Tuesday, October 25, 2011

How to Go to the Vet

Pound signs in the shadows.  Art by Kevin Brockbank for Dogs Today.

One of the things every dog owner has to do is go to the vet, but it only takes a few hours of sitting in a waiting room to come to the conclusion that most dog owners do not know how to go the vet, and, as a result, they are paying a lot more money than they need to.

What do you need to know before going to the vet? More than you think!

Here’s a small skein of advice that, if followed, might very well save you thousands of dollars (or pounds) over the life of your dog.

1.  Know why you are going to the vet.
The average dog needs to see a vet two or three times in his first year in order to get a full array of vaccination shots, but does not need to see a vet for a vaccine ever again. Read that sentence again. The fact that core vaccines last a dog’s lifetime is not new information – it is more than 30 years old – but it is information that the veterinary trade associations are not eager to share with the public because vaccines and health check-ups are the primary source of income for most vets. If you are going to a vet every year for a check-up, an annual teeth cleaning, and vaccine boosters (other than for rabies, if you are in the US or mainland Europe) simply because you got a card in the mail saying it is time for these procedure, then you are simply being ripped off. What about leptospirosis – the one vaccine that wears off after a year or so? What about it? This is a “non-core” vaccine that is nearly useless, is more dangerous than any other vaccine offered up by a vet, and which provides only imperfect protection against a very uncommon problem. My own dogs have spent many lifetimes ratting and going in and out of dens of every type, and I do not bother with a lepto vaccine. My advice, if you want something to worry about, is to forget lepto and focus on socks lying about the house, stray pills that have fallen off the medicine cabinet, and antifreeze in puddles. They are far more likely to kill a dog – even a dedicated ratting dog -- than leptospirosis!

2.  Be wary of new vet clinics that have just acquired expensive new equipment.
Veterinary clinics are like everyone else – they want the latest and greatest new piece of equipment, regardless of whether they need it or not. The problem for dog owners is that once a vet gets expensive new equipment, the pressure is on to use it – whether it’s necessary or not. A simple country vet is going to be able to handle 98 per cent of all your problems, and for the more complicated stuff, you are going to want to see a specialist anyway.

3.  Don’t confuse the relationship.
Your vet is not your friend – he or she is simply a person being paid to do a service. Of course, some vets would like to blur that fact, knowing that if they can position themselves as your friend then you may come to see them more often, you will respond to check-up postcards more often, and you are less likely to push back when medically unnecessary goods and services are suggested.

4.  Receptionists and nurses can bill pad.
While a vet may have ethical qualms about pushing unneeded goods and services, they rarely feel any compunction in having the receptionist or nurse do this bit of dirty work. In fact, the job description of these employees may require them to push nail trims, grooming, ‘specialty’ foods, flea and tick medications, and unnecessary medical tests. Do not be shy about being very clear you are not interested in such add-ons, and do not hesitate to pull out a pen and cross out such additions on your prospective bill.

5.  Know something about the problem or procedure before you go.
If your dog has a health problem, spend some time on the Internet doing a bit of research. Some problems, such as ringworm, can be fixed with over-the-counter topical medications, while other problems may have multiple solutions and your vet may have a financial incentive only to offer the most expensive. The more you know going in, the better armed you will be as an advocate for your dog and yourself.

6.  Avoid junk-billing and upcoding.
What’s junk billing? Annual vaccines are junk billing, and so too are tests for Lyme disease in asymptomatic dogs. What’s upcoding? It’s simply taking a modest health issue or incidence and inflating it into a big bill. For example, after a routine spay-neuter, does your vet want to keep the dog overnight? Why? Is someone going to be at the vet’s surgery all night long? In most cases, the answer is ‘no’. Your dog will do just as well - and get much better monitoring - if he or she simply comes home with you and spends the night in a crate.

7.  Every limp and lump is not a cause for panic.
Go to any emergency vet on a weekend, and you are sure to find several people in the waiting room who have come in for expensive care for very minor problems. But every limp and lump is not a cause for panic. Most canine limps are caused by the same thing as most human limps – a pulled or strained muscle that will self-correct with rest and time. As for lumps, most are simple cysts or non-malignant tumours – no reason to rush to an emergency vet on a weekend.

8.  Ask for a prescription for a generic medication, and buy that medication at a pharmacy.
Many of the medications we give our dogs were made for humans, many are available in generic form, and most can be acquired for very little cost from your local pharmacy. If your vet will not write a prescription or charges extra for it, change vets and tell them why!

9.  Know how to say “no” and be prepared to say it.
The more you know about your dog’s health, the better prepared you will be to have a sensible discussion, and the more empowered you will feel when it’s time to say “no”. Of course, pushing back is easier said that done! The trick, I find, is to know how to push back. If the vet is pushing a new round of vaccines on your adult dog, tell him you have read Ron Schulz’s work on vaccines (he is a world authority) and surely the vet knows that vaccines in adult dogs that have gotten all their puppy shots are not needed? You may be surprised at how quickly those vaccine charges wither away after that!   Teeth cleaning? Sure, but not every year – once every three or four years after the age of five. An overnight stay? Why does he think his surgery will provide more attentive care than you will at home? Other tests are recommended? Why does he think they are necessary?   Really?  And what will happen differently based on what he/she finds.  Is the test actually more expensive than the treatement which otherwise causes no harm?  In fact, that is often the case, especially if the vet is asking you to come for a test for something like worms ($90 or more just for the visit), while treatment is less than a dollar with over-the-counter medications that do the dog no harm.

