I recently wrote a blog here titled “Debunking myths about “rip off” veterinary fees”, and since then, the subject of money has continued to be one of the banes of my life as a vet in practice.
My aim in life is to do a job that I enjoy, and to be paid a reasonable salary: for most people, that just means that you go to work, do your stuff, and come home at the end of each day. For vets, it’s different: every day, as part of our job, we need to ask people to give us money. Most of us would be delighted if this discomfitting task was taken away from us, but unfortunately, it’s an unavoidable part of our job description.
One recent case provided a good example of the type of daily dilemma that faces vets. An elderly terrier, Sam, had a small benign tumour on his flank. He was fourteen years of age, and his owner had been hoping that we might be able to leave the tumour alone: it’d be better to avoid a general anaesthetic unless it was absolutely necessary. When the tumour began to ooze blood, and Sam began to lick it a lot, we couldn’t leave it any longer so he was booked in for surgery. When booking the operation, I mentioned to his owner that it would be wise to take the opportunity to clean up his teeth, which were caked in tartar. And I gave a detailed estimate of the expected costs.
We took all the usual precautions to ensure Sam’s safety. He had a detailed clinical examination and pre-anaesthetic blood tests to ensure that he had no underlying illnesses that could make an anaesthetic risky. An intravenous line was set up to give him continual fluids during the procedure and to give us instant access to a vein if any emergency treatment became necessary. And a vet nurse was designated to hold his paw and to monitor him for every second of his time under anaesthesia, from induction until he was sitting up at the end.
Everything went well: the tumour shelled out quickly and easily, and a line of sutures closed the wound. I carried out a thorough descale and polish of his teeth, as planned. But it was then that the dilemma arose: beneath the tartar covering his teeth, it turned out that two of his molar teeth had large diseased areas. The gum margins had recessed, exposing large parts of the tooth roots. One of the teeth had serious infection, causing the tooth to be loose: it was easily removed. The other molar tooth was more complicated: one root was seriously diseased, but the other two roots were healthy. The tooth needed to be extracted, but it would be a tedious, time consuming surgical extraction, taking over half an hour, and requiring follow up x-rays to ensure that it had been done properly. This would involve an extra cost to the owner of well over £100. I had already given an estimate, and I didn’t feel that I could go ahead with this without permission.
While Sam was still anaesthetised, I asked a nurse to phone his owner to explain the situation. There was no answer on the home line, and the mobile number wasn’t working. What should I do now?
If I went ahead, I’d be carrying out unauthorised work on someone’s pet. If there were any unexpected complications, the owner could hold me liable. And as for the extra cost? Could the owner justifiably refuse to pay?
The safest legal approach would be to make a note of what needed to be done, and then to inform Sam’s owner that he needed a follow up anaesthetic in a few weeks, during which we’d tackle his dental issues. But I knew that it would be far safer for Sam to have the entire procedure completed during this first anaesthetic, and I knew that his owner would be unlikely to agree to pay for a second anaesthetic on top of this first one. So Sam’s dental issues would probably not be treated, and he would suffer as a consequence.
I made an “on the hoof” decision to go ahead with the dental procedure. It took even longer than I had anticipated, and I had to take a series of x-rays rather than just one. By the end, I was happy that Sam had been given the best treatment, but I was nervous about the owner’s response. Would she think that I had done this just as a way of extracting more money from her? What if she genuinely couldn’t afford more than the estimate that I had given her?
I felt so uncomfortable about the situation that I gave a significant discount on the extra work that I had done. Effectively, I ended up working my lunch hour for nothing because I felt so awkward about it.
But what else could I have done? In the interest of the dog, I could not have left painful, diseased teeth untreated.
What would pet owners feel if the vet presented them with a situation like this? Should you pay the full amount of justifiable extra work if it is unauthorised? Do you trust your vet? Or do you feel that we are working more for our own interests than for the benefit of your pet?
Discussion
Hi Pete, a horrible issue to be faced with but I really think that most “normal” people respect their vet’s decision and know that they act in the best interests of the animal. It’s such a shame we don’t have an NHS for pets!
