What are your thoughts on this - vet related.

[Aru]

If the vet didn't actually lay hands on the dog and exam it-ie look at teeth-See what grade of dental disease involved,if multiple extractions might be needed etc and do a quick clinical exam then I would be pretty pissed off to have to pay a full consultation charge in that case.unless theres a reason..ie aggression making the creature untouchable then any vet consult should involve an exam of the animal. Thats just basic practice.

As for the ethics of dentals. lol. I think having a mouth full of rotting, painful teeth with inflamed, infected gum disease would be a much less ethical way to keep an animal in old age then putting it under a ga to have teeth cleaned and extracted if required once proper precautions were taken.

When vets take bloods in dogs before a procedure ,we do a panel to look for anything that would make a general anaesthetic dangerous and to ensure no serious underlying health issues are present- so underlying liver damage as the liver processes the anaesthetic drugs, kidney disease in case the kidneys will need fluid support during the procedure or in case they would not cope at all,infections that may affect overall health, diabetes as unstable diabetics do poorly under anaesthetic, normal clotting factors available so the animal wont bleed out etc.
I have had several dogs and cats that seemed 100 percent healthy on the clinical exam flag up with serious issues on bloods,this ment the elective surgery was cancelled until we got to the bottom of the underlying issues.in some cases the procedures were done later on after issues resolved..in other cases we diagnosed longterm health issues that ment poor dental health was the least of their issues at the time.

old age is not a disease in itself it. it predisposes to other issues- so we do tend to check bloods prior to procedures in older animals, but a healthy older dog is just as able for an anaesthetic as a young dog if they are clinically normal.

A general anaesthetic is required a for a dental as trying to clean the back teeth and clean under the gum line,where most of the damage is done in gum disease,in a dog or cat without it would be pretty much impossible. Also sedating an animal to undergo that sort of procedure would be extremely cruel as they would be immobilised unable to object but still feel everything going on-having your teeth deep cleaned in bad dental disease can be very painful,dogs and cats teeth are not like horses!...that and a deep sedation is also technically more of a health risk then a G.A as it means the airway is not protected-animals not intubated,is not as easily monitored as animals can still be reactive under sedation and is difficult to reverse as quickly as G.A in the case of emergencies.

Having experienced dental pain myself it horrifies me what people expect their dogs to put up with simple because they are old...oh and because they don't act sore. They don't act sore as chronic pain is insidious and you learn to cope.You learn to deal with the chronic ache and try to adapt to it... just because you dont spend every day curled up whimpering does not mean you don't hurt with a chronic condition. i have seen dogs with trench mouths requiring multiple extracts coming into their check ups 7 days later as different animals now that the pain is gone.

Also of course vets are business'.
I will not work for free and expect to recieve my wages from my employer every month so yes I have no issues charging for my expertise. We will always mark up on every drugs we sell as thats how we make money. we cannot compete with online pharmacies as we cannot hold the same level of stock in a practice as a warehouse.
we will charge for more then the procedure costs to do as we need to make a profit to survive.....vets are a business not a charity, we are not subsidised health care this is private health care and you do pay premium for a professional service. As medicine advances and more and more options are available then vet care like human medicine will continue to become more expensive. Its now standard for most practices to have blood labs and xrays on site as well as a full pharmacy and operating theatres. That sort of health care facility is expensive to maintain.

At the end of the day its up to the owners to make their own decisions on how much they are willing to spend on their pets, but its up to the vet to make them aware of all their options.

Pets are an optional luxury not a right.

P.s its a buyers market if your not happy shop around for prices...but be sure to check what your getting for that price...in a 12 year old dog with possible extractions then preanesthetic bloods, fluids during the surgery as well as painkillers post op and possibly antibiotics-depending on how bad the mouth is would be considered the standard of care to ensure the best outcomes....but you'd be amazed at how often this is not going to be included in the on the phone price ...or worse when the dental will be done without the above to save money and to be able to compete pricewise. we offer fluids and bloods for a reason...it decreases your chances of complications..and given that the main one is death I would be wary of places willing to go without bloods and fluids in an older animal,its poor quality medicine...you do often get exactly what you pay for.

