Turn to the ‘Vet’ to protect your pet

3. Does the practice refer patients to specialists?
There are many veterinary specialties, and at some point referral to a specialist or advanced care facility may be necessary for your pet. I’ll be discussing this in much more detail in chapter 4. For example, an animal who needs major surgery may be referred to a surgeon, one with a heart murmur may be referred to a cardiologist, and one with liver disease, kidney failure, or another organ problem may be referred to an internist.

Besides offering expertise in particular areas of medicine, specialty practice groups also provide a heightened level of care. For example, an animal who is very sick or in need of major surgery may be referred to a facility with an intensive care unit (ICU) featuring advanced monitoring capabilities and nursing around the clock.

You want to be sure that your chosen veterinary practice is willing to refer your pet, when it’s in his best interest, to a specialist or advanced care facility. Think of it this way: Referring a patient to a specialist is like passing the ball to someone who is in a better scoring position—an unselfish act for the greater good. You don’t want to be on a team with someone who hogs the ball.

You should be concerned if the practice’s approach is We don’t need to refer, we can do everything here, especially if the practice does not offer a variety of board-certified specialists as well as twenty-four-hour care. This philosophy should make you concerned about your pet’s safety as well as the practice’s priorities.

Questions to ask:
Do you refer critical patients to an advanced care facility? If so, which one?

In what situations do you refer patients to a specialist?

Do you refer patients to specialists for major surgery or advanced diagnostic procedures such as ultrasound?

Do you refer patients who have conditions that are difficult to diagnose or treat to specialists for a second opinion?

4. Are modern anesthetic techniques employed?
I cannot stress strongly enough how important this issue is for your pet. When evaluating whether a practice is using the safest and most current methods of anesthesia, there are three critical factors to look for.

First, find out the type of anesthesia that is used by the practice. The current standard of care is that patients undergoing surgery are anesthetized using one of the modern types of gas anesthesia. Only very brief procedures such as replacing a splint or taking an X-ray should be performed under injectable sedation.

TIP The two modern types of gas anesthesia commonly used by veterinarians are isoflurane and sevoflurane. Halothane, an older gas anesthetic, is not as safe. Do not use a practice that performs surgery without using modern gas anesthesia.

Second, any patient under anesthesia should have an IV catheter in place. During an anesthetic emergency, the catheter is used to quickly deliver potentially lifesaving drugs and fluids. For example, if an animal’s heart rate becomes dangerously low, a drug called atropine can be injected; if her heart stops, a drug called epinephrine can be given; and if her blood pressure drops too low, intravenous fluids and drugs can be delivered to correct this.

Third, patients should be intubated while under anesthesia. Intubation, which is the placement of a tube in the trachea (windpipe), greatly increases the safety of a patient under anesthesia. The tube delivers oxygen to the patient to keep levels adequate, and if his breathing slows or stops, or his oxygen level drops too low, the tube can be used to assist the animal in breathing. During respiratory or cardiac arrest, the tube can be used for prompt resuscitation. In addition, while the animal is anesthetized and unable to swallow or cough on his own, the tube prevents saliva, blood, or regurgitated food from entering the trachea and lungs.

Questions to ask:
What types of modern gas anesthetics are used at the practice?

Do patients have an intravenous catheter placed prior to anesthetic procedures?

Are patients intubated during anesthesia?

5. Are patients properly monitored during anesthesia?
With current technology, there are many ways to monitor a patient under anesthesia. The oxygen level, heart rhythm, and blood pressure can be measured continuously. This type of monitoring is crucial in preventing anesthetic fatalities; by warning the doctor and technician that the patient’s oxygen level or heart rate is falling, it allows intervention to occur before it is too late.

Ideally, the practice should use equipment that allows all three of these vital signs to be followed during anesthesia. At a minimum, the pet’s oxygen level and pulse rate should be monitored during the procedure by a pulse oximeter, which displays the blood oxygen level and heart rate continuously. If your pet has had anesthesia, you can ask to see her medical file, where there should be a record of her vital signs noted throughout the time she was anesthetized.

