Sick Kitty and ER Vet issues (long and kind of rant-ish)

[mvp]

[QUOTE=MeghanDACVA;5631955]

mvp: If you understand the blood work results based on your vet’s explanation, no reason to ask for more detail. But when we are repeating your vet’s blood work I would not be surprised when an owner asks for an explanation. I do alot of mini-physiology with owners.[/QUOTE]

Just to clarify. What I meant was that I asked my vets for copies of the lab results themselves (same to the glucose levels they were doing on a find a correct insulin dose for a diabetic cat.)

I know there will be parts of the blood work that I won’t be able to kinda, sorta turn into any sort of interpretation about my cat’s health. That’s why I want the results-- so that I can show them to the next vet or (especially with stuff like a fructosamine level with the diabetic cat) to compare to future ones.

My point is that this is a form of cost control and helping out my vet or a new one next time. It shouldn’t be unusual to share those with the owner. The horse vet who did blood on an older horse who had lived on bute for a while sent me the results as a matter of course. I guess I learned to expect that from any vet.

[SquishTheBunny]

Daventry - your post suprises me.

The reason estimates are given up front should be fairly obvious in an ER case. You need to authorize it, so the tests can be done if needed.

Acute vomiting can have many causes, and its important to run bloodwork in house to get an idea of what is going on. Radiographs and abdominal ultrasounds are next. Any idea how much this would cost you if you were a human (and being Canadian, Im sure you dont as we thankfully have an awesome health care system), but those basics would likely run about $1500 JUST for a few tests.

The ER/ICU i work at admits all patients with IV catheters/fluids if needed, blood pressures, EKG and bloodwork (PCV, TS, Electrolytes, Lactate, BUN, Base Exesses, and gasses). This gives us all basic parameters on the animal and can monitor his/her progress or decline. We do bloodwork DAILY on hospitalized animals. However, any animals that are not really “SICK” do not get this admittance.

Cost? Well, the radiometer that runs the blood gasses is $80,000 with a $5,000 year service contract. The centrifuge that spins the PCV is $8000, the cost of the radiologist to do the ultrasound is $150 per hour + call in fee for out of hours. The ultrasound machine is $250,000. The ER doctor salary is $80 per hour, the 4 technicians who work ER/ICU overnights are around $25/hour. The Animal care attendants who walk/feed and clean up after your dog are $15/hour. Oh, and the cost of laundry, feeding, cleaning supplies, vetwrap, replacement IV catheters/fluids, ecollars etc…they add up.

your regular vet will be cheaper because they dont have any of that fancy equipment and the overhead of paying night staff.

However, I guess if you felt the “cold” attitude, that was probably the icing on the cake - and yep, some ER vets do come off this way. Unfortunatley seeing it from there end, they see hundreds of people every week with the same story - " I have a sick dog/cat and no money to treat it, why cant you just make him better for free, you ar a horrible person." Happens ALL the time, and can be emotionally exhausting for the vet.

Its unfortunate things ended the way they did, we see leukemia dogs daily and all are managed on a super cheap pred protocol. Sorry your dog didnt do well with it

[SanJacMonument]

Small animal ER Clinics are high, but well worth it if you need a diagnosis it is great to have an informed decision.

It wasn’t that long ago that owners had to make medical decisions based on symptoms alone.

You can still go the symptomatic route, but I prefer a true and modern diagnostic.

[maunder]

I’ve had a positive experience at my local ER hospital. I’ll even name it - Veterinary Specialists of Rochester (NY).

Are they expensive? Yep. Are they necessary? Yep.

I have a little poodle/pekingese mix dog that is about seven months old. She saw my regular vet for lameness and needed to go for further tests and diagnostics from the specialists. She needed a femoral ostectomy and got it.

Between my regular vet and the specialist I’ve spent about four thousand dollars on my wee one. Can I afford it? Absolutely not. I charged it to my credit card. Thankfully I had enough credit on there to do that!

It’s not my dog’s fault that she needed the specialist. My regular vet hadn’t done a femoral ostectomy. This little dog would have had to have been put down and if she didn’t have the procedure would have been in a lot of pain.

Veterinary Specialists is VERY busy. They are a 24 hour practice. They have a line of at least four receptionists at all times. They were friendly, welcoming, sympathetic and professional.

I wanted to put this positive input in because not all ER vets are seemingly uncaring and the staff unsympathetic. These people were GOOD and thorough.

[magnolia73]

My neighbor’s dog was bitten by my cat. Leg swelled. $1600 later and he had been bloodtested for cancer, x-rayed, scanned… oh, and given abx. But they kept insisting that the swollen leg overnight was bone cancer. They claimed to find no bite marks, yet never shaved his leg.