Hi Pete, a horrible issue to be faced with but I really think that most “normal” people respect their vet’s decision and know that they act in the best interests of the animal. It’s such a shame we don’t have an NHS for pets!
Just to respond to a few comments over the weekend:
lynsay brown – The reason that I mentioned that I worked through my lunch hour for free was to make the point that while it was a bit of an inconvenience, it really wasn’t that big a deal. Sorry if it came across to you that I was complaining – I do realise that many people, as you describe, have far worse working conditions than I do.
Stuart Jackson – I agree that with hindsight I should have explored the possible complications and their financial implications with the owner beforehand – the thing is that when you are in the middle of a busy clinic (which is when these things are often set up), you often feel pressurised by the fact that the next person is waiting for you, so it’s difficult to make the time to do this. In this case, the dogs’ teeth looked healthy during the conscious examination other than the tartar – I really didn’t expect to find the complications affecting the roots. But you are right – take the hit, and learn always to make that extra effort to pre-empt this type of situation by explaining, and estimating for, potential extra costs.
Deborah Field – yes we do have a signed consent form before every procedure, and yes it does give us permission to do anything necessary that we judge necessary for the animal – but still, we feel an obligation to be as fair as possible, which means not giving people unexpected nasty financial surprises when we can avoid doing so.
Thanks for your comments everyone.
Just to respond to a few comments over the weekend:
lynsay brown – The reason that I mentioned that I worked through my lunch hour for free was to make the point that while it was a bit of an inconvenience, it really wasn’t that big a deal. Sorry if it came across to you that I was complaining – I do realise that many people, as you describe, have far worse working conditions than I do.
Stuart Jackson – I agree that with hindsight I should have explored the possible complications and their financial implications with the owner beforehand – the thing is that when you are in the middle of a busy clinic (which is when these things are often set up), you often feel pressurised by the fact that the next person is waiting for you, so it’s difficult to make the time to do this. In this case, the dogs’ teeth looked healthy during the conscious examination other than the tartar – I really didn’t expect to find the complications affecting the roots. But you are right – take the hit, and learn always to make that extra effort to pre-empt this type of situation by explaining, and estimating for, potential extra costs.
Deborah Field – yes we do have a signed consent form before every procedure, and yes it does give us permission to do anything necessary that we judge necessary for the animal – but still, we feel an obligation to be as fair as possible, which means not giving people unexpected nasty financial surprises when we can avoid doing so.
Thanks for your comments everyone.
If I didn’t trust my vet, I wouldn’t let him treat our dog. Ob the other hand it has to be said that vets generally play in a different financial league as me, and I have been in situations where my request to pay the additional 200 Euro added to the estimate at the beginning of next month were refused because such a “small amount” wasn’t worth the Admin hassle. I was also self-employed and know all about late payments, but I do think the trust should go both ways..
If I didn’t trust my vet, I wouldn’t let him treat our dog. Ob the other hand it has to be said that vets generally play in a different financial league as me, and I have been in situations where my request to pay the additional 200 Euro added to the estimate at the beginning of next month were refused because such a “small amount” wasn’t worth the Admin hassle. I was also self-employed and know all about late payments, but I do think the trust should go both ways..
Hi Pete,
Nice post.
I understand your dilemma in this situation. I don’t know what laws or code of ethics you work under, but it sounds that, as a vet, you had a moral if not legal obligation to treat the dog?
Pete – Do you get the owners of your animal patients to sign a consent form before you performing any surgical procedures?
If you do, you may like to include a clause that covers that very situation that you have described above? Ie something to the effect that if, during a surgical procedure you find that another procedure should be performed; and that, in the best interests of the animal’s welfare it should be performed as part of, or subsequent to, the first procedure – then you would have the owner’s consent to do so without having to try and make contact with the owner during the surgury. Maybe in the consent form you need to provide a capped amount after somevdiscussion with the owner and before they sign it, so that they are aware of what they may be up for if a secondary procedure is necessary; and of course, you’d have to absorb the costs/time if the second procedure went over that amount.
Hi Pete,
Nice post.
I understand your dilemma in this situation. I don’t know what laws or code of ethics you work under, but it sounds that, as a vet, you had a moral if not legal obligation to treat the dog?
