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What's your threshold for saying "no" to a vet bill?

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    What's your threshold for saying "no" to a vet bill?

    I am strongly considering ending my 20-year relationship with my vet over this issue, but before I pull the plug, I wanted to poll all of you "smarter than me" folks.

    So, I have used this vet for quite a long time. He owns the practice and is the sole vet there, but it's a full-scale practice, with full surgery capabilities, in-house testing, etc. I like him because he's obviously very knowledgeable, thorough, and he takes his own calls after hours; you pretty much have 24/7 access to him if needed. However, he seems quite expensive. If I take my animals in for anything other than annual checkups/vaccs, he ends up wanting to do every diagnostic test imaginable, including x-rays, and the next thing I know, I have a huge bill for what seems like overkill for the original presenting problem.

    Case in point (and the visit which put me over the edge): A few weeks ago, my 8-month old lab mix came down with a case of diarrhea. It started on a Monday night, 6-8 liquid-stool events a day. I immediately switched her off dog food to bland meals of boiled chicken and white rice plus a Tbsp of pumpkin, 2x/day, and started her on some wormer. I observed each and every stool, they were never bloody or oddly colored. Her behavior remained completely normal all week, same (high) energy level, never lost her appetite, continued drinking normally, no pain anywhere (and I palpated her all over a few times). When it didn't clear up after 4 days, I finally made an appointment to have her checked.

    I was very clear with the vet tech when I scheduled the appointment, reporting her normal behaviors, no pain, etc.; literally the only thing "off" about her was this persistent, non-bloody diarrhea. So the vet took her inside for an exam and handed me an estimate bill for everything he wanted to do to rule out all possible causes. Full blood workup (including thyroid), x-rays, anti-nausea meds, injection antibiotic + take-home meds, two courses of wormer, pro-biotics to add to her food for the next month, plus a week's worth of prescription canned food.

    His proposed bill was just under $1200. For a case of diarrhea in an otherwise-healthy dog.

    I told him no, there was no way I could do that. (I mean I COULD have, I do maintain emergency funds for this sort of thing, but I was not willing to deplete a big chunk of that for what did not feel like an emergency of that magnitude quite yet.) So he ended up just giving me the meds, with advice that we would have to do all the diagnostics if she wasn't better within a week. I opted out of the canned food (which would have been $75 alone) to continue with the chicken and rice diet; the bill still ended up being over $400.

    So I ended up withholding food from her entirely for 24 hours (on vet's advice). I skipped the wormer (since I had already given her wormer earlier in the week), I did give the antibiotics. I gave her 2 small meals on Saturday (with added pro-biotics), and Sunday morning she pooped-- a normal, formed stool. And she has been normal ever since. That was a month ago.

    I appreciate that the vet is thorough, but at what point is it overkill?? I feel like there were a lot of options that could have been explored before immediately going to $$$$ diagnostics, which is ALWAYS this vet's first-line plan of action.

    So I am genuinely asking-- am I nuts here? I feel enormously guilty considering dumping this vet, and part of me feels like a bad dog owner to place limits on my dogs' medical needs. And maybe this is true of all good vets, in which case I may need to just suck it up.

    Thoughts?

    *friend of bar.ka

    "Evidently, I am an unrepentant b*tch, possible trouble maker, and all around super villian"

    #2
    IMO, you're definitely not nuts

    I love my vet clinic and my usual vet because they are very practical and realistic. They are very explicit about presenting the minimal, recommended and top-of-the-line levels of care and I've never felt any judgement for not choosing to do every diagnostic possible. In fact, they recently advised me to hold off on a diagnostic because it wouldn't necessarily be definitive and therefore not really worth doing.

    I believe good vets are worth their weight in gold and vets like yours give good vets a bad rap. Pressuring someone into $1200 of diagnostics for diarrhea is crazy IMO

    Comment


      #3
      This isn't the issue of the *bill* it's an issue with the diagnostic/treatment plan. For that treatment plan, the bill is probably fine.

      But I don't know why you would check the thyroid on an 8 month old puppy for what appears to be GI related. Not sure, either, why you would do an xray since it doesn't appear to be a blockage.

