Consumer Guide to Veterinary Medicine
Questions you may want to ask when searching for a new veterinary hospital.
What is the typical wait time for your appointment?
The more time you need to wait, the more nervous and stressed your pet (and yourself) may become.
What do you know about the veterinarian(s)?
When scheduling appointments, do you have a choice of veterinarians to be scheduled with? If you value having a consistency of medical care, you may wish to always see the same veterinarian. Is that possible? Some hospitals with multiple veterinarians will try to match clients with veterinarians. Others may just schedule you with the next available doctor. Some hospitals have trouble keeping quality veterinarians. Can you find out about the back ground of the veterinarian you are scheduled with? Is the veterinarian a new graduate, experienced or even board certified? What is the veterinarians commitment to continuing education? Veterinary medicine is changing as fast or faster than ‘human medicine. Is the veterinarian trying to keep up? Does it matter to you if the veterinarian studies about new anesthesia protocols, behavior or about reproduction? Those are but a few of the things that might interest a veterinarian. What are your needs? How do they match your selection of veterinary hospitals?
How much time will your appointment be scheduled for?
Typically there will be different time allowances for new clients/pet, ill or injured pets, well pets, and other various reasons for appointments. Times may range from 10 min to 60 min. You have a right to know how much time you can expect from the veterinarian. You may want to know if the same veterinarian is working 1 or 2 other exam rooms at the same time as your appointment. If the veterinarian has a great support staff, you may only see/visit for a few minutes, and you and your pet are getting great service, but if there is not adequate/competent support staff, you may not be.
Is the experience for your pet important?
Animals have instincts about people and places and they may be stimulated into a fight or flight mode if a new person invades their territory, handles them quickly and starts poking and prodding them as is needed for hurried examinations. On the other hand, pets may relax and be happy to meet someone that is conscious of their behavior needs and gives them a few minutes to relax and accept the person. What do you think? Don’t most of us want our pets to be wary of strangers and friendly to those we want them to be? Doesn’t it make sense that a pet will be more cooperative and relaxed if there is some time for them to extrapolate the clues of the situation rather than just being rushed through an appointment? Did you know the more relaxed your pet the easier it is to handle them? If each visit they have a hurried appointment, maybe some injections, blood draws and strangers holding them don’t you think they will become more frightened each subsequent visit? The more tense the pets are the more the will feel upset and feel increased pain from simple things like injections. Longer appointment times, a few minutes to greet you and your pet allow for stress levels to subside and you and your pet may have a pleasant pain free visit. Will you have time to cover just the basics, or can you ask about behavior issues and training? Not all veterinarians are well educated in training and behavior. If you have a puppy would you like to get some input on why your puppy isn’t housetrained yet? If you only have a 10 to 20 minute appointment will there be enough time to find out what may be happening at home – which may indicate a health problem – which may not be obvious from just a simple exam. What about your puppies specific breed/type needs? Will the veterinarian make recommendations based on your pup’s breed? Most veterinarians do know about many breed specifics but having the time to discuss them with you won’t happen if you have 10-20 minutes only with them.
How are medical records kept?
Are they legible? If another doctor needs to review the records, can they be read? If they cannot be read, what value are they to you? What value are they to your pet? Do they include all the recommended information? Among other things they should include results of physical exams, laboratory results, interpretation of radiographs, doses and how medications are dosed. If the veterinarian does not care enough to record the information so someone else could help your pet in the future, how could he/she care about your pet now? If your pet was not put on the scale, how can they know the weight of your pet? Or how can they track weight changes? When something goes wrong with your pet, will the medical record help determine the problem? Proper medical records can save you time and money and may save your pet from repeated diagnostics and treatments.
What do you know about the facility?
Ask for a tour. A tour would not be complete unless the treatment areas, the surgical areas and the kennel areas are allowed to be viewed or visited. It is reasonable for a tour to be scheduled during a time convenient for the hospital. It is reasonable to ask for a tour before you become a client of the hospital. When on your tour, check to see if the various areas are clean and relatively free of odors. If you can detect odors, your dog or cat can detect them and may process that information into anxiety or stress. Check to see, or ask about if the hospital reuses needles or syringes. New needles and syringes are packaged in either a plastic casing or paper/plastic type package. Hospitals that do not reuse these will have new ones, and all others will be disposed of in the trash or into ‘sharps’ containers or ‘biomedical waste’ containers. Even many veterinarians are not aware that some brands of needles cause less pain and trauma to your pet. Check to see how staff dries their hands. Reusing paper or cloth more than once before it is tossed or laundered is a source of spreading infection. What sort of flooring is being used in areas where animal area. Flooring should be of an easy to clean material. Obviously, carpeting cannot be cleaned thoroughly, ever.
