Nicole Palumbo, DVM

It’s Sunday afternoon. I am on call and I have three pages to take care of all while working on a laceration repair. The people waiting for me to call them back but must wait until I finish my task at hand because I have an animal under anesthesia and I am the only one there monitoring it. When I call the answering service back, I find out that I now have 4 pages to call back, all with varying degrees of urgency and severity.

The first two emergencies I can easily do by myself, but the last one sounds more critical. When I call them back I explain I think the cat needs to go to an emergency hospital for testing and treatment. The owner is upset because our answering machine says we have a veterinarian available at all times. She believes I should be able to test and treat her pet because we offer on-call services. After explaining what on-call means, and that her cat requires more care than I can provide, she happily takes the number for our local emergency clinic. This happens on a daily basis.

As an on-call veterinarian, I find that both long-term and new clients do not understand what my job entails. Some bang at the front door not realizing I’m not sitting there waiting for emergencies to randomly show up.  Some think I will be able to perform a full workup not realizing that I’m all by myself.

It begs the question, what does your veterinarian provide? Many people don’t ask and don’t really know.  There are several different types of clinics and knowing what kind you go to will help you in case of emergency.

General Practice/No “on-call” or Emergencies:

These clinics typically have set hours from as early in the morning at 6 am to as late as 9 pm. They do not take emergencies after hours and do not have on-call services in case of emergencies. Many of these practices will state on their after-hours phone message where closest emergency clinic is located.

They might still keep pets overnight, with doctors or technicians checking in on patients, but typically do not provide 24-hour care. If they determine your pet needs to be monitored at an emergency clinic it is typically because the animal requires constant monitoring of its vital signs and activity to treat its ailment properly, instead of just being checked on once or twice at night. Most of these practices will have you transfer your critical pet to the emergency clinic for overnight care, and then provide care during the day.   Usually these practices are within minutes of emergency hospitals as well which allows them to easily transfer patients.

On-call practices:

These clinics have a doctor that is “on-call” after hours for questions and simple emergencies. Simple emergencies can be what the veterinarian is comfortable with, ranging from laceration repairs, simple vomiting or diarrhea cases, and occasionally simple assessments to see if the animal needs to go to an emergency clinic. Usually, these doctors work alone or may call in a technician if they need extra help. They are not stationed at the clinic during their on-call night but will take care of any patients in the clinic.

These clinicians may be on call for 48-72 hours straight without any backup. Most will not be able to run lab work, do 24 hour care, or major surgeries. If your pet has been sick for a while or needs a full workup, this isn’t the type of service you require. A single veterinarian without staff cannot provide the best care possible if your pet is in critical condition and pressuring these veterinarians to do so adds extra stress onto them and your pet. If your clinic has on-call services and the doctor determines your pet needs specialized care, take their advice and go to the local emergency clinic.  You wouldn’t want your seizing pet being left alone without someone monitoring it, would you?

24-hour emergency clinic:

These clinics are fully staffed at all times. They will have a veterinarian on the premises seeing patients and taking care of hospitalized pets. They will also be trained in most major emergency surgeries or sometimes will have a second veterinarian on call for emergency surgeries. These clinics will triage patients to take care of more emergent cases, so if your pet is not critical you might have a little bit of a wait.

These clinics are the best for patients that need constant care like seizing pets, diabetics, post-surgical monitoring, and critical medical cases. They will always have support staff on hand to monitor patients and take care of treatments while the veterinarian sees the emergencies. Because these clinics are fully staffed, the prices may be higher than your regular veterinarian. It is their job to help your pet, but you still must take responsibility for your pets’ emergency.

When researching a new clinic or even your current clinic you need to be aware of what they provide and what that means for your pet. This will help you be aware of the limitations of certain clinics versus fully staffed emergency hospitals. If you don’t ask, you won’t know.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

In February of 2014, Dr. Shirley Koshi committed suicide.  I didn’t know her, but she was one of us. I investigated every story written about the situation for the months following her death. I also started looking at the Facebook sites created by “animal activists” that cyber-bullied Dr. Koshi and her practice until she felt like she had no other options. I was horrified to read the stories they put up regarding how and why they were suing their veterinarians.

Most of the stories were very one-sided, but veterinarians were still losing cases. After spending months reading these stories I finally decided to find the good in those awful situations. The majority of those veterinarians who lost their board complaints did so because of poor record-keeping and communication. They weren’t practicing bad medicine, but they got caught in the same trap that a lot of veterinarians do when it comes to board complaints. I didn’t want to become a paranoid veterinarian, but I did want to use that feeling of being under investigation to better myself. These guidelines may seem like common sense, but many veterinarians are still breaking them daily.

1 – Write up records- even if every aspect of the animal was normal, you need to document it.

A thorough veterinary record should not just state: 1-year rabies without any exam findings. They make exam stickers for those who would rather check off “normal” vs. “abnormal.” With digital records, it is even easier to create a complete chart.

2 – Offer multiple treatment plans and document if those plans were rejected.

Don’t be the veterinarian that just offers plan C right off the bat. Give owners options, and document if they reject them. Documentation won’t bite you in the butt later on, but owners complaining that you never offered something will.

3 – Write up plans for when your plans don’t work.

Dermatology cases are ones to keep a close eye on. I always write up when I want the owner to call with an update and thoroughly document my alternative plan if the current one isn’t helping. It also helps if I’m not there for the recheck and another veterinarian is taking over the case.

4 – Write up phone conversations.

Make sure your technicians and receptionists are too. They are a reflection of us and our license is on the line if they do not document properly.

5 – Send take-home instructions with the owner.

These help the owner remember what you discussed in the exam room and allows for clarification of said treatment plans.

6- Know your limitations- offer referrals if your treatments aren’t working.

Don’t be stubborn and continue to treat if the patient is getting worse. Specialists are around for a reason. Use them.

7 – Use the other veterinarians in your practice.

Even if it is to confirm what you are suspecting, having another veterinarian to back up your diagnosis can be super helpful- again, document it.

8 – Be honest with your clients- tell them if you are a 24-hour hospital versus just on-call.

Tell them if their pet will be monitored overnight or not. Tell them if this is the first time doing a particular procedure. Most clients appreciate honesty and it can prevent a lot of anger later on.

9 – Go through medical forms, surgical forms, and consent forms- make sure owners are reading them and understand them.

I’ve had some owners complain that I didn’t catch their dogs’ kidney failure 3 months prior when it was in for a lump removal; only to find out they declined blood work before surgery.

10 – Stay up to date on your medical treatments.

This is a blanket statement since medicine is forever changing. We might hate steroids this month but next month they will be all the rage. But honestly, clients are doing a ton of research these days and will bring up newer procedures that maybe you haven’t bothered to keep up on. Same with vaccines- if you haven’t switched over to three-year protocols (depending on state law) and don’t offer Purevax feline vaccines, you have a target on your back already by most anti-veterinarian websites.

As frustrating as some stories are, there is still a lesson to be learned. We can always do better. Don’t fall into the trap that most veterinarians do when a board complaint pops up. We should never fear a board complaint if our medicine is high quality and we document everything well.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.