Thursday, May 20, 2010

Injection Rejection

I've been to a number of veterinary clinics to work or interview or spent time there as a student, etc. I've also spend time reading on a popular veterinary forum (VIN). And it seems that there are some vets who give just about every patient a "shot" of something, no matter what the pet has or if it really needs the injection or not. The reason is often that the owner likes to see you do something, not just prescribe medication, or it helps the pet start to get better right away, or they want to "jump start" the medication.

I agree that there are a number of situations where injectable medication is valid and warranted. A vomiting pet who can't hold down medications, a pet in severe need of pain control, a pet who can't breathe because of fluid in it's lungs, high fevers, etc. And some owners request an injection even though they know they need to give the oral meds as well.

But if the injection is not medically necessary or not even indicated (like random vitamin shots?) do owners really want to pay $20-$30 or more just to see the vet "do something?" Some pets don't like getting shots, and some medications burn or sting when injected. I don't believe it's common practice in human medicine to get an antibiotic injection for a sinus infection or UTI before getting sent home on a prescription. I tend to think a lot of this is bill padding but I want to know what the pet owning public thinks so please leave your comments!

Another disagreement I have is with excessive diagnostics. There are doctors who want to do bloodwork and x-rays on every pet with vomiting and diarrhea. Let's be real-most of these pets are going to get better if you don't do anything. Most of the rest will get better with pulling food and water for 12-24 hours and starting back with small meals or a bland diet. In vet school they emphasized how important a good history and thorough physical exam is in determining a diagnostic and treatment plan. If you run every test on every patient then you really dumb down the importance of the history and exam. You may as well not even do them in my opinion. I don't think there is anything wrong with offering them, but what I feel is wrong is where owners are made to feel like they are absolutely necessary in every case. I think the owner wants an honest opinion of what you recommend so they can decide what they want.

So again I ask the pet owners-which do you really prefer. Do you want all tests run every time to minimize the chances of something getting overlooked or do you want a reasonable recommendation based on your pet's individual presentation. Knowing what pet owners really want helps us better serve you and your furry family!

7 comments:

tervnmal said...

Great topic! My regular vet is generally not injection-happy. I think she understands I'm not interested in "showy" treatments, just what's truly needed, please.

When my late sheltie Connor was (eventually) diagnosed with liver cancer a number of years ago, I felt the specialist was a little too into diagnostics. I had a four digit bill before anything conclusive was found. I realize you have to run some tests to find out what's going on inside the dog, but by the same token, he didn't spend a lot of time talking with me and reviewing patient history, just ordered one test after another. Then the surgery and recovery was another four digit bill.

I'd rather be safe than sorry but kind of got the feeling he was running many of those tests just because the technology was available and something "might" show up. Many people (not crazy dog people) don't have money to pay a bill like that for a family pet and perhaps some of it could have been avoided. Will be interested in hearing others' thoughts.

Elizabeth said...

I want to know what you honestly feel is best for my pet.. If you think blood work is necessary, fine I will do it. I don't want meds given if they are not needed. I don't need you to always do something.

Sara said...

I like the philosophy "less is more". Less meds, less tests....

I do appreciate a vet who spends the time examining my dog, and asking me lots of questions about habits, behaviors, etc. That is what makes me feel as though she is being thorough. Not necessarily a blood panel.

barb said...

I'm told that at some vet clinics the vets get a commission on each diagnostic test and so they suggest them all. I'd prefer that if they want to run multiple tests to start with one and get the results before doing the rest if possible.

Rohan Shelties said...

I work at a GP/ER/Specialty hosp, and I think that all of our dr.s have a really nice balance of doing just whats necessary. Sometimes I find that some of the GP docs are vacc happy, but thats with most traditional practices. But we also dont just jump on the bandwagon for every new med thats out there either. We have a comittee for everything that comes in. When people started calling and asking for the canine flu vaccs, we told them we would not carry it because our docs didnt feel it was safe, nor was it FDA approved. I often find myself asking them how docs at another local practice (as we have many pets come in through the er) could miss something that we picked up after this first visit. It makes me worry about ever having to change vets...I trusted them before working here, and now I trust them even MORE after seeing them in action. As for me, if the tests are non invasive/non painful, I do them. It was recommended for Heidi to have an aspirate of bone/spleen/lymph and an abdominal u/s and chest rads. Im doing the last two because although I think her MCT is VEWRY unlikely to spread, I feel like these tests will give us the answers we need, w/o having to put Heidi through unneccessary pain...

great topic!
Sheltie-Hugs,
Jenn, Heidi and Shelby

Kathy said...

I have a holistic vet that I drive an hour and a half to see because she does not do those things. I LOVE her. I really trust her opinion because when she says we need something I know we need it in her opinion. My vet that is here in town that I go to on weekends, or when my other vet is booked up always gives me the feeling that he has a hundred dollar minimum...LOL, he will order a test or give some sort of med for EVERYTHING, and I never feel like I trust his opinion as much, I am never sure if he really feels something is necessary or my bill just isnt enough today....I do not mind paying for anything my dogs need and I go in often enough that I feel like my vets should feel ok just ordering what is necessary or at least if they have a hunch and want to do a little extra that might not be totally necessary yet...but they really would like to then talk to me, and let me know what they are thinking. I think that breeds trust at least for me.

Nicki said...

Thanks for all the comments. It sounds like everyone has more or less the same thoughts as me. I figure if I treat everyone's pet as I would treat my own it should be pretty good for most people.