Drug Prices And Pre-an Tests

[ILoveKettleChips]

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Alastair E, your point about Cushing's therapy is a really good one - it's a nightmare. I know of dogs which are Cushingoid and uncontrolled because their owners can't afford the meds full stop. Of course, insurance saves them this worry, but doesn't do anything about the profiteering drug manufacturers.

Unfortunately, the pre-anaesthetic bloods are a bone of contention between vets and owners. Because of the drugs we use routinely, the results of these tests don't change our method of anaesthesia - they do sometimes throw up problems which mean we don't go ahead with the op though. In young healthy animals they're a bit pointless IMO, but as has been pointed out, they're the only way of detecting certain problems while there's still time for treatment. Add to this the fact that it could be argued that a vet is negligent if they do not at least offer these things to clients, and you have a lovely mess of what some people class as extortion and some people class as necessary and valuable diagnostics.

We get round this by offering the tests on our consent form, and we only actively discuss this option with clients in cases where we are concerned about the organs. I don't want anyone to feel guilty if they don't want to pay the extra, because some people can't, but likewise everyone should be given the option. £30 is a lot of money, but not if it allows you to diagnose and control a disease early. And if the tests show nothing? £30 for peace of mind is the only way I can suggest people see it.

 

[JAX]

Thanks ILKC :huggles:

It helps to have a `vets view ` . I know you havnt been practising long , but how many, on average would you say that these `pre`an tests show anything of concern.

I wonder why they call it PRACTISING (w00t) .

 

[BeeJay]

This has thrown up an interesting matter to me. Was Fern tested or not? Hmm 'cause I wasn't told but I suspect that she was. Actually in her case I hope that she was because she's 7 and if she has been then I have bought some reassurance about her liver and kidneys. So I must ask. I was in such a shut down state by the time that I'd got to the vets that wasn't thinking clearly. Hence forgetting to ask and just presuming that they had done it.

I actually do opt for the tests and would have for her simply to buy some peace of mind. I in fact added to the bill because as they needed to GA her to examine her ribs properly I asked them to clean her teeth at the same time.

When they first brought out these tests I can remember being told by my vets that they weren't necessary for young dogs but once they'd got over a certain age then it was a good idea.

The one thing that I truly hate about vets and charging is when they ask if the dog is insured. Mine aren't (about £3000 in vets bills last year) and I always wonder if that means that my dogs will get second best treatment. I don't think that it does but it leaves an unpleasant doubt.

The other thing that I hate is having to pay out large sums of money only to find out that my dog has got something terminal wrong with it and I end up having to have it pts anyway. As mine are pts at home then that also costs me an arm and a leg. All in all about £600-700 of last years £3000 in fact. Actually now I come to think of it add lots more hundreds from the year before when they didn't find out what was wrong. Never checked the stifle joint then. That included a referral too.

Such is dog owning <sigh> and in the end the cost was huge but thank god I found out what was wrong because if her leg had fractured up in the woods miles from home. Well that really doesn't bear thinking about.

 

[ILoveKettleChips]

how many, on average would you say that these `pre`an tests show anything of concern.

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Very difficult to say, because we only tend to perform these tests on animals which we have concerns about, or when the owner insists, so it's not a true representation of the population. Taking into account the fact that usually we have suspicions of disease before the sample is take, probably between 1 in 2 and 1 in 3. This includes samples which look for liver and kidney damage, diabetes, and hypoproteinaemia.

 

[JAX]

Yes , but what about dogs brought in for Gen An. ,with no known probs , eg kidney /liver before hand ? who are tested as a precaution . :blink:

Thanks for your quick responce :huggles:

 

[ILoveKettleChips]

Here's a story about client relations for you:

I saw a dog with a painful foot. It was a large, young, bouncy dog, whose owner didn't have much control over it. It wasn't limping, but snarled and snapped when I tried to look at it. The owner reported that this was unusual behaviour for the dog. There was a small bloodstain at the toe.

I said it was most likely to be a broken nail, but that I was going to be unable to examine or treat the problem without either distressing or sedating the dog. I suggested that we give the dog a painkiller and an antibiotic injection and see it again in 2 days if it was no better. The owner agreed with my suggestion, and all was well.

In the end, I could only give the painkiller - the second injection wasn't going to happen without me being bitten. I advised the owner just to keep the foot clean with saltwater.

The receptionist came to me later to say that the owner's partner had telephoned and said that a relative had said that the dog must have antibiotics as the skin was broken, and that he wanted to bring the dog back the next day, insisting on an antibiotic injection but refusing to see me!

Should I have hospitalised the dog and sedated it (probably just to trim its nail)? Should I have sent them away with a course of (probably totally unnecessary) antibiotic tablets? Should I have expected the owner to muzzle and restrain a large and painful dog in order for me to give an injection that was purely prophylactic? Or was my suggestion reasonable?

Proof, to me, that you cannot please all of the people all of the time, and therefore have to offer everyone everything!

The one thing that I truly hate about vets and charging is when they ask if the dog is insured.  Mine aren't (about £3000 in vets bills last year) and I always wonder if that means that my dogs will get second best treatment.  I don't think that it does but it leaves an unpleasant doubt.

