Through the looking glass

September 5, 2016

medical-arroganceIt’s been more than 20 years since I’ve had a surgery, but when I did, I wanted my surgeon to have a little medical arrogance. You know, the kind of confidence that comes from being really good at surgery and knowing it. It’s not a Marcus Welby world any more. It hasn’t been, not for a long time.

Note to younger readers: Marcus Welby was a kindly family practitioner played on TV by Robert Young. Back in the day when medicine was a kinder, gentler thing and everyone had a family doctor that was less concerned with insurance copayments than taking care of patients.

Back to arrogance. A little bit of arrogance, selectively, is a good thing. If you merit it. At least to me. I’m good with it in a super-competent doc.

What I’m NOT good with is the kind of arrogance that doesn’t allow a practitioner to take in other opinions for the good of the patient. No. I am not good with that, not at all.

And when a veterinarian seems to have that kind of arrogance, well, if it didn’t involve me, I’d laugh.  I’m not laughing. I feel like I tumbled through the looking glass.

So here’s the scenario: My dog, Riley, has high blood pressure.  It looks like it’s an outgrowth of some kidney issues he was diagnosed with last year.  But it’s complicated by the fact that he is kind of high strung. And he does NOT like to have his BP taken. Yes, it’s taken the same way: tiny little cuff. The burning question is this: do we get a realistic BP reading from him or do we get a stressed out, white-coat hypertension reading?  Because he’s been on veterinary BP meds twice a day for months and he is still testing high. Which is rather illogical.

medical-arroganceThe situation is a little complicated. He loves his regular holistic vet a lot. The office has a kind and gentle vibe he’s not afraid of. Last year, based on urine test and high BP his vet there referred him to a nearby specialist in kidney issues, just to make sure she hadn’t missed anything.  The internist there, who had a special interest in kidney matters, said at the time that she saw no real reason to treat him for anything. That it wasn’t unusual for middle-aged dogs to begin to display hints of the things we would deal with as they got older. She suggested monitoring his kidney protein levels every six months.

We liked her a lot. She had a common sense approach.

Now, here’s where it gets complicated.  My pets and I have had a long history at a now huge, high tech vet practice in the Bay area. To be fair, I started taking a cat there when it was just a small office with a couple vets, but over 30 years it grew into a 26-vet practice with advanced capabilities and an incredible facility. It runs 24/7 and you can actually get an office visit any time of day or night if your vet is working. It also is the biggest vet emergency hospital around.  So for Riley’s teeth cleaning this year (which I figured would include extractions) I decided to take him there instead of to his regular vet. If anything bad happened, they would be best equipped to handle it.


As long as no one messes with me, I’m fine here at the vet’s!

Is bigger always better?

In the pre-surgery check, Riley had high blood pressure. His dental surgeon (whom he’d seen regularly a few years ago) got pretty unglued at his reading and was heavy-handed about medicating him after the procedure. So, we did.  But at the two-week check, he still measured high. She wanted to put him on a stronger med, a human med.  And here’s where it gets iffy:

I remembered the specialty clinic and the vet specialist’s calmer demeanor and different point of view. I also remembered that he was less stressed there and got the lowest BP reading he’d gotten. So I suggested Big Vet Surgeon consult with Specialist Vet. After all, their points of view were very different and I wanted to do what was right for Riley. I certainly did not want to overmedicate him and I wanted Big Vet and Specialist Vet to try to agree on next steps.

Big Vet refused. “She’s only an internist,” she scoffed.

Umm. Specialist Vet’s stated special interest was kidney. She’d given seminars on it.  I think I remembered that Big Vet’s special interest on her bio was gerbils. Not kidding.

The conversation was difficult and went round and round. M. heard the whole thing and agreed that she hadn’t heard a word I said and just talk-talk-talked.  She did not want to call Specialist Vet. Then she suggested I call Specialist Vet.

Am I a vet?

Seriously? Am I a vet? Should I be carrying information from one vet to another? Is that the silliest thing I’ve ever heard?  Was it arrogance that wouldn’t allow her to consult with another vet? The bad kind of arrogance?

By this time in our circular discussion that went absolutely nowhere, I was fairly certain that she was flagging me as a bitchy, uncooperative client. In frustration, I said I’d call Specialist Vet. And I did.