What is the protocol for vaccinations?
Not all vaccines were created equal. Should your pet be getting the vaccine? Does your vet require an exam before injectable vaccinations? It is not a good idea to vaccinate pets without considering their age, prior vaccines, current housing/care and exposure to disease, preexisting illnesses, and current physical findings. Vaccines can cause serious illness and should be used judiciously. Is the veterinarian recommending all vaccines, just because there is a vaccine product available?
What do price quotes over the phone tell you?
Before you price shop for veterinary medicine, you should know a few things about what you are shopping for. It is unlikely that prices quoted over the phone will tell you the whole story. For instance, as hard as it is to believe, some veterinarians will quote the price for a surgical service – and when you get there – let you know then that the pet needs anesthesia which wasn’t quoted for. There are places where the price quoted may not include the ‘full package’ such as preanesthesia testing, pain medication, IV catheter and fluids. These things are important to your pet’s health. These things are done for your surgery, they should be done for your loved ones as well.
Consumer Guide to Elective Surgery and Procedures
Thank you for recognizing your pet may need to undergo an elective procedure such as spay, neuter or dental cleaning. Many people “shop around” for the best price without the knowledge of why the cost varies among veterinary practices. This guide was put together to help you find the best fit between the veterinary practice and your expectations for the care of your pet. We recommend you ask for the details and a hospital tour before booking elective surgery and procedures for your pet.
What preanesthesia evaluation will my pet have prior to surgery?
This is important for a number of reasons. A physical examination is our first defense against performing surgery on an animal that may have infectious disease, a heart murmur, or be debilitated from parasites. A preanesthesia blood test can detect for hidden problems that could cause serious complications when the pet is under anesthesia or in surgery.
Preparation of the patient
The patient should be examined and have a preanesthesia screen. In most young healthy pets, this is a simple blood test. In pets that are a little older or have other issues discovered a urinalysis might be recommended. Chest radiographs or other evaluations may be recommended or required if other problems (such as heart problems) are present. To reduce the cost of procedures, these screening tests may be completely omitted at other facilities. Abnormalities may then not be detected until it is too late, or may make recovery after the surgery much harder on the pet and the owner. Once the pet is in the hospital on the morning of the procedure, medications should be used to relax the patient and start the pain management program. Again, forgoing this step leads to a much more nervous pet, which increases the release of epinephrine in the system and can actually lead to increased abnormal heart contractions. Of course, it is cheaper to delete this step. Not placing an IV catheter, not starting IV fluids, no intubation, not monitoring for respiration and heart rate and rhythm, oxygen saturation, carbon dioxide and blood pressure all reduce the cost of the procedure at your pets risk.
The patient should be clipped, vacuumed free of debris and special disinfectants used to prepare the surgical area prior to being moved into the surgical suite.
What safety precautions will be taken with my pet during surgery?
While most surgery is uneventful, emergencies WILL occasionally arise. Early detection of impending problems greatly aids our ability to intervene and correct the problem. An IV catheter will be placed prior to anesthesia induction. The IV catheter is our port for providing emergency drugs if there is an emergency. Having a catheter preplaced is one of the most important procedures for safety. IV fluids will be administered to help maintain blood pressure, provide internal organ support and to help keep your pet from becoming dehydrated. A breathing tube should be placed (intubation) on all anesthetized animals. This keeps the airway open and allows for supplemental oxygen or gas anesthesia as needed. This tube is also very important to prevent aspiration into the lungs if a pet vomits or otherwise has excess fluids/materials in its mouth. If there is an aspiration, this causes a serious pneumonia. A respiratory monitor, heart (EKG) monitor allows the surgeon to keep track of heart rate and rhythm, oxygenation monitor, carbon dioxide and blood pressure monitor are the state of the art and are extremely important. The practice should also have a “crash box” handy, which contains emergency drugs and supplies.
What safety precautions and comfort measures will be taken?
Anesthesia and surgery patients lose body heat through anesthesia and the opening of body cavities. Warmth should be provided during and after anesthesia. If patients get cold the pet becomes uncomfortable and the heart can be affected. Patient temperature should be monitored at regular intervals after surgery and supplemental heating provided as needed. Your pet’s gum color, pulse, and respiration, oxygen saturation, carbon dioxide and EKG should also be monitored. The IV fluids can be warmed to body temperature as well as patients given adequate coverage to reduce heat loss. We use Bair Huggers on all anesthetized patients. This is a forced air warming blanket that they lay on that maintains body temperature and makes for a much more comfortable and safe anesthetic episode.
