Vet Stress Trust me...or not (When basic trust breaks down between pet owners and veterinary professionals)

Here’s a hypothetical for you: You bring your new kitten to your vet for her final well-kitten visit. She’s due for her rabies vaccine, too. The visit proceeds smoothly while the veterinarian performs her physical and answers all your questions. Then you’re done. But where’s the rabies?

Your vet explains that she gave it while you were discussing things and assumed you saw her give it. You didn’t see it happen and somehow you really don’t believe it was given. Doctors forget things sometimes, too, right?

Now you have a choice.You can ask your veterinarian for some kind of proof that it was given and risk insulting her. You might even ask that she administer the vaccine again, just to humor you. Either way, it’s a touchy situation.

Something like that happened to me yesterday morning. I gave a deworming pill to a cat when her owner had been unable to accomplish the task at home. We were talking about how wily cats can be while I administered the medication. It literally took me a second. I think I even punctuated the event with a semi-musical, “ta-da!”

The owner, however, was unconvinced. She swore up and down that I had not actually given the pill. “Trust me,” she said, “you did not give the pill.”

Interesting choice of words, to which I could only respond with an unwavering, “No. Trust ME.”

Inexplicably, the standoff continued and the owner demanded that I administer the pill again. I refused, explaining the side-effects of a double-dose of dewormer. Instead, I offered to re-administer the pill in one week at no charge.

I figured this would be a win-win solution. We’d end this ridiculous argument and the cat would be well-served in the end. Sure, we’d all “lose” something: more time spent, one more pill down the gullet for the kitty and all that. But at least the cat wouldn’t get overdosed and the relationship between veterinarian and pet owner would be salvaged. We might even laugh about it at next year’s visit.

But it wasn’t to be. In the end, the owner remained intractably firm and I explained that she’d need to find another veterinarian to give the pill if that’s what she really wanted. I could not in good conscience knowingly double-dose a patient. Sorry.

Does this scenario remind you of anything? I remember once getting upset at a cashier in Mexico for handing me incorrect change. In the end, I had been wrong and I’d taken my lumps when I found the crumpled, large-denomination bill in my back pocket. I’d gone back to apologize, tail between my legs.

We all mess up when we do little, seemingly inconsequential things throughout our daily lives. No one’s perfect. That’s why I mentally retraced my steps to the medicine cabinet, called up the image of the cat’s chin and the yellow pill on the back of the tongue. I’m SURE I gave it. Every bit as sure as I was when I thought I gave the Mexican cashier that big bill.

Hmmmm....

Only this time it’s not about a bit of money any establishment can swallow citing “the customer is always right” philsophy. And it’s not just about the cat’s well-being, either. For me, the bigger picture is all about the lack of trust. It’s all about how that stainless steel exam table came between us.

In the end, I copied records. I fired the client. And I seethed at myself all day for being unable to negotiate my way out of a paper bag.

July 17th, 2009

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Suffice it to say that my trust issues with vets stem from much more legitimate things than this scenario. I would believe my current vet in such a scenario. And even if I was still left with nagging doubt, I would NEVER demand that a subsequent dose be given, knowing that if I were wrong, I could be OD'ing my pet.

Different situation, but having had a diabetic cat and fostered 2 more diabetic cats, I can remember SO many times when I thought I didn't give the shot correctly -- that the needle went all the way through the skin flap etc. (What we call a "furshot.") Sometimes I was so sure I had done this . . . and almost every time I was later very happy that I didn't act on this belief, when I saw their BGs go down in spite of me being so sure I'd given a "fur shot."

It is almost always better to under-dose or skip a dose than to overdose . . . .

Stefani July 17th, 2009 10:11:04 AM

On the flip side, I recently requested a copy of dog's vet records and got a two page billing summary. When I clarified (which I'd previously done by phone before they sent the billing record) my request again, that I wanted a copy of the actual chart - hand written notes and all; I was fired for "lack of trust". Good riddance. He's also the one who referred me to the board certified surgeon for this dog, the surgeon who moved to another practice (from Houston to Dallas) 33 days after our final visit for one surgery and with her in need of a second and without giving notice to patients (and leaving his client list available to other vets for mail outs of advertisements). Of course, I suspect the first vet knew the surgeon moved and didn't bother to tell me that either. Good riddance to them both.

I find it disturbing how quickly "professionals" are willing to "fire" their clients but that's on a growing list of disturbing things professionals do. I think professionals need to work on their people skills.

