On Tuesday, the Columbia Tribune printed an article about one of the food animal veterinarians, Dr.Schultz, at the VMTH. Click Here To Read It. I also strongly suggest reading the comments and hope that you see a pattern with them.
In defense of Dr.Schultz-he is one of the few clinicians in the hospital that realize that once we students graduate, we will be faced with a completely different world. A world in which there is a limit to client money, there is a limit to available testing and diagnostics, where there is a limit resources and knowledge. He practices more in the manor of a general practioner and for that he should be praised. He isn't trapped in the clinical world of the referral hospital like many of the clinicians (mainly small animal) are. Additionally, I don't think that it is unusual for a veterinarian to be reported to the state board. Yeah, it sucks and your actions as a veterinarian are being scrutinized BUT its probably just someone you made angry. And you can't please everyone.
The article however is very one sided. The university and vet school obviously can't comment on the situation. They spoke with an animal behaviorist from K-State?!?! What would an animal behaviorist know? What about an animal scientist or another veterinarian? What about someone else from Missouri? (Granted, that could be skewed or they may be unable to comment.) Essentially, the article took the word of the man making the complaint as the final word. No questions asked. What he said was right. There wasn't any mention of the condition of these calves prior to being examined. 'Inherited stress syndrome'? Maybe the guy misunderstood and what was really said was 'inherent stress syndrome'. Its not uncommon for a calf to get so stressed out from vaccinations and being worked that they die. Especially if they had some underlying condition such as pneumonia. Also, unless the necropsies were done in the field, they were most likely not done by Schultz. He probably observed them. There was probably a team of students and two pathologists or so actually doing them. We also do not make a habit of releasing the necropsy reports to the owners. The referring veterinarian gets it and then it is there job to interpret and relay the findings. The referring DVM in this case was Schultz!
Anyway, in reading the comments, you may have noticed a pattern. The pattern is general whining and bitching about the VMTH. I'm not saying that these complaints are unfounded. (See later.) But did you also notice that the people complaining are complaining about the small animal hospital and generally not the food animal or equine hosptial? They would have never had contact with Schultz! And all of the people supporting the hospital in general were food animal people. That is one thing the hospital does right for large animal clients-the prices are fairly reasonable when compared to general practice vets. (Except if you actually have a horse in for surgery or a severely sick horse, then its gets a little pricey.) I know we had a horse colic at a horse show in Columbia and Dr.LaCarruba came out and the cost was comparable to what our vet at home would have charged. This is probably why consistanly the food animal section outdoes the other sections.
So here's the truth.
The College of Veterinary Medicine Teaching Hosptial is just that. A TEACHING hospital. In a TEACHING hospital, there are students, interns and residents that all are trying to learn. If you have a problem with inexperienced people trying to learn on your animal, take it elsewhere. One of the reasons that animals are taken from the owner and taken to the back for procedures that a regular vet may perform in front of you is for that very reason. If you were a student attempting to perform something for the first time in front of a worried owner, would you want to do that in front of them or in private where you could get instruction and less pressure? This is also why things take so long. In addition to the student performing an examination, the examination is repeated by the intern, resident, clinician and anyone else that shows an interest. There is time for questions, differential diagnoses and potential tests to be ran. A time for the student to be taught and to learn. I think it is however the responsiblity of the student to instruct their client that because it is a TEACHING hosptial that things take a little longer. Sorry. Its just how it is.
Additionally, where at the regular veterinarian, they would have techs perform some tasks and essentially everything would be done by one person, here there are different departments each responsible for one aspect of patient care. At a regular clinic, the same tech may draw blood, start the test on it, assist with x-rays and watch the animal in the kennel. At the VMTH, there are very few techs relying on students to draw blood which is submitted to the clin path department for analysis. Radiology takes x-rays and a radiologist looks at them, not the same vet that saw the animal initially. (Yes, at the VMTH, the same vet will look at the radiographs too but a radiologist also sees them.) Then there is an ICU department where an entirely different set of people watch the patients. These reasons add to the cost and the time.
In addition to being a teaching hospital, MU is a referral hospital, meaning that the cases that were too difficult to solve in general practice are sent here. We have specialists in lots of different areas when it comes to small animal medicine. Board certified surgeons, radiologists, cardiologists, oncologists, optholomolgists, etc. It costs money to pay these people and to have the diagnostics that are useful for them. What good are they if they don't have the equipment needed to solve the difficult case. You pay for the expertese that is there. You pay for the 24 hour care and attention.
All that being said, I do think that there are times when things are too expensive. And even worse, some clinicians don't get it. They just assume that if you are there, you have money. Its not always the case. I had a case like that and I wish I could have done more for the guy and his dog. And I really wish that the clinician didn't make him feel like a bad person for not having the money.
I also think that extra tests are performed when not needed. I do however understand that in part, its for the learning of the student. Sometimes these tests are done without permission but in leaving you pet with the VMTH, you essentially have left them there with the intention that the best will be done for that animal.
When a client feels that they are having difficulty communicating with their student or veterinarian, it is an individual case.
Clients don't understand the sometimes frustration of the students too. We as students are treated as hired hands yet we aren't paid. (We actually are PAYING for that treatment!) WE are expected to do the dirty work, work the long hours with little help or appriciation at times. WE can't always get ahold of the clinician and can't get our questions answered so we can't always answer the client questions. For some students (myself), this is the most frustrating part. WE can make decisions in care without running it past the clinician yet if we can't get a hold of them...Additionally, for all the harping on logging conversations into the comm log, clinicians don't do it leaving a student looking dumb when the client asks about something the clinician mentioned to them but not the student.
The VMTH has its flaws. I complain incessently about it. I know however that even when I am frustrated that there probably is some learning value unlying it all. If people can't see these things, then they shouldn't bring their animals to the VMTH.