She couldn’t have been nicer. I didn’t share the bad experience but I think she wondered WTF Big Vet didn’t call directly. Why was I, a lay person, trying to figure things out myself?

“I’d sure like to see the latest kidney protein values,” she said, “before weighing in again. And you can bring him in here for a BP reading and I’ll have my nurse hang with him and make friends. We’ll see what we get then.”  I told her I would have Big Vet Practice send the labs.


Does this look like they’re getting a normal BP reading?

The scenario gets stranger. Big Vet Practice –which is 45 minutes away from us–opened a smaller satellite practice 15 minutes away last year.  Riley had gotten a pre-surgery ultrasound there and M said that he was as calm as could be, that he’d fallen in love with the nurse, a beautiful, dread-locked woman, and let her rub his belly during the whole procedure.  So, we thought, why  not take him to Satellite of Big Vet practice so that Beautiful Nurse could charm him into relaxation for BP.  This had been discussed with Big Vet before, so we knew she liked the idea. I called.

I made very clear to the appointment clerk that the appointment was to be with a senior vet there but that Beautiful Nurse was key to the appointment. Without Beautiful Nurse’s presence, there would be no appointment. She promised to discuss this with Beautiful Nurse.

Is anyone listening?

The day before the appointment I had voicemail from Beautiful Nurse.  “Big Vet told me you wanted an appointment with me for a BP.  I am calling to make the appointment. I am in this afternoon and not again until Saturday.”  Beautiful Nurse did not mention the appointment we’d already made for the next day. The one for which the clerk PROMISED she’d talk to Beautiful Nurse.

When I called back, Beautiful Nurse confirmed that no one had spoken to her about the next day’s appointment and that it was not one of her work days.

Why was I surprised?

We had a very nice conversation. I told her the rough outline of the story, said I felt played by Big Vet and that my pet’s best interests were not being served. As much as Riley loved Beautiful Nurse, I would have to think long and hard about whether to return to Big Vet. When I said I knew I’d been flagged as difficult she didn’t say one or another but that kind of confirmed it. I was very nice. I again mentioned that I wanted to do right by my dog and was open to changing meds, but I wanted to be sure it was for a good reason.

I hung up the phone knowing I would not bring him back to either of Big Vet’s offices for next steps. But I didn’t want to burn any bridges because the other closest high tech vet center was two hours away. Why cut off my nose to spite my face?


I don’t know what the big deal is. I’m calm!

I was hoping the labs had been sent to Specialist Vet. While they were at it, I asked that all the surgical records be sent to Holistic Vet, his regular vet. I was sorry I hadn’t hightailed it right back to her immediately after dental surgery, but we were heading back there for certain, now.

If you’ve hung in here this long, I thank you. This is the kind of thing I would call my now dead girlfriend to discuss, and since I can’t, well, here you are and here I am.

The never-ending story

It went on and on–I can’t even remember the details now as it’s been so many months. So, here’s where we ended up:

Specialist Vet called to say Big Vet Practice had not sent the requested records and somehow, she and I began to go around a circle. Maybe she was pissed about Big Vet but we got to the point on the call where I burst into tears and said, “What’s lost in this whole thing is that no one gives a shit about my dog but ME. I have absolutely no place to turn!”

Do you know how hard it is for me to cry to a service provider? But I was so frustrated, I cried.   Taken aback, Specialist Vet then said to leave things to her. She’d get the records and she did: she had to call a tech she knew there to get them.  I got the feeling the Big Vet Practice was not known to be very cooperative with Other Vet Practices. To say the least. Not. Nice. People.

Riley is still on BP meds. We still aren’t getting a true resting BP measurement but he’s doing fine on meds and we’re going to retest his urine protein at the end of September. If it’s better, he might go on a lower dose.  As Specialist Vet said, he is on the borderline and we’re being safe.


Most of the day I’m sound asleep.

What’s the moral of the story? I think it’s that Medicine is about Money, even Veterinary Medicine, here in the Bay area. I guess I might have thought that vets had a more caring point of view, but apparently not. It’s a business to them first, foremost and, clearly, to some of them, that’s all it is.

I had a great vet in Tampa. He was a quarter mile from my house. He knew me well, he knew Riley well. When I was a nervous New Puppy Mom I once brought Riley in and Nice Vet met me in the waiting room. “Carol, let me look at him out here. I don’t think there’s a thing wrong with him and I am not going to take your money.”  Nothing was wrong, I did not get billed. Nice, nice vet.

