How much testing is required?

By August 27, 2019Uncategorized

Where are we going with veterinary medicine? The following topic is quite controversial but you should read this!

It is the beginning of the week and I just finished an appointment with a young dog that was coughing. The cough was a few times per day, dry, not very severe. The dog was happy, ate well. Examination showed that the dog had normal body temperature, coughed only once very superficially – more like clearing the throat. The lungs and heart were normal upon examination. As always we did a thorough examination of the entire body.

The owner had told us that she brings her dog to a daycare facility where they had cases of Kennel Cough in the past week. This dog started to cough on the weekend. Like Whooping Cough in Kindergarten, this dog probably got infected by his mates.

Her dog was vaccinated with kennel cough vaccine, which protects from Bordetella (one of the organisms that causes Kennel Cough), but the protection is not 100% and a mild and short episode of coughing can happen in vaccinated dogs.

On Sunday, the owner was a quite worried and took her dog to a 24 hour emergency clinic. There she was presented with an estimate for a thorough workup. The estimate included bloodwork, bacteriology testing, x-rays of the lungs, ultrasound and the total fee was exceeding easily $1000.00. The client didn’t feel this was right.

Veterinary medicine can be expensive. No doubt. But …

I have serious concerns with this estimate. Where these tests all really required? Veterinarians are trained in school to collect objective data by testing and the make a diagnosis based on the evidence collected. With a clear diagnosis, treatment is then most successful.

My question although remains: Is a workup for $1000.00 really required for a mild case of Kennel Cough? Why would a veterinary colleague suggest every available test for every case? Is the motivation just to avoid litigation, if the assumed diagnosis is not correct? Yes, we veterinarians are sometimes accused of not diagnosing correctly etc. Litigation is terrible and being called in front of the College of Veterinarians for a complaint is a horrifying experience for us practitioners. But really?

Or, is it inexperience of the colleague? Most emergency doctors are highly trained and very experienced.

Or is there other motivation to suggest to the client an expensive (and in my personal professional judgment) not necessary testing. Yes, in my judgment, the suggested tests were not justified. They were not wrong, but unnecessary.

Where are we going with veterinary medicine? Do we have to rely only on the most expensive and technology heavy diagnostics to diagnose a mild upper respiratory infection? I understand, if this dog had severe debilitating cough, or chronic painful cough, the recommended tests would have had more justification – yes, they would possibly be very important.

I always ask myself: What would a family practitioner in human medicine do with a child that has a mild cough? Most of the time the patient will recover with little medicine and no further testing.

I certainly believe that a good physical examination, good judgment, good history taking are most important. Every experienced doctor knows that. Testing is important too, but not always and not every available test.

The dog that I just saw went home and we did not take any test – because it wasn’t necessary.

If you find yourself in situation where sophisticated procedures have been proposed and you don’t feel that you want to do them all right away, please call us. We will gladly give you a second opinion.

We veterinarians at the Animal Hospital of Unionville are here for you. Let’s keep veterinary medicine reasonable.

 

 

 

 

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