Important, or not, or -- ?

July 23, 2010 1:02 PM

I like my vet as an individual professional. Should I be concerned by her corporate office policies, which apparently tie her hands sometimes?

My dog has symptoms that caused the vet to consider that she might have Cushing's disease. Eventually, I agreed to have a test done. This is an expensive test that requires cortisol (sp?) to be specially ordered. The office afterwards called to tell me that they couldn't schedule the test for my dog, because their office wasn't allowed to order it.

American pet owners have probably heard of this chain of vet clinics, which is located inside a chain of big-box pet stores. Why the office couldn't order the test, they couldn't or wouldn't say. The staff told me that they would contact another local chain office, and refer my dog to them for the test. Shortly afterwards, the staff sheepishly told me that it turned out none of the affiliated offices were allowed to order that test. I had to arrange to get it done at an independent clinic.

Everyone - the staff and the vet - was very apologetic about this. But why did it have to be this way? (Money is probably the reason somehow.) And should I feel comfortable going to this vet if some inexplicable directive might occur again? This instance is no emergency, but . . .

posted by Countess Elena to pets & animals (18 answers total)

This sounds really strange. Why would the cost of it be an issue -- presumably they would pass the charge on to you. Have you done any research to find out if the cortisol test is generally in use for determining Cushing's disease? Maybe corporate doesn't allow it because it's not medically indicated for this use?

I'm glad you like your vet, but I have to say that I really avoid the big-box pet retailers. They always rub me the wrong way, whether it's the way they sell animals, the lack of staff knowledge or the general corporate feel. Maybe you can find an independent vet you like as well as you like her.
posted by BlahLaLa at 1:10 PM on July 23, 2010

So, FWIW...I'm work in a clinic and am heading for vet school, and this chain of vet clinic that you speak of (if I am thinking of the same chain, which I am fairly certain that I am) has a reputation for this sort of nonsense. They also have a reputation for overcharging in a major way, and the only thing this particular chain might be useful for is vaccinations. I would find a non-chain clinic that you like, and go with that.

Said chain you speak about, in the opinion of many in the field, is only about profit, and not about the care of the animals. This is opinion, but that doesn't make it invalid. The corporate policies of this clinic are sometimes really borderline unethical. Please, find another clinic...one that is not corporate, and will focus on the needs of your animal and not the profit margin.
posted by bolognius maximus at 1:11 PM on July 23, 2010 [10 favorites]

Here's the simple question. Would you trust your vet to be able to take care of your animal when you need it? Or would you worry that you'd have to take your animal somewhere else?

If it were me, and I was worried that my vet wouldn't be able to take care of my animal, then I'd find a new vet. Especially if the vet knew what to do but was unable to because of something like this. Ignorance is one thing, but knowing what needs to be done and not being able to do it is another.

Really, if this was your kid, would you stay with the doctor or would you go somewhere else?
posted by theichibun at 1:13 PM on July 23, 2010 [1 favorite]

Well, presuming they and the chain's executives are ethical people, there is a set of Veterinary Medical Ethics to adhere to. It's doubtful that an appropriate treatment would be withheld from your pet in an emergency.

They just don't want to pay for an expensive test if there's a risk that they couldn't recoup the costs from you (although one wonders why they just don't ask for payment up front in that particular case).

But regardless ... just as you wouldn't limit yourself to a single doctor to make every single decision ... you should always be prepared to find another vet and/or 24-hour clinic.
posted by Cool Papa Bell at 1:13 PM on July 23, 2010

It could be that they can only work from a list of known/approved tests, and this isn't on it? I say this because I recently underwent some tests for Cushing's at an enormous metropolitan hospital, and there were staff in the blood testing department who had never heard of the tests that had been ordered for me - so, quite possibly a rare test that is therefore not on the pre-approved list.
posted by L'Estrange Fruit at 1:18 PM on July 23, 2010

bolognius, I had heard the same kind of stories, but at the time I picked this vet, I had also heard particularly good reports of this office (plus I had to pick a primary care vet fast for logistical reasons, and they were taking new patients). Nobody has personally disappointed me in the office, but I'm thinking hard about these answers.

BlahLaLa, the vet was up front about the cost, which makes me think that she wasn't aware of the policy and that it's some bean-counting from higher up. The other clinic I talked to saw no problem with scheduling such a test, and the staff person found it strange that I had to make the call.
posted by Countess Elena at 1:19 PM on July 23, 2010

I don't think this bodes will for future care of your dog. Treatment of Cushing's can be fairly intensive and expensive (depending on the cause - surgery, or drugs), so if money is the issue for the test, it seems that would spill over into issues with getting the treatment. It took my family a while to get a firm diagnosis for our dog, and we had very helpful vets with no bureaucratic issues.