      I would expect a fecal test for giardia; maybe some sort of way to rule out Parvo....but I wouldn't move on to the next parts until those were done.

      Comment


        #4
        I totally understand your concern - at least they gave you the options upfront, instead of doing it all and surprising you later!

        This is one reason I love my vet - he knows I'm aggressive and want to do everything possible, but he sits me down and says "we start here. If this doesn't work, we go here. And then if that doesn't work, we can . . ." He's also very good at telling me, "We can do this and that. If neither of those work, we have this option. Here are the risks and here's how often it's effective. It will cost X." The honesty is always appreciated.

        No, I don't think you're nuts. But I'd be wary of cutting ties with a clinic that is so full-service. Maybe just a chat with him?

        Comment


          #5
          Originally posted by Alex and Bodie's Mom View Post
          This is one reason I love my vet - he knows I'm aggressive and want to do everything possible, but he sits me down and says "we start here. If this doesn't work, we go here. And then if that doesn't work, we can . . ." He's also very good at telling me, "We can do this and that. If neither of those work, we have this option. Here are the risks and here's how often it's effective. It will cost X." The honesty is always appreciated.
          Totally agree, and this is what I expect too. Give me a game plan and options. There's a whole lot between "nothing" and "everything including the kitchen sink"!

          Was this clinic like this before covid, or is this a covid thing? You say they took her inside...owners sit in the car, and then the vet calls or talks to you when they bring the dog back out? Maybe this whole "here is everything" is a result of having very limited time with you, so they want to present all possibilities, and they just did a really bad job of explaining that not everything had to happen *right now*?

          Comment


            #6
            You are not a bad pet owner, just more realistic and practical. Maybe that is part of being a horse person.

            I had much the same experience with my constipated kitty a couple of months ago. We have had several bouts of impaction over the years, and after the last one a new vet in the practice wanted to switch form daily Mira lax to Benafiber. The experiment did not work and she was soon impacted. I was told by the practice they would not be able to see her for several days and to take her to the emergency vet.

            After a 3 hour wait in a hot parking lot, we were presented with an estimate of $1500 - $1700. We were stunned and finally said "give us the cat". We expected we would pay for exam, sedation, x-rays, enemas and fluids etc., but not for every diagnostic test under the sun. We compromised with fluids and take home meds. The bill was $400. We still had an impacted cat, and the bill from the emergency vet was pretty close to we had paid from our regular vet to treat the problem. I understood that there would be higher charges from the ER vet, but they did not listen to us that we needed to treat the problem in front of us - not go to the ends of the earth to find out why.

            We took her home, overnighted an order for enemas from Chewy (the same type vet had used in the past), and gave her gentle water enemas to help soften until meds arrived. It was messy, took a little longer, but we all survived and she has been lively, and normal ever since. This will be our new mode of dealing with another bout, if one occurs. Like you, I did not want to deplete the emergency fund on a problem that could have been solved fairly simply. The horse will find a way to use it soon enough.

            That was a bad experience that made me wonder about this new practice. If only my wonderful old vet had not retired and sold the practice. I am not sure if my philosophy dovetails with the new group. I too am looking around.

            Comment


              #7
              I'm kinda ???? with what you did not come away with from your vetting that would have made you unhappy? All possibilities outlined and explained. You chose some and explained why you couldn't do all (or at least not at that time) seems vet was ok and prescribed what you wanted out of that list of possibles. 20 years with them? (him/her) Could it have been at all that he / she knows you well, and wanted all outlined because you're a well informed and involved animal owner and they knew you'd want the full scoop ? I dunno....i'd have been happy with the full suggestions and my respected involvement to begin somewhere I felt best---seems to me you got that?
              ayrabz
              "Indecision may or may not be my problem"
              --Jimmy Buffett

