{"id":1507,"date":"2020-05-05T11:55:41","date_gmt":"2020-05-05T16:55:41","guid":{"rendered":"https:\/\/www.drphilzeltzman.com\/blog\/?p=1507"},"modified":"2022-07-11T10:40:51","modified_gmt":"2022-07-11T14:40:51","slug":"how-do-you-know-if-your-vet-is-any-good","status":"publish","type":"post","link":"https:\/\/www.drphilzeltzman.com\/blog\/how-do-you-know-if-your-vet-is-any-good\/","title":{"rendered":"How do you know if your vet is any good?"},"content":{"rendered":"

This is probably the riskiest post I\u2019ve written in a while.<\/p>\n

I\u2019m sorry, there are no cute kittens today. We bravely tackle a critical topic that should matter to every serious pet lover.
\nOK, but let\u2019s first look at cute kittens anyway\u2026
\n\"A
\nMy hope today is to help you understand an important but mysterious concept: standard of care.
\nStandard of care is a legal expression, not a medical one.
\nThere are different ways to define standard of care, and they\u2019re rather nebulous and subjective.
\n. It is the degree of care, or the level of treatment, a reasonably competent and skilled vet should provide, taking into account the current medical knowledge.
\n. It is the customary practices an \u201caverage,\u201d prudent vet would typically offer in similar circumstances.
\n. It\u2019s the right thing to do to take care of a patient a client trusted us to treat \u2013 in an ethical manner.
\nProblem is, nobody knows what standards of care are. There is no book, no article, no definition of what vets should do in a particular situation.
\nStandards of care are constantly evolving as medicine improves, new discoveries are made and new drugs are invented. They depend on the treating veterinarian, the practice, the town, the region, the State and the country.
\nThere are guidelines, suggested by various veterinary organizations, but they\u2019re only guidelines.
\nThere are basically 3 levels of standards of care.<\/p>\n

1. The gold standard<\/strong>
\nThis is the care typically provided at a vet school, a specialty hospital or a very progressive family practice.
\nIt\u2019s the best and safest way to perform a procedure or arrive at a diagnosis.
\nThe purpose is to reduce risks and complications as much as possible. The end goal is to increase the chances of success as much as possible.
\n2. Reasonable standard of care<\/strong>
\nThis is what the \u201caverage and prudent\u201d vet would agree is reasonable to do for a particular treatment or procedure.
\nAs you can imagine, this is extremely subjective. What might seem reasonable to one vet may seem unreasonable to another. There is no black and white, it\u2019s all shades of gray\u2026
\n3. Sub-standard care<\/strong>
\nThis level of care is not reasonable or acceptable. It could be called negligence or malpractice.
\nIt could harm the patient – and often does.
\nAnd no matter how cheap it is, it is cheating the client.
\nSadly, this is what is sometimes portrayed on popular shows on TV\u2026 and many pet owners don\u2019t even know it.
\nOK, if you\u2019re still reading, you deserve to look at more cute kittens.
\n\"Another<\/p>\n

To better explain those levels, let\u2019s take 5 everyday examples you may be familiar with:<\/strong>
\n. When we diagnose cancer in a pet, we typically take chest X-rays to check for spreading (metastasis) of the cancer to the lungs. Unfortunately, we can miss tiny masses in the lungs what X-rays simply cannot show. A CAT scan may cost much more, but it\u2019s far better to see those tiny masses. Meanwhile, at some practices, the mass would be removed without even taking chest X-rays.
\nWhich approach would you want for your pet?
\n. You can sometimes see a mass in the spleen on a simple X-ray. An ultrasound should not only confirm that the mass is truly in the spleen, but it can confirm that all of the other organs in the belly are OK, and that there is no spreading (metastasis) to the liver.
\nNext up: who does the ultrasound? A family vet who does ultrasound every once in a while, or a specialist who does it 20 times per day?
\nWhich test \u2013 and which ultrasonographer – would you want for your pet?
\n. Some practices will remove a tooth without X-rays and without anesthesia monitoring.
\nMeanwhile, other practices in the very same town will remove a tooth with a dedicated veterinary nurse monitoring the patient under anesthesia. In addition, they will take X-rays of the jaw before and after removing a tooth.
\nWhat level of care would you want for your pet?
\n. Having a tooth removed is not exactly fun. Some practices don\u2019t prescribe pain medications at all – before, during or after the procedure.
\nSome practices will dispense a mild pain killer beforehand (e.g. butorphanol) and a mild pain medication to go home (tramadol).
\nYet other practices will provide a strong morphine-like drug and an anti-inflammatory before the surgery, will numb the area (local anesthesia, just like at your dentist) before the extraction, and will send home two pain killers (e.g. gabapentin and an anti-inflammatory).
\nWhich one would you want if your pet needed a tooth removed?
\n. Some practices would not run any bloodwork before doing a procedure under anesthesia.
\nSome would do basic bloodwork (e.g. a mini-chemistry, which looks at liver and kidney function).
\nYet other practices will do full bloodwork (i.e. a full chemistry, a CBC \u2013 which looks at red and white blood cells), as well as a urinalysis to check kidney function.
\nWhich one would you want for your pet before anesthesia?<\/p>\n