It is safest if a technician or another doctor monitors anesthesia while the veterinarian performs surgery: It’s difficult to effectively focus on both patient monitoring and the surgical procedure at the same time.

Questions to ask:
What kind of monitoring equipment is used for patients under anesthesia?

Is a pulse oximeter attached to each patient to monitor oxygen levels?

Is the equipment used during every anesthetic procedure, or only for certain patients?

Who is monitoring the patient during anesthesia? Is there a veterinary technician assisting with anesthesia, or is the veterinarian alone with the patient while performing surgery?

6. Does the practice have licensed or experienced veterinary technicians?
The laws regarding veterinary technicians vary from state to state. Some states require veterinary technicians to be licensed, similar to a registered nurse for humans; others do not. Licensed technicians receive rigorous training in many areas, including how to properly measure and administer drugs, draw blood, place intravenous catheters, take radiographs, use anesthetic equipment, and monitor animals under anesthesia.

If your state requires licensing, check to see if the practice uses only licensed technicians. Even in states where this is not required by law, some practices will have licensed technicians. The more licensed technicians they have, the better for your pet. If the practice has unlicensed technicians, it is important to find out their level of experience, since they must learn their skills on the job rather than through formal training.

Tip: The first step is to find out whether your state requires all veterinary technicians to be licensed. You can do this by calling the American Association of Veterinary State Boards at (877) 698-8482, or by going to their web-site, www.aavsb.org.

Questions to ask:
If the state requires licensing of technicians: Do you use only licensed technicians?

If the state does not require technicians to be licensed: Do you have any licensed technicians on staff?

What is the level of training and experience level of any unlicensed technicians?

7. Is the practice AAHA-accredited?
As I discussed earlier, the American Animal Hospital Association (AAHA) provides voluntary accreditation to veterinary hospitals that meet stringent standards. AAHA accreditation provides you with assurance that the practice has met benchmarks in a variety of areas, including up-to-date facilities, equipment, patient care, and staffing. If there is an AAHA-accredited hospital in your area, this accreditation is a reassuring sign that the practice strives for a high standard of care.

Question to ask:
Is the practice AAHA-accredited? (You can also check the AAHA website, www.healthypets.com.)

8. How many veterinarians are at the practice?
Although many wonderful veterinarians are solo practitioners, multidoctor practices may offer some advantages.

When there are several veterinarians in an office, your pet gets the benefit of the doctors’ combined experience and knowledge. If a particular radiograph or test result is confusing, a veterinarian can confer with one or more of the other doctors, who may have encountered something similar or who are particularly skilled at interpretation. Additionally, different veterinarians have different areas of expertise. One may be adept at treating skin problems, another at surgery. Because it is difficult for any one practitioner to read every recent article or study and attend lectures on all the latest advances, you may feel more secure in going to a group where the doctors have complementary skill sets and knowledge.

In a group practice, there are also different levels of experience among the doctors, which can be an asset. More seasoned veterinarians are able to advise younger doctors; recent graduates, who tend to be very up-to-date on all the latest theories and technology, can help keep veterans on their toes. (Unfortunately, it is easy to quickly become obsolete in the practice of medicine, human or veterinary.) Unlike the situation in human medicine, veterinarians are not required to perform an internship after receiving their degrees, but can go straight into practice. Many do choose to undergo this valuable postgraduate training, however, and it is an advantage if any of the veterinarians at the practice have completed an internship program.

Some group practices have one or more board-certified specialists on staff, which is a bonus. Additionally, multidoctor practices are often able to afford more advanced equipment and a larger staff, such as overnight employees. They may have more extensive office hours as well.

Excerpted from “Vet Confidential: An Insider’s Guide to Protecting Your Pet’s Health” by Dr. Louise Murray with permission from Ballantine Books. Copyright © 2008. All rights reserved.

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