$1600 into it, I told her to tell them to shave the damn leg and look for a puncture wound. Yup. A puncture wound. Infected. No cancer.

I think they do shit to make $ at ER vets. IMO, really- a dog has a swollen leg after a kerfluffle with a kitty and you DON’T have the leg to find the wound? You jump to BONE CANCER? Yet you had the foresight to start ABX?

My friend’s dog came in with a gaping wound and sat for 4 hours in a crate bleeding. That was only $1000 for the great service. The vet even commented that the dog should not have sat unsedated for 4 hours bleeding all over the cage. Turns out they were short staffed and there was no vet on site 3 of those 4 hours.

I’d call my horse vet for an emergency call vs. go to any of the ER’s.

[threedogpack]

I’ve learned a lot from reading this thread.

I’ve learned that no matter what an ER vet does, it’s likely to be “the wrong thing” according to the owner.

If they handle it too quick, they are jumping the gun.

If they handle it to slowly, they are careless.

If they want paid, they are cold and callous.

If they use meds, they aren’t necessary.

If they do diagnostic procedure, they should not have.

I don’t think there is enough money in a practice to make me put up with most of the people who posted here.

To all the vets and techs, in both emergency and routine care, again I thank you. To all the front desk receptionists who have to sift the stable from the unstable pets, thank you. To all the front desk receptionists who have to put up with clients and do it with a smile on their face, thank you. To all the doctors who support their staff by coming BACK out front to explain why they did what they did and what cost what, thank you.

To all of the people who have had a bad experience but don’t hold it against the vet, good for you.

and lastly, for all the people who have complained here that the vet/staff were cold, difficult, money grubbing, careless, heartless…the next time you need a vet, maybe you need to think about the fact that unlike human doctors, vets don’t HAVE to accept you as a client.

[MeghanDACVA]

Re: 3dogpack comment about human hospitals requiring money up front. Everytime I have been to a hospital for something I have had to pay some large amount upfront. The FIRST place they send you is to someone who does all your insurance paperwork and verifies what you are covered for and then tells you what you have to pay UPFRONT. Period. So this is not new or different in the medical field.

We too get people who are told on the phone what to expect for the exam fee, that diagnostics and treatment are additional and that we do not do payment plans or bill. All too often they show up with no money or only “some” money. And they were told before they ever showed up what to expect.
I had an owner the other day call us about her sick kitten. She had been to another large corporate national practice that of course would not bill her and they told her to call us cuz we would do payments!! Do what? She was very nice and understood and I tried to help her out with suggeting other vets who were less expensive.

We have owners who happily write us a check. Then call the bank and stop payment before they are out of the parking lot.
If someone wants to be able to make payments, all the credit cards and Care Credit are set up to do this. That is what they do. Make the payments to them. And amazingly, no one ever complains about the finance charges on credit cards but people call and complain about ours all the time. Some even flat refust to pay it!!
We do turn people over to collection. Unfortunately. Also unfortunately when we do this we only get a portion of what is collected. And once the account has been turned over we can’t accept the payments anymore. Occasionaly our office manager will break this rule but then she has to send the money to the collection agency so we still loose the same amount of money.
We also have people that we have written off their bill, not even turned over to collections! And they know it. And I will be darned if they don’t come in again later, knowing that they owe us money. Many get nasty because we can’t/won’t see them again. Some however happily fork it over, in cash, at that time so as to clear their account. In those cases we will see them but do require they also pay at least the exam fee for this new visit up front.
We also have people who have been written off just like above and then come in and give us totally new names, etc!! We know require a photo ID for ALL cliients. Even the honest ones.
We also get the “but it is my boyfriend/girlfriend/mothers/bother’s dog” so they feel they don’t have to pay the bill. Of course the boyfriend/girlfriend/mother/bother/etc has no money, often doesn’t know the animal is in the hospital and insists they are not responsible for the bill since they didn’t bring it in (and they are right!).
We have the people who give us wrong addresses and phone numbers that don’t work, have “full” voicemail boxes, incorrect phone numbers, etc. So then we have no way to contact them either.

It is because of people like this that we often appear so money grubbing. Sorry.

[MeghanDACVA]

[QUOTE=SquishTheBunny;5635591]
Daventry - your post suprises me.

The reason estimates are given up front should be fairly obvious in an ER case. You need to authorize it, so the tests can be done if needed.

