A Practical Guide to Picking the Best Veterinarian for your Pet
By Arbutus West, on Monday, October 17th, 2016
It is natural to want “the best” when we seek professional advice. Whether you are picking a plumber or a surgeon for your grandmother’s hip operation, we like to feel like we made an informed choice and are getting value for our money. When it comes to health care, we also want results! No one ever tells their friends “I got the third best surgeon in the city for granny; her office hours were really convenient and she seemed nice… so Grandma will probably be ok…”.
Of course the same is true when picking a veterinarian for your pet. There is one thing that makes vets different from other professionals though is that the patient (your pet) is different from the decision maker and bill payer (you). You have to trust your vet to be competent, ethical and honest while having absolutely no meaningful way to assess what they are doing.
Are those xrays correctly positioned and are the power settings appropriate to the body region? When your veterinarian does surgery on your pet, how much do you know about their suture choice and its effect on pain after? Do you know if they use a $7 suture that is smooth and comfortable, or a $0.2 suture that causes irritation and makes your pet chew at their incision? How does your vet make that choice? They can use a drug that is $10/ml for induction of anesthesia or one that costs $0.40/ml and raises your pet’s chance of anesthetic complications 10 times. Do you know how much training the nurse monitoring anesthetics has? Is there anyone monitoring the anesthetic? Is that drug for kidney failure that the vet prescriber really the latest and most effective treatment, or is it something that is out of date by 15 years?
The point I’m trying to illustrate is that a client rarely has any idea whether they are getting value for their money, or where their veterinarian ranks compared to others in terms of competency. Just like when you’re grandma is in for hip surgery, you have no idea if the surgeon’s hands are shaking because his last 3 patient died. So why do you trust veterinarians? Or dentists, or doctors for that matter?
The answer is: professional license! People assume that in order to become a licensed professional a person has to pass a rigorous selection process (barriers to entry like getting into medical school and passing licensing exams) and that quality controls exist (hospital review boards, professional boards and colleges, even continuing education requirements). Here is where things get weird with veterinarians… We do have strict barriers to entry; veterinary programs are very competitive to get into, usually competitive than medicine, law or dentistry. Students have to dedicate years and often hundreds of thousands of dollars to gain their veterinary education. However, there are ways to circumvent these barriers. Due to international agreements, individuals who trained in other countries and other systems can also get licensed as veterinarians without necessarily going through the same barriers to entry, but this is a complicated manner that I will have to cover another time.
The bigger break from the norm is quality controls. Human hospitals are typically large institutions, funded and regulated by the government. What goes on inside of them is subject to regulation at many levels: federal, state/province, and professional body (like the Canadian Medical Association and the College of Physicians) as well as internal controls like outcome monitoring, internal review boards and morbidity and mortality rounds.
Veterinary clinics or hospitals (the term is interchangeable in our profession) are small businesses typically owned by one or more veterinarian who works in them. These doctors are people like you and me. Like all small business owners their priorities are:
- Don’t go bankrupt
- Don’t have a nervous breakdown
Unlike most small businesses as doctors we have a third priority which typically conflicts with the first two:
- Practice your profession in an ethical and conscientious manner AND make sure everyone who works for you does the same.
There are no external oversight committees or governing bodies concerning themselves with day to day operations. Every state and province has a board or college of veterinarians who are meant to regulate the profession, but this happens in the broadest possible terms and they do not get involved in individual clinics’ or doctors’ affairs unless a complaint is filed by a client. This is important, because the patient (your pet) and the client (you) are not the same in our profession, unlike most others.
You can probably see what I’m getting at. No one has any real idea of what happens in a veterinary hospital except the people who work there, and none of them has any control over it except the owner(s). So here is the important thing: THE PRACTICE OWNER’S PERSONAL ETHICS ARE THE SINGLE MOST IMPORTANT DETERMINANT OF THE CULTURE OF THAT PRACTICE. I could end this article here. Because that is the crux of this problem: when you entrust your pet to a vet, you are entrusting them to the personal ethics of the person who runs the facility. Individual veterinarians MAY have some say in what happens, but typically the only vote they get is the one they cast with their feet, and we all need a job.
The College of Veterinarians of BC explicitly does NOT regulate how veterinarians practice their profession on a day to day basis. Neither does any other state board or college that I am aware of in North America. They do respond to client complaints, but just like most malpractice suits in human medicine, these overwhelmingly result from poor communication not poor medicine. Ergo, poor medicine goes unpunished if the doctor has good communication skills.
So how do YOU pick which veterinarian to go to for your pet’s health care needs? According to the only study I’ve seen on the subject roughly 65-70% of people pick the vet closes to where they live. Convenience and geographic proximity is probably the single worst way to pick a doctor. Most people will spend more time shopping around for a $100 kitchen knife or a $350 jacket than for a veterinarian with whom you’ll likely spend $5,000-$10,000 over the lifetime of your cat or dog.
What about the remaining 30-35%? The advice of a friend/acquaintance/person at the dog park makes up most of the rest of this number. We trust the members of our community and following their advice makes us feel safe so it is a natural thing to do. However, the most common comment you will hear is “Dr. X is so nice, she really cares about Fluffy, you should go to her”. Please note THIS IS A MEANINGLESS RECCOMENDATION. Building relationships, developing trust and getting clients to like you is an important skill for a veterinarian, there are whole units in vet school on “client relations”.
Building a relationship with your clients is one of the most rewarding parts of being a veterinarian in general practice but… Bernie Madoff made billions because he could make people trust him, no matter how clever or careful they were. Frank Abagnale, the inspiration for “catch me if you can” spent 11 months impersonating a pediatrician because people trusted him since he was “so nice”, and his patients couldn’t ask questions (vets often get compared to pediatricians for this reason, and because both of our patients tend to bite).
Personally, I would rather trust the slightly odd doctor who talks funny, has trouble making eye contact and can recite entire medical texts to someone relatable with a warm smile who hasn’t opened a textbook in 2 decades. This goes double for a veterinary doctor! A good rule of thumb here is to remember: veterinarians are people who passed up a lucrative career in medicine, law and commerce to express anal glands, wrangle angry cats and get kicked by horses. Most of us are going to be a little odd. Many of us are genuinely warm and caring people who love helping those around us, but this should never be the sole thing that recommends us to our clients!
Out of the hundreds of new clients that I welcome to my clinics every year, maybe one or two actually ask to see the clinic and talk to me before bringing their pet in. That’s roughly 0.2% by my estimate and it makes me so very happy to have a chance to talk to them, show the facility, and introduce them to my staff. I think “here are some really clever people who want the best for their pet”, but even then I find these wonderful, caring, conscientious people who have taken time out of their day to make sure they pick the best possible health care facility for their animal family member rarely actually ask the right questions. Questions that will really help them determine whether the person before them is a reliable professional or a fraud.
So what are the right questions to ask? In part two of this post I’ll provide you with some practical and simple questions to ask as well as things to look for when you look around a veterinary clinic that will help you assess whether this is the kind of place where your pet will get the best care they deserve.
DISCLAIMER: The opinions expressed in this article are mine and mine alone. Some people will disagree with them, some of them may not be wrong to do so. This is based on my personal experience, having spent my entire adult life in the veterinary profession as a student, doctor, researcher, educator and practice owner, and is not free of personal bias. However, it is a sincere and honest attempt to educate members of the public such as yourself and give you the tools to make sure the veterinarian you pick to care for your pet is the right person for you. Feel free to skip the introduction and go straight to the numbered points if you want a quick guide, but I hope you will find the rest of this article interesting as well.