I may have made a mistake by not staying with Holistic Clinic during this ordeal. We like our vet there a lot. It did give us pause once, though for them to use “our vets need to have balance in their lives” as a reason for unavailability. Um. Hello? Do I care that your vets have balance? I am buying a service from you, balance is your problem.

Et tu, Brutus?

But that wasn’t my main issue with Holistic Vet: we had quite the go-around with the business office there about the expense of blood pressure measurements, which they billed at $150. For a tech to do. No other service.  While specialist vet did an exam and reading both for $125.  When the Holistic Vet tech couldn’t get a good read on our first go around, they wanted me to bring Riley back AND they wanted to bill me again. Can I tell you how many THOUSANDS of dollars I had spent there for our dogs? Can I tell you how shocked I was that they insisted on billing me for this repeat measurement that they couldn’t get the first time? And when I called, the business manager grudgingly said I could bring him back free but for only one try–not 11.  Eleven? Where did that come from?

No.Way. Jose.  And as much as we love Holistic Vet, this episode left a bad taste in our mouths. And we were thinking of switching back to Big Vet.  Until we realized the lay of the land.  This seems to be a pattern, though, in our area, and a disturbing one.


It’s always all about me and I like it that way.

We do have another vet recommendation. Right now we’re back at Holistic Clinic with BP follow up by Specialist Clinic. And we’re sure of only one thing: We won’t be going to Big Vet Practice unless we are in an extreme emergency that our closer Vet ER can’t handle.

I get that a medical practice is a business. But I also get that it is a service business. That it involves our fur babies, whom we love a whole lot. And I don’t think it’s asking too much that there be some care, concern, understanding, cooperation and compassion in the practice of veterinary medicine.

But obviously, that is not an opinion also held by these veterinary clinics.

25 comments on “Through the looking glass
  1. ryder ziebarth says:

    Hung in with the story? I was rapt! Just went through this with George, our eldest Wesite. Three visits, well, make that umpteen over the years( to vets in Florida mostly where MZ ridesnd takes Geo with him for the winter) a swollen foot, an infected ear; a thousand plus dollars, and finally, doctor#2, the owner of the practice, finds the yeast infection he has had FOREVER that cause his itchy skin, “athletes” foot and horrible ear filled with goo, so much so, we thought he was losing his hearing.Did they refund us for the month of visits with inept doctor#1? No–just a $24.00 antibiotic credit that had made Geo horribly sick with vomiting.Gee, thanks. Next steps include a hypoallergenic diet, which I suggested two years ago. I FEEL YOUR PAIN.Thanks for sharing.

  2. Haralee says:

    I hope your pup is on the road to better health and less visits. I think the Vet specialists seem to be a problem with everyday Vets and reverse. I found a Vet that comes to the house.He can only do checkups and shots but no stress for my cats and unlike my other 2 Vets he has not recommended we see a specialist!

  3. Laura says:

    Gosh what a rigmarole. Hope you’re pup is ok now.

  4. Abby says:

    Thanks for sharing your story! I just took my dog to the vet the other day and I am just so thankful for what they’ve done. Truly a life-saver for my pet!

    Abby of Life in the Fash Lane

  5. Ive worked in thehuman medical world for over 30 yeats, and it’s all about the money. As a former pet owner, it’s all about the money. Vets are a different breed. I see them as extortionits praying on our emotions. I brought my cat in for an arthritis check and because he was 17 they wanted to run a $300 cancer screen panel. Sorry, I don’t want to sound uncaring but he’s 17, if he has cancer I’m not going to pay thousands of dollars for chemo for a cat that has maybe 3 years left.

    Dr’s offices move slow. Do you realize how much effort it takes to scan and email a record? Maybe a big 20 seconds. They’re lazy and want the patients to do all the work. It’s all about the dollars. Medicine isn’t how it used to be when we were young and Dr’s and Vets made housecalls. It’s now a business and that’s all it is.

  6. Leanne says:

    It’s the same old story isn’t it Carol – the small family friendly practice becomes the uber practice with all the bells and whistles and somewhere along the way they lose the focus on the patient and it becomes all about the dollars. This has happened in medicine, aged care, vets and goodness knows what else – really sad.

