Nothing hits vets where it really hurts than when news breaks in the hospital of a records request. So-and-so client is defecting to another local practice without leaving word or explaining why. They just want out—usually because they’re unhappy with you for a real or perceived injury to them or their pet.
It happens every other month or so and I guess that’s not too bad compared to the average for a place our size but it’s always painful. We vets are pleasers. We typically want to make you happy—too often at all costs. That’s why it hurts so much to know you don’t think well of us.
For me, it’s enough to ruin a whole day. If it’s an important enough client for whom I’ve given my all, it’s especially debilitating. I must really suck if Mr. X thinks I’m enough of a loser to ask that his records be transferred to Y hospital.
Last week was no different—except that I knew it was coming. The physical exam, labwork and X-rays were normal on this sick pet’s initial visit. He hadn’t eaten well for a couple of days but otherwise checked out OK. When the owners called back to report that he seemed "80% better" after the weekend but still not eating well, I urged them to return for a re-evaluation. They didn’t. I documented it (thank God). The pet died two days later. They left an angry message with the receptionist letting her know they were unhappy with my services. A week later we received the dreaded “records request” in the form of a terse note on legal letterhead.
Ouch. Though I know I’m not to blame it pains me to know that these clients are so displeased with me that they’re willing to take their records to another vet even after their pet has died. If that’s not a bad omen I don’t know what is—the legal letterhead, perhaps?
Hmmm…I wonder if I paid my insurance premium already this year. Excuse me while I check…
Add Comment25 Comments
Soudns like maybe they had to place blame and decided it had better be you than themselves.
Cedarfield January 24th, 2008 01:58:00 PM
Do you ever contact clients to ask why they left (if it's not obvious)? I have twice (over decades) left vet practices due to problems with support staff rather than with the vet. In the most recent case, I loved the vet, but the practice was run by his partner and was completely inflexible. For example, if any procedure was needed, you had to drop your dog off in the morning and pick them up in the evening, you couldn't wait with the dog until it was time to do the procedure or be with them during the procedure, as my current vet allows me to do (especially important for dogs who are terrified at the vet, as they remain calm when I stay with them). I argued for half an hour to get them to attempt a spinal x-ray on my dog without first sedating her (which this particular dog hated) -- they finally agreed to try once if I would agree to sedate her if the first attempt did not work (she laid perfectly still as I knew she would, and the x-ray came out fine). The last straw was when I got into a shouting match (unheard of behavior for me) with the receptionist who decided to give me a different dose of heartworm preventative because my dog had gained two pounds, and who refused to let me ask the vet about it.
The other incident, much longer ago, was with a vet whose tech was very rough with my dog and seemed impatient and uncaring.
A friend who has five dogs and does rescue came close to leaving a vet she loves due to the extremely abrasive office manager, who messed up her bills, refused to correct them and became abusive when asked about it (the vet ended up firing the woman after checking into my friend's complaints).
If you don't run the practice, you might not be able to do anything about these problems, but it still might help you to feel better if you know that the reason someone left had nothing to do with you. If you do have any say in how the practice is run, it would be good to know if one or more of your support staff or the way the practice is run are causing clients to leave.
(on a side note, does anyone else have trouble with the "captcha text"? I am so careful to enter it correctly, but almost always get rejected at least once. Sometimes there are circles that I can't tell if they are the letter "o" or not, but other times I swear I entered it right and it still gets rejected).
Mary January 24th, 2008 02:28:00 PM
Eeesh......How did you hear of the dog's passing? Have you tried to contact this person? The legal letterhead is not a good sign. Perhaps they are having the records transferred for a 'second opinion'?
Keep us posted and good luck!
Amy in Somerville January 24th, 2008 02:45:00 PM
First, let me say the clients you "lost" certainly don't seem like clients you'd want to have in the first place. Shame that the one that suffers is the pup.
The only records request I've done was when I moved across town. There were no hard feelings as they completely understood that it is much easier to cart the critters to the vet that is quite literally *5* minutes from my house than to go 30 minutes. They also were very familiar with my new vet - he bought the practice from my old vet.
