film development result in higher-quality diagnostic
radiographs. Poor-quality radiographs are much harder to interpret, and
important information can be missed. The latest technology in this area is
digital radiography, which is more commonly found in very large or specialized
practices. I recommend you choose a practice that uses an automatic processor-
or has digital radiography, which does not require developing.
If possible, choose a practice that has all these pieces of equipment. If this
is not available in your area, choose the one that seems best equipped or best
meets all the other standards.
Questions to ask:
Do you have equipment to measure patients’ blood pressure?
Do you have equipment to measure patients’ red blood cell levels, such as a PCV
centrifuge?
Do you have equipment to measure patients’ oxygen levels, such as a pulse
oximeter?
Do you use an automatic processor to develop X-rays? (Or do you have digital
radiography?)
3. Does the practice refer patients to specialists?
There are many veterinary specialties, and at some point referral to a
specialist or advanced care facility may be necessary for your pet. I’ll be
discussing this in much more detail in chapter 4. For example, an animal who
needs major surgery may be referred to a surgeon, one with a heart murmur may be
referred to a cardiologist, and one with liver disease, kidney failure, or
another organ problem may be referred to an internist.
Besides offering expertise in particular areas of medicine, specialty practice
groups also provide a heightened level of care. For example, an animal who is
very sick or in need of major surgery may be referred to a facility with an
intensive care unit (ICU) featuring advanced monitoring capabilities and nursing
around the clock.
You want to be sure that your chosen veterinary practice is willing to refer
your pet, when it’s in his best interest, to a specialist or advanced care
facility. Think of it this way: Referring a patient to a specialist is like
passing the ball to someone who is in a better scoring position-an unselfish
act for the greater good. You don’t want to be on a team with someone who hogs
the ball.
You should be concerned if the practice’s approach is We don’t need to
refer, we can do everything here, especially if the practice does not offer
a variety of board-certified specialists as well as twenty-four-hour care. This
philosophy should make you concerned about your pet’s safety as well as the
practice’s priorities.
Questions to ask:
Do you refer critical patients to an advanced care facility? If so, which one?
In what situations do you refer patients to a specialist?
Do you refer patients to specialists for major surgery or advanced diagnostic
procedures such as ultrasound?
Do you refer patients who have conditions that are difficult to diagnose or
treat to specialists for a second opinion?
4. Are modern anesthetic techniques employed?
I cannot stress strongly enough how important this issue is for your pet. When
evaluating whether a practice is using the safest and most current methods of
anesthesia, there are three critical factors to look for.
First, find out the type of anesthesia that is used by the practice. The current
standard of care is that patients undergoing surgery are anesthetized using one
of the modern types of gas anesthesia. Only very brief procedures such as
replacing a splint or taking an X-ray should be performed under injectable
sedation.
TIP The two modern types of gas anesthesia commonly used by
veterinarians are isoflurane and sevoflurane. Halothane, an
older gas anesthetic, is not as safe. Do not use a practice that performs
surgery without using modern gas anesthesia.
(Continues…)
Excerpted from Vet Confidential
by Louise Murray
Copyright © 2008 by Louise Murray, D.V.M..
Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Ballantine Books
Copyright © 2008
Louise Murray, D.V.M.
All right reserved.
ISBN: 978-0-345-50320-6