              Comment


                #8
                I get it..I don't like when my vet's office goes from zero to everything all at once. Luckily, only one vet in the practice does this, and the others are more practical--"Let's start with X and Y, and depending on the results, the next step would be either Z or A and B." I'm totally OK with that. The one vet who tends to go to "Let's do Y, Y, Z, A, B and just to be sure, C and W too," I don't like. He also seems to resent that I'm fairly educated and also research things thoroughly, and likes to "mansplain" things that I already understand. The other vets are fine with the fact that I understand things (I was a biology major), because we can have a real conversation, and I'm realistic about outcomes. I don't mind a combination of "We can start with X and Y for $$ and then go from there" and "Well, we could do all of this for $$$$" as long as they're both presented as choices and explained as to why the difference and is the first approach safe. IMO, they should outline options, tell the client what each option is for, and help the client decide based on their budget, understanding of their own pet, and comfort level with various treatments, not try to intimidate the client into something they're not comfortable with for any of those reasons.

                Comment

                  Original Poster

                  #9
                  Originally posted by Simkie View Post


                  Was this clinic like this before covid, or is this a covid thing? You say they took her inside...owners sit in the car, and then the vet calls or talks to you when they bring the dog back out? Maybe this whole "here is everything" is a result of having very limited time with you, so they want to present all possibilities, and they just did a really bad job of explaining that not everything had to happen *right now*?
                  He's always been like this, even pre-COVID. A few years ago I got divorced and kept all our pets, when I went in for our next visit I told him my situation and that I was going to have to be careful on funds since I was down to one income; that was when he started giving me estimate bills before any procedures. But his approach has always been "throw every test but the kitchen sink" at it. If I take a pet in with any sort of ailment, full bloodwork is automatic ($300ish) and almost always X-rays ($300ish) as well. Year-old cat acting lethargic? X-rays. Older dog showing beginning signs of dementia? X-rays. Young dog with diarrhea? X-rays.

                  This was the first time in 20 years with him that I put my foot down and said "no" to his full TX plan. And while he was not exactly rude about it, this is also the first time in all my years of taking pets there that I did not get a follow-up call the next day to see how my pet was doing. I have a feeling I've been put on the "bad owner" list.
                  *friend of bar.ka

                  "Evidently, I am an unrepentant b*tch, possible trouble maker, and all around super villian"

                  Comment

                    Original Poster

                    #10
                    Originally posted by ayrabz View Post
                    I'm kinda ???? with what you did not come away with from your vetting that would have made you unhappy? All possibilities outlined and explained. You chose some and explained why you couldn't do all (or at least not at that time) seems vet was ok and prescribed what you wanted out of that list of possibles. 20 years with them? (him/her) Could it have been at all that he / she knows you well, and wanted all outlined because you're a well informed and involved animal owner and they knew you'd want the full scoop ? I dunno....i'd have been happy with the full suggestions and my respected involvement to begin somewhere I felt best---seems to me you got that?
                    This is why I'm on the fence... On one hand I appreciate that he has the capacity to be thorough within his practice, but his explanation isn't, "here are the various options," it's presented to me as, "here's what we need to do."

                    And in this particular case with diarrhea puppy, I did bring along a stool sample. I mean if you're going to do ONE test, I would assume you would at the very least want to start there, and it's a cheap test ($30). When I said "no" to the diagnostics, he took the fecal off the plan as well, even though I had given them a sample! (I ended up having to call them back and ask for the fecal to be done; it was negative.)
                    *friend of bar.ka

                    "Evidently, I am an unrepentant b*tch, possible trouble maker, and all around super villian"

                    Comment


                      #11
                      Have you accumulated a reputation over the course of many years and many pets that you want the kitchen sink approach? I think many owner-operator or small-staff clinics learn their clients over the years and customize their approach according to that history. I would talk to your vet, maybe at an annual checkup but definitely outside of an urgent treatment situation, and tell him your expectations or even your budget.

                      I expect I receive a certain kind of care plan/case management as a client with many years and multiple pets who participates in sports, feeds raw, has intact animals, etc. I bet my vet has observed over the long haul that I am thorough but always start with the conservative approach. The client coming in after me may also be bringing in a 7yo intact male herding breed but may receive a very different plan, even for the same issue.

