Cost of Veterinary Care - a Vent

[Dad_Said_Not_To]

[QUOTE=Coyoteco;7395728]
It is not clear to me that there is any benefit for antibiotics being prescription only[/QUOTE]

The average person who is not a medical professional has no idea what antibiotics would be the best option for a given infection and has no way or knowledge of how to perform a culture and sensitivity should one prove necessary. There’s also a large part of the general population that believes that antibiotics will help with conditions like the common cold. Misuse and abuse of antibiotics contributes to the development of antibiotic-resistant bacteria. And you think that making misuse/overuse of antibiotics easier is a GOOD thing?

[Coyoteco]

[QUOTE=Anne FS;7396020]
Ghazzu, I really appreciate your posts. They point out so many misconceptions we as animal owners have about veterinarians, in particular lately about how veterinarians as doctors are heavily regulated and must abide by many laws and if you don’t you’re going to lose your license. Meanwhile, pet owners are convinced that you’re just a mean ol’ money grubbing harpy whose goal is to fund your lavish lifestyle at the expense of people who REALLY love animals.[/QUOTE]

I don’t understand the meaning of this post so cannot respond to its contents.

[SquishTheBunny]

Actually, its not a WALLET that’s the client - its the person. Just because someone has the finances to do something, doesn’t mean they would want to. Or, if a person doesn’t have the finances, doesn’t mean they cant find a way.

Logically speaking, yes…you do what you can afford. But this world isn’t filled with logical people.

[Coyoteco]

[QUOTE=Dad Said Not To;7396191]
The average person who is not a medical professional has no idea what antibiotics would be the best option for a given infection and has no way or knowledge of how to perform a culture and sensitivity should one prove necessary. There’s also a large part of the general population that believes that antibiotics will help with conditions like the common cold. Misuse and abuse of antibiotics contributes to the development of antibiotic-resistant bacteria. And you think that making misuse/overuse of antibiotics easier is a GOOD thing?[/QUOTE]

First, you seriously truncated your quote of my post. That was a bit misleading.

Why do you think a large part of the population believes that antibiotics will help with conditions that are viral in nature? A pharmacist didn’t tell them that - it is physicians who over prescribe antibiotics and have caused the current problems.

I have never had a physician culture for the purposed of determining the type of antibiotic before prescribing one. I have had my vet do such cultures, however. I have also had the pharmacist correct the antibiotic prescriptions of physicians on more than one occasion - well the physicians assistant/nurse sometime and the physician sometime.

[starrunner]

I could take a poll in my family and I would say at least 75% of them would want antibiotics for the flu, despite heavy information and literature drop contrary to this.

Heck, look at most farms. The second a horse has nasal discharge of any type, people want them on SMZs.

[SquishTheBunny]

[QUOTE=Coyoteco;7396229]
First, you seriously truncated your quote of my post. That was a bit misleading.

Why do you think a large part of the population believes that antibiotics will help with conditions that are viral in nature? A pharmacist didn’t tell them that - it is physicians who over prescribe antibiotics and have caused the current problems.

I have never had a physician culture for the purposed of determining the type of antibiotic before prescribing one. I have had my vet do such cultures, however. I have also had the pharmacist correct the antibiotic prescriptions of physicians on more than one occasion - well the physicians assistant/nurse sometime and the physician sometime.[/QUOTE]

Agree…although my doctor did so cultures for strep throat. Although in the past few years, Ive especially noticed that physicians have very much cut back on distribution of antibiotics. At least up here in in the great white north.

[Dad_Said_Not_To]

I truncated it because I felt that the majority of the post was not relevant to the statement that I was countering and I’m not a fan of making people scroll through excess print unnecessarily.

I think a large part of the population believes that antibiotics will help with viral infections because people generally don’t understand how antibiotics work, nor do they understand the basic differences between viruses and bacteria. I think that the overprescription followed that, as people insisted on being given medication and refused to listen to explanations that antibiotics would do nothing for their illness.

