How to Handle Misdiagnosis

How do you all handle misdiagnosises? Alert the vet that missed “it”, do nothing, other?

This particular case was missed by 2 different vets both of which believed the issue was a non emergent issue, and I attribute the severity of the issue now to the original misdiagnosis (vet 1). Vet 2’s clinic has seen my horses before without issue but I have never dealt with the particular vet and surgeon who worked on/ consulted on my horse this time. The issue ultimately requires surgery, limb provisions and a 7-10 day hospital stay so not a small “miss” by any means.

Are you asking whether you can sue for malpractice? I doubt that’s worth it in most cases, and a good way to not have a vet.

Horses aren’t easy to diagnose. They can’t tell us what hurts. Injuries can get infected. Lameness is hard to diagnose.

If you have an ongoing relationship with Vet One you could mention this in the course of time. But not now while you are mad. Also you might just want a new vet altogether.

Impossible to say without knowing the issue. The following things can be hard to either diagnose, or to know if they will become a problem.

Tendons, ligaments, muscles.

Feet: abscess, bruise, broken coffin bone, soft tissue injury?

Colic: how severe, does it need surgery now?

Cuts turning into cellulitus or lymphangitis.

Basically everything.

Sometimes an owner gets an optimistic diagnoses and then does things that make the problem worse. So it’s hard to pin that entirely on the vet.

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I do nothing, except file the offending vets in my mental “vaccine only” vet category. Lots and lots of vets have ended up on that list. I’ve learned that if it’s anything other than routine care, it’s worth it (and ultimately cheaper) to haul to the clinic.

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I’m not going to get into the details of the issue I had, but two new grad vets came out to see my horse who was exhibiting major signs of pain: the thousand yard stare, about 20 wrinkles above her nostrils and very significant reluctance to walk. They attributed this to something totally unrelated, and I had to insist they give her pain meds. Mare had to be euthanized two days later as soon as another vet I know saw her. She had a fractured humerus. I still thank God in the small hours of the morning that we didn’t have a catastrophe in between the vet visits.

I moved my animals from that practice and discussed why with the senior vets. It wasn’t the missed diagnosis, really. It was that the new grad vets had no feel for the degree the horse was in pain, and were willing to tell me it was an abscess in her foot or a bump on her cannon bone. I was in denial but knew it was more than that. I couldn’t risk those vets coming out on an emergency call for another horse, especially if I was away. I moved my animals because of that.

Your considerations may be different.

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When something like this happens, I find it helpful to figure out what I hope to achieve.

Do you want to educated the vet?

Do you want an apology?

Do you want compensation?

There are a lot of drivers. Some of them are “worth it.” A lot of them aren’t. But before you reach out, definitely know the goal of the conversation.

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No not at all thinking about litigation. More so wondering if it is something they find valuable (depending on how it’s presented of course).

This specific case is regarding bone and vet 1 refusing to look further after finding what they believed to be the issue despite my insistence that was not the sole issue. Vet 2 somewhat correctly diagnosed the issue but missed the magnitude/ seriousness of said issue.

@endlessclimb Typically, I agree and vet 1 certainly falls under “never use again” for other reasons as well. Vet 2’s clinic is the best clinic in a several hour radius and home to a nationally renowned specialist that is top in their respective field. I’ve never, ever had any issues with them before (as a clinic) and would have never expected a missed diagnosis from them. If I were to rule them out as well, the nearest emergency care I could get (with imaging - I have a lovely routine vet who is great for choke, stitches, colic etc but doesn’t have digital xrays or ultrasound) would be the hospital 2.5 hours away.

I understand where you’re coming from. A couple years ago a vet recommended and performed hind suspensory neurectomies for my young horse, who was also lame on one front leg. He said the front end lameness was likely compensatory. I had been reading about DSLD/EPSA and asked if he thought my horse might have that. He said, “I wouldn’t worry about that” (in an email so that’s an exact quote).

