In the line of fire

*WARNING-Long post ahead*

Working on the phones instead of actually handling cases in a normal clinical situation, I am always amazed at how often I have to think of the concept CYA (aka cover your a**). Since I don't actually get to see the patients, if anything goes wrong based on the advice I give, it would seem logical that I would be in the line of fire if an owner wants to file suit. On the phone, we don't have the same connection or interaction with the owner, and it can be difficult to gauge whether the person on the other end actually understands what you are trying to tell them.

First example:
Owner is hysterical (ie crying on the phone and screaming "Oh my God, I've killed my pet") because she gave her dog 1 tablet of her thyroid medication.
Me: Ma'am, this is not going to be life threatening to your dog. Calm down, I can help you.
Owner: Oh God, I know she's going to die
Me: I can talk you through this. Please calm down. Your dog will be fine.
Owner: I just know something bad is going to happen...I'm on the way to the vet right now.
Me: Ma'am, this is something we can handle at home. Your pet is not going to have significant problems from this. It isn't necessary to run your animal to the vet just yet.
Owner: I just arrived at the vet. Please tell them what to do so my dog doesn't die. (FYI-I spoke with the vet once the owner calmed down and was making more sense. No, this particular ingestion was not a problem for this pet, and no treatment was necessary)

Now obviously this owner was not listening to a word I said. She was panicked, and just needed someone to listen to her panic. I don't think it was a comfort thing for her either. She was convinced her pet was going to die from this, and just my word alone was not going to be enough to persuade her otherwise. Would it have been in my and the pet's best interest to give the owner advice on how to treat this and manage the signs at home? Probably not. In fact, with how little the owner was listening, I'm actually glad the pet went into the clinic for reassurance, because knowing my luck, this particular pet would have had a reaction.

Second Example:
Young owner (teenager) called because a family member applied an OTC flea medication intended for dogs to her cat. This is very serious, and the cat had already been symptomatic with seizures and tremors for several hours. I explain that the cat needs to be seen by a veterinarian immediately as this is life-threatening and cats can die from this. The owner said that she understood, and would take her cat to the vet first thing tomorrow morning (20hrs later). This is not what I meant by taking the cat to the vet immediately.
The best I can do is document my recommendations and say a short prayer for the animal to survive until treatment is performed.

Last Example of CYA:
An owner's dog gets into a certain type of rat poison that is a neurotoxin (FYI, many veterinarians out there think all rat poisons cause bleeding problems and are unaware there are multiple types of rat poison). Based on our research and experience, the only treatment needed for the dose the dog received was 1) Make the dog vomit OR 2) Give activated charcoal (a "medication" that binds to the toxin).

Now, activated charcoal is not benign. It has it's own potential complications, which can be life threatening, and in most situations, if I can avoid giving it, I will as I do not want the treatment to be worse than the disease. (FYI, many vets do not realize there can be life-threatening problems with charcoal. I didn't when I worked in private practice) In this case, the emergency vet had already made the dog vomit (appropriate) and wanted to also give charcoal (inappropriate in this situation). I explained my concerns, and the vet did not believe the information I gave her. She insisted on recording in the record that "Per Dr. [me], the dog is not to get activated charcoal. Per Dr. [me], the dog can go home without any additional treatment" said in a disbelieving condescending voice "I guess I'll just send the dog home without further treatment."

OK, fine with me-I don't want to be liable if the dog is given charcoal against my judgement and develops life threatening problems from an unnecessary prodcedure. And in fact I had to document this in the medical record as well (obviously with some judicious wording).

Although malpractice lawsuits are not as common in veterinary medicine compared to our human counterparts, they are starting to become more frequent. And there are becoming more changes to the way we as veterinarians maintain our medical records, word our advice, and conduct cases to prevent liability. In fact, some of the calls we get at the poison center are from vets who know how to treat the toxicity, but want to document they consulted with a speciality service so if complications develop, they are less likely to be involved in a lawsuit.

I came across this fitting comment in a medical blog I read.
From Dr. Flea's Blog (a pediatrician)
"I will add only that I am once again drawn to the comparison between [doctors] and baseball umpires.

Of the latter it is said that they are expected to be perfect from their first day of work, and to improve thereafter. This, I'm afraid is the standard to which the American doctor is held.

The difference between doctors and umpires is that when the latter makes an error he does not get his ass sued off."