Monday, April 16, 2018

How to Go to the Vet

Pound signs in the shadows.  Art by Kevin Brockbank for Dogs Today.

One of the things every dog owner has to do is go to the vet, but it only takes a few hours of sitting in a waiting room to come to the conclusion that most dog owners do not know how to go the vet, and, as a result, they are paying a lot more money than they need to.

What do you need to know before going to the vet? More than you think!

Here’s a small skein of advice that, if followed, might very well save you thousands of dollars (or pounds) over the life of your dog.
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1.  Know why you are going to the vet.
The average dog needs to see a vet two or three times in his first year in order to get a full array of vaccination shots, but does not need to see a vet for a vaccine ever again. Read that sentence again. The fact that core vaccines last a dog’s lifetime is not new information – it is more than 30 years old – but it is information that the veterinary trade associations are not eager to share with the public because vaccines and health check-ups are the primary source of income for most vets. If you are going to a vet every year for a check-up, an annual teeth cleaning, and vaccine boosters (other than for rabies, if you are in the US or mainland Europe) simply because you got a card in the mail saying it is time for these procedure, then you are simply being ripped off. What about leptospirosis – the one vaccine that wears off after a year or so? What about it? This is a “non-core” vaccine that is nearly useless, is more dangerous than any other vaccine offered up by a vet, and which provides only imperfect protection against a very uncommon problem. My own dogs have spent many lifetimes ratting and going in and out of dens of every type, and I do not bother with a lepto vaccine. My advice, if you want something to worry about, is to forget lepto and focus on socks lying about the house, stray pills that have fallen off the medicine cabinet, and antifreeze in puddles. They are far more likely to kill a dog – even a dedicated ratting dog -- than leptospirosis!

2.  Be wary of new vet clinics that have just acquired expensive new equipment.
Veterinary clinics are like everyone else – they want the latest and greatest new piece of equipment, regardless of whether they need it or not. The problem for dog owners is that once a vet gets expensive new equipment, the pressure is on to use it – whether it’s necessary or not. A simple country vet is going to be able to handle 98 per cent of all your problems, and for the more complicated stuff, you are going to want to see a specialist anyway.

3.  Don’t confuse the relationship.
Your vet is not your friend – he or she is simply a person being paid to do a service. Of course, some vets would like to blur that fact, knowing that if they can position themselves as your friend then you may come to see them more often, you will respond to check-up postcards more often, and you are less likely to push back when medically unnecessary goods and services are suggested.

4.  Receptionists and nurses can bill pad.
While a vet may have ethical qualms about pushing unneeded goods and services, they rarely feel any compunction in having the receptionist or nurse do this bit of dirty work. In fact, the job description of these employees may require them to push nail trims, grooming, ‘specialty’ foods, flea and tick medications, and unnecessary medical tests. Do not be shy about being very clear you are not interested in such add-ons, and do not hesitate to pull out a pen and cross out such additions on your prospective bill.

5.  Know something about the problem or procedure before you go.
If your dog has a health problem, spend some time on the Internet doing a bit of research. Some problems, such as ringworm, can be fixed with over-the-counter topical medications, while other problems may have multiple solutions and your vet may have a financial incentive only to offer the most expensive. The more you know going in, the better armed you will be as an advocate for your dog and yourself.

6.  Avoid junk-billing and upcoding.
What’s junk billing? Annual vaccines are junk billing, and so too are tests for Lyme disease in asymptomatic dogs. What’s upcoding? It’s simply taking a modest health issue or incidence and inflating it into a big bill. For example, after a routine spay-neuter, does your vet want to keep the dog overnight? Why? Is someone going to be at the vet’s surgery all night long? In most cases, the answer is ‘no’. Your dog will do just as well - and get much better monitoring - if he or she simply comes home with you and spends the night in a crate.

7.  Every limp and lump is not a cause for panic.
Go to any emergency vet on a weekend, and you are sure to find several people in the waiting room who have come in for expensive care for very minor problems. But every limp and lump is not a cause for panic. Most canine limps are caused by the same thing as most human limps – a pulled or strained muscle that will self-correct with rest and time. As for lumps, most are simple cysts or non-malignant tumours – no reason to rush to an emergency vet on a weekend.

8.  Ask for a prescription for a generic medication, and buy that medication at a pharmacy.
Many of the medications we give our dogs were made for humans, many are available in generic form, and most can be acquired for very little cost from your local pharmacy. If your vet will not write a prescription or charges extra for it, change vets and tell them why!

