Thursday, July 7, 2011


I'm frustrated and irritated about my last 24 hours at work. Here's just two of the reasons why.

Situation #1
Pet owner calls and states that their dog just ingested rat bait, a poison that results in bleeding.  We let them know that this is an emergency, and they should come in immediately so we can induce vomiting, give charcoal and likely prescribe the antidote for this type of ingestion, vitamin K.   Seems pretty straight forward, right? A problem that we can fix.  A GREAT prognosis, if we act quickly.

You can read the specifics about the disease here, if you like.  The basic principle is this - rat bait is a POISON that works by making rats bleed to death.  It can do the same thing to dogs and cats, if they eat enough.  After ingestion, prevention of toxicity is by decontamination (as above - removal from the body with vomiting, and charcoal to prevent absorption).  If you do nothing, your pet is at risk for life-threatening bleeding.  Once bleeding occurs, the treatment is plasma, and vitamin K, which carries a significantly higher cost and chance of death than dealing with the problem right away.  ESPECIALLY if you watched them eat it.  WHY would you take the chance?

This particular person did not seem to agree with the above.  The man argued with my staff on the phone, and after several calls and two or three hours later, he finally arrived.  He was rude, insulting, and an all-around jerk with my staff and myself. He reluctantly agreed to let us induce vomiting on his dog, and when we he finally did, unfortunately, no rat bait came up.  He waited too long for successful vomiting.  This person continued to do nothing, except for  insult me, my staff, and complain about our prices. "HIGHWAY ROBBERY!" He screamed, "It's not even an EMERGENCY!" (Yes, sir, it actually is.)  Complaining about prices to me at my ER is like complaining to the checker at the grocery store.  The cashier scanning your items has exactly as much control over the price of bread as I do over the price of the exam, or the cost of inducing vomiting -- that is, ZERO control.  Mr. My-dog-ate-rat-bait-for-the-second-time-and-it's-your fault bitched, moaned, screamed and stomped his feet.  He yelled that his daytime doctor would have charged half of our fees.  I tried to help him understand that keeping the pet ER open is expensive (see a very well written post by Homeless Parrot, here), but it didn't matter.

I really don't like getting yelled at for trying to do the right thing.  It's not my fault you didn't pick up the poison.

Situation #2 -

Client arrives because her very small dog just ingested a whole, very large rib bone.  I performed and exam and discussed options with her; essentially 1)endoscopy to attempt retrieval without surgery 2)try to induce vomiting, with the known risks of this sharp bony item 3) surgical removal, or the least safe option, 4)wait and see what happens.  The bone was very large compared to the 15# dog, and had an extremely high probability of becoming obstructive, or causing damage to the intestines.

Fortunately, her pet was stable.  Unfortunately, we were very busy and the client had to wait about 30 minutes for x-rays as there were several pets to have exams, images taken, or procedures performed before it would be her pet's turn (including a dog that was laterally recumbent and unresponsive, a cat having difficulty breathing, and a dog who couldn't urinate.  All obviously much more emergent and therefore, triaged ahead of her dog, who wasn't yet vomiting or painful).

What did the client choose to do?

She left in a huff.   Now that's really going to help her pet, isn't it?

It's not my fault your dog ate the bone.  I'm just trying to help fix it.  It's not my fault that there are other animals here who are more sick than yours, increasing your wait time.  If your pet was dying, you'd want us to see it first, too.

I'm a people pleaser, a hard worker, and I'm dedicated to fixing pets.  It frustrates me when clients don't believe that we work long shifts and stay up all night to HELP, when they assume that we have bad intentions, when they are unkind, and when they don't let me help their pets.


  1. In the first case you describe, unfortunately you can't fix stupid!
    I know this situation puts you in a big dilemma, give him the boot for his behaviour and the dog suffers or even dies.. I honestly don't know what the answer is. But I am sorry that you and your staff had to put up with that, when all you want to do is help.
    It has to upset you and add to the stress. All I can suggest is think about an animal you saved, one whose life you made a difference in. I know a day does not go by without me thinking how grateful I am to my own vet for saving my boys life when she diagnosed him in an Addison's crisis. Hopefully you have clients that have shown their gratitude. I know a card or even a thank you goes a long way and some days more than others!

  2. How can good pet owners protect themselves from vets who do rip off people (they ARE out there!), without having to be rude? I feel guilty at times for the way I have had to speak to vets, but it has often resulted in better communication and more open, honest responses about care. I believe though, that there is probably a better way? Any advice?

  3. Hellien -- good question.

    Honestly, I don't think that being rude is ever beneficial in improving communication. There are several good books that can help to understand the patient-doctor relationship that I would highly recommend - including "How Doctors Think" by Jerome Groupman and "Better" by Atul Gawande.

    Instead of being rude, ask a lot of questions. Make sure you understand the diagnosis and recommendations. Bring a friend who can help you to listen and take in the information. If the diagnosis is serious, you can always ask for a second opinion (although this may be a problem if it's after hours). If you get a bad vibe and feel that you're not meshing well with the doctor (and, if it's not an emergency) GO SOMEWHERE ELSE. You have to TRUST the physician/veterinarian or there is no way that they can provide service to you. While our job includes client education, there's obviously no way that you can be as educated as the doctor.

    Vets who "rip-off" people are few and far between. Most of us DVMs out here are struggling in tens or hundreds of thousands of dollars of student debt, trying to make a living charging 5% of what MDs charge for the same services.

    Lastly, medicine isn't black and white. There are many, many ways to do the same thing, often depending upon which generation the doctor graduated and where they were trained. (YES, there is a wrong way, too -- and that's why you need to find a vet you trust, and use second opinions when you can). "Rip off" is also a very insulting phrase - the ER that charges 50% more for a procedure than your regular veterinarian is not trying to price gouge - it's unfortunately the price of doing business and keeping the doors open (trust me. You don't want to know what it costs every single day!)

    Hope my rambling helps. feel free to write back, and thanks for the comment!