PJBoosinger July 17th, 2009 10:37:25 AM

I don't think that you are "unable to negotiate your way out of a paper bag." I think you offered a perfectly reasonable solution to the problem to this client and she was being unreasonable. Yes, we are all human. Yes, sometimes our minds play tricks on us making us believe that we did something that we didn't. But in the end, if there was a potential of double dosing there and all the risks associated, I'd definitely wait a week.

Shannon July 17th, 2009 10:43:42 AM

Yes, we're all human but in a professional/non-professional relationship, the scales are very much out of balance and a professional who acts unprofessionally or is perceived to have done so not only harms their own standing but that of the profession. When a professional is a quick draw to react (as in firing a client within moments of an incident) instead of taking time to cool and think it over, they are perceived to have behaved badly, acted on emotions instead of acting professionally, based on cool reflection.

I'm not questioning Dr. K's decision not to risk potential double dose; merely how/when she chose to handle the aftermath. Clients/patients get to be emotional and stressed. It is a luxury that should not be indulged in doctor, lawyer, accountant, or other professional when acting in that capacity.

PJBoosinger July 17th, 2009 11:05:52 AM

You know, this was an interesting situation. Not really too acrimonious, just a matter-of-fact standoff. Since she was convinced her cat needed the pill right then and there, there was really nothing else I could do. It was kind of strange. I've never faced that kind of situation before.

Because she "NEEDED" the pill, there was nothing else to do but send here elsewhere for it. I guess I technically didn't fire her since I did not send a letter, but the copied records were placed in her hands and that was certainly the implication.

It's not as if I think I couldn't have been wrong, just that she was so convinced she was right. What can you do with that? Beyond making a reasonable offer to compromise (and mine was reasonable, I think)...nothing.

Dr. Patty Khuly July 17th, 2009 11:49:07 AM

I don't feel that the client was reasonable here...but I also don't think that was a firable offense, either. if I fired a client over that, I'd probably be next. I'm not sure what I would have done--I've definitely had folks not see me give vaccines, but I haven't had one ever ask me to repeat an injection either. If I'm giving a pet a pill in front of an owner, I usually explain what I'm doing (and do it in slow motion, if the cat is amenable to that) and then actually give the pill. With some cats, speed is the key in giving the meds. :P

drsteggy July 17th, 2009 12:05:03 PM

Sometimes, people just have to agree to disagree. As an incredibly stubborn person, I can see myself in the owner's shoes and imagine that once the owner calms down, she will probably feel sheepish about her behavior. Your offer to readminister the pill next week is very reasonable, and if the owner had really stopped to think, she would have realized you had the kitty's health in mind.

Posey July 17th, 2009 12:12:35 PM

Trust is so important. I am reluctantly changing vets. Until recently I was happy with mine. We had a long relationship. He understood that I was a well informed client who wanted to be actively involved in making health decisions for my pets.

I brought my two dogs in about 6 weeks ago, one for his annual exam and boosters, the other to just have the vet look at an oddity in how he was walking. Neither was showing any symptoms of anal gland problems. My previous dog had NEVER had her glands expressed. I did not ask for the dogs' glands to be expressed. Yet the vet proceeded to express both dogs' glands, and with my Bostie, caused him excruciating pain -- so much that he is now afraid to even enter that vet clinic. He screamed in pain, clawed his way out of the tech's arms, gauging the tech's arm deeply (drawing blood), and jumped off the examining table.

I was shaken. WTF was going on? Why do this, and if you are doing this, why not tell me or ask me first? I specially had kept going to that clinic after moving because I trusted this vet even though the location was not convenient. But now, every time I brought my dog there, he would be traumatized. So I decided, time to change. No, he didn't do the dogs serious injury but he did violate my trust. And I could not see bringing a sick dog to a place that now terrifies him. I am sorry to end this relationship, but he really did a dumb thing when he didn't take the time to just ask first.

Susan July 17th, 2009 12:18:44 PM

How about ensuring she knows she can come back if there's an emergency before she finds a new vet (or a list of emergency centers) and/or if she reconsiders upon cooler reflection of her own? Or is she under the impression she was fired?

When I'm in my office, I'm in my element. When I'm in another professional's office, my own profession or a different one, even if I think I'm being rational at the time, I'm not in my element and it may take hours or days for me to absorb and process. Do you know enough about this client to know if she's had issues with vets in the past? Is it possible you inadvertently gave her a "flashback"?