I felt a little bad, because I felt like I was saying, "You're not worth a 30 minute drive", but my current vet is just so super awesome (and had been my parents vet) so when I moved and his practice was so close, I just couldn't imagine going anywhere else.
Cindy January 24th, 2008 03:07:00 PM
Does your clinic charge for records requests? The vet I worked for started doing that and it drove me crazy, partially because the receptionists at the new clinic would yell at me about it (like I had a say). And half the time the request would just die at "that'll be $5" so the new clinic never got the records. The vet was always really antsy about these too - she'd yell at me if I forgot to ask why they switched, and her mood would drop for hours after one of these, even if it was just people who moved, who accounted for a majority of transfers. We had great loyalty, and people drove across town to see us when they moved.
One time she got really upset about a client who moved an hour away and got angry with me for not getting the reason for the defection. I said the new area code was reason enough, but apparently not good enough for her!
Julia January 24th, 2008 03:47:00 PM
I move often and was surprised to be grilled about it at my last practise. I felt like I should be apologising for leaving town! LOL
emily January 24th, 2008 04:02:00 PM
I have information on file at the 5 minute vet in case of emergencies and make the 30 minute drive to the regular vet.
Although I feel that my pet's records are MY records, I have always asked for my records in person, to come to ME, not some new practice. I pick them up in person. I do it with my dentists and my vets, a smile and a thank you seem to ease over any hurt feelings. Or, if I need to vent my frustration, it gets said to the correct person, not the poor receptionist (or to the right receptionist if that's the issue).
There are few things that can ruin a day faster than getting flamed for someone else's mistake, and few things more pointless than flaming the wrong person
As for your legal letterhead nastyness, I suspect that's for a malpractice threat... but how much of that is just grief and anger versus a true threat that will be taken to court. Who knows.
If you actually pointed out to this owner how much more money and time they're willing to spend on their now dead pet just to harass you versus their reluctance to work with you on a sick but living pet, you'd be right but cruel. So I just did it for you. They traded a dollar of prevention for a grand of cure.
Border Wars - Christopher January 24th, 2008 05:28:00 PM
I recently boarded my dog at another vet clinic because it was the only boarding facility that had indoor/outdoor large dog runs available on really short notice. They wanted me to have my current vet fax all the information over to them about my dog. Instead, I just brought them all of my medical records when I went to board, and I took them back with me when I picked Beau up. I didn't want my current clinic to know I was using someone else's services (they don't have a boarding facility on-site) because I didn't want them to think I was defecting! So don't worry, you do have some patients out there that just need to take their dog somewhere else this one time, but will be back. The same thing will happen to me again this coming month when I take my dog to the vet school to get his heartworm test done - I want the free Sentinel (oh, the joy of being a vet student and all our freebies.) I don't want my current doctor to think I'm leaving him, it's just that for this one thing, I'd much rather get a free year of Sentinel than pay $99 for 6 months of it.
First Year January 24th, 2008 06:46:00 PM
It seems strange to me that one could be charged (even if it's just $5) for records. I've never had the need, w/my pets' records or my own, but maybe it's the norm? I understand the thinking behind it (someone has to pull up the records, make copies, fax or mail them, etc.), it just seems like it would be one of those things that an owner would have a legal right to at no charge.
anna January 24th, 2008 07:43:00 PM
They may be asking for the records for a necropsy that they're getting done elsewhere.
I've never left a vet on bad terms, so I've always told when I've requested vet records - it's usually things like I moved, or I had to bring my pet to a 24-hr emergency vet and I'm choosing to complete the treatment there for the 24-hr monitoring, so I want them to have her records so they could best treat her.
zandperl January 24th, 2008 08:45:00 PM
Patty, you are obviously a sensitive soul!
Laura Bennett January 24th, 2008 09:21:00 PM
how about a vet refusing to release to me the XRays of my dog? They claimed it was "illegal". I should have challenged them to cite the law. They insisted they could only transfer them directly to another vet. And I had to sign a release, name the vet and give the reason.
Excuse me! HIPPA doesn't apply to animals! Animals have no right to privacy! The records belong to ME, because I paid for them.