 

[Alec Swan]

……..

Pets are an optional luxury not a right.

…….. .

I agree with you.

If we consider the ethical stance of 'most' of our veterinary practices, then we have to consider that they are obviously being run as businesses and the idea that we have professionals who are running welfare enterprises in some airy fairy altruistic fashion, simply doesn't make sense.

I have a good friend of many years standing who is a senior partner in a large practice. His opening line on the subject is that OF COURSE the bulk of their work comes from insurance work, or at least the most profitable, as he also points out that with the attendant costs of employing staff and running a practice, so it is indeed a business. "If I put down every animal that comes in here when in reality it may only have six months to live, then I'd have no clients". "Of course we offer treatment to animals which are simply being kept alive, but without that work, we'd have no business". We are compelled to consider these facts and we also have to consider that as owners we have to face up to our responsibilities and it's our responsibility to decide whether we allow an animal to go through often lengthy and invasive treatment, with the outcome in a few months time being a difficult parting for both our often beloved pet, and ourselves.

A local guy, who's himself been seriously ill having had chemotherapy and who's gay and lives alone, had his constant companion a Papillon called Mellors. My neighbour doted on, and adored his friend who was his constant companion. Mellors was quite clearly having problems of some sort in his throat, he had a GA to allow an investigation and a huge cancerous growth was found. It was suggested that at the age of 12 years he had the option of chemo but my neighbour instructed that he not be brought round from his GA. My neighbour was a brave man. The attending vets suggested that treatment could well give the dog another six months, or so, but my neighbour pointed out that he himself had had such treatment and he wasn't going to put his friend through it.

The main point of this post is to point out that we as owners, though listening to professional advice, are the one's who have to make the decisions and it's a little unfair if we place the burden upon the vet who has to decide whether they abandon the income derived from treatment, or do what in their hearts they know to be right.

Back to the start! The question of an ethical stance is always going to be compromised when a vet has a business to run, gives employment to staff and raises his own family, when expected to decide upon treatment for an animal which, at best, has a very poor prognosis. Expecting a vet to make such decisions is unfair and wrong in my view. The decision as to whether we treat an animal or we don't, rests squarely with us, the owners.

Alec.

 

[blackcob]

I must admit to being slightly baffled by your post, Alec.

the vet who has to decide whether they abandon the income derived from treatment, or do what in their hearts they know to be right.

That is almost never the vet's decision to make and has always rested solely with the owner, which you eventually conclude, but without also accepting some owners will make an informed decision to pursue further treatment or even palliative care that has nothing to do with making profit for the vet and everything to do with providing care they think is appropriate for their pet and their financial situation. Am I alone in being able to have an honest and realistic discussion with my vet? One that includes all options, opinions and financial considerations. If anyone feels they are being railroaded into making the most profitable decisions at the expense of welfare outcomes then they need to find another vet!

To go back to the OP's example, spending £300 on bloods, drip and dental on a 12 year old yorkie could be an entirely appropriate decision which will make an astonishing difference to the quality of that dog's life, which may continue for a good few years yet. Too many people consider dental disease normal and inevitable in older dogs which is a shame, it has such an effect on quality of life and an impact on many other body systems.

 

[Alec Swan]

…….. the vet who has to decide whether they abandon the income derived from treatment, AND do what in their hearts they know to be right, (added) or whether they simply continue with a costly treatment, with the likelihood of continued suffering and for the sake of a generated income.

……..

Alec.

I realise that it didn't make much sense. My apologies. I've altered it and added to it in the hope that I've now explained what I had intended to say, but failed.

Whilst end of life care levels will be at the owner's discretion, I believe that whether under 'advice' or not, to continue with a degenerating and almost certain life-ending complaint or disease which will be likely to cause distress and pain and to no purpose, other than to support the owner's belief that what they're doing is right, is wrong, and it's that simple. Whilst few want to accept it, there are far too many vets who rather than point out the inevitable distress that will be caused by continued treatment, do so, generally when the animal is insured and when the payout limit has been reached, then arrive at the eventual decision "Perhaps we should now consider what's right for Fido". To believe otherwise, is naive.