Acute vomiting can have many causes, and its important to run bloodwork in house to get an idea of what is going on. Radiographs and abdominal ultrasounds are next. Any idea how much this would cost you if you were a human (and being Canadian, Im sure you dont as we thankfully have an awesome health care system), but those basics would likely run about $1500 JUST for a few tests.

The ER/ICU i work at admits all patients with IV catheters/fluids if needed, blood pressures, EKG and bloodwork (PCV, TS, Electrolytes, Lactate, BUN, Base Exesses, and gasses). This gives us all basic parameters on the animal and can monitor his/her progress or decline. We do bloodwork DAILY on hospitalized animals. However, any animals that are not really “SICK” do not get this admittance.

Cost? Well, the radiometer that runs the blood gasses is $80,000 with a $5,000 year service contract. The centrifuge that spins the PCV is $8000, the cost of the radiologist to do the ultrasound is $150 per hour + call in fee for out of hours. The ultrasound machine is $250,000. The ER doctor salary is $80 per hour, the 4 technicians who work ER/ICU overnights are around $25/hour. The Animal care attendants who walk/feed and clean up after your dog are $15/hour. Oh, and the cost of laundry, feeding, cleaning supplies, vetwrap, replacement IV catheters/fluids, ecollars etc…they add up.

your regular vet will be cheaper because they dont have any of that fancy equipment and the overhead of paying night staff.

However, I guess if you felt the “cold” attitude, that was probably the icing on the cake - and yep, some ER vets do come off this way. Unfortunatley seeing it from there end, they see hundreds of people every week with the same story - " I have a sick dog/cat and no money to treat it, why cant you just make him better for free, you ar a horrible person." Happens ALL the time, and can be emotionally exhausting for the vet.

Its unfortunate things ended the way they did, we see leukemia dogs daily and all are managed on a super cheap pred protocol. Sorry your dog didnt do well with it :([/QUOTE]

Wow, maybe I should move to Toronto!! I make $43/hr as a board certified, 30 yr experinced vet in a 24 hr ER/CC/referral practice who also does my own ultrasounds!

[grayarabpony]

[QUOTE=threedogpack;5636552]
I’ve learned a lot from reading this thread.

I’ve learned that no matter what an ER vet does, it’s likely to be “the wrong thing” according to the owner.

If they handle it too quick, they are jumping the gun.

If they handle it to slowly, they are careless.

If they want paid, they are cold and callous.

If they use meds, they aren’t necessary.

If they do diagnostic procedure, they should not have.

I don’t think there is enough money in a practice to make me put up with most of the people who posted here. [/QUOTE]

WRONG.

Nothing gets under my skin more than having a bad experience and then have someone else insinuate that I’m a whiner, and that the practice that didn’t do a good job is the victim. It’s assanine.

@threedogpack;5636552

…the next time you need a vet, maybe you need to think about the fact that unlike human doctors, vets don’t HAVE to accept you as a client.

Yes, thank goodness there are lots of ER practices in my area, including one at a local university.

[MeghanDACVA]

We have bad experiences with other people and it makes it worse when it involves money or a “family” member.

Not everyone is perfect. We all make mistakes.
It isn’t the PRACTICE that did a bad job, it is that particular vet, tech, receptionist, etc. Like I said, none of us are perfect.

I have had farriers “do a bad job”.
I have trainers/coaches “do a bad job”.
I have had barn owners “do a bad job”.
I have had my parents “do a bad job”.
I have had teachers “do a bad job”.
I have had hair dressers “do a bad job”.
I have had plumbers/mechanics/etc “do a bad job”.
And on, and on, and on.

Did the vet that missed the bite wound make a mistake? Yes. Have you ever made a mistake? I will bet, yes.
Have I ever had a patient come in for something the owner thought was simple and straightforward that in the course of treating it we found some other major problem? Yes.

Life isn’t perfect. People aren’t perfect. Vets are people.

[Laurierace]

I took my elderly, semi-conscious, love of my life sheltie into the ER to be euthanized and the vet on call who also happened to be the owner refused to let me stay with him during the procedure so I took him home. I was hoping he would either die on his own or make it through til morning when my regular vet office opened. Unfortunately neither of those things happened and I had to take him back to that same office at 5am during hurricane Isabel! Thankfully a different vet was on duty and he agreed to let me stay with him. He was now completely unconscious. I will drive into the city if necessary to avoid ever giving them another penny again.

[grayarabpony]

@MeghanDACVA;5642014

Not everyone is perfect. We all make mistakes.
It isn’t the PRACTICE that did a bad job, it is that particular vet, tech, receptionist, etc. Like I said, none of us are perfect.

Wrong again. It was the practice, because it was how the practice was run. Anyway, how would you know, were you there?

