The 10 Commandments of Veterinary Office Visits
By Nancy Kay, DVM
I: Thou shalt push thy veterinarian off her pedestal.
Much to my supervisor’s chagrin, I adamantly refuse to wear a white lab coat. I agree that it would keep my clothing clean and help me stand out as a doctor, but I shun it because I believe it hinders relaxed, open conversation with my clients. (I don’t think dogs are crazy about white coats either.) I’m referring to what is known as the “white coat intimidation factor,” a phenomenon that gives the doctor an air of authority and superiority.When she is on such a “pedestal,” two-way communication
flounders. Medical advocacy requires active client participation, and a client who is intimidated does not feel comfortable voicing an opinion. In most cases, the pedestal on which a veterinarian resides
is a figment of the client’s imagination. I’m delighted that the profession is viewed favorably, but vets truly don’t deserve any extra helpings of adulation. So, before you arrive at the veterinary clinic, prepare yourself to “push” the vet off her pedestal. Remember, this is a simple mind-over-matter endeavor. And, if your vet clings fast to her pedestal, consider choosing a different teammate!
II: Thou shalt be present.
A face-to-face conversation with your vet is invariably more valuable than connecting later via phone or email. Actually being there allows you to view x-rays and see how to administer medication. And, don’t forget, given the choice, your dog would absolutely, positively want you to be by his side!
So, do not ask your mother, your brother, your housekeeper, the kid next door or anyone else to pinch-hit for you.Unless you’ve had recent discussions with your veterinarian to arrange a procedure, if at all possible, avoid simply dropping your dog off at the veterinary hospital in the morning before you go
to work or school. If this is truly necessary, consider arranging a discharge appointment, during which time you and your veterinarian can talk about your dog face-to-face. When a dog is experiencing significant symptoms or is sick, it helps to have all the decision-makers present at the time of
the office visit. If this is difficult to arrange, the person present should take notes, and even consider tape-recording the conversation with the vet. This is useful, since details inevitably get lost in translation—especially when travelling from spouse to spouse! Consider bringing the kids along (unless they will create a significant distraction), as they can be wonderfully uninhibited sources of information and keen observers of their dog’s habits. Lastly, turn your cell phone off before entering the exam room. A client who answers a call while I am discussing her dog’s health isn’t truly “there” with me.
III: Thou shalt let the staff know if thy dog is aggressive.
All dogs are capable of unpredictable behavior. A savvy veterinary staff can usually peg an aggressive pooch within seconds of meeting him. Occasionally, one surprises us and bites—either a member of the staff or the client. Everyone feels terrible, but it’s made far worse when we learn that the client knew it could happen, but failed to warn us. I clearly recall a nasty bite to my hand with no
warning glare or growl to clue me in. As I stood by the sink washing my wound and muttering under my breath, the client had the audacity to inform me that the same thing had happened to the last veterinarian they had seen! I momentarily fantasized about biting her, but showed tremendous
restraint. If your pup has previously growled or attempted to bite in a clinic setting, it is vital that you divulge this information. Trust me, withholding such important information is the quickest, most effective way to alienate yourself from an entire staff, and you will not be welcomed back. The flip side of this coin is that veterinarians have nothing but respect for the client who brings along a muzzle that’s just the right fit. A dog acts out of character in a hospital setting for a number of reasons. Pain, fear, a bad experience or the need to protect their human can all provoke aggression. Fortunately, 80
there are many humane ways to work effectively with an aggressive dog: chemical sedation or muzzling is a reasonable option. Sometimes, simply separating a dog from his human subdues this aggressive tendency. Restraining with brute force (a.k.a. “brutacaine”) is never warranted.
IV: Thou shalt provide information.
The “history” of your dog’s health, past and present, is exceedingly important, more so than many people realize. This often provides more clues for a correct diagnosis than the actual physical examination. Your vet will want to know if you’ve seen any changes in behavior, appetite, thirst or energy. Report any vomiting, diarrhea, coughing, sneezing, decrease in stamina, or change in bladder or bowel habits. Do some sleuthing on the home front.
Medication and Diet
Bring your dog’s current medication to every visit, so drugs and dosages can be confirmed. Your veterinarian will want the name and strength of the drug, not just a description of the tablet. (Many medications come in the form of small, round, blue pills!) All too frequently, we come across a prescription that has been dispensed, or is being administered, incorrectly. And, know the brand name of the food your pup eats. The color of the bag and name of the store where it was purchased simply won’t give your veterinarian adequate information.
Prior Medical Conditions
First-time visitors to a vet clinic should have in hand their dog’s vaccination history as well as any medical records, laboratory test results and x-rays that pertain to prior problems. If your dog’s recent symptoms or medical history are somewhat complex, it helps to see a concise written summary of events. For example, when your dog has had a seizure disorder for the past nine months, providing a
journal of the dates and duration of the seizures might be extremely helpful. By the same token, it is possible to provide too much information. I once received an inch thick log of many months’ worth of a patient’s bowel movements—including weights and lengths (I couldn’t possibly make this stuff up).