I also wonder if your relationship with your own vet is one which is born of your own understanding and wishes, and if when recognising that, your vet approaches you and your dogs in a different manner to those who he deals with who are are well insured and stand before him with a blank stare. In business, we deal with our clients as we find them and those who won't be 'bulled' are dealt with in a different manner to the remainder. There's no other explanation, that I can see.

Alec.

 

[cobgoblin]

Rd

I realise that it didn't make much sense. My apologies. I've altered it and added to it in the hope that I've now explained what I had intended to say, but failed.

Whilst end of life care levels will be at the owner's discretion, I believe that whether under 'advice' or not, to continue with a degenerating and almost certain life-ending complaint or disease which will be likely to cause distress and pain and to no purpose, other than to support the owner's belief that what they're doing is right, is wrong, and it's that simple. Whilst few want to accept it, there are far too many vets who rather than point out the inevitable distress that will be caused by continued treatment, do so, generally when the animal is insured and when the payout limit has been reached, then arrive at the eventual decision "Perhaps we should now consider what's right for Fido". To believe otherwise, is naive.

I also wonder if your relationship with your own vet is one which is born of your own understanding and wishes, and if when recognising that, your vet approaches you and your dogs in a different manner to those who he deals with who are are well insured and stand before him with a blank stare. In business, we deal with our clients as we find them and those who won't be 'bulled' are dealt with in a different manner to the remainder. There's no other explanation, that I can see.

Alec.

I agree with you on every point Alec except one - the discussion on what's best for Fido tends to happen AFTER the insurance is exceeded, often by a considerable amount.

 

[Aru]

Depends on the vet alec.
Im what we call an associate.not a practice owner just working for a company. I dont earn comission based on the work I do.I work for a set salary and do not get bonus' etc so there is no financial gain for me in the procedures I advise to clients.

If an animal is insured or not only comes into the question if finaces are an issue brought up by the owner.

I may be lucky though the practice i work for has very strict company policy on how we do things however and we are expected to follow certain procedures in work ups.one of our main rules however is judge noone on how they look or act in a consult., regardless of your preconceptions everyone should recived the gold standard advise on what is best for their pet at the time.if we are working within financial concerns then that will change things but the job im being paid to do is to give my proffesional opinion on an illness and a course of treatment for the animal in front of me..its up to the owner to let me know what constraints we are working under and for them to make the decisions on what they want to do. Its true in many insured animals we treat to gold standard policy as it is usually the quickest way to diagnose an issue...but often also the most expensive as we can run several tests to get a full clinical picture instead or ruling out issues individually...but if finances have to be considered and gold standard is not an option for what ever reason we then break it down to other options and try and prioritise which tests will provide the most information or rule in or out the most options within a set budget. Its about providing all the options to the owner to make an informed decison.

Personally I would not put an animal through chemotherapy.bar perhaps for lymphoma(as it can be curative)....but my personal opinion is irrelevent. it is my duty as your vet to tell you all your options and while I might not believe in chemo it would be negligent of me not to inform owners about the possibility of that treatment option.

I have met animals that were they my own i would have euthanised them weeks or months before their owners were willing to....
In my previous practice I was the one who got given all the awkward quality of life conversations as apparently I'm quite good at having that chat..(personally i dont enjoy being dr who recommends death nicely constantly but every practice needs one person to man up and deal with the emotional people) but not everyone thinks that euthanasia should be preformed before treatments have been done in terminal cases and many people hold out hope that their pet will be one of the few that will pull though inspite of the odds against it......and not every vet is good at having a quality of life talk.plenty of vets,i even see it amoung my friends, do tend to think 100 percent clinically and just try and find the cure or solution to the dogs issue without considering quality of life for the animal...but thats just personality! Everyone person is an individual in their repsonces and vets are just people.

