Careful selection of your veterinarian may be the single most important step you can can in helping ensure your pets safety. But beware: internet ratings sites, peer recommendations, and reviews in publications etc. are notoriously unreliable as indicators of patient safety, as they often end up being "popularity contests."
Don't pick a name out of the yellow pages; don't pick a vet simply because of proximity or cost. We recommend the following steps:
1. Recommendations from trusted friends. This is a good place to start, but must be followed by an investigation on your part. When you evaluate recommendations from friends, the longer the relationship with the veterinarian, the more reliable the recommendation. In particular, has the veterinarian helped your recommending friend through end of life or old age issues with one or more pets? A veterinarian's candor and commitment are often most apparent during the senior years of a pets life -- and certain are most critical at that time. Can your friend think of instances in which the vet dealt sensitively and honestly with difficult news or choices? Has this veterinarian been candid and honest about admitting his failings and limitations? Is the practice forthcoming and open with records, etc? There is no such thing as a vet so perfect that no mistake will ever be made. There are, however, huge qualitative and ethical differences among vets, and long-time clients are best able to speak to those issues.
2. Check with the State Veterinary Board for Discliplinary Record. Once you have recommendations in hand, file a FOIA request with the State Board of Veterinary Medical Examiners to obtain the veterinarian's disciplinary record. We recommend eliminating ANY vet with ANY disciplinary record. Why? Because all State Boards dismiss the majority of consumer complaints without action. If action was taken, the complaint likely contained very disturbing information that you will never get to see. You should assume that if a disciplinary action exists, the infraction committed by the veterinarian either did, or could have, caused injury to a pet. You will need to "read between the lines" as in many states, the judgments or findings are public record, but the complaints themselves are not. If the vet has findings demonstrating behavior that might have led to the injury of a pet, then it is likely that it did.
3. Look Up the Vet on Consumer Ratings Sites -- Even One Negative Review Indicates a Problem. If there are any negative comments on consumer ratings sites (such as Insider Pages, CitiSearch, Angie's List, Yelp.com, etc) it is likely that there are issues with the practice. Remember -- you should give more weight to one negative review than 10 positive ones. Why? Well, just like Amazon.com, one negative review of a vet tends to lead to a mysterious, uh, coincidental flurry of overwhelmingly positive reviews. Check it out -- were the positive reviews all posted after the negative one? This is how vets (and other businesses) "game" the ratings. A 5-star rating on a site is meaningless -- read all reviews and take any negative review seriously. Also remember -- some review sites will remove a negative review with just one word of complaint from the business reviewed, so again, 5-star ratings are meaningless. What you are looking for on these sites are ANY negative reviews, which indicate a problem.
4. Do Not Give Undue Credence to AAHA Certification or Magazine Ratings. Kindness Animal Hospital had AAHA certification -- that is one reason I went there. Yet look what happened to us. And Marc Katz admitted that at the time Toonces was boarded there, he did not have one single solitary licensed technician on staff. It is in my estimation easy for a vet to "game" AAHA inspections/certification reviews. Furthermore, as pertains to magazine "Best Ofs . . . " and advertising -- remember -- vet that focuses disproportionately on marketing and bolstering his reputation through advertising and enjoining his clients to participate in surveys that enhance his reputation may paying more attention to generating income than to patient care. This is not to say that these things are meaningless -- but rather, they are no guarantee, and should not be given undue weight.
Make clear your desire for informed consent. Some of the most heartbreaking stories I've heard are from pet guardians whose pets died during procedures or treatments that they didn't even know were being performed. In one case, a popular Maryland veterinarian (allegedly) placed a young dog under heavy sedation for a routine knee ex-ray -- and the dog never woke up. Records indicate that the drug given the dog required careful monitoring and the administration of an antidote. To this day, the pets grieving family live with questions about whether the antidote was given properly and in a timely fashion -- for a routine x-ray that, in more patient hands, wouldn't have required heavy sedation at all.
Are you willing to give the vet carte blanche while you pet is in his or her hands, or do you want staff to obtain your permission before each procedure? If the answer lies in between, where do you draw the line? Specifically remember: "Going under" an anesthetic of any kind will always carry risk. We recommend that you demand to be consulted and notified before your pet is anesthetized for any procedure. If your pet will be anesthetized, talk to your vet about the anesthetic options, choosing the safest effective option. And check on your pet.
Ask How Many of Their Veterinary Technicians are Licensed by the State. In most states, like Maryland, it is perfectly legal for a veterinarian to call a staff member a "veterinary technician" even if that person has little or no formal training or licensure. The state trusts the vet to teach the technician the things he or she needs to know to do his or her job, and to supervise the "technician" in accordance with regulations. However, in the reality of day to day business at veterinary hospitals, this is not always done, and the state won't know there is a problem until a tragedy occurs. Then, punitive action may be taken against the vet if a complaint is filed -- but, it will be too late. Your pet may be injured or worse -- dead. Do not blindly trust that those individuals at your vets office with this title have proper medical training. ASK whether or not the practices technicians are certified or licensed. If the answer is "yes," ask to see the licenses -- which should be posted on the premises or readily available. We strongly recommend against enjoining the services of a veterinarian whose practice cannot provide proof of licensed technicians on-staff. If possible, find a practice that explicitly seeks to hire only licensed technicians. While passing the state licensure exam is not an ironclad guarantee that the technician will never make a mistake, it is the only objective, third-party proof you can obtain of medical training. Do not take the vets' word for it. Remember, a veterinary technician is to a veterinary practice as a nurse is to a medical practice: he or she will have a lot of hands-on contact with your pet, which may include administering medications, monitoring status under anesthesia, or other life and death duties. Also, if the vet has only one or two licensed technicians on staff, ask detailed questions about what duties are permitted to be performed by licensed technicians, unlicensed staff/assistants, and which duties the veterinarian will personally supervise and which he or she does not. In asking these questions, you will signal that you are a concerned guardian that intends to monitor the quality of care your pet receives.
