It’s been more than 20 years since I’ve had a surgery, but when I did, I wanted my surgeon to have a little medical arrogance. You know, the kind of confidence that comes from being really good at surgery and knowing it. It’s not a Marcus Welby world any more. It hasn’t been, not for a long time.
Note to younger readers: Marcus Welby was a kindly family practitioner played on TV by Robert Young. Back in the day when medicine was a kinder, gentler thing and everyone had a family doctor that was less concerned with insurance copayments than taking care of patients.
Back to arrogance. A little bit of arrogance, selectively, is a good thing. If you merit it. At least to me. I’m good with it in a super-competent doc.
What I’m NOT good with is the kind of arrogance that doesn’t allow a practitioner to take in other opinions for the good of the patient. No. I am not good with that, not at all.
And when a veterinarian seems to have that kind of arrogance, well, if it didn’t involve me, I’d laugh. I’m not laughing. I feel like I tumbled through the looking glass.
So here’s the scenario: My dog, Riley, has high blood pressure. It looks like it’s an outgrowth of some kidney issues he was diagnosed with last year. But it’s complicated by the fact that he is kind of high strung. And he does NOT like to have his BP taken. Yes, it’s taken the same way: tiny little cuff. The burning question is this: do we get a realistic BP reading from him or do we get a stressed out, white-coat hypertension reading? Because he’s been on veterinary BP meds twice a day for months and he is still testing high. Which is rather illogical.
The situation is a little complicated. He loves his regular holistic vet a lot. The office has a kind and gentle vibe he’s not afraid of. Last year, based on urine test and high BP his vet there referred him to a nearby specialist in kidney issues, just to make sure she hadn’t missed anything. The internist there, who had a special interest in kidney matters, said at the time that she saw no real reason to treat him for anything. That it wasn’t unusual for middle-aged dogs to begin to display hints of the things we would deal with as they got older. She suggested monitoring his kidney protein levels every six months.
We liked her a lot. She had a common sense approach.
Now, here’s where it gets complicated. My pets and I have had a long history at a now huge, high tech vet practice in the Bay area. To be fair, I started taking a cat there when it was just a small office with a couple vets, but over 30 years it grew into a 26-vet practice with advanced capabilities and an incredible facility. It runs 24/7 and you can actually get an office visit any time of day or night if your vet is working. It also is the biggest vet emergency hospital around. So for Riley’s teeth cleaning this year (which I figured would include extractions) I decided to take him there instead of to his regular vet. If anything bad happened, they would be best equipped to handle it.
Is bigger always better?
In the pre-surgery check, Riley had high blood pressure. His dental surgeon (whom he’d seen regularly a few years ago) got pretty unglued at his reading and was heavy-handed about medicating him after the procedure. So, we did. But at the two-week check, he still measured high. She wanted to put him on a stronger med, a human med. And here’s where it gets iffy:
I remembered the specialty clinic and the vet specialist’s calmer demeanor and different point of view. I also remembered that he was less stressed there and got the lowest BP reading he’d gotten. So I suggested Big Vet Surgeon consult with Specialist Vet. After all, their points of view were very different and I wanted to do what was right for Riley. I certainly did not want to overmedicate him and I wanted Big Vet and Specialist Vet to try to agree on next steps.
Big Vet refused. “She’s only an internist,” she scoffed.
Umm. Specialist Vet’s stated special interest was kidney. She’d given seminars on it. I think I remembered that Big Vet’s special interest on her bio was gerbils. Not kidding.
The conversation was difficult and went round and round. M. heard the whole thing and agreed that she hadn’t heard a word I said and just talk-talk-talked. She did not want to call Specialist Vet. Then she suggested I call Specialist Vet.
Am I a vet?
Seriously? Am I a vet? Should I be carrying information from one vet to another? Is that the silliest thing I’ve ever heard? Was it arrogance that wouldn’t allow her to consult with another vet? The bad kind of arrogance?
By this time in our circular discussion that went absolutely nowhere, I was fairly certain that she was flagging me as a bitchy, uncooperative client. In frustration, I said I’d call Specialist Vet. And I did.
She couldn’t have been nicer. I didn’t share the bad experience but I think she wondered WTF Big Vet didn’t call directly. Why was I, a lay person, trying to figure things out myself?
“I’d sure like to see the latest kidney protein values,” she said, “before weighing in again. And you can bring him in here for a BP reading and I’ll have my nurse hang with him and make friends. We’ll see what we get then.” I told her I would have Big Vet Practice send the labs.
The scenario gets stranger. Big Vet Practice –which is 45 minutes away from us–opened a smaller satellite practice 15 minutes away last year. Riley had gotten a pre-surgery ultrasound there and M said that he was as calm as could be, that he’d fallen in love with the nurse, a beautiful, dread-locked woman, and let her rub his belly during the whole procedure. So, we thought, why not take him to Satellite of Big Vet practice so that Beautiful Nurse could charm him into relaxation for BP. This had been discussed with Big Vet before, so we knew she liked the idea. I called.