Its also very difficult to have this discussion with people while they are still reeling with the the fact you are telling them bad news. Some people want to do everything in their power to prolong their animals life or at least they believe that initally without understanding what it involves,some people will blame you for talking them into killing their dog and are horrified that its even suggested as a potential option ...but in many longterm cases its often for the humans benifit that the dog is being kept going...thats just the truth. there are often other underlying issues going on in a persons life that prevents them from being able to let go. Its defiantly an issue and ethically perhaps it is questionable to profit from someones emotional trauma by continuing to treat the pet...but whats the alternative...refuse to treat it to the best of you ability and have the owner hate you for refusing to give their dog the best chance/keep them comfortable until they are ready...
some people also simply feel like they cannot decide to kill their pet as it would be murder and wrong.....
discussing euthanasia and prolonging a dogs life in terminal situations is a hell of a lot more emotion ridden then a simple economical solutions of the vet simply chosing to make money.....wait until you have had people call you a murderer and calling you heartless uncaring and a terrible person for suggesting euthanasia for a terminal dog before suggesting that we are just prolonging dogs lives for money....theres always more to peoples lives with their companion animals then what meets the eye and trying to deal with that minefield and be the objective clinical solutions provider is not easy.

I have no idea how doctors cope with dealing in terminal situaitions in people, perhaps its easier as euthanasia is not an option so they only have to occasionally talk people into turning off life support..but i deal with these sort of situations a few times a week and its emotionally charged everytime...even when the owner is ready to let the pet go its always an emotional situation.you do get used to it after a while but that said its still ocassionally just ...horrific. I can honestly tell you as a vet that those constant talks and preforming euthanasia are one of the reasons we have an incredibly high burnout rate..my old coworker graduated in a class of 75, ten years out and only 25 were still working in clincial practice thats a pretty scary statistic..and of course incredibly high suicide rate within the proffesion but thats a thread in itself right there.

Be way easier just to keep them going for the money everytime.....

Perhaps a lot of this is I am a girl and soft despite my putting on a front in real life as well though the boys seem to be better at stepping back and not getting emotional about things.they are defiantely better at the blunt economics of the situation as well!

 

[Tiddlypom]

Rd

I agree with you on every point Alec except one - the discussion on what's best for Fido tends to happen AFTER the insurance is exceeded, often by a considerable amount.

Surely I'm not in the minority in that my vets (both small and large animal) are guided by what is best for the patient, and not for their bank balance?

ETA Thanks for your long post, Aru. I've seen recently the distress felt by a vet who PTS a long standing patient.

 

[MurphysMinder]

Surely I'm not in the minority in that my vets (both small and large animal) are guided by what is best for the patient, and not for their bank balance?

ETA Thanks for your long post, Aru. I've seen recently the distress felt by a vet who PTS a long standing patient.

No you're not in the minority I am sure, every vet I have dealt with over the years has in my opinion put the patient first when coming to the end of their life for any reason.
And yes , an excellent post Aru. It's not just the female vets who are distressed on losing a patient I am sure, in fact my male vet was tearful when he came to put my old GSD Buffy to sleep, she had read a veterinary dictionary and had many weird ailments so he had spent a lot of time with her over the years Although maybe girls do get more emotionally involved, which is why my daughter has a headcollar hanging in her room from a mare she treated but was unable to save.

 

[blackcob]

I also wonder if your relationship with your own vet is one which is born of your own understanding and wishes, and if when recognising that, your vet approaches you and your dogs in a different manner to those who he deals with who are are well insured and stand before him with a blank stare.

This is where I come clean and point out that my vet is also my boss - but I was a client for many years before I became an employee, nothing has changed about the way we discuss my pets in consultations and I hear the same discussions with clients every day. Aru has summed it up very well, thank you for the heartfelt post.

 

[PucciNPoni]

Surely I'm not in the minority in that my vets (both small and large animal) are guided by what is best for the patient, and not for their bank balance?

ETA Thanks for your long post, Aru. I've seen recently the distress felt by a vet who PTS a long standing patient.

No you are not alone. I'm not just speaking on behalf of myself or my own animals, but I have inside knowledge and see time and time again vets I work with who will always consider the animal first. THe end decision always rests with the owner of the animal. But thorough information provided to help guide their decision is always offered.