"Is Your Veterinarian Being Honest With You?"

Dr. John Hallett

Sometimes, my dad would lecture me and my brother about something my brother did wrong, and I would interrupt to say, "But dad, I didn't do it." Dad didn't like interruptions, especially when he was on a roll sharing his life lessons with his captive audience. Dad would scowl at me and say, "Son, if the shoe fits, wear it!" I was insulted that I had to sit through a lecture when my brother was the one who left the dirty dishes in the sink or tracked mud in the house. Dad was trying to say, "if this doesn't apply to you, then just listen anyway."

Last week, there was a 20/20 episode on ABC asking "Is Your Veterinarian Being Honest With You?" Many veterinarians are insulted by the episode and are angry that our profession is being accused of cheating pet owners.  I, however, have decided to take my dad's advice because "the shoe doesn't fit."

I realize that a small number of veterinarians do things that are dishonest or unethical or just outdated. I agree with 20/20 that pet owners should be educated and involved in their pet's care, and they should ask questions.  The veterinary community is not highly regulated, and there is wide variation in the level of care offered in different facilities. 

Let's look at some of the points made in the 20/20 piece.

Recommending services to boost the clinic's income:

I believe that a veterinarian can and should make a profit by practicing good medicine, educating pet owners, involving owners in the decision making process, and by charging appropriately for what is done. Veterinarians do not have to resort to selling unnecessary vaccines or procedures just to make money.  Not every client is going to follow every recommendation, but when they leave my office, they will be educated and involved.

Two areas cited by 20/20 are dentistry and lumps:

Dentistry:

I do my best to do a complete oral exam on awake dogs and cats. It is hard. They move, they lick me, some try to bite, and none will tell me that a particular tooth aches. I try to predict when a pet needs a dental cleaning under anesthesia based on what I see in the exam room. The problem is that I often miss problems that only become apparent once the pet is anesthetized because that allows me to probe the gum line and look closely at all the teeth. We are constantly reminded that 60% of the tooth is hidden below the gum line and only becomes visible when dental radiographs (X-rays) are done. Dental radiographs can't be done without general anesthesia in pets. We also have to balance the cost of labwork, monitoring, and safe anesthesia with the need for dental work. I wouldn't cut corners to save a few dollars with my own pet, and I won't with my patients either.  I do my best to recommend dental cleaning and evaluation under anesthesia before teeth need to be extracted, but I can't always do that based on my oral exam in an awake patient. I rarely recommend annual dental cleaning and never based on age alone, but if I see gingivitis, a crevice between calculus buildup and the gum, a gingival mass, or if I smell bad breath, then I will recommend a procedure. For more information on veterinary dentistry, watch this 3 minute video from our practice.

It is interesting to note that one of the dogs that 20/20 argued did not need dental cleaning did have an oral mass clearly visible next to the upper left premolar. That mass should be removed under general anesthesia and submitted for biopsy. Hopefully, it is benign, but some oral masses can destroy bone in the jaw (or worse).

That brings me to lumps and tumors: 

My oncology professor taught us that you can't tell what a mass is just by feeling it. Masses on the skin and under the skin are easily assessed with a fine needle aspirate using the same size needle we use for vaccines.  If I see fat cells under the microscope, then it is most likely a benign lipoma. Without the needle aspirate, I'm just guessing. Anybody can guess. People pay me for my educated opinion and expect me to make recommendations based on my 23 years of practice experience and the most current information available in the veterinary literature. They pay me to look in the microscope, not to guess.

If an owner tells me that a mass has been there for years and hasn't grown or changed, then I am less likely to suggest an aspirate. I educate the owner, tell them the cost, and let them decide. If the owner chooses to wait and monitor the mass, then that is their educated decision, and I tell them to return if the mass grows rapidly, bleeds, or becomes painful. Sometimes, I see things in the microscope that are clearly cancer or are worrisome, and I recommend removing the mass and sending the tissue in to a pathologist for review. Of course, we discuss cost, risks, and potential benefits with the owners.

I love helping animals, but I do not work for free. I do have staff to pay, expensive equipment, overhead, and personal bills, but those bills do not drive my decisions. Providing excellent care for my patients is always my goal.  I treat all my patients the same way I treat my own pets. Yes, keeping pets healthy can be expensive, but consider that veterinary care is far less expensive than human medical care, even with the Affordable Care Act on the way. I believe the majority of veterinarians are honest, but there are unethical or lazy people in all professions including veterinary medicine.

My advice to pet owners: 

• Ask your veterinarian questions
• Discuss options and potential outcomes
• Ask for articles from reputable sources if you want to learn more
• Get a second opinion from a board certified specialist if needed
• Ask your veterinarian what continuing education they attend or how they stay current

My advice to veterinarians: 

• If the shoe fits, wear it! Otherwise, stop complaining about a TV show and use it to educate your clients.

If you would like to watch the 20/20 episode, click here.