Getting the most for your money at the Vet's office:
6 tips to help you and your pet
Not sure where your money goes at the vet office? Uncertain about what it is you actually paid for? Do the potential costs of care prevent you from going to the vet when your pet is sick? This article can help you get the most for your money at the vet’s office. It is not about how to get your vet bill lower for routine care, but how to get the most value for your dollar at the vet when your pet is sick; which is also when expenses are highest (and come without guarantees). It is about how to work ‘better’ with your vet to make the diagnostic and therapeutic process more efficient, which in turn makes it less expensive.
We often try to avoid up front costs on testing due to expense. We opt for a ‘wait and see’ or a “can’t we just try antibiotics first” approach to cut costs. Sometimes this will work. Many mild illnesses will get better with nothing more than time. When it doesn’t work, the cost of multiple vet visits and ineffective trial therapies quickly adds up...and your pet is still sick, or getting sicker. The smaller amounts you spend stretched out over weeks or months quickly become a sum greater than paying up front for testing or expertise that would have gotten the answers you were looking in first place. More importantly, the chances of successfully treating the underlying disease or condition diminishes over time. The more advanced any illness gets, the harder and more expensive it is to treat. Inaccurately diagnosed or managed illness always comes with a worse prognosis for recovery.
That said, I am not a proponent for aggressive blanket testing whenever the problem is not self-evident. This too can be wasteful for you and stressful for your pet. Subjecting our pets to medicine in any form, be it testing or treatments, is always stressful. Stress is not healthy. Animals don’t like to experience it, I don’t like to administer it.
The goal? Getting real answers and treatment OPTIONS in the most cost effective and least stressful (for you and your pet) manner.
When your pet is sick, follow these guidelines for a better visit to the vet.
1. Provide a precise comprehensive HISTORY of the problem in as few words as possible. I know this is not always easy; signs and symptoms can be vague—THUS THE REASON TO KEEP THINGS SIMPLE…”just the facts m’am”. While no one knows your pet better than you, and expressing your opinions and observations is essential, resist the temptation to over-interpret the signs in your pet. ‘Interpretation’ is subjective and can be misleading to your vet. Listen to his/her questions, and provide the best answers in the fewest words. Vets are trained to listen and we choose our questions carefully. BEFORE you get to the vet, think carefully about your pet’s problem. Providing the following information will be extremely helpful; keep it simple and try to stay objective unless otherwise asked.
a. What is the problem(s)?- list them, and list them simply, using as few words as possible. ie) frequent urination, seems painful or uncomfortable, difficulty walking, abnormal gait, decreased appetite, vomiting, diarrhea, weight loss, drinking excessively….
b. When did the problem(s) start? (approximately as best as you can recollect)
c. How has the problem(s) progressed…quite simply, is it getting worse, staying the same, or getting better? This is VERY important, don’t overlook it.
Summary: With this basic information, delivered in concise and simple language, your vet will often be able to make a diagnosis or a good guess, before even examining your pet. A GOOD HISTORY OF THE PROBLEM IS CRUCIAL TO UNDERSTANDING IT…TAKE THE TIME TO ORGANIZE YOUR THOUGHTS ON THESE POINTS.
2. The Physical Exam: Allow, encourage and be patient while your vet does a thorough physical exam. I cannot tell you how many times I have seen obvious examination findings overlooked--be it enlarged lymph nodes, a heart irregularity, or an abdominal tumor (a 7 lb. splenic tumor in one instance...overlooked by another veterinary specialist!). A thorough physical exam is partner to a thorough history. Many owners don’t understand the flow of the physical exam or what is being done. An experienced veterinarian can do a good physical exam very quickly. To most owners it looks as though nothing has been done. Ask your vet to walk you through the exam so that the thoroughness of the exam becomes clear to you. The physical exam is structured and generally includes an evaluation of body weight and temperature, an evaluation of mucous membrane color (typically lips, tongue and gums), evaluation of eyes, ears nose and teeth, lymph nodes, listening to heart and lungs with stethoscope, feeling the abdomen for abnormalities like masses or fluid, and an evaluation of the skin, muscles and bones. This is often a quick evaluation, scanning for problems that you the owner may be unaware of. A slower more thorough evaluation occurs in the areas your history brings to light. For example, if you come to me because your dog has been limping on the right front leg, which started 13 days ago and seems to be getting worse (a thorough objective history in 16 words), I will examine all systems in your dog, and then pay extra attention to the leg. Be an advocate for your pet, and be an active part of his/her medical care. Vets are people too. On any given day I may have a 100 distractions from my personal life and other veterinary patients. If there is something I have overlooked during my physical exam, I welcome a reminder from you...”Dr. Maguire, how was Fluffy’s temperature (substitute lymph nodes, gum color, abdomen, heart) today?” “Oh! Thanks, I almost forgot to check that!” Helping me stay focused during your pet’s examination is not second-guessing my ability, it is becoming a partner in your pet’s care…and I always appreciate it. It shows me that you care, and are willing to become an active participant in your pet’s well being.