One year and thousands in vet bills later the horse was still crippled and I had to euthanize him. Post-mortem biopsies confirmed DSLD. I forwarded him the biopsy results with a friendly, non-accusatory message. I hope it makes him consider the possibility in just one future patient and spare someone else all the time, money, and heartbreak.

That said, I’ve known him a long time and owe him a great deal for saving my older horse’s life/FEI career with an experimental surgery. I used to send him updates on that horse’s career so it wasn’t out of the blue to send an update on the young horse. If he were just some vet I’d seen once and never talked to before or after I would have felt a little weird about it.

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Ultimately, number 1 but 2 and 3 would be appreciated of course. I find it helpful in my profession to be alerted when I have missed something, so that I can be more aware moving forward. I would hope a health care professional want the same, though I know not everyone is receptive to unsolicited feedback.

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Practicing medicine is an art. Vets offer opinions. Sometimes they’re wrong, and that’s why alternate opinions are a thing. No one can know everything, unfortunately, and there is an awful lot that’s open to interpretation.

Reaching out with a carefully worded note regarding the dx to inform is reasonable. The news may be well received, or it may be taken poorly. You’ll need to be prepared for either outcome.

Reaching out expecting an apology is unlikely to be fruitful.

If you’re looking for compensation, having your attorney contact the vet directly may be a better avenue, but know that will blow up the relationship, and potentially make it difficult to get any vet care at all.

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I just want to say I’m so sorry that happened to you; that is truly horrific. If I were the vets who made such a grave mistake, I would want to know so I never did something so horrendous again, especially since you expressed doubt.

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Thank you Naturally Happy. Actually the “lead” new grad happened to be at the barn for something else as my vet friend made the diagnosis. She reached out to new grad to discuss her findings and new grad’s only comment to me was “It should be radiographed”. Ummm, no. That would have compounded the fracture and not added to the diagnosis. (It’s a tough area to radiograph.) I’m not sure she wanted to know any more about it or discuss it. I hope she learned something.

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This. And, it just as often happens in the reverse situation - where something grave is diagnosed only to find that it wasn’t as serious as expected. I had this with a dog - suspected CCL tear, and the specialty clinic said it wasn’t. I was happy to tell my vet that he was over cautious - and he was happy as well.

You could ask the current vet to notify the prior vet(s). That way it’s just a courtesy for the file, without any judgement.

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I am going to third this point!

Hind sight is 20/20.

I do not think there is a vet alive that has not made a diagnosis mistake at some point.

I would think most vets would be happy to get an update on what the actual diagnosis was. Maybe send the report so they can ‘update their files’.
I actually really like the idea that @S1969 suggested above, have the treating vet send along the information.

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Over the years, yes, vets have missed stuff. It’s a fact of life. Animals can’t talk. If it still doesn’t seem right, get a second opinion or haul to a hospital. I guess I never held it against the vet. Good thing, too, because that inexperienced vet was spot on a few months later and saved my horse’s life. Go easy. It’s a tough job. Don’t you guys remember all those James Herriot stories? Sometimes they miss something. Trust your gut and get another opinion, but I wouldn’t write off any vet. And I sure as heck wouldn’t sue any of them. As long as they were sober and tried to treat your animal, I doubt you’d have a case anyway. Large animal vets, especially those that do farm calls, are getting rarer.

The only vet I will never call is suspected of an actual ethics violation (euthanized a horse on her property and left it out in the open. Laughed at the pile up of dead wildlife…yes, it was reported to the state). Plus, she and her family members post racist cr*p on social media. Yeah, she’s on the “do not call” list. I’ll haul to the vet hospital before I let her set foot on our farm.

Speaking of all this, have you ever followed up with the opposite? The younger vet prefers texting her directly. After a good save on her part. I texted my appreciation. They need to hear that. I cannot imagine how many times they doubt themselves as they drive away or worry days later when it isn’t going as well as it should be. Not just a thank you, but a real sincere, ‘you just saved my horse’. ‘Nice job, she’s really doing better with those meds’. I’ve had occasion to say both this past year. It felt good to say it and she was happy for the feedback. I don’t know how often they hear that sort of thing. They look tired and beat down most days. Most of the time they just hear grumbling about the bill.