I have had a physician do a culture and sensitivity when it was apparent 36 hours after starting antibiotics that they were doing nothing for a sinus infection that was no longer contained within my sinus cavity and was making the entire side of my face swell and ache unbearably. The second antibiotic, which was prescribed at the time the sample was taken for the C & S, was effective, so we fortunately did not have to wait for those results to come in.

[Coyoteco]

[QUOTE=Ghazzu;7395973]
And the issue of which antibiotic, and what dose, never mind whther one is even indicated, is just a smokescreen MDs use to rip you off, right?

see above. Antibiotic resistance is a serious problem right now, and throwing the doors wide open so anyone can self-medicate willy-nilly would be an utter disaster.

The Board of Registration is not a “vet association”. They are the state government’s regulatory agency charged with enforcement of the veterinary practice act. And in my state, they have begun to drop the hammer on distribution of prescription medications that are not within the statutory guidelines.

My guess is that any changes in the statutes will take the form of being more restrictive rather than less.[/QUOTE]

prescriptions again:

Most people will continue to see a physician. Those of us who feel confident in medicating ourselves should be able to do so. I don’t know about you, but my family does not take a medication on the advice of a physician without researching it to ensure the doctor didn’t make a mistake. I responded to the overuse of antibiotics in a different post to someone else. The problem originates in part in the over use of antibiotics by physicians. I see no reason that I cannot get an antibiotic for myself from a pharmacist. The pharmacists tend to catch physician errors relating to antibiotics anyway. I don’t know why you got snippy about the “doctors ripping you off thing”. I never said anything remotely resembling that. And the physician prescribed antibiotic issue applies to animal medications in what way?

Vet association:

That’s semantics. The attorney general’s office or legislature rely on a panel of vets to determine the standard practices. Those become the regulations that are enforced. So, it is the veterinary association that determines the rules that govern it. The process by which that becomes regulation is not the subject of any of these posts. It is the decision of the veterinarians that is enforced by law.

I agree that the goal of the veterinarians association is to make the care of animals more restrictive in an effort to raise the earning power of the veterinarians it represents. This will be a problem for pet and livestock ownership in the upcoming decade(s). Over and over, some vets complain that they are not compensated like physicians. That is the mindset that is being instilled by at least some vet schools. I foresee this as a terrible path for animals and the people who love them. PETA couldn’t implements a more effective plan to eliminate animal ownership.

[Coyoteco]

[QUOTE=Dad Said Not To;7396264]
I truncated it because I felt that the majority of the post was not relevant to the statement that I was countering and I’m not a fan of making people scroll through excess print unnecessarily.

I think a large part of the population believes that antibiotics will help with viral infections because people generally don’t understand how antibiotics work, nor do they understand the basic differences between viruses and bacteria. I think that the overprescription followed that, as people insisted on being given medication and refused to listen to explanations that antibiotics would do nothing for their illness.

I have had a physician do a culture and sensitivity when it was apparent 36 hours after starting antibiotics that they were doing nothing for a sinus infection that was no longer contained within my sinus cavity and was making the entire side of my face swell and ache unbearably. The second antibiotic, which was prescribed at the time the sample was taken for the C & S, was effective, so we fortunately did not have to wait for those results to come in.[/QUOTE]

I didn’t say that nobody should be allowed to go to a physician. A person who is convince that he needs antibiotics for a sniffle is not a person who is likely to refrain from going to a doctor. I simply said that most drugs should be available to all without a prescription. I remain unconvinced that antibiotics should be by prescription only.

[SquishTheBunny]

Coyteco - here, vets can prescribe medication (with their own discression) only if a physical exam has been performed in the past 2 months. (SO fluffy was in for a PE a few weeks ago and was clear…owner noticed yesterday fluffy has worms…vet should be OK to prescribe meds over the phone).

The only exception is to when a “repeat” has been put on a prescription. Ie. if your cat has a prescription for drontal with 5 repeats, then the vet does not need to see the pet until the repeats have been all used. So, if 8 months later you notice worms again…you have a repeat on the medication so all you need to do is go to the pharmacy to get it filled.

(I suppose a better example would be something like prednisone…a dog requires it for allergies as needed…vet prescribes 10 pills, but puts 3 repeats on the presxription so anytime throughout the year the owner can refill)

I would think this type of process would be useful for large animal vets who have to prescribe antibiotics/bute etc. to clients?