Summary: The physical exam is another critical component of your pet’s evaluation. Realize that there can be a 1000 distractors which might lead to something important being overlooked...vets are only human. Becoming part of the process as an advocate for your pet will not only help you to better understand what you are paying for, it will also help prevent important findings from being overlooked. Be an advocate...but not a pain in ass; its a fine line.
3. The merit of initial diagnostic testing (blood tests, x-rays, etc): Generally speaking, vets don’t just recommend basic tests or x-rays for the hell of it. Extracting precise medical information from a non-speaking patient is difficult, and it depends a lot on the pet owner. There is often more to distract from the true medical problem than there is to lead to it. Blood tests offer objective information about the health of the patient. Basic tests usually include a Complete Blood Count (CBC), a Serum biochemistry, and a urinalysis.
a. The CBC provides information about the state of the red and white blood cells and the platelets. There may be up to 18 different parameters used to evaluate the number and character of blood cells on a standard CBC, any of which may provide hints as to the cause of a disease process. Did you know that there are 5 different types of white blood cells, each with unique functions?
b. The serum biochemistry is a test that measures various non-cellular parameters in the blood which reflect how the body is working. Up to 25 different blood values are measured in a routine serum biochemistry panel. Liver and kidney health, blood sugar levels, electrolyte and mineral levels (sodium, chloride, calcium, potassium, phosphorus), the acid-base balance in the blood as well as other proteins, enzymes, and cholesterol are all evaluated. The serum biochemistry will tell you about how the body is working, and if it is not, why.
c. A urinalysis is an analysis of the urine. It is not just to check for bladder infections. Measurable parameters in the urine also reflect kidney and liver health and can be a major aid in identifying diabetes…a urinalysis is necessary to confirm or deny many abnormalities identified in serum biochemistry. For example, kidney values in the blood can be high for non-kidney reasons--you need to look at the urine to distinguish the causes of high kidney values in the blood. The urinalysis parameters are essential for interpreting many abnormalities in the serum biochemistry.
Dogs and cats can look perfectly healthy, yet have serious significant underlying disease that will only be detected with objective tests. ALWAYS consider basic tests as part of the minimum workup (diagnostic evaluation) for your sick pet. If your vet doesn’t suggest these tests, ASK if they should be considered.
Summary: Basic laboratory tests have value. They are essential in accurately determining the underlying causes of some illnesses. Finding out now is almost always more cost effective than finding out later. Accurate diagnosis now almost always carries a more favorable prognosis than accurate diagnosis later. Accurate diagnosis often requires these basic tests.
4. ASK QUESTIONS/GAIN UNDERSTANDING: Although I cannot verify the reference, I have been told many times that studies in human medicine find that a patient listening to his or her doctor only comprehends or retains about 10% of what is said to them...MISCOMMUNICATION OPPORTUNITY. Medical explanations are difficult to understand. When you are stressed about your pet’s illness, these things are even harder to comprehend. All vets understand this, nevertheless its sometimes hard for us to judge just how much of what we have said is being understood. You NEED to understand, so that you can make informed decisions! I will almost always say to a client, “that was a lot of information I just gave you, is there anything you don’t understand or want me to go over again?” It is important that you ask questions when you need clarification. Be part of the process.
Bring another set of ears to the exam. If you are not medically versed, or are very anxious, it is a good idea to bring a friend or partner who can do some listening for you. They might ask questions you do not think of or they may be able to explain things to you when you get home and realize you had 50 questions you forgot to ask in the office. Take notes if you need to. If you are the type who absorbs the written word better than the spoken word, ask your vet if there are any references or reading materials regarding the problem(s) they are discussing. I have many prepared articles discussing the more common or complex disease processes for just this purpose. The more informed you are, the more you become involved in the decision making process and the less chance for miscommunication.