EmilyS January 24th, 2008 09:49:00 PM
While I certainly don't charge for records (why fan any flames or charge people for their convenience when it comes to moving?), X-rays are another matter. Unless copies can be made on site, it is indeed illegal for us to give them away. Legally, we must keep them on site for seven years. As long as you sign them out with a promise to return the, legally you can have 'em. All you have to do is sign on the dotted line promising to return them. With digital rads all the rage (expensive though they are) everything can just land on a nice CD so all loose ends are tied up. I can't wait to get our dig rads!
Dr. Patty Khuly January 24th, 2008 10:00:00 PM
Its a shame people change vets without saying why, when often a meeting and explanation would help and may mean they stay with you. Maybe some people don't feel comfortable doing that, or think a vet appointment means you need to both pay for it and bring along a pet.
Convenience can be a factor - emergencies and weekends to the local vet, and all day appointments at a vet closer to where you work because of their opening hours and your working hours. Not ideal, but convenient.
Robin January 24th, 2008 10:45:00 PM
I was going to ask the same question as Emily S -- why all the trouble about radiographs?
I repo'd a pup I'd placed four years ago, who now has a *significant* trauma history, and it was as if I'd asked for the vet to fedex out his freakin' firstborn. I was requesting that the old radiographs go to my vet, the dog's new vet -- half a state away. What good are those films going to do him sitting in a file in a vet's office he'll never see again? (And as an aside, the really incriminating stuff was documented in his records -- like, the vet choosing not to radiograph him when he was *first* hit by the car going 30 mph -- because, why would you need to see a picture of the insides of someone who'd just had that mechanism of injury?)
So, can the radiographs transfer to a different practice or not? What is this law about retaining radiographs for 7 years -- federal? state? I really want to see a citation on that one.
When I taught college, we were advised to retain student records for 7 years -- but that was "a good idea if a problem comes up," not a "law." It was to CYA for liability, in case that whiny student decided you ruined his life with an unjust B-. This is not the same as "by law." (And it has been 15 years now, so I really need to pull out all those old blue books and class rosters from the attic and have a merry bonfire celebrating the end of academic life.)
I agree with Emily S. There is no critta HIPPA, and I *bought* that film, thank you! It's mine.
BTW, in the absence of a digital x-ray, you can get a very good digital image of a radiograph using a decent digital camera on a tripod, with the film up on the light box. I now photograph all my own and my dogs' films. This is for orthopedic stuff, it might not be clear enough for soft-tissue images. My vet is cool with it -- they were very interested to see how well the images turned out. My chiropractor was cool with it. But the hospital where I went for some foot x-rays had a nervous breakdown about it! I think they somehow thought I'd be running to an ambulance chaser with my Canon as soon as I left. (But the whole point was, I couldn't run anywhere, which iz why we needed to x-ray my foot...)
H Houlahan January 25th, 2008 12:20:00 AM
For those of you out there discussing charges for tranferring medical records: Have you tried to switch pediatricians or even general (human) practitioners lately?? It seems that everyone has joined this bandwagon of charging when you request records. I don't personally agree with the practice, but I fear it will become the norm before too long.
As far as rads, Emily, Dr. K is right. You, as the owner, do not "own" the xrays, the hospital does. You paid for a diagnostic service. My understanding is that medical providers are required to keep medical information "secure and private". If you take the x-rays out of the hospital, the hospital has then lost the ability to keep that record private. There was recently a case of a woman who removed several pages of her medical record to keep her children from knowing that she had Huntington's disease (http://www.privsecblog.com/archives/medical-record...)
I can easily see clients who would want to remove (or in some cases, add or alter) information in the medical record in order to show a different story or scenario.