Pete – Do you get the owners of your animal patients to sign a consent form before you performing any surgical procedures?
If you do, you may like to include a clause that covers that very situation that you have described above? Ie something to the effect that if, during a surgical procedure you find that another procedure should be performed; and that, in the best interests of the animal’s welfare it should be performed as part of, or subsequent to, the first procedure – then you would have the owner’s consent to do so without having to try and make contact with the owner during the surgury. Maybe in the consent form you need to provide a capped amount after somevdiscussion with the owner and before they sign it, so that they are aware of what they may be up for if a secondary procedure is necessary; and of course, you’d have to absorb the costs/time if the second procedure went over that amount.
If there is a fault in this process then its one of failure to achieve fully informed consent. Having identified that an old dog’s teeth were badly tartared, then the discussion on treatment and cost should have anticipated potential findings during the procedure. It isn’t difficult to identify a bad dental case in an old dog but more difficult to express the potential treatment pitfalls, but there is no real excuse for not discussing them. The result is – take the hit, learn from it.
If there is a fault in this process then its one of failure to achieve fully informed consent. Having identified that an old dog’s teeth were badly tartared, then the discussion on treatment and cost should have anticipated potential findings during the procedure. It isn’t difficult to identify a bad dental case in an old dog but more difficult to express the potential treatment pitfalls, but there is no real excuse for not discussing them. The result is – take the hit, learn from it.
I have no problem paying for work that helps any of my dogs..even that which was unknown until the procedure had started.. What I don’t like is the way veterinary practices are going.. large companies now buying them up and… THE SHAREHOLDERS… that I am solidly against..people not in it for the care of animals.. but .. MONEY.. the new young vets have little chance of making it on their own.. sad..
I have no problem paying for work that helps any of my dogs..even that which was unknown until the procedure had started.. What I don’t like is the way veterinary practices are going.. large companies now buying them up and… THE SHAREHOLDERS… that I am solidly against..people not in it for the care of animals.. but .. MONEY.. the new young vets have little chance of making it on their own.. sad..
Seriously! Ypu moan about losing your dinner hour lucky you get a dinner! We work in a violent job where getting punched kicked spat at is a day to day hazard we work through dinner all half hour of it! You chose to be a vet, I chose to help people but I didn’t sign up to be physically and verbally abused, overtime is mandatory but unpaid the wage at the end of the month just about covers
Seriously! Ypu moan about losing your dinner hour lucky you get a dinner! We work in a violent job where getting punched kicked spat at is a day to day hazard we work through dinner all half hour of it! You chose to be a vet, I chose to help people but I didn’t sign up to be physically and verbally abused, overtime is mandatory but unpaid the wage at the end of the month just about covers
I am glad you made the decision to address all the dental issues for this dog. Tough call but proves that welfare of the animal is more important to you than anything else. If I were the owner I would be hugely grateful…unexpected expense is a difficult one but perhaps rather than heavily discounting u could have discussed payment by installments or deferred payment if the treatment was covered by insurance. Bottom line as an owner I do sometimes feel that the cost of some vet treatment is exorbitant moreover the cost of medicines( eg £34 for pee stix! to check for infection prior to neutering) But for surgical skill and expert care I can not argue. K Gray
I am glad you made the decision to address all the dental issues for this dog. Tough call but proves that welfare of the animal is more important to you than anything else. If I were the owner I would be hugely grateful…unexpected expense is a difficult one but perhaps rather than heavily discounting u could have discussed payment by installments or deferred payment if the treatment was covered by insurance. Bottom line as an owner I do sometimes feel that the cost of some vet treatment is exorbitant moreover the cost of medicines( eg £34 for pee stix! to check for infection prior to neutering) But for surgical skill and expert care I can not argue. K Gray
You defo did right if that was my dog I relie on my vet best decision and plus of his age I wouldn’t like to do two anaesthetics.. and would have no problem paying the extra
You defo did right if that was my dog I relie on my vet best decision and plus of his age I wouldn’t like to do two anaesthetics.. and would have no problem paying the extra