About 50 percent of the time as we are nearing the end of our business day of appointments, emergencies and procedures, we get an urgent call from an owner desperate to get his/her pet in to be seen. Whether a condition is related to gastrointestinal distress, troubled breathing, dietary indiscretion, or injury, these calls only occasionally have legitimately JUST occurred and vindicate the call just as we are readying to close. Most of the time, however, the condition has been going on for most of the day, for several days, and even for several weeks; and the owner just now at the end of our day decides the the condition warrants urgent attention.
While our first inclination is to is to ask, “Why did you wait to call us 15 minutes before we close when your dog’s vomiting started 5 days ago??!!,” our the well trained front desk staff at my veterinary hospital instead takes down the pertinent information and presents the case to the doctors and technicians on service for guidance in what to advise the client. Vomiting is but one example of these types of calls, but let us use that as an example of considerations for what seems to be a straight forward clinical sign.
Vomiting could be the result of simply dietary indiscretion, for which a simple course of anti-nausea medication, GI protectants, outpatient fluids, and possibly a course of antibiotics may suffice to resolve the issue. It could also be the result of potential deadly diseases such as pancreatitis, ingestion of a foreign body that became obstructed, ingestion of a toxin, infection, kidney failure, liver failure, and cancer (list list could go on indefinitely).
There is also the question of patient stability. Stated patient who has been vomiting for 5 days may now have serious electrolyte imbalances, dehydration, shock and organ compromise, even in cases that had fairly innocent causes for onset. In deciding on our recommendation for this case example, we are faced with the following questions:
1.) How long will it take the owner to get the pet to the hospital?
2.) What kind of work-up are we anticipating? (bloodwork, x-rays, outpatient treatments could take 45 minutes to an hour to turn around)
3.) Is this patient stable enough to realistically treat him at a general practice about to close?
All of this of course needs to be contemplated while technicians and doctors are scrambling to discharge patients from hospitalization or procedures, finishing up the last appointments, breaking down and cleaning medical equipment, sterilizing instruments, and doing a general cleaning of the hospital to prepare the facility for the next day.
While we may feel some frustration at the owner’s discretion in waiting until this time to call us, our concern is first and foremost for the patient. Although we may not be thrilled with our client’s judgement in the moment, we still sympathize that they are worried enough to call us and the alternative to seeing us is being referred to the 24 hour emergency and critical care hospital with vets and techs they are not familiar with and that costs the client a great deal more than work up and treatment at our facility does. In short, we sincerely wish to help both client and patient at these times but it is not always feasible.
In cases that we determine that it is not in the best interests of the patient to come to us dues to foreseeable stability concerns and/or we deem a work-up or potential treatment course to be too time consuming to reasonably get done with our medical team getting ready to leave (some of whom are on the tail end of a 12 hour shift) and we recommend the emergency hospital, some clients understand, while others express anger toward us.
If you are inclined to be the latter in such a circumstance, please understand that you are deflecting your anger at the wrong people. In this case example, the person you should be most angry with is yourself.
Dr. Roger Welton is a practicing veterinarian and well regarded media personality throughout a number of subjects and platforms. In addition to being passionate about integrative veterinary medicine for which he is a nationally renowned expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport. He is president of Maybeck Animal Hospital , runs the successful veterinary/animal health blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care, and fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.