I made very clear to the appointment clerk that the appointment was to be with a senior vet there but that Beautiful Nurse was key to the appointment. Without Beautiful Nurse’s presence, there would be no appointment. She promised to discuss this with Beautiful Nurse.
Is anyone listening?
The day before the appointment I had voicemail from Beautiful Nurse. “Big Vet told me you wanted an appointment with me for a BP. I am calling to make the appointment. I am in this afternoon and not again until Saturday.” Beautiful Nurse did not mention the appointment we’d already made for the next day. The one for which the clerk PROMISED she’d talk to Beautiful Nurse.
When I called back, Beautiful Nurse confirmed that no one had spoken to her about the next day’s appointment and that it was not one of her work days.
Why was I surprised?
We had a very nice conversation. I told her the rough outline of the story, said I felt played by Big Vet and that my pet’s best interests were not being served. As much as Riley loved Beautiful Nurse, I would have to think long and hard about whether to return to Big Vet. When I said I knew I’d been flagged as difficult she didn’t say one or another but that kind of confirmed it. I was very nice. I again mentioned that I wanted to do right by my dog and was open to changing meds, but I wanted to be sure it was for a good reason.
I hung up the phone knowing I would not bring him back to either of Big Vet’s offices for next steps. But I didn’t want to burn any bridges because the other closest high tech vet center was two hours away. Why cut off my nose to spite my face?
I was hoping the labs had been sent to Specialist Vet. While they were at it, I asked that all the surgical records be sent to Holistic Vet, his regular vet. I was sorry I hadn’t hightailed it right back to her immediately after dental surgery, but we were heading back there for certain, now.
If you’ve hung in here this long, I thank you. This is the kind of thing I would call my now dead girlfriend to discuss, and since I can’t, well, here you are and here I am.
The never-ending story
It went on and on–I can’t even remember the details now as it’s been so many months. So, here’s where we ended up:
Specialist Vet called to say Big Vet Practice had not sent the requested records and somehow, she and I began to go around a circle. Maybe she was pissed about Big Vet but we got to the point on the call where I burst into tears and said, “What’s lost in this whole thing is that no one gives a shit about my dog but ME. I have absolutely no place to turn!”
Do you know how hard it is for me to cry to a service provider? But I was so frustrated, I cried. Taken aback, Specialist Vet then said to leave things to her. She’d get the records and she did: she had to call a tech she knew there to get them. I got the feeling the Big Vet Practice was not known to be very cooperative with Other Vet Practices. To say the least. Not. Nice. People.
Riley is still on BP meds. We still aren’t getting a true resting BP measurement but he’s doing fine on meds and we’re going to retest his urine protein at the end of September. If it’s better, he might go on a lower dose. As Specialist Vet said, he is on the borderline and we’re being safe.
What’s the moral of the story? I think it’s that Medicine is about Money, even Veterinary Medicine, here in the Bay area. I guess I might have thought that vets had a more caring point of view, but apparently not. It’s a business to them first, foremost and, clearly, to some of them, that’s all it is.
I had a great vet in Tampa. He was a quarter mile from my house. He knew me well, he knew Riley well. When I was a nervous New Puppy Mom I once brought Riley in and Nice Vet met me in the waiting room. “Carol, let me look at him out here. I don’t think there’s a thing wrong with him and I am not going to take your money.” Nothing was wrong, I did not get billed. Nice, nice vet.
I may have made a mistake by not staying with Holistic Clinic during this ordeal. We like our vet there a lot. It did give us pause once, though for them to use “our vets need to have balance in their lives” as a reason for unavailability. Um. Hello? Do I care that your vets have balance? I am buying a service from you, balance is your problem.
Et tu, Brutus?
But that wasn’t my main issue with Holistic Vet: we had quite the go-around with the business office there about the expense of blood pressure measurements, which they billed at $150. For a tech to do. No other service. While specialist vet did an exam and reading both for $125. When the Holistic Vet tech couldn’t get a good read on our first go around, they wanted me to bring Riley back AND they wanted to bill me again. Can I tell you how many THOUSANDS of dollars I had spent there for our dogs? Can I tell you how shocked I was that they insisted on billing me for this repeat measurement that they couldn’t get the first time? And when I called, the business manager grudgingly said I could bring him back free but for only one try–not 11. Eleven? Where did that come from?
No.Way. Jose. And as much as we love Holistic Vet, this episode left a bad taste in our mouths. And we were thinking of switching back to Big Vet. Until we realized the lay of the land. This seems to be a pattern, though, in our area, and a disturbing one.
We do have another vet recommendation. Right now we’re back at Holistic Clinic with BP follow up by Specialist Clinic. And we’re sure of only one thing: We won’t be going to Big Vet Practice unless we are in an extreme emergency that our closer Vet ER can’t handle.
I get that a medical practice is a business. But I also get that it is a service business. That it involves our fur babies, whom we love a whole lot. And I don’t think it’s asking too much that there be some care, concern, understanding, cooperation and compassion in the practice of veterinary medicine.
But obviously, that is not an opinion also held by these veterinary clinics.