Summary:
a. Don’t be embarrassed about what you don’t understand. You are not expected to fully understand the ins and outs of medical conditions, testing, etc. in a short appointment. I expect that you won’t understand everything I have said. I also expect you to ask for clarification on the points you don’t understand. I am grateful for the opportunity to clarify important points. When you ask questions, you are telling me that you care and that you want to be informed and part of the process...this is good!
b. Bring a friend to help you listen and ask questions.
c. Ask for written articles or resources which might help you better understand...or that you can peruse on your own time in the comfort of your own home.
5. RESEARCH: Do your homework. Summarize the facts and conclusions discovered or hypothesized by your vet…and then learn more. The bottom line is this: the more understanding you have regarding your pet’s disease, signs, or possible disease processes, the better chance for effective management of the problem(s). Here are some websites that might help you learn more about the initial conclusions about your pet’s illness:
a. http://www.ncbi.nlm.nih.gov/pubmed/ This is a medical scientific literature search database. It will give you access to the very latest published scientific articles, and it provides free abstracts (summaries) of the articles. It is NOT an informational website where you can read a summary of diabetes in cats. It is a library of published scientific research articles. The key to using it is using the correct search words…be patient, there is a wealth of information here. Remember it searches both human and veterinary sources, so include the species of your pet in the search or you will get endless human articles…not bad to peruse anyway. For example, if your vet suspects your cat might have inflammatory bowel disease, you can go to this site, search ‘cat inflammatory bowel disease’ and you will be given a list of scientific research articles relevant to your search chronologically listed from most recent to oldest. You will be able to read a summary of each article in most cases. You will find the latest research on this site.
b. http://www.petmd.com/ This site is more an online pet magazine than a health resource, but they have accumulated a sizeable library of articles about various medical conditions in pets. I have perused many of their medical articles and I think they have done a good job in keeping a fairly up to date medical resource library. There are inaccuracies and there are gaps in the info, and there is no substitute for a good vet or a vet specialist, but you will learn and gain some valuable info about specific disease processes. Just remember, no single source of information is 100% right or wrong...just extract bits and pieces to enhance your understanding.
c. http://www.petplace.com/ This site is also a glorified medical resource, albeit an internet pet magazine…but…many of their articles are written by veterinary specialists writing in their field of specialization. What that means is that you get both up to date and very accurate information, but from a lengthy article that is difficult for the lay person to understand. So if you have patience and/or medical background, you will find this useful…if not, you will find it frustrating…”I just want an answer to my question!”
d. Beware of non-qualifed resources on the internet, they can be more detrimental than helpful.
A good vet will value the research you have done on behalf of your pet, and it will make things easier for him/her to explain if you have educated yourself. There are a ton of reasons why the information you have researched may not be relevant to your pet’s case (usually miscommunication between you and your vet), so educate yourself, but remain humble; no one likes a know-it-all.
6. Veterinary Specialists: If you were not aware, there are veterinary specialists in the fields of neurology, oncology (cancer), cardiology, internal medicine, ophthalmology, dermatology, and surgery. The scope of medicine in animals has grown so tremendously that it is impossible for any one veterinarian to be proficient in all aspects of medicine…so, as in human medicine, specialization has evolved. A veterinary specialist typically undergoes 4 years of specialized academic training, an advanced degree, and board certification in his/her field of specialty, in addition to the 4 years of vet school required to be a veterinarian; that is 8 years of academic training in veterinary medicine as compared to the 4 years of training a general veterinarian receives. Veterinary specialists can be found easily these days, but still not in all regions. If you think your pet’s medical problem is complex…if you would like second opinions about your pet’s medical conditions, or if the problem remains elusive after initial efforts by your vet…ask your vet if referral to a specialist should be considered…or look for a specialist in your region.
Use these resources to find a regional vet specialist:
http://www.vetcouncil.org.nz/specialistList.php
http://acvim.org/websites/acvim/index.php?p=2 (board certified specialties in internal medicine, oncology, neurology, cardiology)
http://acvs.org/ (board certified veterinary surgeons)
https://www.acvd.org/ (board certified veterinary dermatologists)
http://www.acvo.com/ (board certified veterinary ophthalmologists)
Very often, when working with a veterinary specialist, you will get to the source of the problem sooner, they will be able to offer you the very latest treatment options and be more familiar with prognoses associated with these options. A veterinary specialist works in concert with your general veterinarian and enhances the overall medical care opportunities for your pet…your family member.
If your pet is sick and you want to optimize your chances of getting him/her better in the most cost effective manner, these tips will help. I have 15 years of experience as a referral veterinary specialist…this is the advice I offer my family and friends.