Veterinary Care Decisions: The Other Side Of The Coin – The Cost Of Defensive Medicine

You may have heard the phrase “defensive medicine” used during the recent health care debate in the United States. 

Veterinary Care Decisions: The Other Side Of The Coin - The Cost Of Defensive Medicine

Defensive medicine describes the situation where a doctor decides a patient’s care not simply based on what is best for that patient but also considers a perceived need to cover his or her white-coated backside in case things don’t go well.

Defensive medicine is not limited to the human health care system.

Veterinarians often fall into this mindset as well.

Consider the following scenario:

A previously healthy, well-taken-care-of adult dog shows up in the clinic with a relatively mild case of diarrhea. The vet performs a physical exam and uncovers nothing remarkable.

  • the dog is not dehydrated
  • his abdomen feels normal
  • he doesn’t have a fever and
  • he appears to be bright and feeling like himself

The veterinarian will probably want to examine a sample of feces under the microscope to look for parasites or abnormal bacteria. If everything looks good under the microscope, the vet is left with a decision to make.

Option A: The conservative approach

Many dogs with these symptoms have a simple case of gastroenteritis, often because they ate something that they shouldn’t have.

Treating them with a bland diet and a medication to help clear up the diarrhea is a perfectly reasonable approach, even though a definitive diagnosis has not been reached.

Option B: The CYA approach

Gastroenteritis is a strong possibility. However, a long list of other diseases, some of which can be very serious, cannot be ruled out without more diagnostic testing to gather as much information as possible from the outset.

  • blood work
  • urinalysis
  • abdominal x-rays, and other laboratory tests

Which is the correct approach?

Frankly, both options have their pros and cons, and neither is ultimately right or wrong.  The secret to navigating these types of situations is COMMUNICATION.

In a perfect world, veterinarians in these types of situations should describe all the options available to owners, including their risks, benefits, and costs. Then, the owners can then make educated decisions about the right choices for them under their own unique circumstances. 

This is exactly what many veterinarians do, but alas we do not live in a perfect world. 

The key is to have a choice

Some vets get into the habit of routinely offering only “Option B.” 

Should something go wrong, which is a possibility with either option, it is always easier to defend oneself by saying “I did everything I could think of” than “in my judgment, more testing was not necessary.”

So, if you are in a situation where you think that your vet is only giving you “Option B,” speak up. 

Most doctors are perfectly willing to approach a problem differently as long as it doesn’t compromise your dog’s comfort and chances of recovering. 

The trade-off is that you, your dog’s guardian, have to take responsibility for the decisions that you make. 

What if you choose “Option A” and your dog’s condition doesn’t improve? It is time to go back to the vet and move on to “Option B.”

Related articles:
What Makes a Good Veterinarian: Veterinarians Are People First

Further reading:
Effect of client complaints on small animal veterinary internists

  1. I think my vets are pretty good about presenting Option A and Option B at the same time. They never make me feel bad for choosing Option A to start. However, I had a bad experience with an emergency vet would only would present Option B until I signed something that I refused option B and then came back with another option. This went on 3 times and I felt like I was buying a car instead of getting medical treatment for my dog.

  2. After spending 25 years in healthcare, I’m very familiar with defensive medicine – and I’m so glad it’s being talked about in the veterinary field. Informed options are important – and it really requires the pet owner to carefully listen and analyze the choices that best fit their dog’s situation.

  3. I don’t think I’ve ever heard that term, Defensive Medicine. How awful! If my dog was the subject in your hypothetical Vet visit, I’d want to go with Option A and if my dog didn’t improve in a few days I’d go for Option B. You’re right, the important thing is for the pet parent to be given all the options and the chance to decide themselves.
    Love & Biscuits,
    Dogs Luv Us and We Luv Them

  4. The practice I use has multiple vets. One is for sure an option B. I always ask to see the practice owner because he’s more an option A style. I go for a more conservative approach. The CYA style feels like a money grab, I feel that way about most doctors for humans too. With option A you can move to option B if you need to.

  5. Reading this, I am happy to know that we have a great veterinarian that outlines all of our options, allowing us to make the right choice for us and our dogs. In most cases, I will opt for option B simply however there are times when option A make sense. As long as the line of communication remains open between you and your veterinarian so that you can make a shift if need be moving forward.

  6. I tend to go with option B now that my dog is older. That’s what saved her when we found out she had a splenic mass 2 years ago. Interesting article.

    • Absolutely. A splenic mass is an example where aggressive approach is the optimal solution. Same goes for things such as GDV, pyometra and so on.

  7. Luckily, I’ve worked in academic healthcare for my professional career and am proud to say I have not seen a CYA doctor. That is an offense that can run afoul of CMS and JCAHO. However, in veterinary medicine there is not the same type of oversight – that has always been my worry. I believe strongly that there should be an outside oversight agency – the whole DCM issue is an example of where separation is needed.

  8. The practice I use has multiple vets. One is for sure an option B. I always ask to see the practice owner because he’s more an option A style. I go for a more conservative approach. The CYA style feels like a money grab, I feel that way about most doctors for humans too. With option A you can move to option B if you need to.

  9. I’m very lucky with the girls’ veterinarians. They do give me many options and I trust their advice. I’m one of those cat moms who will rush to the vet when one of the girls aren’t “quite right” and the vet will be honest with me about if he/she thinks it’s something serious.

  10. Marjorie Dawson

    We had a vet once who always threw every test at you. In the end I suspect people left because most of the time it was just a money spinner. Our Weasley was kept alive longer than he should have been thanks to them stringing us along. Not all vets are as thoughtful as they seem.

  11. My vet is good at explaining the options. We usually go with plan A and then switch if things don’t get better. Actually the reason that I have stuck with this vet for more than 15 years, is that she is willing to refer me to a specialist when the problem is beyond her expertise. My previous vet never did that unless I asked for a second opinion.

  12. The vets we go to currently are great about offering several options when one of our pets has a health issue. They don’t pressure us to spend money on defensive medicine, but also let us know that it is an option.

  13. Great Post! Yes, I have been to a few different vets with my pups where option A is more of the vets style and a couple that use Option B most of the time.
    I believe there are still a lot of pet owners that just don’t take their pets to the vet because of the very high cost, which is unfortunate for the pet’s health.
    I always keep my dog up to date on their yearly check ups and vaccinations. When a procedure is suggested when they are sick, I always ask the cost and whether it is really necessary or not, and just hope that the vet is being honest with me.
    (From Ava Jaine, Dachshund Station)

  14. When Layla is a bit off for some reason or another I always email my vet to tell them what is going on and if they think it is an emergency then I take her in, less stressful for her. My vet knows I am against medications and will look for the alternative the way I do for myself so we work together as a team and figure it out so that way no one is to blame.

    I feel if you are on the same page with your vet life is so much easier

  15. I was very lucky in the past to have an awesome vet who would always explain all options to me, then help me to make an informed decision. Since we just moved I had to switch vets, and although we visited for our initial meet and greet I’m not sure yet what her approach will be when/if any health issues come up. I feel very strongly about owners being advocates and the voices for their pets, so will always make sure to have an in depth conversation with my vet and fully understand my options before choosing any one course of treatment.

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