Sunday, January 26, 2014

A brief video interlude

The hospital staff video is a favorite of ours here at VBB central, and we are really enjoying this one from Main Street Pet Care in Joplin, MO! I wish we were that creative around here but sadly we are a more bookish lot. Ah well.

When you're done watching that, if you're a fan of med student videos and the spleen, here's another fun video for you. If, like Dr. Grumpy, you are totally out of touch with pop culture, here's a tip- it's a parody of "What Does the Fox Say?" by Ylvis. Look it up.

Saturday, January 25, 2014

Yay! My Dog Doesn't Have Cancer! Now Give Me My Money Back.

There has been much talk on here about how clients could be better clients if only they... <fill in the blank>

Well, here's one.  How about if, when you bring your dog in for a wound that is necrotic and stinks so bad you can smell it from across the room, and we recommend debridement and closure and oh, I dunno...  maybe suggest a biopsy of the tissue because you aren't quite sure how long it's been there...  and we want to make sure it's not a cancerous lesion...

When we call you with the good news that it's not  cancer and the wound should heal with no complications...

How about if you  don't get all pissy with us, accuse us of stealing your money and making frivolous recommendations and instead...  just say thank you for making sure my dog doesn't have cancer.  I feel so much better now!

There's a novel idea.

Wednesday, January 22, 2014

In which we look like idiots for no good reason.

A friendly and collegial veterinarian from a local specialty/ER vet hospital left us a voicemail regarding our mutual patient who apparently "stopped by last night" and "was found to be in congestive heart failure, which was a big surprise to the owner. I'll be in first thing tomorrow so feel free to call me to discuss this, or I will try to call you before I head home," she said on our voicemail.

So I looked up our records on this pet....and found that at her last visit, she had come in as an emergency to our appointment-only day practice, and informed us she had been dry heaving earlier in the day, and subsequently developed difficulty breathing. She wasn't in any particular distress at that moment, but we worked her in and saw her. 

The physical exam findings were very concerning. The dog had a grade IV/V systolic murmur, focused over the mitral valve area, and bilateral crackles were noted during auscultation of the lungs. She was breathing rapidly but did not seem particularly distressed. She had lost about 15% of her body weight since her last visit three months previously, without having been placed on a reducing diet. 

Our chest radiographs revealed an enlarged heart with an alveolar pattern present in the perihilar area right dorsolateral lung fields.

The owner was informed that we strongly suspected this dog was in congestive heart failure and that we would like to arrange for a consult with a cardiologist, an echocardiogram, or if the owner would prefer not to seek specialty care, we could initiate treatment after just a few more tests done in our hospital (we wanted to get an ECG, and some basic bloodwork).

The owner elected to take the dog home without additional testing at that time, telling us she needed to think about it seriously and decide what to do and how to budget for it. We explained that it would be ok to at least start some treatment without additional testing if there was a big money concern, just to try to make the dog feel better, but she chose to go home and promised to call back on Monday (this happened on a Friday). We gave her the emergency clinic phone number handout we have on hand for this type of situation and wished her well.

When we didn't hear from her that Monday we left her a voicemail. We left another one several days later, too. When we didn't hear back we wondered if perhaps the pet had died suddenly, and were very concerned for the next week, wondering if we could have helped more.

Then, about three weeks after the appointment here - the voicemail came, the voicemail in which the specialist cheerfully describes how our client went over there completely "unaware" that her dog was in heart failure despite having "just been in to see the regular vet, who didn't know what was wrong."

It is this type of scenario that keeps the bourbon people in business, is all I can say. I know the specialist probably realizes that clients aren't always telling the whole truth, and not all referring vets are morons -- but it is hard to hear this kind of thing anyway, and I do worry about being perceived as an incompetent moron by the specialists in these situations.

Wednesday, January 15, 2014

Threats and shenanigans

It's been so bitterly cold across most of America lately - in an effort to stay warm, I have been thinking about summertime. When I think about summertime, I start off with images of sandy beaches and umbrella drinks - and usually end up with images of heatstroke and DIC. So, this story came to mind today. Enjoy!

A stray dog was brought to VBB Central once by a Good Samaritan. A real Good Samaritan - the kind who takes financial responsibility for the situation, not the kind who simply moves the problem from his lap to your lap. Anyway. He'd found this dog roaming his neighborhood and he thought it would be a good idea to bring it to us, because it had been outside for so long, he considered it a stray. He asked us to examine it and get it up to date on vaccines. He wanted to adopt it if possible. 

When we examine stray pets, we scan for a microchip, to see if possibly there is an owner somewhere looking for the animal. In this case, we found a chip, and were able to reach the owner - who told our receptionist that while he was unable to leave work at that time to pick up her pet, he would be happy to come get him in the morning. Okey-dokey. The Good Sam paid our bill for the care up to that point and went home, and the dog got put into the boarding kennel for the night. 

The next day, the owner came in to pick up the dog. When presented for the bill for the dog's overnight care (a whopping $23 boarding fee) he went ballistic. In the course of his ranting he expressed the belief that he had expected the care to be free, because it wasn't his choice to bring us the dog. Also, the dog should have been taken to the tax-funded shelter (there isn't one in his township, nor ours for that matter, but this fact was lost on him), and we were insane to expect him to pay. OK then.

So, Dr. VBB attempted to defuse the situation by telling Mr. Deadbeat to just take the dog and go home, and that instead of attempting to collect the boarding fee from him, VBB Central would report the stray dog situation to the township, and the township would handle it from there (historically this means that the township will assess a very large fine from the pet owner - and btw, this dog was not licensed, either, which is another fee). The man continued screaming. It got to the point where clients in the exam rooms with the other veterinarians were becoming fearful for their safety. One client asked "um, how well do you know that guy? are you sure he doesn't have a gun or anything?" At that point Dr. VBB, realizing that Mr. Deadbeat clearly has no intention of leaving, calmly said "if you'd rather stay here and yell instead of taking your dog and going home, I'm going to have to call the police and ask them to escort you off of our property. You are interfering with our business."

The man gets even MORE incensed. He is now asking Dr. VBB for her name, license number, social security number, all kinds of identifying information. He says he is going to "report [her] on the website" and she will lose her license, "why you say call police, you cabeza de mierda, you hate Hispanics, you want la migra send me home? you think I'm illegal? twenty years I'm American citizen! I'll take your license, pendeja!" But when Dr. VBB attempted to respond, the man just kept yelling and screaming over him. The man also refused to accept Dr. VBB's business card, which she offered to him so that he would spell her name correctly when he reported her to the board, of course...

This was going on for at least half an hour. Finally the man and dog went out to his car, and the staff at VBB Central watched warily from the window. That's when we saw the man put the dog into the trunk of his car! Bear in mind it was about 97 F at the time, too - and that car had been out there for at least an hour in the sun at this point. So against her best judgement as far as resolving this situation went, Dr. VBB went back outside and said "please do not do that, it is very dangerous for your dog." So of course he started in again "who do you think you are? you OBSERVE ME? you ain't allowed to observe ME! I'll have your license, pendeja!!" But luckily, while continuing to rant and rave, the man put the dog in the back seat, got in the car, and drove away.

It really kind of ruined that whole weekend at VBB Central though.