Is this practice not used at most clinics in the states?

[Coyoteco]

[QUOTE=SquishTheBunny;7396298]
Coyteco - here, vets can prescribe medication (with their own discression) only if a physical exam has been performed in the past 2 months. (SO fluffy was in for a PE a few weeks ago and was clear…owner noticed yesterday fluffy has worms…vet should be OK to prescribe meds over the phone).

The only exception is to when a “repeat” has been put on a prescription. Ie. if your cat has a prescription for drontal with 5 repeats, then the vet does not need to see the pet until the repeats have been all used. So, if 8 months later you notice worms again…you have a repeat on the medication so all you need to do is go to the pharmacy to get it filled.

(I suppose a better example would be something like prednisone…a dog requires it for allergies as needed…vet prescribes 10 pills, but puts 3 repeats on the presxription so anytime throughout the year the owner can refill)

I would think this type of process would be useful for large animal vets who have to prescribe antibiotics/bute etc. to clients?

Is this practice not used at most clinics in the states?[/QUOTE]

That makes sense and does make it a more workable situation. What I am reading on this thread, though, leads me to believe that such renewable prescriptions won’t be legal here in the US. The situation that concerns me is when an animal owner has an ongoing relationship with a vet for the care of his animals but then is prohibited from working with that owner in a way that is beneficial to the animals. Why does the veterinary association think that each vets decisions should be micromanaged to such an extreme degree?

I find myself wondering about all those hunt people who keep ACE on hand to tranquilize their horses. How is that legal under the system described? Do they have to have a vet exam before each hunt?

Perhaps Ghazzu will answer your post. eta … well strike this sentence in light of her last post lol.

[amm2cd]

[QUOTE=Anne FS;7395825]
I wonder why people really hate for veterinarians to make a good living. It GALLS them. The human doctor who drives a beautiful new car and lives in a gorgeous expensive house is totally normal and acceptable, but god forbid an animal doctor live half as well.

We’re paying for the KNOWLEDGE.
…
As much as we know and can do for ourselves, we NEED someone who can fix the serious things. These people are physicians. Physicians have very specialized knowledge they’ve worked very hard to obtain and maintain. (well, maybe not Dr. Pol on the maintaining part. ;))

I’m looking forward to numerous threads on why cars cost so much. After all, the car dealer only paid $X for each one of those cars on the showroom floor, but charges THOUSANDS more than the car cost him! That’s outrageous!

And McDonald’s charges $1.00 for a soda. You know how much that soda costs McDonald’s? Cup included? $0.17. How dare they charge me around SIX TIMES AS MUCH as the soda cost them. How dare they!!![/QUOTE]

You could say the same thing about engineers working for energy companies. Or MDs or lawyers.
Knowledge costs $$. Some can afford it, some cannot. That’s how the world works.

[Ghazzu]

@Coyoteco;7396278

prescriptions again:

Most people will continue to see a physician. Those of us who feel confident in medicating ourselves should be able to do so. I don’t know about you, but my family does not take a medication on the advice of a physician without researching it to ensure the doctor didn’t make a mistake. I responded to the overuse of antibiotics in a different post to someone else. The problem originates in part in the over use of antibiotics by physicians. I see no reason that I cannot get an antibiotic for myself from a pharmacist. The pharmacists tend to catch physician errors relating to antibiotics anyway. I don’t know why you got snippy about the “doctors ripping you off thing”. I never said anything remotely resembling that. And the physician prescribed antibiotic issue applies to animal medications in what way?

The depth of your ignorance is so astounding that I am giving up.
I’ll throw in the towel.
You win.
No need to see an MD when you think you need an antibiotic.
With the help of your trusty pharmacist, you’ll undoubtedly pick the right one, and you’ll just know that what you are suffering from is a bacterial infection, and that it will respond to the medication you’ve chosen.

Likewise with your animals. No need to consult a vet, just check with your friendly pharmacist again. You two will be able to figure it out.