V: Thou shalt confess everything.
If your dog has trained you to feed him nothing but table food; if you have been sharing your own prescription medication with your pooch; if he fell out of the back of a pickup truck because he was not properly tethered; even if he has just eaten a plate of marijuana-laden brownies—you must
force yourself to rise above any embarrassment or awkwardness and be truthful with your veterinarian. I once had to confess to a large-animal vet that I’d fed rhododendron trimmings to my goats. Rhododendrons are toxic to goats, causing terrible abdominal distress— something every veterinarian learns in school, but I’d somehow managed to forget. Ingestion requires immediate
and specific therapy, so my confession facilitated my goats’ complete recovery, thank goodness. I still feel a wee bit embarrassed when I cross paths with the vet who saved them. Ah, the things that keep us humble!
VI: Thou shalt pause for confusion.
It is just about impossible to do a reasonable advocacy job if you don’t understand what your vet says. As the saying goes, “What we don’t understand, we can make mean anything.” Most veterinarians, myself included, lapse into “medical speak” because we are so used to these terms running around
in our heads.We might say to a client,“Ruffy is in renal failure and needs aggressive diuresis,” instead of,“Ruffy’s kidneys aren’t functioning properly, and we can help him by giving him intravenous
fluids.”We need you to stop us in our tracks when we confuse you. If you are a “visual learner,” ask your vet to draw a picture or show you what she is talking about on your dog’s x-rays, lab report or ultrasound images. Remember, always “pause for confusion”—when you don’t understand, stop and
VII: Thou shalt share thy concerns.
Most veterinarians do what they do because they appreciate how much dogs mean to their humans.Who better, then, to empathize with you? To help you, your vet needs you to tell her your particular worries and concerns:
•Are you feeling scared or angry? (Anger is a normal stage of the grief process—many people experience it in response to a dog’s illness.)
•Are financial limitations creating a roadblock?
•Are you convinced your dog has a terminal disease?
•Are you terrified by the thought of anesthetizing your dog because a beloved pet once died unexpectedly while under anesthesia?
•Are you receiving pressure from family or a co-worker to put your dog to sleep, but you don’t think it’s time yet?
Your vet will be better able to understand your reasoning if she knows how you are feeling, and you will receive a much-needed dose of empathy.
It’s never easy discussing financial worries—candor suffers because the subject is often awkward and much too personal. Clients feel guilty and worry about being judged when cost needs to be a factor in medical decisions. Be aware, though, you should discuss this matter up front. Be sure to get an estimate before services are provided so as to avoid any unpleasant surprises.Ask about payment
plans or prioritization of services.Most veterinarians are willing and able to provide reasonable financial options.
VIII: Thou shalt ask questions.
Asking questions is the most resourceful way to be your dog’s medical advocate. In the heat of the moment, when you have received some disconcerting news, a child is tugging at your arm and your dog has just lifted his leg rather too near the veterinarian, it is easy to forget the important questions you were meaning to ask. It pays to write them down beforehand. No doubt you will do some homework and research when you get home, and you will invariably think of more questions you should have asked. No problem. Veterinarians expect clients to call with questions after they’ve had
some time to process and ponder the information they’ve received.
IX: Thou shalt treat the entire staff well.
I get really peeved when I learn that a client, who has been sweet as can be with me, has been abrupt, condescending or rude to one of my staff. Everyone deserves to be treated with equal respect, and, without a doubt, the entire staff will know if this has not been the case! Likewise, a client who has been respectful and gracious will have the “red carpet” rolled out the next time she visits.
X: Thou shalt always come away with a plan.
What do I mean by this? It is this simple: Every time you talk with your veterinarian, be sure you know exactly when and how you will next communicate. Consider the following examples:
•Your six-year-old Norwegian Elkhound has just had his annual checkup, and, much to your delight, everything is completely normal. The “plan” is to bring him back in one year for his next “annual.”
•Your three-year-old Chihuahua-Jack Russell Terrier mix has just been evaluated for coughing, and prescribed an antibiotic and cough suppressant. The “plan” is to call the hospital in one week to report whether or not the cough has fully resolved. If not, chest x-rays and a blood test will be scheduled.
•Your Golden Retriever puppy has a heart murmur. Ultrasound reveals a problem with the mitral valve in his heart. Future prognosis is uncertain. The “plan” is to repeat the ultrasound in six months, or sooner if coughing or decreased stamina is observed.
•Your Terrier mutt just had surgery to remove bladder stones.At the time he is discharged from the hospital, the “plan” is to feed him a special diet to prevent stone reformation, return in two weeks for removal of the stitches, and schedule a two-month follow-up to recheck a urine sample.
Vets often fail to provide clear follow-up recommendations, and well-intentioned clients often fail to comply with them. Do your best to solidify the “plan” and put it in writing. You’ll be glad you did.