@MeghanDACVA;5642014

Life isn’t perfect. People aren’t perfect. Vets are people.

Yes, thanks, I know that. However, there is a huge difference between making a mistake and acting like it’s tough cookies if the patient has a bad outcome, and making a mistake and acknowledging it and learning from it.

There’s no reason why a client shouldn’t open their mouth if they think what happened was wrong. Either to the vet or practice manager or on a bulletin board.

[Bicoastal]

This thread makes me really sad. I worked as a receptionist in small animal surgery/ER. Then as a tech. Then either/or. It is stressful, emotional, difficult for staff, owners, and pets. It is really upsetting that the overall opinion of ER care is what it is :no:.

I hope those practices that have repeatedly disappointed got the staffing they need to do better by their patients: the animals. I do hope folks will not generalize a whole practice based on one person/experience but of course I understand if that is their only experience they have nothing else to go on.

The small animal surgery (ortho, soft tissue, neuro) I worked with had a great reputation. Not cheap, but you knew that before you came in. Same owners/staff/practice open a 24hr ER and reputation tanks . Same staff. Same practice. Different clientele with different resources presenting different injuries/disease.

ER vets are crucial to pet owners and sacrifice a lot to make themselves available nights and weekends because they love animals. They are not driving imported cars or living in gated mcmansions (none of those I know). They may not have great people skills, but I’ll turn the other cheek if my pet will be responsibly treated in a medical crisis.

[Blu]

[QUOTE=magnolia73;5636481]
My neighbor’s dog was bitten by my cat. Leg swelled. $1600 later and he had been bloodtested for cancer, x-rayed, scanned… oh, and given abx. But they kept insisting that the swollen leg overnight was bone cancer. They claimed to find no bite marks, yet never shaved his leg.

$1600 into it, I told her to tell them to shave the damn leg and look for a puncture wound. Yup. A puncture wound. Infected. No cancer.

I think they do shit to make $ at ER vets. IMO, really- a dog has a swollen leg after a kerfluffle with a kitty and you DON’T have the leg to find the wound? You jump to BONE CANCER? Yet you had the foresight to start ABX?

My friend’s dog came in with a gaping wound and sat for 4 hours in a crate bleeding. That was only $1000 for the great service. The vet even commented that the dog should not have sat unsedated for 4 hours bleeding all over the cage. Turns out they were short staffed and there was no vet on site 3 of those 4 hours.

I’d call my horse vet for an emergency call vs. go to any of the ER’s.[/QUOTE]

On the other end of this spectrum, I saw a middle aged chocolate lab on emergency who “stepped on a rose thorn” and had a wound on her foot. The owner insisted that she saw the dog step on a rose thorn in the back yard. Refused any diagnostics, just fix the wound.

We listened, the dog got antibiotics and bandaged.

Dog comes back. Foot is worse. Really think that we need to do diagnostics or take away the “wound material” because we suspect it could be cancer. Owner refused, wanted more antibiotics, more bandaging.

Dog comes back, still not better, even a little worse. Owner finally concedes to xrays and surgical removal of the teensy tiny area that the owner thought was a puncture wound.

It was submitted (begrudgingly) and it was indeed cancer.

The owner would have saved all those exam fees, expensive antibiotics, if they had just listened in the first place instead of treating us like money grubbing vets who don’t know what we are doing. Also, the dog would not have suffered for weeks (she was lame and painful) nor would she have had to have additional surgery to achieve margins.

I won’t spend my time responding to other posts which have been so eloquently answered by MeghanDACVA.

[Blu]

The above anecdote is also not unusual nor far between. I can’t tell you how many people come in and armchair vet and just want it done their way and you become a vector for their internet diagnoses. Run this this and this and not that I won’t pay for it, its not necessary.

And they are the first people to shoot off the hip when the animal is not diagnosed.

[Arrows_Endure]

I honestly don’t mind paying for my animals to be seen.

I think my biggest complaint was that I TOLD them upon walking in the door I had a budget of $400-$500. Then I got an estimate that was twice what I told them my budget was. I then got treated like I was scum of the earth because I couldn’t afford everything on that estimate. When I reiterated my budget, and asked her what tests would be considered most important, she told me that they were all necessary.

I had no problem with her expertise. I had no problem with paying the walk in the door fee. I don’t have a problem with paying the higher rates for treatment and diagnosis. I have a MAJOR problem when I am honest up front, and that is disregarded.

So, I vote with my money. I won’t go back to that clinic. I wish Meghan were in my area, she sounds like a vet I would be happy to have treating my critters in the middle of the night.