A cursory googling shows that the Cortisol test is to rule out Cushing's. They'll need to do other tests to determine if it actually is Cushing's, and what is causing it (a tumor is the most common cause, but there are other potential causes which determine treatment). This is step one in a potentially long process, I'd vote for getting another vet, preferably who has experience dealing with Cushing's diagnosis and treatment.
posted by SugarAndSass at 1:20 PM on July 23, 2010

This is odd. Just last week I had my cat at the vet's and over heard the very phone conversation that you must have had. But my vet isn't a large corporate affiliate, the very opposite, a very small private practice. I also heard the discussion of the vet and vet-tech after phone call.

Apparently Cushing's is rather rare, and the test is very involved, requiring special training and equipment. Your experience may not be the result of corporate policies, sso much as the simply not having the needed resources. Remember, that every vet wishes to be in private practice, and the ones employed by chains are usually recent graduates, fine for almost everything, but without great deal of advanced, and unusual, skills. I wouldn't blame your vet personally for this at all. If the treatments are necessary, she will probably be able to supervise them, and her sympathy and your familiarity with her will be important.
posted by Some1 at 1:29 PM on July 23, 2010

Ignoring the issue of the ethics of patronizing a chain veterinarian and focusing on what's important:

As your dog ages (and especially if it has a chronic illness) this type of issue is going to become more and more likely. Taking the pets to the vet is already enough of a pain in the butt, having to negotiate and travel to get things things done (and then to have to visit a whole different outfit!) just compounds that.

Life's hard enough. Ask your friends for referrals and I bet you can find a good vet that won't be so bound up in red tape. A good vet is reassuring only if they can get your animal the best care, and it sounds like yours is institutionally prevented from doing that. Sorry, that's a real shame.
posted by Mayor Curley at 1:31 PM on July 23, 2010

Just a personal story about our experience with a chain veterinarian:

Our long time vet closed his office. We went looking in advance for a replacement vet for our (then) two dogs, and found one with a banal name nearby, which turned out to be part of a chain of vet shops. And then here is what happened:

1. I had called in advance, several times, to make sure our dogs' records were sent to the new vet before the old vet's office closed. When we arrived for our first annual appointment, which was after the date the old office closed, the chain vet shop had no idea where our dogs' records were. And they never did find them. One of their less experienced employees let slip on a later visit that probably they were destroyed wholesale, with all their other animal records, during a recent reorganization of records.

2. The new vet shop front desk staff refused to allow us to take from the office the signed authorization our vet there gave us for re-supply, from an on line pet medication supplier, of medications one of our dogs took for anxiety. We were required to buy our meds at the vet shop, at inflated prices.

2. One of our dogs developed a tumor near his tail. We took him into the vet shop when we saw it, and met with our (really wonderful) vet who said he felt confident he could operate and remove it. We set a date for the operation and removal.

3. When we came back, the vet seemed very uncomfortable. He said that he wasn't really sure if the tumor was operable, and that he didn't really have the right facilities. He also said he couldn't help us with a referral to a vet who could operate, as it was against the clinic's policy.

4. Our poor dog got sicker and his tumor got larger despite the meds our vet shop vet prescribed. Our vet seemed to be having some trouble meeting our eyes. Then we returned for a visit and the front office staff told us our vet no longer worked there.

5. We moved both our dogs' care to our current entirely wonderful veterinary hospital, which is a solo, non chain operation. The vet shop refused to send our dogs' records from the vet shop treatment to them.

6. We put our dog with the tumor down at the new hospital. They were hugely kind, but it was too late for them to hope to save our dog's life.

In short, run, do not walk, to a good, real, non chain vet shop vet.

Sorry about the sad story. This is not a cheery day on MeFi, is it?
posted by bearwife at 2:16 PM on July 23, 2010 [2 favorites]

Please stay away from Banfield- they are docs in a box. There are those rare gems out there, which it sounds like you have found, but the corporate culture keeps them from doing their job.

Testing, and treating, cushing's is a pretty simple exercise and SHOULD NOT BE THIS HARD.

As for going to other vets as opposed to this vet, well that's up to you. Dogs/cats can't talk and can't advocate for themselves and there are some RDVMs (day practice vets) out there that are REALLY BAD- as in bordering on malpractice. My wife, who was an emergency vet until she started her internal medicine residency, would sometimes mention to me some of the cases transferred to them by the RDVMs in the area. Not so much horror stories or sensationalist, "OMFG, you won't believe what this day clinic did/didn't do."