Tomcat1765 January 25th, 2008 08:46:00 AM
X-rays are obviously a touchy issue. I just spent the last 20 minutes reviewing the Veterinary Practice Act (which is the source for these issues) and researching threads of this very popular issue on the Veterinary Information Network. Here's the scoop: Medical records need to be maintained for 36 months. Radiographs are the property of the veterinary hospital--forever if they so choose. Apparently, what the client "owns" is not the X-ray itself but the *interpretation* of it. Yet most all practitioners rely on this magical 7 year number I mistakenly referred to as law because it's the industry standard. That means that if we don't keep them on hand for seven years the court system (in the event of a lawsuit) might consider us to be "not practicing to the standard most vets deem acceptable." Having said that, copies of an X-ray can easily be had should you choose to sign out your X-rays and do so yourself (emergency facilities usually have copiers since they don't like to rely on having the client bring the X-rays back). I also like to take pictures of X-rays and email them to clients. That's fairly simple, too, though your camera typically needs to be a higher quelity than mine for radiologists to agree to interpret them. Hope that helps.
Dr. Patty Khuly January 25th, 2008 08:54:00 AM
The only time I've requested records of a pet is when the ownership has been transferred to me, and therefore, I'd rather go to my vet- especially if I'm not living in the same town the animals came from.
Georg January 25th, 2008 09:08:00 AM
My dogs' records are somewhat fragmented because I use different vets for different purposes. I have one vet I use for most routine stuff, but I do try to keep on good terms with the clinic that is two minutes from my house in case of emergencies. I also have a different vet I use for alternative approaches (think TCM) and one I plan to consult for possible acupuncture. Oh, and yet another that I used to use regularly whom I now use only for rabies vaccinations (she has the knowledge and experience to give me homeopathics to counteract the damage induced by the rabies vaccine -- one of my dogs has nasty personality changes where she acts like a rabid animal after receiving rabies vaccines unless she also receives a homeopathic remedy).
kabbage January 25th, 2008 12:45:00 PM
thanks for the clarification on the x-ray not-law. I'm not surprised to read that it's a standard of practice rather than a law. In my case, the clinic refused to allow me to sign them out and transfer them myself. For my own human xrays (where HIPPA does apply), I have NEVER been refused taking out/signing for them out. It's only one of many reasons I don't much favor this clinic (it's the only one open weekends/evenings so I sometimes have to use it)
p.s.. yes, I have LOTS of problems with the captcha image. It's got so many squiggles in the background, it's next to impossible to tell which are the letters.
EmilyS January 26th, 2008 10:55:00 AM
IMHO, we pet owners should be ROUTINELY requesting a duplicate copy of the records for our pet EACH time we visit, and I advise this on my website.
There are several good reasons for this, in the ABSENCE of any complaint or dissatisfaction. Here are 3 of those good reasons:
1. Assessing the recordkeeping is a part of continuously assessing the quality of the practice (just one part, not the whole thing). We should all be doing this, all the time, even when we trust and have confidence in our vets. Are the symptoms recorded? Are discussions between you and the vet recorded? Is consent -- or decline -- for services recorded? Are all vitals recorded? Are the staff initials and times that treatments were given or vitals taken recorded? Are those technicians whose initials appear there LICENSED? Who exactly is providing treatments to your pet -- high school students, or REAL vet techs?
2. Reviewing the records is a part of making sure you GOT everything -- that you and the vet discussed everything you need to discuss. For example, many years ago I had a cat who I brought in from the street, who appeared to have recurrent URIs. I kept taking him in, and the vet kept giving me antibiotics. The last time I did this, the antibiotics did not appear to be working. I took him back and ended up having to leave him there, because they were backed up that morning.
He died of an acute asthma attack that day at the vets. Well, he was euthanized because he was going to suffocate from it. The vet that called me informed me that HIS RECORDS indicated he had been diagnosed with ASTHMA on one of the previous visits. However, the very busy vet -- who spent only 2 or 3 minutes talking to me the previous visit, and give me antibiotics -- neglected to convey this diagnosis me, and neglected to discuss possible treatment options. My kitty died unnecessarily-- surely, the worst thing I could have done was leave him at the vets, where he was terribly frightened -- while he was in the middle of a prolonged asthma attack. IF I had the records from that previous visit, and IF asthma diagnosis was recorded, I would have called them after the fact to discuss it with the vet, since she neglected to bring it up. However, I had not asked for a copy of the records. So, I had no way of knowing this was what his problem was.
Getting records would have avoided all that.
