Always call your veterinary if any medical emergency occurs or in the slightest doubt as to your pet’s condition.
This information sheet is designed to help non-veterinary people evaluate the health of cats and dogs. Its not a comprehensive guide and will not give you all the answers. Also, its not meant to replace veterinary care or advice.
Dr. Arnold Plotnick, D.V.M.
Therapy by Referral
A veterinarian’s average day brings moments of joy and sorrow, satisfaction and frustration. It’s joyous to examine healthy puppies and kittens and to diagnose and treat illnesses successfully. It’s depressing to have to tell clients bad news. When it comes to frustration, however, nothing beats having to look a client in the eye and say, “I don’t know.” Fortunately, someone else may know.
More and more general-practice veterinarians are referring their complicated cases and uncommon conditions to specialists, where high-tech diagnostic procedures such as endoscopy, ultrasound, spinal taps and myelograms are handled routinely, and magnetic resonance imaging (MRI), computed tomography (CT) scans and radiation therapy may be performed, as well. Since specialists see more of these cases than do “GPs,” they are better able to expedite their diagnosis and treatment.
Practitioners may also refer a client to a specialty practice if the animal patient would benefit from intensive care facilities. Occasionally a seriously ill pet may need cardiovascular, respiratory or other type of 24-hour monitoring. Around-the-clock fluids, oxygen, nutritional support or frequent medications are examples of services that a 24-hour referral center can provide.
Some veterinarians may perceive that clients seeking second opinions are dissatisfied with their performance. This is usually not the case. It is prudent for any pet owner, when faced with a complex diagnosis or a guarded prognosis, to want a second opinion. Veterinarians who recommend specialists for a second opinion may actually prevent the loss of clients who might otherwise seek second opinions from nearby general practitioners. Specialists will discuss a case only with the referring veterinarian and will send the client back to the primary veterinarian upon completion of the evaluation. The use of a specialist for a second opinion demonstrates that the veterinarian only has the animal’s best interest at heart.
As a matter of fact, in today’s litigious society, the risk of incurring a malpractice suit for not seeking the services of a specialist is becoming a reality. Courts recognize a duty on the part of physicians to refer complex medical cases to specialists, and though this is an uncommon reason for veterinary malpractice suits, the American Veterinary Medical Association guidelines state that practitioners who are unable to adequately diagnose a condition or to treat an animal appropriately “should make the client aware of other diagnostic or treatment options.”
Before 1950, there were relatively few specialized veterinary practices, and referral services were rarely used. During the ’60s and ’70s, the use of specialists expanded, although they were available mostly at academic institutions. Over the last 20 years, however, the training of clinical specialists has grown dramatically, and there are now 6,979 specialists registered with the American Board of Veterinary Specialties. Specialists can be found in private referral practices, research facilities, and even in some general practices, in addition to universities.
A referred case is a form of continuing education. Discussing a case with a specialist while it’s being worked up is more educational than most formal continuing-ed seminars, and is much more informative than trying to muddle through a difficult clinical case on your own.
Clients must be informed that there’s a significant cost associated with a trip to a specialty practice. High-tech equipment is expensive to purchase and costly to maintain, and numerous highly trained personnel are required to operate the equipment effectively and communicate with the client and with the referring veterinarian. A visit to a specialist can easily run into the thousands of dollars.
Veterinary specialists have much to offer the general practitioner and the client. Perhaps the greatest benefit of referral—for everyone involved—is the satisfaction of knowing that everything possible is being done for the patient.