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I understand this, and I don't like asking the question myself, but it serves two important purposes. For those who do not insure (and those who don't know there is such a thing), but possibly should, it may prompt them to look into it. For those whose dogs are insured, we know we don't have to broach the delicate subject of finance in a time of distress or panic. Unfortunately some vets will always x-ray wallets, but it's so difficult to deal with this subject without making less munificent people feel guilty and more affluent people feel insulted!

 

[ILoveKettleChips]

Yes , but what about dogs brought in for Gen An. ,with no known probs , eg kidney /liver before hand ? who are tested as a precaution . :blink:
Thanks for your quick responce  :huggles:

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My response included those. As I said already, we don't test routinely, we only test dogs with suspicion of disease, or those whose owners request it. I don't include those with known disease, because if it's known then of course the tests will throw up something!

For those whose owners request the tests without our recommendation, there will always be the odd diabetic/early renal/hepatic failure among them. Very few, because these conditions can often be suspected on the basis of the clinical examination and history. But yes, it has been known. In fact, I saw a wee dog the day before yesterday, who is enjoying happy times in the face of liver failure following a pre-dental blood test last year!

 

[June Jonigk]

When I worked in a vet practice, we had a 6 month old Westie in to be castrated. The owner opted for pre-anaesthetic blood profile, and it showed problems with he liver. The dog was treated and castrated at a later date, but it would not have done the liver much good to have an anaesthetic at that time.

Having moved from the area, I now use different vets, and the chap we see is very much for saving money where possible - yes, I have to agree that it is strange for a vet, but we really appreciate it. If he says something is needed, we have no hesitation but to do it. It is difficult when you think your vet is suggesting something you think is unnecessary - there will always be the exception, but generally I think they are just trying to provide the best treatment for your dog.

Having insurance doesn't necessarily mean the vet is adding on extras for the sake of it, it means that they can use the very best there is, without having to worry about whether the owner can afford it. For instance - if your bitch went in for a pyometra op, and your vet was worried about whether you could afford it, he might just cope without having the bitch on a drip, so he could save you costs - but if she was insured, he would put her on a drip as a matter of routine. Vets have many many clients that don't pay, and they are not a subsidised charity. It always amazed me, the amount of people who would come in for treatment, and then just say "oh, I haven't got any money". I wonder what they would have said in Tesco's if they had loaded up their trolley, and then expect to leave without paying.

Vets come in for a lot of stick over costs - and yes, some do overcharge, but if they do, you are free to change to another practice that doesn't. I tried two other practices in Hereford before I settled for the one I considered the best (and not just the cheapest). I know you never see a poor vet, but they do have a lot of overheads, and the cost of running a practice is not cheap. Here's another thought - I bet there's not many of them on even half of the £100,000 a year your GP gets (w00t)

 

[BeeJay]

>Having insurance doesn't necessarily mean the vet is adding on extras for the sake of it, it means that they can use the very best there is, without having to worry about whether the owner can afford it. For instance - if your bitch went in for a pyometra op, and your vet was worried about whether you could afford it, he might just cope without having the bitch on a drip, so he could save you costs - but if she was insured, he would put her on a drip as a matter of routine. Vets have many many clients that don't pay, and they are not a subsidised charity. It always amazed me, the amount of people who would come in for treatment, and then just say "oh, I haven't got any money". I wonder what they would have said in Tesco's if they had loaded up their trolley, and then expect to leave without paying.

I don't understand your above statement June. This business about the dog being put on a drip. Surely if the dogs needs to be on a drip then it is put on one. If it doesn't then it isn't. You are implying that vets may deliberately withhold treatment from uninsured dogs. That should be a decision made by the owner NOT by the vet. A vet shouldn't have to make decisions like that. They shouldn't be making value judgements about how much someone can afford. Either the dog needs the treatment or it doesn't.

 

[ILoveKettleChips]

I don't understand your above statement June.  This business about the dog being put on a drip.  Surely if the dogs needs to be on a drip then it is put on one.  If it doesn't then it isn't.  You are implying that vets may deliberately withhold treatment from uninsured dogs.  That should be a decision made by the owner NOT by the vet.  A vet shouldn't have to make decisions like that.  They shouldn't be making value judgements about how much someone can afford.  Either the dog needs the treatment or it doesn't.

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The drip example was actually a good one - some practices drip up any animal that undergoes a general anaesthetic. Some don't. We only drip up a pyo case that has evidence of kidney dysfunction on bloods, or is clinically unwell. However, if an owner requests absolute gold standard then we would happily drip up a pyo - but it probably wouldn't be necessary.

Another example - a dog has a fatty lump - we remove it, and it is obvious to the naked eye that it is just fat. The only way to prove that it is a fatty lump, however, is to send it for histo, thus adding to the cost. Some owners would be outraged if we did not send it - 'deliberately witholding treatment'? Some, however, would be upset that we had incurred them extra and unnecessary cost.

Don't forget that although you are happy and prepared to accept vets fees, whatever they may be, you are potentially in the minority. Most people have a limit on what they can or will spend on a pet - if someone only has £100, I'd rather spend it on spaying the pyo bitch, than dripping it up!

