When should you seek a specialist for your pet? Just as with your own medical health concerns, you want what is best for your pet in the realm of veterinary care. As pet owners we all recognize, whether the owner is part of the lay public and or a veterinarian themself, we want veterinary health care to be appropriate to the situation and costs to be as reasonable as possible. There is always a balance being sought between the concepts of the health status of the pet, the pet’s social status in the family, financial budgets, age and other confounding health issues of the pet, the emotional costs to us as owners and families, and what may be achievable expectations. Obtaining a specific diagnosis allows a better understanding of the prognosis (medical expectations) for a specific pet in a specific medical situation. There are times however, when having an exact diagnosis might help refine the prognosis but ultimately not change it. So when should your pet’s health care extend beyond that of your general veterinary practitioner, your pet’s “regular vet”? As veterinary internists and oncologists at AVIM&O, we know effectively, establishing the prognosis and “how” a problem will be managed are often of greater importance than the diagnosis as the client sees the situation. Obtaining a specific diagnosis has the goals to allow for more specific treatment selection, clearer estimate of prognosis, and in some cases, increased comfort for the pet. But, obtaining a diagnosis at times provides a huge comfort to owners in “knowing who the (medical) enemy is” and what it is that they are making major medical decisions about. Many clients have felt and said that “knowing it was [cancer, or untreatable]” gave them comfort in hard decisions. In some cases, this can be an answer arrived at quickly, albeit filled with emotion. At other times, there is more difficulty in knowing “what is the right thing to do” for your companion. Anecdotally, I would say that about 1/3 of my referral clients are content with a second opinion, finding confirmation in what their referring veterinarian has told them. About 1/3 of my clients will opt for another one or two diagnostic tools, specific to the situation or referral, just to have a better understanding about what they are making decisions. And about 1/3 of clients who have been referred to me with their pets want to go further and proceed one or two days at a time while making decisions as information emerges. Of our clients referred to a veterinary referral center, it is a relatively small number who have the resources or intention of being “all in”, proceeding aggressively to what is fully available, from the get-go. Referral , or “Specialty”, veterinary medicine is available in almost all geographic areas now. Internists, cardiologists, oncologists, orthopedic surgeons, neurosurgeons, ophthalmologists, soft tissue surgeons, … are all well represented in veterinary medicine. A specialist is identified by definition of state veterinary practice acts (the rule by which the professions legally operate), identified by the American Veterinary Medical Association and American Animal Hospital Association, the “specialty” professional colleges for each group, and by what should be the “norms” of professional ethical conduct. There are general veterinary practitioners who are very good at some area of special interest. And there are some who may, conversely, be weak in other areas. The same holds true for “Specialists” in veterinary medicine. Having the “certificate” that defines you as a specialist does not always make someone “good” at what they do. But it is a guide, a standard, and a basis for the general public to have some level of trust and understanding that they are getting a specialist level of care. We all know that saying “you are good at something and being good at it” can be two separate issues. But, what defines a certified specialist? To be a specialist in veterinary medicine requires undergraduate university degree (4 years usually), a doctor of veterinary medicine degree (4 years), usually 1-3 years of internships or general practice experience, then three years of residency training, and finally, passing a very difficult certification examination. A certified veterinary specialist is then able to use the word “specialist”. Otherwise, a special interest is an “area of interest” or “practice limited to an area of interest in …”. My point is that there has to be some guide post from which to start your search for a higher level of care for your pet. I believe that in recent years, there no longer exists an animosity or hesitance for clients (or veterinarians) in requesting “second opinions”. As a client, seeking the best information for your pet, there is no reason to fear “hurting Doc’s feelings.” It is a normal part of human and veterinary medicine in a world of expanding capabilities and explosion of knowledge. So, who defines this status of specialty certification? American Veterinary Medical Association The colleges for each specialty group State Boards of Veterinary Medicine and veterinary practice acts for each state AVMA Principles of Veterinary Medical Ethics is a published ethical guideline as to when to present the option to a client about referral to a specialist: The needs of the patients come first Honesty and integrity are to be exemplified – not misrepresenting your own credentials Veterinarians who havent the experience or equipment to manage and treat certain emergencies in the best manner, should advise the client that more qualified or specialized services are available elsewhere and offer to expedite referral to those services if requested The veterinarian-client-patient relationship (VCPR) is the basis for interaction among veterinarians, their clients, and their patients. The referral veterinarian (specialist) who provides the requested (by the owner) veterinary services. A new VCPR is established. The referring and referral veterinarians must communicate as feasible. Attending veterinarians should honor client’s requests for referral and becomes the referring veterinarian. Referral (receiving) veterinarians may choose to accept or decline clients and patients from public and the attending veterinarians as not every veterinarian, patient, client relationship is a good fit for all. Patients are usually referred because of specific medical problems or specific services that are needed, or a second opinion is sought. Referral (specialist) veterinarians should provide services or treatments relative to the referred conditions, and they should communicate with the referring veterinarians and clients if other services or treatments are required. (sometimes the situation is not what it was thought to be for the pet) When a client seeks professional services or opinions from a different veterinarian without a referral, a new VCPR is still established with the new attending veterinarian (in this case the specialist, but it could be another general practitioner as well). When contacted, the veterinarian who was formerly involved in the diagnosis, care, and treatment of the patient should communicate with the new attending veterinarian as if the patient and client had been referred. AAHA Referral Guidelines AAHA is the American Animal Hospital Association and a voluntary program to provide evidence of quality practices and facilities. Discussing and offering referral to specialists is part of providing the highest quality of care for patients Enhancing teamwork among veterinary professionals The referring veterinarian should: Be aware of the specialty services available in their geographic area . A referral should be made in a “timely” manner, based upon the patient’s condition and those resources that optimize patient care and requests of the client A general practitioner and client should consider a referral when there are any of the following: a need for additional expertise and/or advanced training a need for additional equipment or services to provide further diagnostic testing or care an inconclusive diagnosis an unresolved or worsening medical condition a need for medical supervision (24 hours/7 days/week) client dissatisfaction with the progress of the case Further considerations of ongoing professionalism, appropriate follow-up medical care, considerations for communications in complicated situations, all lead to consideration of “what comes after” the initial referral. The degree of expectations for continued involvement of specialists with cases varies with the time interval since previous contact, complexity of the case, monitoring and treatments, and geographic distances. Options are given to owner and expectations or thoughts of the range of results and medical of values are extended to the best of what is possible in an often subjective, uncertain, and changing situation!
Posted on: Mon, 11 Nov 2013 19:41:23 +0000
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