I did not report these people -- it was a "boutique" practice with a great rep -- and I paid my final bill. I was very young and much more forgiving then, I gave them the benefit of the doubt that the vet was just so overwhelmed and busy, it was an oversight. But if it happened now, I would act differently.
3. In the event of an emergency -- A Katrina, for example -- you may need to relocate with your pets. Having a copy of the pets records will be very valuable in seeking care in your temporary home. And also, if you need to go to the ER, having records is much more accurate than trying to recall everything.
So, these are very good reasons why you should always -- or at least periodically, get copies of your pets records EVEN WHEN you have no complaints.
As for circumstances when a complaint arises . . . .
Obviously you need records then, the problem is, I have VERY GOOD REASON to believe that many veterinarians will CHANGE them -- "doctor the records" if you will pardon the pun -- once the request comes in, to ensure that any complaint filed against them with the State Board will be dismissed. I personnally am of the OPINION that this occurred in the case involving my cat Toonces. Records I saw the day he was seizing after insulin was given to him with the wrong syringe -- they were not in the copy of the records given to me when I requested them, and the vet claims that they don't exist. I am not in the habit of hallucinating things I see.
So, again, getting copies of the records as you go, will also give you something to compare against if the records mysteriously change once you have a complaint.
As for your situation Dr. Khuly, re:
"They just want out—usually because they’re unhappy with you for a real or perceived injury to them or their pet. "
Thank you for acknowledging that sometimes there is real injury. I take you at your word that you have looked inside yourself and asked yourself some tough questions about this particular case, and in your self-inventory, truly believe that there is nothing you could have done better.
If you should at some point, think differently, then the best path is always honesty -- relentless, and bold honesty. Everyone can make a mistake or overlook something. Owners most often are angered when a vet fails to take responsibility for something, or re-writes the past in a way that absolves themselves. In some cases, there is nothing you could have done better.
I would recommend, though, calling the owners and hearing them out. Without getting defensive. Remember, they are probably dealing with their own guilt too -- guilt for not having brought the pet back in when he was only "80 percent."
Compassion goes a long way.
I will never forget the last conversation I had with the vet who was found in violation of the Practice Act in the case of my cat. He actually BLAMED ME for not having brought an insulin syringe in with my cat -- as though THAT was the reason his UNQUALIFIED UNSUPERVISED son used a tuberculin syringe.
If anyone ever wanted to MAKE SURE they got reported, all they need to do is blame the owner.
Words to the wise.
Stefani January 26th, 2008 12:24:00 PM
An aside on the radiograph issue...
We use a service offered through our lab where our radiographs are taken and read out by board certified radiologists. We do this for many reasons--it has made us hone our radiographic techniques so that we always (well, 90% of the time) get a diagnostic and well exposed radiograph the first time, meaning staff and pets have lower radiation exposure (yay!) This service also picks up subtle things we may miss, and means we are constantly getting little bits of continuing education/feedback with every shot we take.
As a bonus though, this service scans our films and keeps them on a server (we are at least a year if not more from digital rads, I think) From there we can import images to our own medical records, so when I pull up your pet's record on the computer in the exam room, we can also pop up the radiographs. We have checked with our state VMA and they consider it OK to keep our "copy" of the film on the server--we don't need the physical radiograph. I don't think we have entirely settled what we're going to do with a physical films (we get them sent back in batches) just yet...but certainly giving a hard copy to a client if they move or have a referral appointment or whatever is less of a hassle.
DrSteggy January 26th, 2008 04:54:00 PM
I've moved around quite a bit, so I've requested my animal's records before. Usually it's nothing personal, but rather I'm moving out of state so I need the records. I don't necessarily think a records request is a personal issue.
Raven's Mom January 26th, 2008 09:03:00 PM
I've started always having lab results (blood tests mainly) faxed to me as soon as they arrive and I keep a complete file of all of those. Plus I periodically ask to have the vet records, notes, faxed to me as well. It's invaluable information and is building, with my dog's rather complex suite of health issues, into an impressive cumulative record, through three vets, of what has and hasn't been done with him.