And while we're on the issue of trust :) Does one tell the new vet about what happened with the previous vet so the new vet will exercise their best people skills or does one risk those potential "flashbacks" because telling the new vet may make them paranoid? Lawyers routinely call the previous attorney to get filled in. Do vets? (I know some of the vets here will only release records to the new vet and that's either to get their side in first or at least give the impression they might as a form of intimidation.) It's never easy, is it?

PJBoosinger July 17th, 2009 12:19:37 PM

Just musing here, as I think the way you handled it was more than reasonable, but it seems likely that the person didn't trust you because she couldn't believe you could pill the cat without it being a huge fight. If there was another, innocuous, similarly sized pill that you could have given (Capstar?), to show how easily you are able to accomplish the feat, maybe that would have made her a believer?

Mary Straus July 17th, 2009 12:32:05 PM

PS: I wish both my recent twerp vets had fired me months ago. I'd have been mad but at least I'd have known to be looking for new ones instead of left hanging for 6 months. :) Sorry, I'm mad but also confused. The surgeon moved. Big deal, just tell everyone; copy files, current clients first, prioritize and work backwards. And now he's trying to revise history. And he wonders why I now question every word, every notation in his files. WTF???? Seriously, this can't be easier or less time consuming for him than if he'd been honest from the beginning.

PJBoosinger July 17th, 2009 12:32:17 PM

Mary, That was my initial thought but I'm guessing by then the cat would have been picking up on the owner's stress and maybe even Dr. K's and that attempt could well have backfired :) Based on my own cats, it was probably the swift, matter of fact, stealth that made this a successful dosing. It rarely works a second time in a short time frame with mine :)

PJBoosinger July 17th, 2009 12:36:21 PM

Do you have a history with this client? Is this her normal demeanor, or was she having a bad day?

My work entails dealing with the criminal population..even so, I traat everyone how I'd want to be treated. I even give most a free pass for one rude action.. but after that you get what you give...and I've learned that you can't reason with stupid, crazy, or people who just LIKE to argue...

I am basing this on the relationship I have with my vet, and even tho we agree to disagree on some things, like diet, I TRUST HER and would never call her a liar, which is what this client was, in effect, doing to you.

If she was concerned about her cat, she would have taken up the offer for the pill again a week later. She seemed mor bent on being right and making sure you knew it..

agadoresmama July 17th, 2009 12:48:37 PM

When I was looking for a family doctor many years ago, there was a particular Dr. I wanted, but I was fired before I was a patient with the standard "Dr. X isn't taking any more patients right now."

I told the nurse on the phone"Well, tell Dr. X that I am not taking any other Dr's right now." She hesitated but went and told him.

When she returned she said that he would see me. He has been my Dr. for 25 years now.

Bob Jones July 17th, 2009 12:59:50 PM

I too have pilled a cat so fast that the person with me didn't even notice, but luckily I'm not a vet. And I was able to slo-mo how to pill the (elderly, laid back) cat to demo 'how you pill a cat'.

But I would have come back a week later for the pill.

redheather July 17th, 2009 01:26:24 PM

I think the not-so-implied accusation of lying is what would have done it for me. This "oh the professional and the client are so unequal, the client is entitled to be stressed or upset" stuff might fly if the cat were there for an emergency, but not for getting a worming pill. If things escalate between us and a client to the point where they are making accusations of misconduct, it is time to end the relationship. You know, even a restaurant has the right to refuse service. Why is it you think the rule is any different for a professional?

Susan July 17th, 2009 01:53:17 PM

In the case of a vaccination, it's fairly easy to 'prove' it's been given. You take out the vial beforehand to warm it up (placing it on the counter or exam table), you take out the syringe from the drawer and tighten the needle, go through the process of drawing it up into the syringe, and then giving the animal a 20 second scratching/rubbing at the injection site to dull the nerve endings a bit, then give the shot. Even with the most talkative of clients, unless they're not facing you for this process (and some clients are weird about needles so step out of the room - then they just have to trust us), they couldn't have missed all that. In addition, you can show them an empty vial and syringe, and after putting the stickers on the record, that should convince them (unless they're certifiable) that you wouldn't have gone through the whole process to inject the vaccines in the garbage can or sink...so it had to have been administered to the animal.

