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.


  1. I hate it when clients take "We need to do some more tests," as "We have no idea what's going on!"

  2. Trust me, the specialists don't think you're an idiot. We know that the clients don't listen, don't remember, or flat out lie 50% of the time.

  3. I worry about the same thing, too. People don't listen, and give someone else the wrong story.

  4. People always get so irritated that I ask the same questions as the tech/assistant, but it's because I get a completely different answer 50% of the time! And that's only a minute later.

    Document, document, document!

  5. The specialists know - it's amazing how many clients 'have done everything and still don't have an answer' then you get the regular vet history and... you guessed it.... repeatedly declined further testing......

  6. My brother recently had a cat diagnosed with cancer. When the vet told him, he used the words "the findings are consistent with..." instead of "your cat has...". To my brother this meant that maybe his cat didn't have cancer after all.

    I have no idea how you can possibly account for the fact that clients are very good at not hearing things they don't want to hear.

  7. I'm dying to know, did you call the specialist back and discuss how you already diagnosed the dog with CHF 3 weeks prior?

  8. Been there, done that. Clients are the same everywhere.

  9. The clients say similar things to you about us specialists Im sure. That's why we call. So everyone knows whats really happening. :)