Dealing With (Mis)guidance
“I can’t believe what Dr. A told my client,” a colleague told me recently about an obstipated cat. “He told her that cats do miserably after colectomy.”
The owner went online, read a very different story, and went to Dr. B, who referred her to us for surgery.
This is a very delicate situation. Communication with referring vets is a like a religion. Should I call Dr. A to discuss the real prognosis of colectomy? Should I let Dr. A know that he has lost a client and why?
But then if Dr. A calls the owner, will the client be mad at me for “ratting?"
In such a case, ignoring the situation may be the most diplomatic situation. The biggest loser will, however, be other obstipated cats who meet Dr. A.
(Note: It goes without saying that Dr. A is an excellent vet who truly cares about the welfare of his patients.)
A similar situation occurred a few years ago. Dr. C told her client that 100 percent of the laryngeal paralysis patients she has seen died after surgery. That time, I did dare to call Dr. C, wondering about this dismal track record.
I asked her, “How many cases have you actually seen?”
“Two,” she replied.
Well … I was never exactly good at math or statistics, but I do believe that two cases do not constitute a representative sample.
So what can we possibly tell the client that will not violate our No. 1 principle: "Make my referring vets look good?"
Usually I say something like: “Ms. Smith, you have to understand that it’s easy for me to diagnose X or perform Y. I cheat. I do this kind of surgery all the time. Your vet doesn’t, which is exactly why she wisely decided to refer Fluffy to a specialist.”
Most clients understand that. Some don’t.
Dear reader, I hope you are never in this situation. If you are not sure about a diagnosis, prognosis or treatment option, what I would suggest is that you call your trusted specialist (surgeon or other) to discuss the situation openly. That’s what we’re here for. And we won’t even charge you!
The conversation should include an honest evaluation of complications and risks. So yes, there can be complications after colectomy. The most common one is diarrhea. Until the body adjusts to losing its colon, which normally reabsorbs water from feces, the stools will be softer. But most cats eventually do great after surgery.
And yes, there can be complications after “tie back” surgery. The most dreaded one is aspiration pneumonia. But most dogs never have pneumonia and do great after surgery.
Any surgery has inherent risks, just like any veterinary procedure, whether it is giving a vaccine, doing dental prophylaxis or repairing a fracture.
One of the many jobs of the specialist is precisely to explain those risks honestly to pet owners so that they can make an informed decision.
02/01/2010 - Anesthesia: It Ain’t Over Till It’s Over
01/18/2010 - Who should euthanize Leia?
01/04/2010 - Changing the world, one patient at a time