The funniest thing of that night? My 16+ year old cat that was eating, purring, and meowing at the vet and at me was described as “depressed with a dull mental state”. Shoot, I hope that vet never see’s our five year old cat. He’s almose comatose 95% of the time, except at dinner time. She’d probably describe him as a cat with one foot in the grave.

[MeghanDACVA]

[QUOTE=Laurierace;5642039]
I took my elderly, semi-conscious, love of my life sheltie into the ER to be euthanized and the vet on call who also happened to be the owner refused to let me stay with him during the procedure so I took him home. I was hoping he would either die on his own or make it through til morning when my regular vet office opened. Unfortunately neither of those things happened and I had to take him back to that same office at 5am during hurricane Isabel! Thankfully a different vet was on duty and he agreed to let me stay with him. He was now completely unconscious. I will drive into the city if necessary to avoid ever giving them another penny again.[/QUOTE]

I am very sorry you had that horrible experience. We do alot of euthanasias with the owners present. Actually, I think anymore that is the norm, not the execption. I (and alot of others) put an IV catheter in first though. This allows the owner to hold, pet, cuddle, whatever the pet while I do my job.

For me, euthanasias are the toughest cases I see. It is not uncommon for me to be in the exam room for up to an hour after the pet has passed away. Just being with the owner, listening to them, talking with them, etc. And these are people and pets I have never met.

I am not saying all vets should do this. But I do agree that some degree of compassion should have been shown. Again, I am sorry for your experience. I wish I could make it better for you.

[Trakehner]

I hate these bloody crooks. Radiographs aren’t expensive to take, especially with digital x-rays…no film/developing etc. They’re easy and a real money maker for the human doctor wanna-be’s.

Sedation…a real rip off…"Oh, but we need to do a chem panel and a full blood testing to make sure Fluffy is in good enough shape to get a shot of acepromazine/ketamine etc. Bull Scata…again, a money maker.

Fecal float…2 cents of solution, 20 cents for a test tube (if you even get a new one vs. washed out) and a minute to view the slide…another rip off, doesn’t take a lot of talent to spot a roundworm ovum, or to tell a hookworm from a whipworm egg.

I had an old Boxer, a lovely girl, had an “old dog bump” taken off her leg. The vet said, “We don’t like the look of that and would like to send it off to the vet pathologist”. I laughed in her face and told her to ship it off, but I wasn’t paying for it. Later when a lipoma (probably) finally made it time to put her to sleep, the vet afterwards said, “A necropsy is only several hundred dollars, wouldn’t you like to know what happened to her?” Worked in some profanity that time…money grubbing idiots.

Small animal vets, especially emergency vets, are getting a terrible reputation (and it’s deserved). Just because you watched ER and House and see all the neat tests you can do, you can’t justify screwing pet owners over with unneeded tests during a time of high stress and perhaps not them being in a not great state of mind…gee, sounds like a funeral home preying on the family.

[Trakehner]

This is so darned cute:

Cost? Well, the radiometer that runs the blood gasses is $80,000 with a $5,000 year service contract. The centrifuge that spins the PCV is $8000, the cost of the radiologist to do the ultrasound is $150 per hour + call in fee for out of hours. The ultrasound machine is $250,000. The ER doctor salary is $80 per hour, the 4 technicians who work ER/ICU overnights are around $25/hour. The Animal care attendants who walk/feed and clean up after your dog are $15/hour. Oh, and the cost of laundry, feeding, cleaning supplies, vetwrap, replacement IV catheters/fluids, ecollars etc…they add up.

So, to justify the machine, they have to use it a lot…even when it isn’t needed, they use the machine, gotta show it’s profitable. A microhematocrit PCV centrifuge isn’t $8K, it’s under $1,000 and all it’s spinning is a tiny pipette tube…here’s a brand new one: http://www.mohawkmedicalmall.com/products/Graham_Field_Hematocrit_Centrifuge.php.

What a load of crap. While in college I started a medical lab for racehorses at Laurel Race Track…tests are cheap, coggins are dirt cheap and I know what a profit making item labwork can be for vets if they want it to be.

[wendy]

comment about human hospitals requiring money up front. Everytime I have been to a hospital for something I have had to pay some large amount upfront. The FIRST place they send you is to someone who does all your insurance paperwork and verifies what you are covered for and then tells you what you have to pay UPFRONT. Period. So this is not new or different in the medical field.

I’ve never been asked for money at a human hospital? been quietly sent totally unexpected and completly outragous bills months later, yes. Sorry your disgusting meals really shouldn’t cost $200 each. And the room just wasn’t nice enough to cost $5000 a night.