“Dr. Randolph, you recently wrote a post on continuity of care, but what about when things aren’t working out on a case? When should a pet owner seek a second opinion for his cat or dog?”
Yours is an excellent question, and one that many pet lovers face during the lives of their pets. While each situation is unique, there are some general guidelines you can follow.
One recommendation will be common to all of the scenarios below: discuss your feelings with the treating veterinarian before seeking a second opinion. More on this concept later.
In this first set of scenarios let’s draw a picture of a veterinarian you have been associated with for a long time, a doctor you have confidence in, and whom this particular pet has seen at least several times.
ACUTE, LIFE-THREATENING ILLNESS
If your pet has an acute illness that appears to be life-threatening, you will want to be guided by prognosis and response to treatment. Clearly, if the prognosis for recovery is poor your local veterinarian may be doing all he can do, but the illness is just too severe for the patient to recover. If the illness is something a pet should be able to recover from, but isn’t, you may need to convey to the clinician that you want diagnostics and/or treatment to be more aggressive. Of course, this approach will be more expensive. If his response is that he’s doing all that can be done, it may be time for a change of doctors. The best change in this scenario might be referral to a specialist or referral center, where board-certified internists and surgeons can lend their expertise to your pet’s care. This, too, will likely be associated with increased costs. Consulting with another local veterinarian probably isn’t a good idea in this scenario as acute illnesses often don’t afford the luxury of wasted time.
CHRONIC, NON-LIFE-THREATENING ILLNESS
In the case of a chronic illnesses such as weight loss, limping, longstanding diarrhea or slowly-progressing skin conditions, time is on your side. Again, convey to your pet’s doctor if you want him to be more aggressive with diagnostics and/or therapy. He may have perceived vibes from you to the contrary, making him reluctant to spend more of your money.
There is an old saying that applies here: “If what we’ve been doing is not working, it’s time to try something else.” Sometimes we are convinced that a certain medication is going to work, and our minds just won’t accept that it’s not. We may need a nudge to try something else.
Alternatively, we may need a nudge to open our minds to a new diagnosis. I once treated a Cocker Spaniel successfully for a skin condition. He has relapses occasionally, but always responded to treatment with a variety of medications. One time he came in, the condition looked the same, but wouldn’t respond. I referred him to a board-certified veterinary dermatologist, who diagnosed a completely different disease process.
One of the challenges I love with dermatology is that so many different conditions look so similar, yet are completely different complexes with completely different treatments. In this particular case I needed the dermatologist’s fresh look at the patient to see that this episode was slightly different.
Likewise, if you feel your pet has had sufficient time to get well, or at least improve, and hasn’t, ask about a referral to a specialist, or a local veterinarian who has a special interest in that organ system or disease. For example, we are fortunate to have a nearby colleague who is not a boarded surgeon, but has advanced training in orthopaedic surgery and is talented at diagnosing limping conditions. Many of us refer to him here on the Mississippi Gulf Coast when our patients need surgery or the orthopaedic diagnosis eludes us.
NEW CITY, NEW DOCTOR
What if you’ve just moved to a new town, your pet is ill, and you haven’t been going to the treating veterinarian for long? Perhaps he hasn’t had the opportunity to “prove himself” to you yet, and give you confidence in his abilities. Your best first move might be to call the veterinarian who treated your pet before you moved and describe the pet’s problems, along with the medications he’s taking. Even if he charges you a consultation fee it will be time and money well-spent. He can then tell you whether he thinks your new doctor is on the right track, is way off base, or just needs to change the diagnostic and/or therapeutic approach. If he thinks you need a different veterinarian he may even be able to tell you whether he knows a clinician in your new city. Even if he doesn’t, he may be able to give you some tips on choosing a new veterinarian.
In the beginning I mentioned that you should discuss your feelings with your current veterinarian. If there are misunderstandings about your feelings about your pet, how aggressive you want diagnostics and/or therapeutics to be, this is the opportunity for both of you to be on the same page. If he feels a second opinion is in order, he can give you advice on whether a local general practitioner might be able to help, or whether your pet needs to be seen at a referral center or university veterinary hospital.
Dogs and cats with behavioral problems represent a special challenge. Fortunately, there are veterinarians who have a special interest and special training in behavior, and there are board-certified specialists for those problems. If your pet suffers from aggression, fear of noises, separation anxiety or other such disorders, referral to a behavioral specialist might not only save time and money, it might save a life.