Of course, all of this advice is predicated on the fact that you have not acquired a dog that is a complete and utter health wreck, requiring constant attention for a chronic problem.

Vets, of course, do not see such animals as problems, but as business opportunities.

In the world of veterinary care, the breathing problems of Bulldogs, the eye problems of Pugs, the cancer problems in Bernese Mountain Dogs, the wrecked hips of German Shepherds, and the collapsing hearts of Cavalier King Charles Spaniels, are what help put a new wing on the house.

No wonder, then, that in half a lifetime of going to vet clinics, I have yet to see a pamphlet on diseased, defective, and deformed breeds to avoid.

Where’s the money in that advice?

This article appeared in the November 2011 issue of Dogs Today.


M said...

The major problem I'm running into these days is "policy." I fired my last vet for "policies" which to me made no sense. When challenged on them they held their ground and I responded by heading elsewhere. It takes me 45 minutes to get to my vet office now but at least I feel like I'm not being taken advantage of.

The straws that broke my back-
They would not neuter my dog without an updated rabies shot (because the vaccine he got the month before at a shot clinic wasn't good enough) along with a kennel cough shot but they will be happy to give the shot the day of surgery. Last I checked vaccines are not wands - you do not wave them over a dog and suddenly the dog isn't able to contract or spread a disease.

Part two of this gem requiring an overnight stay on a neuter even though no one would be in office because apparently I the owner cannot possibly tell if the dog is having a bad reaction to his lack of testicles or anesthesia.

Total cost for dog neuter on a completely healthy normal 7lb dog according to them was $235 plus pain meds. After firing them I got the job done 2 miles away from this clinic for $70 - my dog was dropped off at 8 am picked up at 3 pm. Laser surgery with internal dissolving sutures, No pain meds required - as far as I could tell my dog didn't even notice his balls were gone.

I think people aren't quick enough to fire poor/ridiculous service in the vet industry - I also think there is a lack of followup to vet failures or the courage to seek second opinions.

Funder said...

If you live in a HW-endemic area, vets want to test for heartworms yearly before they renew your preventative RX. And if you board, most boarding places want the (stupid) bordatella vaccine 2x a year. But yeah, spot on advice in general.

Viatecio said...

The key phrase used by staff is "You get what you pay for." After all, that $235 M would have paid for the neuter would have included pre-surgical screening, pain meds, EKG monitoring, Doppler/pulse ox/NIBP, probably a heavy narcotic along with the pre-med, anal sacs and nail trim done...when in reality, the $70 she paid probably got her pretty much the same thing, minus all the fancy equipment that really doesn't say much other than the dog's heart is going. A simple pulse-ox or Doppler machine by themselves can do this, along with someone to man the anesthesia machine and make sure the dog doesn't wake up in the middle of the procedure.

Mind you, the clinic for which I work is one of those that would charge the higher end. Remember, "You get what you pay for." Then again, when that's where my paycheck comes from, I need to make every part of that procedure count. And finding a job at another vet's office is not an option; it took me months of interviewing to land this one.

Keep in mind that that doesn't mean I don't disregard in the SLIGHTEST what you write here about the veterinary field and the scams/kickbacks involved. Rather, it's interesting to have a first-hand look at how they really work.

Unfortunately, with some unscrupulous vets, you DO get what you pay for in terms of srevices...they don't spend the time the client needs to have all questions answered (truthfully or not is a whole other ballgame), they don't give the right med (had it happen already where I work), or are just not nice at all.

PBurns said...

The heart worm testing game for a dog that has been on ivermectin is a scam, and skip going to the vets to get a prescription for Ivermectin. See >> http://terriermandotcom.blogspot.com/2008/05/billion-dollar-heartworm-scam.html

As for Bordatella, that too is a scam if the vet is simply dosing your dog the day it is admitted: the nasal vaccine takes two days to kick in. And, of course, if you are not boarding your dog, you do not need bordatella at all. It's just a cold for dogs!

Funder said...

Yeah, but like you noted in the linked post, collie-types shouldn't receive ivermectin - a collie in the south really should go to the vet and get tested/rx'd!

I travel about once a month, and my dog stays in a really nice independent (non-vet) boarding place. They require current bordatella. I understand that from their point of view - if they start sending dogs home with kennel cough, half their clientele will freak out and never use them again. I don't really care if Cers is exposed to it or is vaccinated for it; she's quite healthy and the vax only harms my pocketbook. Before I started boarding her I refused it on general principles :)

Viatecio said...

Another thing I would like to hear people say to the vet, but will never happen:

"If I have any questions about my pet's medical care, you're the first one I'm going to call. If I have questions about behavior, then I'll call a qualified trainer."

Not quite sure about who to call regarding nutrition, because vets do not get a good education in that at all and the internet is too full of conflicting advice that might work for some dogs, but lead others to an early death. Either way, the logic should stand that a veterinarian is the medical provider for the dog. The trainer is the one who has been taught how to change, shape and teach behavior. Rarely do the two fields mesh successfully in which no-nonsense, real-world advice is given for both.

There have been days when I want to turn to my vet, look her in the eye, and ask her "Just how many dogs have you trained to qualify you to give the advice that you currently hand out?" My guess is, not ton which that advice has actually worked!oo many!

Unknown said...

I like the seventh tip where you talked about not making a big deal of small problems like a limp or a lump. Pet owners can get very nervous about small things this, but it is understandable why you suggested to wait a bit longer before going in to the vet. I will remember that; I have a Mini Aussie, and I want to make sure he is healthy without breaking my bank.