OP, that’s not directed at you anyone else who had a loss or a painful misdiagnosis. Just a general thought about encouraging your local vet. Especially those good ones.

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Do you know if the 3rd vet (presumably clinic where the horse had surgery?) will notify the referring vet? My experience at specialty institutions has been that you usually have a “referral vet” name in your file and, at the time of discharge, the patient file (or at least a summary of the stay) is sent back to the referring veterinarian.

Depends on the context of the miss. Generally, if the vet is young and not so experienced and open to learning…then we all learn and are better in the end. If the issue is complex and most vets might have been stumped…then I’m glad if we get to an answer.

There is one very high level performance vet in the area…I will not use under any circumstances. I loaned my semi-retired FEI horse to a rider at my trainers to compete. The instructions were that if there was anything vet related to immediately contact me…I would troubleshoot it and take care of it (ie - they didn’t even need to pay). I go to a show and they come with my horse…and are standing him in a huge muck tub of ice water and he reeks of DMSO. They tell me their performance vet says he has sore feet. Umm…this horse has never had sore feet in his 20 yrs. I watch him and recognize his usually super lovely extended trot is gone. Call my vet…she immediately asks about the check ligament. We get home from the show…I drive and pick up my horse and my vet ultrasounds. They had almost caused a major lesion in the check lig. The high performance vet was extremely rude and disrespectful at the next event we were all at. She should have 100% been able to diagnose that and been more professional.

A more recent scenario…my vet’s new partner (new out of school) came to see my gelding running a temp. Wanted to go straight to oxytet for tick borne illness. I said no…wait until the blood comes back because of the risk of the oxytet. Went over her to the senior vet…who agreed. Blood showed no tick illness…2 days later he blew a massive blood clot and cellulitis. In that case I see it as a good learning experience for her.

Also had my very good vet euthanize my mare for what was presumed a small intestine twist…she actually had acute pancreatitis. Something super rare…not really treatable and no one (even the teaching hospital) would have figured that out without an necropsy. We all learned on that one.

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If it is a vet that I have a long standing, good relationship with I would let them know what the accurate diagnosis ended up being.

I guess there would be plenty of vets who would take it the wrong way but my vet isn’t one of those. Any vet can miss things on occasion. Even the best. It is up to us to find a vet who can hopefully get us answers if we feel our vet has done all they can.

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I think this works well if it means a specialist (especially if at a University or other clinic that is used to taking a lot of referrals) is talking to the “barn” vet. If it’s peer to peer, basically competing practices, I don’t think I’d ask this of the vet, unless I knew the two vets had a great relationship. Depending on the specifics and who is involved, there could be hard feelings (rightly or wrongly, vets are people too) and I wouldn’t want to put the current vet in an awkward spot.

I do agree with everyone who says it’s worth passing the information along, in something like an email or text. How it is received and what is done with the information is up to them. Though it will help if you can keep the message focused on the eventual diagnosis and effective treatment, rather than on blaming them or the resulting trouble (although you have the right to feel that way, telling them with likely get their defenses up and kill the learning opportunity). You may well help another horse and owner down the line not go through this.

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I am surprised that so far no one has brought up the impaired veterinarian consideration. Veterinarians are people. Some drink on the job, some abuse drugs, some use recreational drugs, and some are growing old and don’t want to admit it’s time to hang up the stethoscope and twitch for good.

I had a very intelligent surgical residency trained solo practitioner vet with a couple of decades of practice experience who was perfectly capable until noon, which was when he began drinking for the day. We went through several bouts of missed diagnoses, and inappropriate medication and medication doses. I happened to overhear his daughter at a social event complaining to someone about her father’s heavy drinking. I moved on to another vet right away.