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Issue: 60 - Dec 16, 2013
‘Tis the Season For Keeping Your Sanity When ER Reports Beckon
By: Patty Khuly VMD MBA
Patty Khuly VMD MBA

‘Tis the season for reports from your local ER. You know the kind. They describe everything from owner-induced dietary indiscretion to all manner of last-minute emergencies –– most of which could have been handled during office hours had anyone been paying attention to their pets instead of gift shopping, tree trimming and driving frantically through holiday traffic.

So it follows that ‘tis also the season for ER-directed exasperation and inter-hospital acrimony. I should know. This last week’s stack of reports has offered me these three gems:

#1 The after-hours urticarial reaction

This little Pom’s face blew up big enough to seal her eyes shut. Which, inexplicably, led to an ER doc-authored lecture against administering the leptospirosis vaccine. Now, not only had I not [yet] administered lepto to this pediatric patient, she hadn’t even been vaccinated within the past two weeks. (So you know, this was no mere heresay; an underlined “no more lepto vax for this patient” accompanied the report.)

In the aftermath of this kind of slight, you can’t blame me for feeling that my professional sovereignty had come underfoot. After all, a) a vaccine reaction had been “definitively” diagnosed in spite of the dubious connection, b) veterinary malfeasance was implied (mine!), c) my traditional recommendations for a series of two lepto vaccines (for my high risk area) had now been effectively nixed, and d) I hadn’t even administered the vaccine!

Moreover, I’m sure you’ll agree that it’s no fellow’s right to throw a colleague under the bus for what amounts to the standard of care. Sheesh!

#2 The redirected referral

Then there’s this pet peeve to consider: My derm referral for a patient with recalcitrant ulcerative dermatitis and boring histopath results was waylaid during her recent ER visit (for another issue altogether) when the ER doc suggested she see another dermatologist than the one I’d recommended.

Steam blew when I’d heard about this one (from the client this time, not the report). I mean, isn’t it my prerogative to recommend my derm of choice? Or am I all wet on this one, too?

#3 The “NO TRIFEXIS!” decree

When a recent report came attached with a “NO TRIFEXIS!” proclamation (and little else) I couldn’t help but wonder what had precipitated it. After all, this young, healthy patient’s gastroenteritis hadn’t appeared (to me or anyone else) to have anything whatever to do with the Trifexis she’d received (almost three weeks ago). But there it was in black and white in all caps, to boot.

When I’d called to get more info on this head-scratcher, I’d been told it was this doctor’s personal policy to urge that all unwell patients discontinue use of this drug until all media reports and questionable cases had been thoroughly investigated and resolved.

Beleaguered as I’d felt by this point, I didn’t have the heart to explain that such a policy would put the bulk of our veterinary meds under a [similarly asinine] moratorium. And since I’m this prescriber’s medication, doesn’t it stand to reason that I should be the one to issue any stays and discontinuances? Hmmm …

You’ll probably agree that most of these transgressions amount to no big deal. After all, effective communication in the wake of these issues is typically enough to put them to rest. (OK so I had a little extra trouble with the lepto conversation, but you can’t win ‘em all.)

Yet in the wake of last week’s trio of head-slappers, I couldn’t help thinking that something is increasingly amiss with professional courtesy these days. I mean, don’t all veterinary programs offer a “professional issues” course that details these things? Don’t parents teach children basic manners anymore? Does the Golden Rule no longer hold sway?

Having worked the night shift for a significant percentage of my professional life, I well understand its challenges. In fact, I’ve doubtless committed many similar errors and probably managed to perturb my referrings on more than a few occasions. Nonetheless, I’d like to think my misdemeanors never amounted to the lack of collegiality evidenced by my examples.

Which is why sometimes I can’t help thinking there should be a list of commandments to help manage the relationship between ERs (and specialists, for that matter) and general practitioners. If we had one, I’d bet there’d be a lot less inter-disciplinary strife on the referral front, more pets would get the care they need, and veterinarians like me would find it easier to keep their sanity –– which is a precious commodity this time of year!