Several months ago, I met with a new client who informed me she was looking for a different vet. She had been seeing a colleague of mine, whom I’ll call “Dr. X”, for many years, but was looking to make a change.
“Don’t get me wrong,” she explained. “I really like Dr. X. And I understand that she doesn’t have a crystal ball. But so many tests! And I could never get a straight answer when I asked what they were for. I couldn’t shake the feeling that I was funding her continuing education.”
Ouch. So why do we run all of these tests?
The short answer is that it’s responsible medicine. As more and more people begin to see pets as members of the family, the demand has increased for state-of-the-art medical treatment. Modern thinking means modern medicine, and higher expectations of the veterinary profession.
Routine bloodwork, regular dental cleanings, advanced diagnostics, and specialty hospitals were certainly not the standard of care when I was a kid. But does your pet really need them? Or as a friend put it recently, “How do I ask my vet if a test is really necessary without sounding like I’m cheaping out, or questioning his judgement?”
I have a saying I’ve used since my first year out of vet school. Twenty-one years later, it’s still relevant. “I never run a test unless I think the results might change my plan.” A culture and sensitivity, for example, will let me know exactly which antibiotic will kill the bug your pet is fighting. Yes, it’s another test. Yes, it’s an additional charge. But superbugs are becoming more and more common.
If I know exactly exactly what I’m fighting, I can rest assured I’m not blindly throwing useless antibiotics at a pet whose immune system is already compromised. I can also make certain I’m not contributing to the superbug epidemic by creating one in your poor pet! A culture is a test that may change my treatment plan. And while pre-anesthetic bloodwork on a healthy, bouncy puppy may seem excessive, I’m looking for signs of problems that may not be visible during the course of a routine physical exam.
For instance, if the bloodwork reveals liver values which are not within normal ranges, I’ll need to rule out a congenital liver problem before putting your pet under anesthesia - even for a routine procedure like a pediatric neuter. Yes, this too means yet another test. It also means I have something to address before even thinking about anesthetizing your puppy. In other words, the result of the test may absolutely change my plan.
However, another recent example was a second opinion on a dog who had been diagnosed with a severe reproductive tract infection. I concurred with the original vet’s assessment, as well as his recommendation for immediate surgical intervention. The family took several days to decide on a course of action. By the time I saw the dog again, she was barely clinging to life. In a textbook world, we would have run a similar pre-anesthetic panel.
But the twenty minutes it would have taken to collect the sample, run the test, and interpret the results, were twenty minutes Candy the poodle did not have. I was fairly certain the bloodwork would come back showing a sky-high white blood cell count, which would tell me what I already knew - Candy was suffering from a life-threatening infection, and immediate surgery was her only hope.
The test would have told me she was a poor candidate for anesthesia, that the risk of losing her on the operating table was dangerously high. But surgical intervention gave me the one and only chance to save her life, regardless of what the labwork revealed. In other words, it was not a test that would have changed my plan. We rushed Candy to surgery, and she pulled through with flying colors.
I can hear the horrified gasps of some of my colleagues as they frantically scroll to the comment section. “No bloodwork?! But there might have been something else going on! He missed the opportunity to pick up any additional, underlying conditions! Like diabetes! Or Addison’s Disease!” And indeed I did. But frankly, when presented with a patient that is close to death due to an infection, I’m not going to obsess about their calcium levels.
It’s the equivalent of worrying about the lawn when the house is on fire. When Candy came in two weeks later to have her stitches removed, we collected a blood sample to ensure her body had cleared the infection - and of course, to look for signs of any underlying conditions like diabetes or Addison’s Disease!
Diagnostics are vital and necessary tools for veterinary practitioners. Most veterinary horror stories involving cases gone wrong are directly connected to owners who decline recommended tests; please don’t think I’m endorsing carte blanche for pet parents to decline diagnostics.
Neither I nor any colleague in my circle has access to psychic powers or a crystal ball. We’re good, but we’re not that good. That said, clients should never feel as though they are being coerced into agreeing to pointless tests, or funding teachable moments for veterinary staff. If you aren’t sure why a test might be necessary, simply ask your vet:
“How might the results of this test change your treatment plan?”
This lets your vet know you respect the process, whilst still expecting a sensible treatment plan as the ultimate goal. It is not an unreasonable question, and he or she should be able to easily articulate an answer. If you’re met with a prickly attitude, an avoidance response, (read, BS answer), or worse yet, a blank stare, it’s entirely possible your vet does not have a treatment plan in mind.
It may be time to find a vet who orders diagnostics with an endgame in sight, and can better explain their value. Because even the soundest of treatment plans, will only work when pet parents and practitioners work together. This requires solid communication, which is always a two-way street.
Next time, we’ll discuss some other questions you can ask to ensure you’re getting the most bang for your diagnostic buck!
Dr. Kupkee is the lead practitioner at Sabal Chase Animal Clinic.
Do you have a question for Dr. Kupkee? Send him an email by clicking here.
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