If the pill had been placed on the counter or the exam table, in plain sight, while you explained any effects it would have (seeing worms in stool, or loose stool, or nothing, is that's the case), then, after pilling the cat, if the pill isn't on the counter or table, you'd should (although in this particular, oddball case, maybe not) be able to say, "well, it was here, and I gave it, and now it's gone." If you had taken it out of a pocket, but kept it in your hand, the client probably never saw it in the first place, so it's harder for them to believe it was given to the cat. Still, why would they think you would lie, is the question that only the client can answer, and you may never be able to get that answer from her, so just move on. Other people's motivations are often completely crazy and you'll only make yourself crazy agonizing over them.

KateH July 17th, 2009 02:14:13 PM

Yellow deworming pill? Was it a Drontal? I think if I had been in that situation (which is admittedly very strange...and also imaginable since I'm usually the one pilling cats if they need to be pilled), I'd have just given another pill, given the drug's wide safety margin. And I'm not a vet, but I'd don't think the ones I work with would mind. Not that Dr. K's response was unreasonable - it was probably the best solution. But I'd hate to lose a client over something so trivial, especially if it's not going to hurt the patient. For example, we use a lot of liquid pyrantel in our practice...I always draw up 1.5X or 2X the dosage, depending on the animal's demeanor and how likely I think they are to spit some of it out (cats, especially). That being said...I would have been careful to notate the whole incident in the record.

anna July 17th, 2009 02:16:30 PM

"even a restaurant has the right to refuse service. Why is it you think the rule is any different for a professional?" For the same reason Dr. K sees a difference between her restaurant experience and this one involving a professional :) The "customer" isn't always right when a professional is involved and that puts a burden on the professional to be even more persuasive and not hoity, toity. There's a long history of professionals coming across that way and it stems from the days when professionals didn't charge for their services but were members of the elite who provided their services at their whim and people had to essentially beg for help. Unfortunately, the attitude survives despite that professionals are now paid and it comes across as even worse these days. Even a hint of that attitude may be incredibly offensive to someone paying for services.

If my son takes me to the doctor and is a stubborn smart ass, does my doctor have the right to fire me and leave my health care in limbo because of my caretaker's attitude? Or does a professional have at least some obligation directly to the patient? I've had legal client whose friends and family paid their bills and they were often asses and wanted privileged information despite having been warned they wouldn't get it (even their bills were redacted). However, I never fired a client, to whom my professional duty lies, for the third party's idiocy and, if I'd ever absolutely had to, I would have had an obligation to see the client through to new counsel first as the court would be unlikely to let me off the hook prior to that.

PJBoosinger July 17th, 2009 02:35:58 PM

If the Internets have taught us anything its that you can't blindly trust anyone, especially when it comes to pets.

This seems like an insignificant enough issue to draw the line on for the client and your solution was extremely gracious I think.

Sheyna July 17th, 2009 03:18:09 PM

Bob: I'm going to remember that line. It's brilliant.

agadoresmama: Yes, I did feel like I was being called a liar. But I can't let my ego get into it. If I did, I'd be firing anyone who seriously questioned my judgment--and it happens all the time in lots of small ways.

To those who think I fired her to quickly: In this case, I do feel like I should have made the offer to see her back. But since it was the second time we ever saw her, I doubt it'll play out that way. Sometimes it's good riddance. But I should have given her a chance. More so because I didn't know her? Maybe.

Dr. Patty Khuly July 17th, 2009 03:23:44 PM

"In this case,..." Thank you for that. Maybe it won't make any difference at all but a quick call or note to her might leave less of a bad taste for the next vet to deal with. Just a thought (because I know you've seen those clients just like all of us :). "If I did, I'd be firing anyone who seriously questioned my judgment--and it happens all the time in lots of small ways." Ain't that the truth! IMO, the worst is me being on the other side of a lawyer's desk, bad for us both. I get the impression from some previous blogs that you've had a similar experience on the other side of that steel table. :)

PJBoosinger July 17th, 2009 04:06:39 PM

In the world of process improvement, Demming was the master in Japan and he was followed by Shingo with Poka Yoke devices.

These are simple devices that validate a process while it is being performed. The suggestion above that a pill be placed in plain site in a cup on the table, Then give the pill. This is such a device. If the cup is empty the pill was given. A variant is used for the elderly for their daily doses. A containeer with the doses for the week is clearly labeled with each day so they know if they have taken their pills for the day.... providing, of course that they know what day it is.

I don't have a problem with the day of the week because of my routine. Sometimes I'm not sure of the decade. At work they start the converstaion with "This is the year 2009.. you are in... , I am your boss..." in order to give me a context for the conversation.