[EDIT-Originally published to Blogger on 8/23/11.]
In defense of Dr.Schultz-he is one of the few clinicians in the hospital that realize that once we students graduate, we will be faced with a completely different world. A world in which there is a limit to client money, there is a limit to available testing and diagnostics, where there is a limit resources and knowledge. He practices more in the manor of a general practioner and for that he should be praised. He isn't trapped in the clinical world of the referral hospital like many of the clinicians (mainly small animal) are. Additionally, I don't think that it is unusual for a veterinarian to be reported to the state board. Yeah, it sucks and your actions as a veterinarian are being scrutinized BUT its probably just someone you made angry. And you can't please everyone.
The article however is very one sided. The university and vet school obviously can't comment on the situation. They spoke with an animal behaviorist from K-State?!?! What would an animal behaviorist know? What about an animal scientist or another veterinarian? What about someone else from Missouri? (Granted, that could be skewed or they may be unable to comment.) Essentially, the article took the word of the man making the complaint as the final word. No questions asked. What he said was right. There wasn't any mention of the condition of these calves prior to being examined. 'Inherited stress syndrome'? Maybe the guy misunderstood and what was really said was 'inherent stress syndrome'. Its not uncommon for a calf to get so stressed out from vaccinations and being worked that they die. Especially if they had some underlying condition such as pneumonia. Also, unless the necropsies were done in the field, they were most likely not done by Schultz. He probably observed them. There was probably a team of students and two pathologists or so actually doing them. We also do not make a habit of releasing the necropsy reports to the owners. The referring veterinarian gets it and then it is there job to interpret and relay the findings. The referring DVM in this case was Schultz!
Anyway, in reading the comments, you may have noticed a pattern. The pattern is general whining and bitching about the VMTH. I'm not saying that these complaints are unfounded. (See later.) But did you also notice that the people complaining are complaining about the small animal hospital and generally not the food animal or equine hosptial? They would have never had contact with Schultz! And all of the people supporting the hospital in general were food animal people. That is one thing the hospital does right for large animal clients-the prices are fairly reasonable when compared to general practice vets. (Except if you actually have a horse in for surgery or a severely sick horse, then its gets a little pricey.) I know we had a horse colic at a horse show in Columbia and Dr.LaCarruba came out and the cost was comparable to what our vet at home would have charged. This is probably why consistanly the food animal section outdoes the other sections.
So here's the truth.
The College of Veterinary Medicine Teaching Hosptial is just that. A TEACHING hospital. In a TEACHING hospital, there are students, interns and residents that all are trying to learn. If you have a problem with inexperienced people trying to learn on your animal, take it elsewhere. One of the reasons that animals are taken from the owner and taken to the back for procedures that a regular vet may perform in front of you is for that very reason. If you were a student attempting to perform something for the first time in front of a worried owner, would you want to do that in front of them or in private where you could get instruction and less pressure? This is also why things take so long. In addition to the student performing an examination, the examination is repeated by the intern, resident, clinician and anyone else that shows an interest. There is time for questions, differential diagnoses and potential tests to be ran. A time for the student to be taught and to learn. I think it is however the responsiblity of the student to instruct their client that because it is a TEACHING hosptial that things take a little longer. Sorry. Its just how it is.
Additionally, where at the regular veterinarian, they would have techs perform some tasks and essentially everything would be done by one person, here there are different departments each responsible for one aspect of patient care. At a regular clinic, the same tech may draw blood, start the test on it, assist with x-rays and watch the animal in the kennel. At the VMTH, there are very few techs relying on students to draw blood which is submitted to the clin path department for analysis. Radiology takes x-rays and a radiologist looks at them, not the same vet that saw the animal initially. (Yes, at the VMTH, the same vet will look at the radiographs too but a radiologist also sees them.) Then there is an ICU department where an entirely different set of people watch the patients. These reasons add to the cost and the time.
In addition to being a teaching hospital, MU is a referral hospital, meaning that the cases that were too difficult to solve in general practice are sent here. We have specialists in lots of different areas when it comes to small animal medicine. Board certified surgeons, radiologists, cardiologists, oncologists, optholomolgists, etc. It costs money to pay these people and to have the diagnostics that are useful for them. What good are they if they don't have the equipment needed to solve the difficult case. You pay for the expertese that is there. You pay for the 24 hour care and attention.
All that being said, I do think that there are times when things are too expensive. And even worse, some clinicians don't get it. They just assume that if you are there, you have money. Its not always the case. I had a case like that and I wish I could have done more for the guy and his dog. And I really wish that the clinician didn't make him feel like a bad person for not having the money.
I also think that extra tests are performed when not needed. I do however understand that in part, its for the learning of the student. Sometimes these tests are done without permission but in leaving you pet with the VMTH, you essentially have left them there with the intention that the best will be done for that animal.
When a client feels that they are having difficulty communicating with their student or veterinarian, it is an individual case.
Clients don't understand the sometimes frustration of the students too. We as students are treated as hired hands yet we aren't paid. (We actually are PAYING for that treatment!) WE are expected to do the dirty work, work the long hours with little help or appriciation at times. WE can't always get ahold of the clinician and can't get our questions answered so we can't always answer the client questions. For some students (myself), this is the most frustrating part. WE can make decisions in care without running it past the clinician yet if we can't get a hold of them...Additionally, for all the harping on logging conversations into the comm log, clinicians don't do it leaving a student looking dumb when the client asks about something the clinician mentioned to them but not the student.
The VMTH has its flaws. I complain incessently about it. I know however that even when I am frustrated that there probably is some learning value unlying it all. If people can't see these things, then they shouldn't bring their animals to the VMTH.
[EDIT-Originally published to Blogger on 8/23/11.]
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