How will pain be controlled for my pet?
This is very important – surgery hurts! The anesthetic will not provide pain control once the pet wakes up. Pain should be controlled before, during and after the day of surgery.
Will I receive written post-surgical care instructions for my pet?
Aftercare of surgical patients is very important for proper healing. The hospital should provide written discharge instructions for your pet.
In what ways can the services be compromised to lower prices?
There are many ways that corners are cut. Although your pet may survive the procedure, greater risks will be taken and comfort sacrificed. These risks are known to increase the chance of infection, pain, suffering and death. Disappointingly, not all veterinary hospitals take all the necessary precautions for your pet. We firmly believe that the clinics that cut corners are not adequately informing their clients of the risks involved. We believe owners should have choices and should not be disrespected if they cannot afford uncompromising care, but feel all pet owners should be informed that the lowest price almost always means the lowest service, safety and comfort for your loved one. We have exhaustively researched all the issues to develop our protocols. We believe our patients deserve uncompromising care.
The patient should be prepared for surgery in a preparation area, not in the surgery room. This prevents hair and debris from possibly contaminating the surgery area.
It is expensive to have an area where only sterile surgeries are performed. So, if the surgery area is not a single use area infection rates are increased by increased traffic within the room. Performing surgeries or procedures that are not sterile surgeries in the surgical suite increases infection rates. Having a sink in the same room as the surgery increases infection rates. Carpeting or poorly maintained flooring, ceilings and or walls in the surgery room increases the infection rate as these can harbor debris, bacteria and viruses. Without touring the facility, you have no way of knowing if these problems exist.
Surgical preparation and attire of surgeon and assistants
Surgeons and assistants should prepare themselves to prevent contamination by wearing a surgical cap and mask. They should scrub their hands three times before donning a sterile surgical gown and gloves. It is somewhat ironic that food workers are required to wear a cap or somehow control their hair, but veterinary surgeons are not. Your surgical assistants should be experienced, certified veterinary technicians. There are no laws that govern the experience, age, or any qualifications for the people who are monitoring your pet’s anesthesia episode! Unfortunately, many clinics have inexperienced and noncertified people running the anesthesia.
Surgical instruments and supplies
Instruments used should be of high quality and well cared for. Using less than high quality instruments can lead to increased tissue trauma and increased pain and a longer healing time. The surgical pack of instruments should be used on only one pet, then cleaned, lubricated, repackaged and sterilized. Using instruments on more than one animal between cleanings and autoclaving can lead to increased chance of infection and infectious disease. Surgical gloves are made to be disposed of after each surgery. In some hospitals, gloves are reused. The chance of microscopic holes in them drastically increases, leading to increased rates of infections and complications. Of course that is still better than in the places that are not using gloves at all, or are using nonsterile exam gloves for surgery. The choice of suture material varies greatly. The differences may not be readily apparent to pet owners that cannot compare differences, but those who have studied and tested the choices have published that there are differences on both gross and microscopic levels. Some places reuse suture materials not used up from a prior surgery. These materials have been dragged through the tissues of the prior animal and may be placed in a cold sterile solution until used again. Obviously, infection rates can be increased as well as tissue trauma. Suture materials may even weaken from such practices. Another cost cutting method is to use suture off a reel. This is an inexpensive way to purchase suture materials. These sutures are then rolled off the reel and threaded through a needle (which may have been used on multiple pets in the past and be dull). The longer the reel has been in use, the greater the chance of contamination, all this leading to higher infection rates. Additionally, the suture that is threaded through the needle leaves a much larger hole in the tissue it penetrates. This increases tissue trauma, pain and healing time. The alternative is to use suture materials that are prepackaged for single use and have a swaged on needle. The suture material is one piece with the needle and is inserted into the rear end of the needle. This allows for very tiny, nontraumatic punctures that produce less pain and tissue trauma. Since the needles are then used only for that, the needles stay sharp, again leading to decreased pain and tissue trauma. Suture selection also involves determining what material to use. Some materials are not very strong, and cause increased inflammation within the tissues or the knots can even untie. These materials are very inexpensive. Better products have less reaction, with less pain and tissue trauma/inflammation caused, allowing faster healing and greater security.
The surgery performed
We have mentioned many things that can change how the patient is after the surgery even if the typical owner cannot appreciate the difference. The above-mentioned cost cutting choices have in the past and do still occur. In addition to not cutting corners, we close most surgical sites with hidden or buried suture patterns. This means, that the pet does not have to return for suture removal and the sutures are less likely to get caught on things around the house. We have an open invitation for our pet owners to bring their pets by at no charge post surgery to check the surgery site.