My point is, if you think you've found a vet who is doing right by you, and your pets, and are happy with the level of competence, stay with them. If they are in this evil corporation, fine, just ask them to be up front with you about anything they find and to recommend someone who can deal with possible issues in a timely/no hassle manner.

If you are near boston (I saw Mass. in your profile) Angell is a FANTASTIC hospital and teaching facility that has every specialty under 1 roof. They also have some of the best veterinarians in the world working for them. The link is to their primary care facility.
posted by TheBones at 2:18 PM on July 23, 2010 [2 favorites]

OK, bearwife, that tears it. I'm going to see if they'll take me on at the other clinic.

I wish I could go to Angell for primary care, TheBones -- they are excellent, very kind at the ER, but too far away for regular trips without a car.

Thanks for the good words, everyone --
posted by Countess Elena at 2:26 PM on July 23, 2010

"There are those rare gems out there," as in the vet, not the clinic. Sorry for the confusion.
posted by TheBones at 2:30 PM on July 23, 2010

Just to speak to the Cushing's issue, the cortisol test isn't unusual (it was the first of many tests my dog had to diagnose his Cushing's), thought it can be a little involved, timing-wise. So it shouldn't be an issue of new, unusual, or experimental testing/medication.

Sounds like too much corporate idiocy running the shop. I hope you can find a good, local, independent vet who can take care of your dog (and you) in a competent and caring manner. And I hope you get the Cushing's diagnosis resolved soon, either way - that whole thing is a major pain in the ass until you know what's going on and can get treatment in place. If you were here in Seattle, I'd drive you and your pet to our vet myself, because I *know* she's got it together!
posted by Lulu's Pink Converse at 2:34 PM on July 23, 2010

I started to write my own tale of woe about dealing with chain vets, but I decided that tonight's too nice a night to bum anyone out -- especially myself. Suffice it to say, my wife and I now go to a local, non-affiliated vet, and we're really happy with them. They don't try to push bogus treatments on us, and their prices are ridiculously cheap compared to the chain -- so much so that we end up donating the difference to their charity work, just because we want to make sure they stay in business. Find yourself a non-chain vet, even if it means you have to drive a little further.
posted by crunchland at 3:12 PM on July 23, 2010

Another vote for non-chain vets here. If you're in Houston, I can't give a higher endorsement than that I have for the Briargrove Animal Clinic on Westheimer. The best way I can describe the great service is "An old-fashioned country vet, in the middle of Houston."

In 2008, my late wife had a nervous breakdown and was in the middle of a week-and-a-half stay in a mental hospital on the other side of town. Mid-week, to keep it short, my dog (167lb St. Bernard) had an injury that required first a trip to the 24-hour emergency vet, and then I had to take him to my normal vet the next morning.

A few days later, Max's wound was healing, but it had caused other problems, and basically one of his hips was shot and he couldn't stand up and walk. The difficult decision was made to put him down. I laid down on the floor next to him and held and petted him while the doctor did what had to be done.

Afterwards, I was pretty torn up. I asked, "I beleive I owe you folks some money." He looked at me and said "Right now, you need to be worrying about yourself and your wife. I'm about to go on vacation for a couple of weeks; why don't you give me a call later this month and we'll worry about settling everything up then."

How many chain vets would do something like that? I'm guessing not many, if any.
posted by mrbill at 5:43 PM on July 23, 2010 [1 favorite]

Cushing's can be dangerous be treating it is simple, if Banfield is giving you this crap about it you really need to excuse yourself and find a new vet. Apologize if you feel you need to, but, really, you can just ask for a copy of his records next time you go and then make an appointment at a new place.

And yeah, Banfield is crushingly oppressive to work for, too. My girlfriend nearly went insane before she found a new job.
posted by InsanePenguin at 4:12 AM on July 24, 2010

Countess Elena, I Memailed you, but I'll post it here as well.

I can't remember where you are in relation to me, but Porter Square Vet just outside of Davis Square in Somerville is a truly fabulous vet office. They have a lot of specialists in particular kinds of animals. I know this because in searching for rabbit vets, it's very hard to find a vet office who has clientele beyond cats and dogs. Porter Square has small animals specialist. I would imagine their dog and cat vets are also highly trained and that some have particular specialties.

I know Angell is expensive, but it may be worth it for the testing. Angell is also really good about working out payment plans.
posted by zizzle at 4:22 AM on July 24, 2010