Obtain all records, every time you leave the vets. Every time your pet visits the vet, get complete copies of the bloodwork, and any logs kept if your pet stayed there for any length of time. Early on in your relationship with the vet, inspect the records for signs of careful recordkeeping. Are all medications given noted on the logs? Are the initials of the treating staff, or their names, clearly marked? Are the times and amounts of medications noted? Before you leave the office after each visit, review the records, and make sure that important facts are noted -- including symptoms you described to the veterinarian, treatment options discussed, and of course, all vital signs and test results obtained.
We cannot stress strongly enough the importance of continously obtaining records and monitoring them for evidence of careful and detailed recording. If your pet should be harmed due to veterinary incompetence, negligence, etc., you are going to need the records to progress with any complaint -- AND you will need them when you take your pet elsewhere. Very sadly, a number of individuals we have talked to had proof of a vets failure to diagnose a condition, or failure to adequately treat a conditions -- documented in the records. Yet, they failed to get copies of these records AT THE TIME those services were (or were not, as the case often is) rendered. And when they decided they wanted to file a complaint, they found that the records documented conversations that never took place, or diagnoses and treatments that mysteriously were never previously discuss. Sanitization of records is common in these cases. When your testimony disagrees with the records, it is the records that will be believed.
If you need another reason for getting these records at every time, think of this: What happens if the building burns down? What happens if you have to take your pet somewhere in an emergency when your vet is closed? What happens if another Katrina hits -- and comes to your town -- and you need to temporarily relocate with your pet. You will need veterinary care in your temporary home. Having records in your possession can make all the difference in being able to accurately explain your pets health history, and of course, gives you added protection should you ever question the care and diagnoses given to your animal.
As you obtain these records, look them over at the time. This is a valuable tool for continuing to evaluate the quality of your selected vet. For example, if your pet had labwork, identify all values outside of normal range. Did the vet discuss these with you? Are all notes initialed and dated? Are all medicines given documented, including the amount and time they were given? Are observations about the animal noted? Are YOUR comments and remarks to the vet recorded as background for diagnosis?
If the answer is no to any of these questions, your vets practice may not be taking your pets care as seriously as you deserve.
If your pet must stay at the hospital -- In advance, find out which veterinarians will be attending your pet. Make an effort to contact each one of them, and convey your concerns and requests. This may sound demanding but remember: An unwillingness to talk to you is a bad sign. If veterinary technicians will be caring for your animal, find out in advance if these individuals are licensed and certified. Regardless of their licensure status, again, try to speak with each one at the beginning of his or her shift. Obtain status updates on your pets condition at least twice a day. Visit daily if possible, and request an opportunity to visit your pet in the area where he or she is being kept. While there, assess the pets quarters. Are they clean? Is the pet being kept warm and well hydrated? Is there food, vomit, or liquid in the pets quarters? Is the pet's chart readily available? Does it show accurate and well-documented entries? Talk to the technicians on duty. Do they appear to be familiar with your pet, it's condition, and special concerns?
Consider Finding a New Vet if Staff are Habitually Unavailable, Not Forthcoming, or Balk at Your Requests to Visit Your Animal or Be With them During Treatments. While we understand that veterinary hospitals are busy places, and that it is not appropriate for pet guardians to be present during surgeries, or invasive procedures in which the presence of a concerned guardian might actually get in the way. However, for routine things such as exams, blood draws, etc. there is no reason for you not to be able to be with your pet if this is reassuring for your pet -- or for you! Also, you have a right to visit your pet when he or she needs to be in the hospital. If your veterinarian is hesitant to let you visit -- or denies you a visit -- remember -- your pet is a family member. If this were your mother, father, partner, or child, you would raise the roof if they told you that you were not "allowed" to visit. So don't put up with it.
Consider Finding a New Vet if Your Current Vet Wants to Keep you Dumb, Resents Your Intelligent Questions, Web Research, or Participation in Communities Devoted to Disease-Specific Care. The internet is both wondrous and potentially dangerous. There is a lot of good information and some bad information. But it is an invaluable source of emotional support for pet guardians facing chronic or terminal disease in pets. It is also a good research tool -- as long as you "consider the source." You have a right to do research and be an informed advocate for your pet. You have a right to ask questions. You have a right to question protocols. You have a right to learn. If your vet resents your active participation in your pet's care, is threatened or angered when you come in asking questions as a result of research you have done, it is a bad sign. When you challenge your vet, he or she may listen, and consider some of your suggestions, offer to look into alternative approaches, and get back to you. An open-mind is a good sign! However, your vet may instead spend some time explaining to you why the course he has chosen for your pet is the right one, rather than any alternative approach you may have found while doing research. Either of these responses is appropriate. However, it is never appropriate for a veterinarian to dismiss your concerns out of hand or lose patience with you for questioning the choices he is making for your pet. Ultimately, the responsibility is yours. And remember -- so is the money. The vet works for you, not the other way around, so assert yourself when needed -- for the good of your beloved pet.
Above all, even if all of the above "checks out OK" -- if a "little voice" tells you something is amiss, trust the "little voice."
Our friends at Stempy's site (www.stempy.bravehost.com) have developed a checklist to help you screen and evaluate potential veterinarians. You can contact Greg and Cindy Munson through Stempy's site to ask for their suggestions as well.
You can never be too well informed.