You should also learn prestidigitation, that way you could cheat your customers by clearly showing that you pulled it from their ear, then give it to the animal while actually pocketing it. I am sure there must be big bucks in not administering the medicine...

You never know if the customer actially believed the medicine wasn't given or if they were simply causing an issue so they didn't have to pay. There is a book, and I have forgotten the name.... This is the year 2009.... but it teaches people how to cheat a vendor by complaining about the service.

Poka Yoke devices can protect you from them as well.

Bob Jones July 17th, 2009 05:06:06 PM

maybe keep a placebo handy for next time?

jim hall July 17th, 2009 05:08:58 PM

OK, let's give them the benefit of the doubt and assume that they REALLY REALLY did believe they saw EVERY move Dr. K made and they were 100 % sure that she hadn't given the pill. If they truly believed this and knew the pill was needed, then they needed to say something. (Although I would have probably gone for the 1 week repeat, or asked what the potential adverse effects of a re-dose would be).

It is what we call a "Lesson Learned" in that Dr. K could do something like what Bob suggests which is have a more obvious, deliberative process where it's not left up to her memory. Having an assistant HAND YOU the pill, for example, or even always having an assistant in the room, might help. Being more obvious/demonstrative as these things are done.

I remember once three times in a row mis-remembering that I'd done something at work when I followed up I could see that I had not. Each time, I thought I did this thing, and I did this 3 times in a row, the very same thing on the very same day. It was a bad day, but OTOH, pointed some flaw in my process. This just related to doing something with a piece of paper -- = no one's health is at stake. But sometimes if you "think of" an action you are going to do, your brain remembers it as an action you DID do. That is why some external, objective tool to verify is important.

Stefani July 17th, 2009 05:24:08 PM

Stefani, My son and I have a variation of that. He thinks he told me something and I'm sure he didn't. We've finally figured out that he practices what he wants to say to people and sometimes convinces himself he's actually done so. Certainly has honed my memory quite a bit since my strokes (as a matter of self defense :) and he sure didn't believe he was doing it until 2 other people pointed out similar issues with him! We resorted to email for critical communications for a while.

I think I'll always be grateful that my mother had near photographic memory and I couldn't get away with altering history even a tiny bit without being called on it (although I certainly didn't appreciate it much in my teen years).

PJBoosinger July 17th, 2009 05:57:33 PM

Perhaps someone else wrote this and I missed it. With a rabies vaccine -- unless youy use the 10 dose jugs -- you can have a practice of peeliong off the label and stickiong it in the record. This also documents the lot number and expiration date of the vaccine. If the client sees this in the chart, they should reasonably accept that the vaccine was given. (or not)

Dr. Steve Dubin July 17th, 2009 06:05:18 PM

Dr. Dubin, I was thinking the same thing. All the tags from the vax are stuck on my pets' records.

But the larger issue: Would I believe what my vet tells me? Yes, I would. I wouldn't hestitate to ask if I think I missed something, but if I can't trust my vet I have the wrong vet. And I don't have the wrong vet, for almost 20 years now.

Gina Spadafori July 17th, 2009 06:20:08 PM

talk less and make sure that the client sees the pill go in. It's one of the many reasons I hold my own pets not techs...hard to miss a procedure if your participating in it.

fire the client over a droncit tablet? (or whatever pill wormer) sure your not pms ing....seems a little....overreactive. But I wasn't there...wish I'd thought of "firing" medical professionals years ago....

LorriM July 17th, 2009 06:29:07 PM

There's an art to turning away a potential customer you don't want. Recomend them to one of your competitors.

Evet July 17th, 2009 07:03:30 PM

Don't feel guilty or in funk for telling a client to GET LOST. Bad customers can really end up costing you big time.

The heartbreaking part is the pet has to suffer living with these types.

Evet July 17th, 2009 07:19:34 PM

Susan: Wow, that was just plain dumb. Did you say the dog w/ walking issues was scooting on his rear? Still, to not warn the client is inexcusable since a LOT of dogs have issues with anal gland expression & become very upset.

I agree with Stefani, upset over a pill would be the least of my "trust" issues! I would probably be amazed with the no hissing, foaming, and drooling & want to see it done again , so I could learn how ;)

PJB: check out Texas Vet Board Watch for consumer information, it is not 100% guarantee , as some of us have learned. Your description of shuffle off to Buffalo, leads me to wonder. Most departing vets will inform the client as a courtesy.