  7. Carol Graham says:

    I don’t recall if we have discussed this before, Carol, but we have rescued over 30 dogs — all with problems – some serious. A few weeks after putting them on a complete raw food diet, their problems disappear and they live long healthy lives. The only time we have been to a vet in many years is to get their monthly pedicures. Your pets will thank you and you won’t believe the positive changes.

  8. Grammy says:

    What a cutie Riley is! Sorry you had to go thru all that to get the best treatment for your pet. They are our babies and we love them and want the best for them. Same goes for people doctors too, seems some are just in it for the money 🙁

  9. It is definitely a problem in the Philadelphia area too. We drove 45 mintestinal to take our pups to a country vet that didn’t have to work, she just loved being a vet. She eventually had children and limited her hours.

  10. My G——-d! I need a martini now! You are going to need high blood pressure meds soon. This is totally crazy….where is Marcus Welby when you need him?????BTW, Riley is adorable!

  11. Barbara says:

    We had a similar situation with Sydney. She has a seizure condition and we knew it when we agreed to adopt her. Once we got her we realized it was much worse than expected. Our dog, Duffy, (the author), had seizures but nothing like Sydney’s. Over time the phenobarbitol was increased again and again and after 2 years she went into liver failure.
    The closest vet hospital was an hour away and they took her right away. After several days they called and said she needed a liver transplant! You can only imagine the cost and no guarantees.
    We declined and told them we were bringing her home and would love her and care for her as long as we had her. On the way out the door, the Vet said to me, “I’ve had 16 cases and only one survived.”
    When we left the vet hospital we had 17 different medications! It was incredible trying to keep up and, she had no appetite so we had to force the pills down her throat each time. She was fur and bone. Talk about stressful!
    Then one night we had hamburgers for dinner and she seemed interested. After we ran out of ours Dave ran to McD’s for more! It was the turning point. She gradually got her appetite and strength back and we found a better medication for her seizures. Now we get those meds from Canada, (shh don’t tell anyone), and it has been 8 years since the liver failure.
    Oh, and I couldn’t wait to call that bitch vet and tell her, “You can tell people now you’ve had 2 survive, and the 2nd one without your suggested surgery.”
    It’s amazing what we will do for our fur babies, isn’t it? Best of luck with Riley!! such a cutie!

  12. Barbara says:

    Oh, and one more thing…during her bout with liver failure we started making our own dog food. It’s really easy and all good stuff. I’ll give you the recipe if you’re interested.

  13. rain says:

    i hope poor Riley is feeling better. he’s adorable.

  14. Anita says:

    Unfortunately medicine is about money whether it is human or dog medicine. Money talks and that is all. I do hope that your dog Riley is feeling better these days. Hopefully they got the blood pressure under control.

  15. Andi says:

    I wish they still had “Marcus Welby” kind of doctors around

  16. I’m sorry you had to go through all of this. When we had our Newfoundland, we had a housecall vet who became our close friend. She cared so much about her and it was so different than going to a Big Vet. Medicine needs to change and put people and animals before money. It’s disgraceful.

  17. sue says:

    What a story! I can tell how much you just adore your little one Carol. I hope Riley is feeling better and the BP is under control. I wish it was Marcus Welby days again – simpler and more caring. Unfortunately, that isn’t the real world now is it? However, I would certainly not be returning to the state of the art practice. I suppose it is the same in the ‘human’ world – some doctors are just in it for the money pushing patients through as quickly as they can, whilst sometimes you find a gem who is in the profession for the patient.

  18. Frances D says:

    Riley and you are on my mind and in my heart. Sending healing vibes your way.

  19. Elizabeth O. says:

    I can’t believe vets and doctors who think about just the money that they’re going to earn. I honestly thought they were sincere about saving lives and as it turns out everyone is pretty much blinded by money. I am sorry for what you experienced, this is terrible practice!

  20. Such a great informative post! I hope Riley is feeling better.

  21. Annie says:

    Reading this… I’m extremely happy that I never had to take my dog to a vet (except for what’s absolutely necessary, like shoots and.. well that’s about it )…

  22. This brought back memories of my many visits to the vet with my dogs. Yours is really a cutie.

  23. candy says:

    Our vet is like family. She knows our animals personally and always goes the second and third mile to help them out.

  24. Medit says:

    OMG this doesn’t sound ok!

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