How do you feel about large veterinary hospital chains? Do you like them or hate them?
I have always been partial to smaller veterinary clinics. My instinct tells me that corporatization and good care don’t mix—what do big corporations care about more, their profits or the end-user?
One of my veterinary friends has left such a chain specifically for those reasons. My experience with a university hospital resulted in mixed feelings.
After months of not getting anywhere dealing with Cookie’s front leg lameness, it was time to consult with a specialist.
Further information: Example Report for Dog PT: Cookie’s New Lameness
Unfortunately, getting a timely appointment during COVID-19 is anything but easy. Our veterinarian reached out to several places to see whether they’d accept a referral. As it turned out, of all the potential choices, only one hospital takes non-emergency cases and doesn’t have months’ worth of back-log. It does, however, belong under one of the corporate chains.
Making the decision
When I saw that the hospital belongs to one of the large veterinary groups, I was skeptical. It was, however, our only option. Should I take it or leave it? I looked up the specialty veterinarian we would be seeing. He looked competent and caring. And I wanted to get to the bottom of Cookie’s problem once and for all. Great veterinarians can be found at a clinic of any size—I decided to go ahead with the referral appointment.
Large hospital versus small clinics
There are some obvious advantages of large hospitals such as all sorts of fancy equipment, veterinary specialists, and so on. There are, however, big hospitals that don’t belong under any corporate chains—the one we visited does.
As long as a great veterinarian runs them, small clinics remain my preference unless my dog’s needs are beyond their capabilities. That’s what we ran into with Cookie—we needed a specialist.
Communication
Once our local veterinarian initiated the referral process, the hospital communicated well and promptly. After accepting the referral, they contacted me directly to set the appointment. They were forthcoming in accommodating our needs. We didn’t know whether Cookie would need arthroscopy or not, and they don’t do a consultation and surgery on the same day. We booked the consultation, and, because of the distance we had to travel, booked the surgery for the next morning should it come to that. Both parties understood that that may or may not happen.
After the initial contacts, however, reaching anybody in the hospital was impossible. I received instant messages confirming the appointment after it was made and then, closer to the date. The second message also had a feature where I would confirm the appointment.
From our place, it is a seven-hour drive to get there. I wanted to confirm the appointment once again before we’d embark on the journey. Of course, these days, you cannot call any place without encountering the automated system—this one has no option for a live operator. It has a directory, but that is quite dysfunctional. And even after I made it to the correct department, all I could get was voicemail. Nobody called back despite multiple messages. When I reached out via email, eventually, I received a response from one of them.
Things were no different on the day of the appointment or after, even though by then, I finally had extensions for the people I was trying to reach. I could have whispered my concerns into a well with the same result.
The consultation
The impression you get when you enter the hospital is a corporate, mass-production air. Everybody was nice and friendly but rushing about their bit of the process.
However, the specialist didn’t put an unreasonable limit on the length of the consultation—which often happens in many hospitals—the exam and discussion took roughly an hour. I was pleased with that because you cannot arrive at a good diagnosis during a 10-minute appointment.
The veterinarian was thorough, competent, dedicated to a good outcome for Cookie, and frank. He did not make any recommendations for expensive procedures that would be of no benefit for Cookie. After we discussed our observations and his findings, we decided to forego arthroscopy and proceed with cell therapy instead. Cookie was to come in to get it done early the next morning.
Further information: Front Leg Lameness in a Rottweiler: Cookie’s Sore Front Legs
My impression was that the specialist was experienced, knowledgeable, and up-to-date with the latest research. Sometimes, though, when one knows a lot, they come to believe they know all—there is no such thing as knowing all.
The subject of sedation
Depending on the outcome of the consultation, we expected that Cookie would undergo either an arthroscopic procedure or no surgery at all. Arthroscopy meant general anesthesia, and Cookie never had a problem with that before. The cell therapy, however, is done under sedation, and Cookie responded to the standard protocol poorly, to say the least.
As soon as we decided on cell therapy, I brought up the issue Cookie had and how a different veterinarian changed the protocol to accommodate her. The adjusted protocol worked perfectly and caused no problems for Cookie.
Further information: Does Your Vet Listen to You? Cookie’s Post-Sedation Complications
The specialist promised he would contact either Cookie’s local vet or the vet who sedated her successfully to find out what protocol would be best. He had contact for both of them. I even call them both, giving them heads-up that he’ll be seeking that information to prevent any hold-up.
At the same time, I fetched the protocol I wanted used and emailed it.
The day of the treatment
Hubby dropped Cookie off for her procedure early in the morning, hoping to be on their way back home as soon as possible. He, too, gave them the sedation protocol to use.
Cookie was released no sooner than 2 PM, groggy and virtually unable to walk. The procedure went well, and we were told that Cookie might be rather out of it for most of the ride home.
The fallout
Seven hours later, back home, we could barely get Cookie out of the truck and into the house. She needed substantial support, ataxic, and almost unable to walk. Cookie remained that way for 36 hours post-release from the hospital. She couldn’t even change position on her bed without help. When she tried to move, we both had to help her up and around, and her body was spilling from our hands like liquid.
At 3 AM, I left a message with the specialist, explaining that Cookie is in bad shape and asking what sedation protocol they used. Later I left more messages and emailed but didn’t get any response from anybody.
Did they use the adjusted protocol, and Cookie reacted this poorly anyway? Or did they ignore our concerns and went with the standard protocol?
It wasn’t until I got a copy of their records from our local vet when I learned that they indeed used the standard protocol, disregarding our wishes. We further learned from the notes; it wasn’t a mix-up but a conscious decision. They ignored us completely and did not contact anybody to discuss the matter either.
In closing
We did get a diagnosis we were seeking, and Cookie got her treatment. However, many things went wrong that didn’t need to. We needed a specialist to assess Cookie’s lameness, and I still believe it was the right decision. When it comes to that part, the veterinarian knows what he’s doing.
There were no other options available to us within a reasonable time-frame. However, I am furious about other things that took place, the most terrible of which was the sedation decision. Would this happen in a smaller clinic?
The upside is that Cookie is responding to the cell therapy well.
Needless to say, though, that my feeling about large veterinary hospital chains has not improved.
Related articles:
What Makes a Good Veterinarian: Veterinarians Are People First
Further reading:
The corporatization of veterinary medicine
Who is Buying Veterinary Hospitals