 

[BeeJay]

>Don't forget that although you are happy and prepared to accept vets fees, whatever they may be, you are potentially in the minority. Most people have a limit on what they can or will spend on a pet - if someone only has £100, I'd rather spend it on spaying the pyo bitch, than dripping it up!

You've not looked at what June has said. Which was.

>For instance - if your bitch went in for a pyometra op, and your vet was worried about whether you could afford it, he might just cope without having the bitch on a drip, so he could save you costs - but if she was insured, he would put her on a drip as a matter of routine.

My point being is that it isn't the vet's job to be worried about how much an owner can afford. That's the owners job. Vet's as far as I'm aware aren't privvy to my bank account so I expect a vet to discuss how much a treatment is going to be and not decide for themselves what I can or can't afford. THEY AREN'T IN A POSITION TO KNOW HOW MUCH I OR ANYONE ELSE CAN OR WILL PAY. They have to ask the owner first. I'll decide what I can afford and what I can't. I'm an adult and if I can't pay for the treatment then I'll say so.

If the vet KNOWS having asked the owner how much they are prepared to or can pay then that's different. But June's comment implied that they are making value judgements about people without asking them first. Which is why I asked her to clarify it. :thumbsup:

You have since gone on to say that it's down to you whether lumps are sent off for testing or not. Surely it's down to you to advise but NOT to decide. That's the owners decision to make. I would be well upset if a vet took it upon themselves to send any test off without my permission. I expect to be asked.

 

[June Jonigk]

My point being is that it isn't the vet's job to be worried about how much an owner can afford. That's the owners job. Vet's as far as I'm aware aren't privvy to my bank account so I expect a vet to discuss how much a treatment is going to be and not decide for themselves what I can or can't afford. THEY AREN'T IN A POSITION TO KNOW HOW MUCH I OR ANYONE ELSE CAN OR WILL PAY. They have to ask the owner first. I'm an adult and if I can't pay for the treatment then I'll say so. I'll decide what I can afford and what I can't.

To be honest Barbara, I'm afraid most people are judged by how much you think or know they will pay - and if you knew the amount of treatment that vets give, but never get paid for, you would probably understand why. I have to say that knowing you, and most probably the fact that you've seen your vet more often than you've seen me, I'm sure he knows that you would pay anything necessary to treat your animals. Unfortunately that is not the case with the majority of people, and as a veterinary practice is a business, it has to be run as so. It's a sensitive issue because of the way we feel about our dogs, but when it comes down to it, as much as a vet has trained to treat and save animals, it is also their job that they do to earn a living.

Perhaps I didn't make the drip thing clear - what I meant was, if the vet knows that money is not a problem, i.e. the dog is insured, then he will use whatever he feels is of benefit to the animal, no matter what the cost. If the vet feels that money is a problem, he would probably give the animal post op fluids orally. If the dog was dangerously ill with a pyo, then he would use a drip no matter what. I wasn't suggesting that a vet would withhold treatment because he thought you couldn't afford it - in my experience, if this is the case, he would tackle the financial side first, and then perhaps decide on a cheaper course of treatment. We all like to think that our vet is our God, but at the end of the day, they have to earn a living, and because of this I'm afraid they have to make generalisations about their clients. Hope I'm not giving away the secrets of veterinary practice!!

 

[maggymills]

it is sort of up to the vet to be worried about how much owner can afford,

because SOMETIMES even when the owner is asked if they want say histology sending off, they are only thinking of whats best for the pet at that time, and then when the they're told the bill-

theres a big fuss made of the charges, and leave the practice having only paid what they think the treatment should cost!

this does occur occasionally- and this is why the vet sometimes has to make his own decisions :b

 

[ILoveKettleChips]

You have since gone on to say that it's down to you whether lumps are sent off for testing or not.  Surely it's down to you to advise but NOT to decide.  That's the owners decision to make.  I would be well upset if a vet took it upon themselves to send any test off without my permission.  I expect to be asked.

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Nononononono, not down to me - of course we give the option. If we're suspicious, the lump is packed up and ready to go once the owner has consented. If it's a big splodge of fat, we store it carefully on a damp swab until we can advise the owner not to waste their money! I'm sorry that you were led to think otherwise from my post. The problem here is that there are times when you just can't press a pause button while you phone the owner to get consent and discuss charges - sometimes things just have to be done and decisions have to be made there and then - can the bleeding dog's owner afford the extra £50 for Haemaccel? Who cares, the dog has to get it anyway, the owner's going to have to afford it - a vet has to make that judgement and not waste time contacting owners. Fortunately these times are rare, but on the whole nothing is done without discussion and consent.

One point I would raise though is that sometimes it IS a vet's job to worry about what an owner can afford. If we gave every animal the gold-standard treatment we wouldn't have much cash left to run the business - half of our patients would be referred to specialist centres and the rest would leave huge unpaid bills! It's a sad fact that without an NHS for animals, and because our decision-making is client-led, some animals will have salvage procedures instead of repairs (eg amputations instead of external fixation), some will have palliative care instead of specific therapy, and some animals will go with their illnesses undiagnosed.