Veterinary medicine is like any other decision in life:
\n. You can have lunch at McDonald\u2019s or Olive Garden or a fancy steakhouse. You\u2019ll be fed either way.
\n. You can fix your own sink, or have a plumber fix it, or have a master plumber replace and upgrade it. You\u2019ll have a sink either way.
\n. You can go to work on a bicycle, in a Ford Fiesta or in a BWM. You\u2019ll get to work either way.<\/p>\n

But there is a huge difference here: we\u2019re not talking about lunch, a sink or a car. We\u2019re talking about a living creature, who might go under anesthesia or get major surgery.
\nThe reason vets recommend certain tests is not to drain your bank account.
\nThe reason is to reduce the risk of complications – including death – as much as possible.
\nThe reason is also to improve comfort, decrease pain and increase quality of life.<\/p>\n

Are you still with me? Then you totally deserve to look at more cute kittens.
\n\"Cute<\/p>\n

So, what\u2019s a concerned pet lover to do?
\n. Make sure you compare apples to apples. If you get a $200 estimate from one clinic and a $1,000 for the one across town, don\u2019t assume that one vet is a nice guy and the other is a crook.
\n. Ask for an explanation of every line item on the estimate. You have a right to understand what you are getting into.
\n. Ask questions about the procedure itself. Who is doing it? How many times have they done it? What is their success rate with this procedure? Dare to ask these tough questions!
\n. Ask questions about complications. What are the most common (theoretical) complications you should be prepared for? What (actual) complications has this particular vet observed? What will they do to reduce the risk of complications?
\n. Ask questions about the things that are usually skipped on \u201ccheaper\u201d estimates: what pain management protocol will they use to make sure your pet is comfortable? Will your pet be monitored during anesthesia? By whom? With what qualifications (or what letters after their name)? Will they do it start to finish, or whenever somebody remembers to do it, or never?
\n. If you would like to provide the gold standard to your pet but you\u2019re concerned about being able to afford it, then please get pet insurance \u2013 a great plan preferably – it will solve 99% of the problem.<\/p>\n

Bottom line: make sure you understand the full story behind an estimate, and what it means for the safety of your pet and the success of the procedure.<\/p>\n

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified<\/p>\n

www.DrPhilZeltzman.com<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

This is probably the riskiest post I\u2019ve written in a while. I\u2019m sorry, there are no cute kittens today. We bravely tackle a critical topic that should matter to every serious pet lover. OK, but let\u2019s first look at cute kittens anyway\u2026 My hope today is to help you understand an important but mysterious concept: […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[157,9,156],"class_list":["post-1507","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-phil-zeltzman","tag-veterinary-medicine","tag-veterinary-surgeon"],"yoast_head":"\nHow do you know if your vet is any good? | Dr Phil Zeltzman\u2019s Blog<\/title>\n<meta name=\"description\" content=\"My hope today is to help you understand an important but mysterious concept: standard of care.Standard of care is a legal expression, not a medical one.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.drphilzeltzman.com\/blog\/how-do-you-know-if-your-vet-is-any-good\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"How do you know if your vet is any good? 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