                      I think that's actually a good thing. You started saying pretty favorable things about your vet. I would talk to him before aborting the practice. Maybe also call around to other similar practices to check prices for annual exams, HW, vaccs, rads and see if this vet really is more expensive.

                      Comment


                        #12
                        I was trying to somewhat ask the same thing Bicoastal was...if you feel its a matter of him knowing you for that many years of treating your animals? But if you feel he's taken advantage of you all these years by always suggesting high costs items no matter what then you've kinda answered your own question. if you feel you're being ripped off, and that is the point of his approach, then I'd walk.
                        ayrabz
                        "Indecision may or may not be my problem"
                        --Jimmy Buffett

                        Comment


                          #13
                          My vet is definitely in the "try the cheaper tests/options first" group. He's an old retired large animal vet who opened what was supposed to be a part-time small animal practice with his vet wife when they retired and moved to TN. Now it's a 6-day a week thing and his wife hardly ever puts in hours. He's used to people having budgets for their animal care, and he wants to make sure they understand what is coming. Part of that (I'm sure) is not wanting to eat a large bill if he pulls out the stops and the owner abandons the animal. But mostly he's just a rational guy who understands how the world works.

                          Personally, I think it's important that you and your vet are on the same page. And Henry, I wouldn't go back to a place that doesn't respect me. This vet will pull out medical texts and make copies for me, and we'll look stuff up on the internet together in his office. He treats me like more than just a wallet.

                          StG

                          Comment


                            #14
                            Communication is the reason why I am starting to look for other options with my current small animal practice. Covid has put even more strain on the problem, but even before many of the vets in the practice went from 0 to the kitchen sink and I would have to slow them down and tease out the solutions. I also like to start with a conservative treatment and then work logically forward. I understand that every client is different in expectations and experience, but I want my vet to listen and react accordingly when I talk with them, rather then have to work hard out of an all or nothing scenario.

                            My kitty ER visit highlighted that my current clinic is now a "throw everything first at the problem" approach, and I would like to move a bit more slowly when it is not a crisis situation. I would compare it to a trainer who does not acknowledge the clients goals or learning styles. I know it takes time and work to build that communication, but if I suspect that no one is listening, or I have to say the same thing over and over then it might be time to move on.

                            My area has a number of clinics that can offer similar services, so for me it it a matter of finding one with an approach I am more comfortable with. If there are fewer options for you then another attempt at establishing how you would like to proceed may be worth the effort. Covid protocols have made it even harder to start with "this is how I would like to proceed". when the tech takes the dog and only after the exam do I get a chance to talk to the vet. So much is lost in translation.

                            Comment


                              #15
                              I think some vets practice defensive medicine.

                              The flip side is the simple approach, that doesn't work and then the angry owner who says why didnt we do all this other stuff sooner.

                              it is a no win situation for many clinics
                              _\\]
                              -- * > hoopoe
                              Procrastinate NOW
                              Introverted Since 1957

                              Comment


                                #16
                                I once had a vet who would always propose the most thorough course of treatment; not because she wanted to blow all my cash, but because she did not want to have a client say “if only I had known about x option”. A responsible pet owner should consider all options, do their research and determine their risk tolerance when selecting the best treatment. And it sounds like you did that very well! If you would like to be able to take your pet to the vet for treatment without all the research, you could try to find a vet who is more well aligned with your perspective. If you stick with your current vet, it’s important to remember that he isn’t telling you what to do, he’s presenting you with all the options to consider. Ask lots of questions about risk and cost for each option and then go with your gut. It’s so hard to makes these decisions for our wonderful pets!

                                Comment


                                  #17
                                  Sorry that's crazy.

                                  But I feel like sensible vets are getting harder to find anymore. Maybe it's fear of litigation. Or social media blasting when things go south. Or insane vet school loan bills coming due. No idea but it's rough out there.

                                  My horse vet now wants to ultrasound everything. Used to be max bute/rest for 4 days, see how he feels on the 6th. Now it's lets ultrasound. Then lets ultrasound a week later. Then let's ultrasound at the 2 week recheck. Everything gets the ultrasound.

                                  I thank the dog gods my old school dog vet hasn't retired yet. I don't know what I will do when that day comes. I suppose avoid going in unless I fear death.