Vet association:

That’s semantics. The attorney general’s office or legislature rely on a panel of vets to determine the standard practices. Those become the regulations that are enforced. So, it is the veterinary association that determines the rules that govern it. The process by which that becomes regulation is not the subject of any of these posts. It is the decision of the veterinarians that is enforced by law.

Again, you are piss ignorant of how legislation and statute work.
The state legislature doesn’t give a damn what DVMs think, and they aren’t to quick to change the law for anyone in the fashion you imagine.

Leaving aside the probability that a majority of DVMs in this commonwealth would probably not lobby to get the law changed to allow us to just drop off bottles of medication to brilliant diagnosticians like yourself to have “just in case”.

And I know it’s hard for you to wrap your mind around it, but it really truly is because what you propose is bad medicine.

[Ghazzu]

[QUOTE=SquishTheBunny;7396298]
Coyteco - here, vets can prescribe medication (with their own discression) only if a physical exam has been performed in the past 2 months. (SO fluffy was in for a PE a few weeks ago and was clear…owner noticed yesterday fluffy has worms…vet should be OK to prescribe meds over the phone).

The only exception is to when a “repeat” has been put on a prescription. Ie. if your cat has a prescription for drontal with 5 repeats, then the vet does not need to see the pet until the repeats have been all used. So, if 8 months later you notice worms again…you have a repeat on the medication so all you need to do is go to the pharmacy to get it filled.

(I suppose a better example would be something like prednisone…a dog requires it for allergies as needed…vet prescribes 10 pills, but puts 3 repeats on the presxription so anytime throughout the year the owner can refill)

I would think this type of process would be useful for large animal vets who have to prescribe antibiotics/bute etc. to clients?

Is this practice not used at most clinics in the states?[/QUOTE]

Works like that around here, but again, the animal has been seen, and the medication is appropriate. Writing an Rx with refills is within the practice act.
Once the number of refills has expired, the animal must be seen again. And it would depend on the condition/medication how many refills would be indicated.

[McVillesMom]

Thank you, Ghazzu, for once again articulating what I was thinking, far more eloquently than I could have!

[grayarabpony]

[QUOTE=Coyoteco;7396229]
First, you seriously truncated your quote of my post. That was a bit misleading.

Why do you think a large part of the population believes that antibiotics will help with conditions that are viral in nature? A pharmacist didn’t tell them that - it is physicians who over prescribe antibiotics and have caused the current problems.

I have never had a physician culture for the purposed of determining the type of antibiotic before prescribing one. I have had my vet do such cultures, however. I have also had the pharmacist correct the antibiotic prescriptions of physicians on more than one occasion - well the physicians assistant/nurse sometime and the physician sometime.[/QUOTE]

Actually it’s patients who won’t shut up until they get an antibiotic. DH has worked with physicians who would cave but due to resistance problems I think physicians are going to be more and more reluctant to cave.

Antibiotics should NOT be sold over the counter.

[Coyoteco]

Ridiculous post Ghazzu - simply ridiculous.

[Coyoteco]

[QUOTE=Ghazzu;7396442]
Works like that around here, but again, the animal has been seen, and the medication is appropriate. Writing an Rx with refills is within the practice act.
Once the number of refills has expired, the animal must be seen again. And it would depend on the condition/medication how many refills would be indicated.[/QUOTE]

So, are you saying that in your practice, you are allowed to write a prescription for an antibiotic that is refillable beyond the current need? If my horse had an infection and needed an antibiotic anticipated to run 10 days, could you write me a prescription refillable for four courses of ten days? I’m not asking you to do this. I am simply asking if this is something you would and could do?

Or, BUTE, does your prescription cover the number of pills necessary (using pills for simplicity) for the current need only. Then with a refillable prescription?

[Coyoteco]

[QUOTE=McVillesMom;7396443]
Thank you, Ghazzu, for once again articulating what I was thinking, far more eloquently than I could have![/QUOTE]

Yes lol if only we could all be so eloquent with the use of “piss” in such a context, or any context? Ah, such a way with words Eloquent “piss” lol.

[McVillesMom]

I was referring most specifically to the first and last sentences of that post.