To the Heart of the Matter

To me this is the saddest of cases!

A very nice man brought his 8 year old, female spayed, King Charles Spaniel to our practice. The history was that he previously lost a King Charles to cardiac issues, a problem that commonly effects this breed.  That experienced devastated him and he vowed to do everything in his power to avoid cardiac issues in this next dog if at all possible.

We had been providing care for this dog for a number of years and early on the veterinarian heard an innocent systolic click when listening to the heart.  It was mentioned and this client  sought a cardiac consult and an echocardiogram immediately and spend upwards of $400 on that evaluation annually by a cardiologist.  All was well.  He wanted the best for his baby and he went to any lengths to provide that.

We recommended dentistry for his dog and this brought up a whole host of fears about anesthesia. He was afraid he may lose his dog.  We tried to assure him that with frequent professional care, we could provide the shortest and ultimately safest anesthetic experiences for his sweet baby.  We showed him how we have state-of-the-art monitors and that we have a dedicated anesthetist for the procedure.

He said he would consider this carefully.  

What he did, in an attempt to safe guard his beloved was to seek a second opinion.  He went to another practice.  They witnessed his concern and they offered to provide anesthesia-free dentistry and told him that that would be ultimately safest.  He provided this level of care for his dog twice.  The second time, they told him that they got most of the work done but that Nala was not allowing all of it.

Fast forward to a couple weeks ago.  This client came in for his annual exam.  He related to our veterinarian that his baby was dropping food and was eating very carefully.  This very compliant, gentle dog allowed us to show him that there were multiple mobile teeth and that his baby needed to have a deep cleaning and full mouth radiographs.  

Once we anesthetized this patient and obtained a full set of diagnostic X-rays, we identified 27 teeth that we needed to be extracted because of either greater than 50% bone loss or tooth root abscessation.  This man was horrified.  The work was provided and the pet is doing wonderfully.

What breaks my heart is that this man wanted the best for his dog.  He was not stingy with his money in relation to this dog.  He was misled that providing anesthesia-free dentistry would provide the same care for the dog as we would provide with the aid and expense of anesthesia.  In the long run, this King Charles Spaniel experienced long term periodontal infection and we know that that can negatively affect the heart...the organ he was so worried about in the first place.

"I didn't say they could extract THAT MANY TEETH!"

Sorry it has taken me a while to post the next blog.  Right after I posted the first, I was in the midst of a whirl wind pet sitting for a dear friend, speaking to a class of sophomore and junior high school students, speaking at Rau Animal Hospital's  client education seminar and preparing to travel to Las Vegas to present at the Western States Veterinary Conference.  The wind has settled and I have poured a cup of coffee to sit and catch up with you.  Can I refill your cup before we chat?

I had the opportunity to speak to a large group of technicians while in Las Vegas about developing a thriving dentistry department.  One of the discussions we had concerned dentistry admissions processes and consent forms.  I shared that when I visit practices often I see that the consent form has three selections from which to sign off:

Some look like this:

If further problems are detected while my pet is under anesthesia (initial all that apply)
__________ Do whatever is needed to give my pet a healthy oral cavity, but not limited to tooth extractions.
__________ Do only what is authorized
__________ Please contact me before doing any additional procedures.  if I can not be reached while my pet is under anesthesia then:
                         ___________ Perform whatever procedures are needed
                         ___________ Do only what I have authorized

I would like to challenge this form of consent.  I understand that this is an attempt to handle problems that occur every day in practices across the country.  Our patient is under anesthesia, the mouth is cleaned, charted and all X-rays have been taken.  We now know that there is much more pathology than originally expected.  A call is placed to the pet's guardian and they can not be reached.  This leaves the veterinarian in a quandary and a state of frustration.  Do we do whatever is needed or not?  With this form of consent many feel they have "informed consent" to proceed with therapy and surgery or at least it gives them guidelines and client expectations under which to proceed. 

I also know from having talked to many employing this type of consent, that clients are still disappointed with the bill.  They feel they did not give consent to spend "that much money" and they are shocked at the number of teeth extracted.   And, unfortunately, it is common practice for the receptionist to present the client with the total bill and it is often she/he that has to take the initial heat...in front of all of the other clients.  So, in many cases, the person that has the least amount of dentistry training on staff, the person that was probably not involved at all, the person that has no power to amend the bill, often bears the brunt of the client's disappointment.  And we wonder why practices find it hard to keep wonderful customer service representatives and why some our front line staff members can get surly with our clients!

So, my question is, if we asked these clients; did we meet your expectations, do you think they would say "YES!"  Do you think they are going to be apt to provide the same services next year?  Do you think these clients are going to recommend this experience?