"There's a long history of professionals coming across that way and it stems from the days when professionals didn't charge for their services but were members of the elite who provided their services at their whim and people had to essentially beg for help. Unfortunately, the attitude survives despite that professionals are now paid and it comes across as even worse these days. Even a hint of that attitude may be incredibly offensive to someone paying for services." I call that abuse of authority and a host of other censored words!

Dr. K: I would really blow it off to : a bad day for the client, questioning things can sometimes be habit for people in order for them to process & digest, & just maybe you would remove the pill charge...who knows. But I wouldn't give it more thought, nor fire the client.

And I have made that embarrassing booboo at a sandwich shop & apologized profusely.

good reasons for lack of trust: here & here

Barbara A. Albright/NH July 17th, 2009 07:29:34 PM

I have never had that particular thing happen with giving a pill but I could see how someone would miss the administration. I usually use a 'pill popper' and follow with a small syringe of water. I never really thought about it being more 'obvious' to the owner but I think that it would be as comparted to just using your hand. Based on this post I will be sure to be more aware of whther or not the owners actually see me doing something to their animal. I have just taken for granted that they are paying attention; unless they can't stand the sight of needles.

As to the firing of the client -- I think I would just hold my ground that I had given the pill and the offer to repeat in a week at no charge (more than gracious). Then I would just leave it up to her - she can stand there and argue or she can take her business elsewhere. But if she was going to just be ranting and loud then I think the move to get her out of there as quickly as possible so other clients don't have to listen to her is a good move. Then not only are you losing the one client but she could influence others (unrightly so in this case)

I would look at it that if she was not willing to trust you for such a small thing then what would happen when the pet is really sick. It is near impossible to do a good job for someone like that and I think you just saved yourself grief later on. She can hopefully find someone that she can trust and work with and ultimately that is better and what is most important for the pet.

J.C. July 17th, 2009 10:53:16 PM

When I was looking for a new vet when I moved, one I tried (and never went back to), didn't weigh my pet, take a temp, check his ears, anything. I came in for shots and they did no examination, just the shots. Then when I went to get flea meds, they had my 100 lb dog down as 75 lbs and gave me the wrong flea meds. I pointed this out and they just said "oh." and swapped the meds. What if my dog had been getting actual medicine and I hadn't been paying attention to what they put for his weight? I mean, its not like weighing a dog takes more than a minute. I never went back because if they can't do something that simple, how can I trust them with something serious?

Valerie July 17th, 2009 11:23:27 PM

Wow, you can actually 'fire' a client in the states.

In to Uk we have to 'put up and shut up'.

I'm moving to America...

LittleVet July 18th, 2009 11:02:57 AM

I love the juxtaposition of the last two comments. I guess that's what America's all about: good and bad all rolled into one.

Dr. Patty Khuly July 18th, 2009 07:24:02 PM

Vet grrr story:

The clinic I favor has about five vets there. I took my beagle/basset in about a month ago for what I suspected was a pinched nerve/slipped disc (she screamed every time she moved.) I got in with a dr I'd met once or twice before, because to me this was an emergency. He confirmed my suspicions and she got medications. However, I will never see him again, I'll go elsewhere if one of "my" vets can't get us in because of two things:

1.) He initially said she was fine because she was sitting and wagging her tail and being astoundingly cute. I told him no, that's not right, she would normally be all over you exploding with joy. This is not how my dog behaves, sitting politely. (Wish I could say otherwise.)

2.) He gave me all kinds of issues because, I admit it, she had fleas. I had been in two weeks previous for when she sprained her toe (a mystery to us all) and bought heartworm prevention because to me, when having to make a $$ choice between heartworm and fleas (in Florida), I'll get the hwp every time. I knew she had fleas, and I'm also in there at LEAST once a month, (and have the chart to prove it) yet he was all concerned about fleas. Never mind I am telling you she's been in agony this morning and I'm scared for her, even if she decides not to say a peep while here, never mind what I came for or that I spend crazy money here and send you clients all the darn time, just harass me over a few fleas. She wasn't infested. It wasn't pretty, but it was the least of my concerns, and I intended to get advantage and capstar while I was there anyway.

If it weren't for the other two vets there that I absolutely adore, I'd change clinics to one closer to home that's just as nice.

As for pilling the cat, I think Dr. K offered her a very reasonable alternative, and that it's not her fault the client didn't see it that way.