                                  Will say I requested radiographs for my fabric eater pup when he used to have GI issues. But we took pics, oral barium, more pics in the a.m. Never had anything stuck but it was my worst fear with him. Just a couple bucks and priceless piece of mind. No thyroid check though. Weird.

                                  He's still on probiotics so that's good stuff. But the feed store carries them for much less then 400 bucks.

                                  Comment


                                    #18
                                    Originally posted by Weezer View Post
                                    I once had a vet who would always propose the most thorough course of treatment; not because she wanted to blow all my cash, but because she did not want to have a client say “if only I had known about x option”. A responsible pet owner should consider all options, do their research and determine their risk tolerance when selecting the best treatment. And it sounds like you did that very well! If you would like to be able to take your pet to the vet for treatment without all the research, you could try to find a vet who is more well aligned with your perspective. If you stick with your current vet, it’s important to remember that he isn’t telling you what to do, he’s presenting you with all the options to consider. Ask lots of questions about risk and cost for each option and then go with your gut. It’s so hard to makes these decisions for our wonderful pets!
                                    I agree that everyone should be aware of what risk level they’re comfortable with for their pet, but I’m not sure it’s fair to say that responsible pet owners should do their own research. I am not a vet and I can’t presume that my internet research comes anywhere close to a DVM. I go to a vet because I want and need them to explain their assessment find as well as any diagnostic and treatment options - including the benefits and risks of each.

                                    Even if the intent is there, I wish more vets were clear that all of a treatment plan isn’t required. When the vet tells me they want to do A, B, C, D, and E it feels awkward and a bit rude to respond with “Are C and D really necessary?”

                                    Comment


                                      #19
                                      It is a doctor's job to present you with options. Though I agree a thyroid check seems odd. Maybe he has been bitten one time too many by clients getting angry that he didn't go whole hog to start with. Maybe he has been taken to the board. I had a client get angry when I tried to do her a favor and charge slower price for anesthesia. The problem was that the description said "for spay/neuter." And I couldn't change the description. I told her that we aren't doing a spay, but she demanded I take it off. So I charged her full price for surgical anesthesia. The difference was over $100. She took her dog and left. Do I offer the difference any more. No. Just one person can change a doctor's point of view

                                      Comment


                                        #20
                                        I've been through this twice this year and changed vets accordingly. Posted earlier in the Off Course forum.

                                        What I eventually discovered - corporate takeover, retirement funding, or both.

                                        With the small animal vet (about which I didn't post), as of January 1 they went "corporate". There are several (maybe more than several) mega corporations that are buying up small but profitable private clinics to add to their nationwide conglomerate which includes "partnerships" with pet food companies, etc. etc. etc. Often this happens when a senior vet wants to retire and fund his or her retirement so the clinic is sold to the mega corporation which proceeds to do all the nasty stuff like "prescription pet foods" at astronomical prices but with sketchy if not downright dangerous ingredients, and maybe worse things like mandatory over-vaccination and the infamous "wellness packages" which require a pet owner to subscribe - to the tune of $400-$600 a year - on pain of the clinic "refusing to treat new issues if you don't subscribe." And things like multiple diagnostic procedures for the same minor issue - xrays plus ultrasounds plus CAT scans or even MRI (referral to another clinic under the same corporate umbrella at more than a full body human MRI would cost even without insurance.

                                        Similarly in an equine clinic - in my vet clinic's example two senior vets retired December 31 and as of January 1 the usual charges skyrocketed. For example, a farm call charge in their normal range jumped overnight from $50 to $125 for non-emergency calls, and the list goes on. They also push really REALLY hard for more diagnostics than would be indicated in a horse that is pretty darn healthy, albeit with some age, showing zero symptoms of what they claim, rather hysterically and without true bases, is "wrong" with him.

                                        It is easy enough to determine whether a clinic has corporatized, for lack of a better term. Check your state's corporation division business filings and take a publicly available peek at who's running the show.
                                        Surrealism: once an art form. Now indistinguishable from daily life. (Forgot who said that.)

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