Thursday, April 21, 2016

Reasonable Expectations: Discussion of All Options Regardless of Cost

by Nancy Kay, DVM 

Veterinarians wear many different hats when they are in the exam room. It’s a given they provide medical care for their patients. But did you realize that, for their clients they often assume the role of social worker, calendar planner, grief counselor, and even mediator when there are conflicting opinions between family members (mostly spouses)?

Why on earth some veterinarians wish to also become financial planners for their clients is beyond me! 

These are vets who pick and choose which medical and surgical options to discuss based on what they think their clients can afford.

I don’t work this way- I believe in presenting every option that is reasonable for my patient and then letting my client determine what they can and cannot afford. This means that my client will hear all the same options whether he or she arrives at my hospital driving a Mercedes Benz sports car or a jalopy. The American Animal Hospital Association agrees with my modus operandi- they conducted a study documenting that ninety percent of people want their vets to present every option regardless of cost.

Please hear what this is saying: it is perfectly reasonable for you to expect discussion of all options for your precious family member regardless of cost!

Let’s consider the example of a torn cruciate ligament.

The knee joint contains cruciate ligaments that are responsible for keeping the upper leg bone (femur) in alignment with the lower leg bone (tibia). Cruciate ligament tears commonly occur in large breed dogs and there are several options for treating this injury. The least expensive option is rest and anti-inflammatory medications, the cost of which might be a few hundred dollars over the course of a several months. This nonsurgical least expensive approach restores mobility and use of the leg, but predictably results in arthritis within the knee and chronic lameness.

The most expensive option is one of two highly specialized surgical techniques (referred to as TPLO and TTA) performed by board certified veterinary surgical specialists. Such surgery is the very best bet for restoring complete lifelong soundness to the knee. Depending on where the dog lives (everything is more expensive in California!) the cost for this surgery is $3,000-$4,000. Tack on post-operative rehabilitation therapy (on an underwater treadmill) and add another $500-$1,000 to your bill.

The “in between options” include various surgical procedures that many general practitioners perform. While they are less expensive ($1,000 to $2,000) such surgery is less likely to result in an arthritis-free knee. Treatment of cruciate ligament disease is a clear example of, “You get what you pay for.”

Now there are a number of factors to consider when determining the best treatment option for a torn cruciate ligament. 

Perhaps the dog is ancient and debilitated and the risk for general anesthesia and surgery is too great. Perhaps there are other medical issues that are likely to be life ending soon- in this situation it would be irresponsible to choose surgery.

There are many factors to consider, and finances may be one of them. 

But how would you feel if discussion of medical therapy for your dog’s cruciate ligament tear was purposefully withheld because your vet assumed you could afford surgery? Likewise, what if there was no discussion of referral to a surgical specialist because your vet felt it would be too much of a financial stretch for you?

Do you want your veterinarian to be your financial planner or would you prefer to hear about all the options, then decide for yourself? 

Let me know how you feel about this. By the way, it might be wise to let your own veterinarian know as well!


Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at, local bookstores, and your favorite online book seller.

Did you get your copy of Speaking for Spot yet?

If not, go get the book. It's likely the most important dog book you'll ever read.

What about Your Dog's Best Health? If it isn't on your bookshelf yet, you ought to add it to your must-have books. This books contains information about what is reasonable to expect from your veterinarian Such as round-the-clock care, written cost estimates and much more.

Do you know what you should be able to expect from your vet?

Articles by Dr. Kay:
Reasonable Expectations: The Ability to Discuss Your Internet Research With Your Vet
Finding Dr. Wonderful And Your Mutt's Mayo Clinic: Getting Started
Even The Best Veterinarian Can Make A Mistake
A Different Way to Spay
Making Tough Medical Decisions For Your Dog: Lily's Story
If You Don't Know What A Lick Granuloma Is, Count Your Blessings!
Anesthesia-Free Dental Cleaning 
Talking Teeth 
Urinary Accidents
I Can't Believe He Ate That! Foreign Body Ingestion 
What Caused Murphy's And Ruska'sPneumothorax?
The Whole Picture: When The Test Results Don't Match What's In Front Of You 
Stop that Scratching
Veterinarians And Vaccines: A Slow Learning Curve
What is a Veterinary Specialist? 
Veterinary Specialists: Oncologist 
Veterinary Specialists: Cardiologist 
Veterinary Specialists: Internist 
Veterinary Specialists: Neurologist
Veterinary Specialists: Surgeons
Nutritional Management of Canine Epilepsy
Have a Miniature Schnauzer? Know about Sick Sinus Syndrome (SSS)
Puddles: Potential Health Hazard for Your Dog
What Is Glomerular Disease?
Leaky Dogs: A Primer on Urinary Incontinence  
Eight Tips for Coping With Your Dog’s Age-Related Hearing Loss
Gut Feelings and Second Opinions  
Reasonable Expectations: Access to Round-the-Clock Care 

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