I changed vets last year and did not explain it to the vet I left. But she had been made aware of the primary problems I was having there, which were with the support staff. It always felt like I was intruding or annoying just being there. No one demonstrated any interest or concern for my pets. The office manager was clearly surly by definition of her personality and I doubt that she meant to be as rude as she was. But, as I told the vet when I did discuss this issue with her, at some point it doesn't really matter to me WHY she's rude and surly. I just don't need the hassle. And I want to take my animals to a place where they are (1) more professional in their behavior, and (2) seem concerned about their welfare.
The new practice is so much better. As soon as I finished my first appointment there, I wished I'd changed vets long before.
Sometimes, too, it's just an issue of "fit." I like thorough, comprehensive, and DETAILED explanations. A vet who won't give me that is a poor fit for me. I want to hear about all the options and then I can choose what seems appropriate/possible to pay for. And I like to be treated like a semi-intelligent individual - start out treating me like a colleague and work your way down in med speak rather than starting out by treating me like it's all just too complicated for me to understand. I look for a vet who gives me and my pets that kind of treatment. I knew I loved the new vet when, after giving my kitty a dental, he pulled out the laptop computer, pulled up the dental x-rays, and went over them with me, without my even having to ask.
Perhaps most important, I expect to be part of the treatment team.
I think vets have a hard job... there are so many different levels of "pet owner" and I'm sure it's extremely difficult to figure out how to work with each one. And even then sometimes the fit just isn't there.
Natalie January 26th, 2008 11:32:00 PM
I came upon this site while doing a search regarding any ill effects my dog could suffer if vaccinated twice for rabies in a 3 month period (a 3 yr. vaccine). This was done by the vet, I believe, due to the offices secretary ordering it done along w/ the bordella shot for kennel cough. She told me after-the-fact, of the policy for dogs to have all vaccinations and kennel cough vaccine before the are groomed there. He was there simply for grooming appt. which he had set for 2 wks. prior and we have never been informed of this policy. My husband had taken our dog to another vet (which we plan to switch to permanently) in late Spring because our current vet had required a wellness exam before giving any vaccinations adding another $40 to the bill. We did not feel this necessary at the time and sought other prices at neighboring practices and found they give vaccinations we needed for $40 w/ no additional exam cost which would have been $80. So he took hiim there and really like the care given and cost. When our pet needed teeth cleaning and some removed we called for prices as well as we felt the vet we had used charges a minimum $400 for cleaning and xrays needed but it could go as high as $1200 to also remove any teeth. We again went back to the newer, more cost effective vet and had it all done for $280--cleaned, 5 teeth pulled that were infected and antiotic all together. This vet no longer does grooming so we went back to our closer, local vet w/ the satellite clinic 10 miles from our home for the grooming. This is when I picked up my dog from what would have been a $30 grooming (which was all we could afford to do for now w/ the dental bill and previous recent treatment and death of our cat this summer and an older dog in the winter). The bill came to $109 and the secretary went on to inform me then that because my husband cancelled the rabies appt. earlier in summer and our dog never had it, they gave it to him along w/ kennel cough vaccine prior to grooming. I was shocked and she was angry (at me!) when I told her that our dog did in fact have rabies shot. She asked where, and I informed her he took him to another vet. She further interrogated me as to where? and that she would need me to bring in proof that we had this done or they would charge me. I was so in shock that they would give him shots w/out calling us first or informing us of this policy for grooming which we never knew of before and have been grooming our dogs there for 15 yrs. It also upset me that she felt it ok to give someone a bill over $100 when they were expecting $30. Then, I got upset over my dog having this done to him and the treatment to me by this woman. She has always been abrupt but I could handle that, but this was diferent. I wonder if the vets who co-own the 2 clinics know how she treats customers and what is going on. I haven't contacted them though I know the one vet/owner fairly well but it is a small town and this woman can be nasty and spread things around and I don't need it right now w/ losing my job, etc. I am tempted, however, to do something about this to protect others and their pets and I wonder what things have been done to others as well. This vet will be losing much business in the future from our family as well.
Jody October 8th, 2009 10:21:41 AM
Add Commment