9.  Know how to say “no” and be prepared to say it.
The more you know about your dog’s health, the better prepared you will be to have a sensible discussion, and the more empowered you will feel when it’s time to say “no”. Of course, pushing back is easier said that done! The trick, I find, is to know how to push back. If the vet is pushing a new round of vaccines on your adult dog, tell him you have read Ron Schulz’s work on vaccines (he is a world authority) and surely the vet knows that vaccines in adult dogs that have gotten all their puppy shots are not needed? You may be surprised at how quickly those vaccine charges wither away after that!   Teeth cleaning? Sure, but not every year – once every three or four years after the age of five. An overnight stay? Why does he think his surgery will provide more attentive care than you will at home? Other tests are recommended? Why does he think they are necessary?   Really?  And what will happen differently based on what he/she finds.  Is the test actually more expensive than the treatement which otherwise causes no harm?  In fact, that is often the case, especially if the vet is asking you to come for a test for something like worms ($90 or more just for the visit), while treatment is less than a dollar with over-the-counter medications that do the dog no harm.

Of course, all of this advice is predicated on the fact that you have not acquired a dog that is a complete and utter health wreck, requiring constant attention for a chronic problem.

Vets, of course, do not see such animals as problems, but as business opportunities.

In the world of veterinary care, the breathing problems of Bulldogs, the eye problems of Pugs, the cancer problems in Bernese Mountain Dogs, the wrecked hips of German Shepherds, and the collapsing hearts of Cavalier King Charles Spaniels, are what help put a new wing on the house.

No wonder, then, that in half a lifetime of going to vet clinics, I have yet to see a pamphlet on diseased, defective, and deformed breeds to avoid.

Where’s the money in that advice?

This article appeared in the November 2011 issue of Dogs Today.
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5 comments:

Mary Paddock said...

I was very fortunate to have a vet clue me into the facts concerning annual vaccinations some years ago.

Interestingly, when I had my 12 year old German Shepherd (since passed on) in for an ear infection back in 2010, a young vet from this same office asked me if Sol's vaccinations were up to date. The proper answer to this question to this question was "yes" and probably would have been the end of it. Foolishly I replied that we didn't feel that vaccinations were appropriate at his age and that he'd had all the shots he would ever need some years before. He proceeded to give me a dirty look and explained how he could still contract diseases at his elderly age. I thanked him and let it go at that. 'Was relieved when he left the practice and I could go back to just dealing with the vets who'd taught me this and other useful facts that saved us a number of unnecessary trips to the vet's office.

Simba said...

The most recent vet I saw was not exactly known for holding his tongue on the breed of dog you got. "Where did you get her and can you take her back?"

He also did The Talk on breeds to avoid when people were getting a new dog. Bulldogs were definitely mentioned, can't remember what else.

Buenzlihund said...

If only prospective bills were to be had in this country. I have been trying to get straight forward answers to very basic cost inquiries from vets here. At best you get a verbal answer and those have never been the actual amount on the bill afterwards.
More than once I havr been told that I can not get a quote even for something as simple as a vaccination or a wormer or such but that I'd have to actually show up at the office so they can have a look at the dog first.
We have a long way to go before even getting close to the american habit and it will be long because customers feel intimidated by vets and fear they could not get service if they "act up".
Currently without a vet for my dog, I take a somewhat fatalistic stance: if he needs a vet it will most likely be an emergency. In the case of a life or death situation, any vet will do if as near-by as possible and available that very moment. In every other case there will be enough time to do vet-shopping and possibly even go across the border.

Jennifer said...

On point #1. Yes, ok for many vaccines. NOT for rabies. The Rabies Challenge, specifically set up to challenge the frequency with which rabies vaccination is needed, report as follows from their testing results so far: "Our conclusion from studies with the initial rabies vaccine is that the immunity conferred by that product, and assessed by the in vitro RFFIT, was excellent for the first three years, but declined during the fourth year, and continued to drop during the fifth year. The second vaccine group, which is now seven years from vaccination, have and are providing the definitive data.". Ie, lifetime immunity not yet demonstrated. Further testing might show the memory response still gives reliable immunity after 3+ years, but these are slow, expensive, and somewhat cruel tests (some dogs may get rabies and have to be put down).
And of course, there are legal reasons to stick to the 3 year schedule for rabies vaccination.

Robert Pryor said...

This article is so true.