Having worked (human) ER shifts in the past, I must say that 24 hour ER availability is expensive, and in ways that can’t always be counted by dollars, either. Finding the trained professionals who are willing to work overnights, in conjunction with their day duties, is a big piece of it.
I’ve seen plenty of professionals say “You’re not paying me enough for me to continue providing this service”. Then one either has to offer more money, or curtail the service.
Splitting up the cost of taking the radiographs and the cost of developing them feels sneaky to me, particularly if they have a digital x-ray machine, which many clinics do. Also, charging for 12 hours of nursing care when he was only there for 5 also needs explaining.
That said, the total amount doesn’t feel that unusal for a small animal urinary blockage. The fact that you are in a relatively small town also ties in. It looks like there aren’t that many veterinary hospitals in Kingston, Ontario, let alone ones that are open all night.
If they do decide to refund some of your money, don’t expect it to be a lot.
Let me ask the vets responding - how much of an emergency is something like this? Could it wait until morning? I usually go with the “Blood isn’t gushing out and my pet is breathing okay - it can wait” theory. Now, for something like a poisoning, that would be different, but if they just seemed to have difficulty urinating, is that an emergency?
(For the record, I have a similar criteria for taking myself to the ER).
StG
Being unable to urinate is decidedly an emergency. It doesn’t take very long for the retained urine to throw the body’s blood chemistry completely out of whack and kill the animal. Timing is especially an issue in animals, where we can’t ask them exactly how long they’ve been unable to pee.
And, it’s incredibly painful. For an excellent example of how painful, watch the second season of Deadwood
If you ever have an animal that you know for sure can’t pee, it needs to go to the veterinarian right now, as much as an animal who is actively bleeding or continuously wretching (a strong symptom of bloat).
Depends. If a pet is straining but still passing urine, I’d probably wait till morning and go to the regular vet. If a pet isn’t passing urine at all, as sounds like the case here, hie thee to a vet immediately. Depending on how long the animal has been blocked before you’ve noticed it not peeing, it could die before morning.
Could you elaborate a bit here? Granted vets can have their specialties just like human docs, but if he has the tools, the time, and the talent why not finish the job. It sounds like he was most of the way there in this case.
Er, not really. To actually remove the stone(s) would have required opening the abdomen and the bladder, scooping out all the schmutz, irrigating the whole thing, and closing the abdomen back up. After you retropulsed the stones so you could get at them without filleting his penis, that is. It’s a pretty long and involved procedure, and the increased anesthesia time and the surgical time would have driven the price through the roof.
Very, very few big things get cut in the middle of the night, and those are always things that just absolutely cannot wait. C-sections, GI foreign bodies, bloats, and diaphragmatic hernias are about it, really. If it’s more serious than a few stitches and less serious than those conditions, it’s getting stabilized and waiting till morning.
If you’re a general practitioner who takes your own call, like the guy I work for now, a) there’s no advantage to doing it in the middle of the night and treating or cutting other people’s animals sleep-deprived if it can wait, b) there’s no point dragging me out of bed and paying me overtime plus having me working sleep-deprived the next day if it can wait, c) if you and the only tech in the building are both tied up doing this surgery that can wait, there’s nobody to work on an emergency that comes in during this time, and stuff that comes in during the wee hours typically needs to be seen pronto, and d) many emergency cases who ultimately need surgery aren’t great anesthetic risks right off the bat and benefit from a few hours of stabilization treatment prior to surgery.
That last one and the price issue are the biggies for an emergency clinic like the one I used to work at. A lot of the cases we saw were shocky when they first came in, and aside from it being bad medicine, taking a shocky patient into surgery when you don’t absolutely have to is a liability risk and a potential malpractice lawsuit. It was better for the animal and better for the owner’s pocketbook for us to stabilize the animal and get it in better shape for the regular vet to cut it in the morning.
(S)he may have the tools, talent, and the time, but he may be in a situation where he accepts referrals with the agreement that he will address the emergency and do no more. State boards also may address the question of what an emergency clinic may offer.
An emergency clinic only thrives if the local practices send their emergencies their way. Local practitioners may resent an emergency clinic doing anything that they could do (and reap the profits).
It is one reason I prefer to handle my own emergencies. In a stable patient, for me, retropulsion of stones into the bladder is a 10 minute thing. I can go into the bladder and retrieve stones in an additional 25 minutes. Add ten to fifteen minutes more for a urethrostomy. However, if my client has spent $900 already on emergency care, in my neighborhood they may not be able to shell out $500 for me to do a cystotomy.
I do not call what I do emergency medicine, but rather continued care. I see only patients with whom I have a prior history.
My general advice to pet owners is to look into the emergency protocol of your veterinarian before an emergency arises.
YMMV big time. Personally, I like emergency medicine. I would rather do some cool surgery at night and just deal with being a little tired the next day. That is why we have a coffee pot at the office.
Also, except for very rare cases, I fly solo for emergencies. For something that needs ventilated (like a diaphragmatic hernia) I call in a tech, my daughter, or my gf, and slip them some cash.
Also, in my one man practice emergencies that need immediate care are once a week or so things. I can triage and do what is needed if it is a very bad night.
Would you like to the dog bite scars on my arm from the poor dog who was in excruciating pain from his bladder rupturing in the middle of the night and my arm got a little too close to his mouth? Yes, it is a “get seen right away” type of emergency. I don’t blame the dog, the muzzle got loose and came off, this dog was in so much pain he had no idea what he was doing. I hurt for this dog even before I was physically hurting for this dog.
Basically, if they are not passing any urine, straining frequently and uncomfortable it needs to be seen right away.
Also, if it’s a male dog or cat, you should just suspect a blockage. Females rarely get obstructed though it is possible if they have a big enough stone but I’ve only seen it twice in female dogs and each time they passed the stone before we could pass a urinary catheter, usually after we have taken their x-rays and put them in a cage while we prepare the anesthesia and tools for catheterizing them. Which is fine by us because catheterizing females is a bitch.
Touche`:D
I’d guess it’s a time thing. If there’s only one vet. running the store, that person can’t very well be scrubbed in to surgery and thus unavailable to see other patients for a few hours.
One thing I don’t understand - I work on large animals, but there is also a small animal arm. The bill a horse owner gets for having having a horse evaluated, then getting colic surgery performed on his horse and the post-op care is often LESS than a dog owner pays for having a gastric torsion operated in our hospital.
Despite the fact that if the dog needs 1 liter of fluids a horse will need 10 in the same time span. There are costs - mainly professional -that are built into small animal bills.
Just this weekend I saw this on a door mat:
My Veterinarian Drives a Porsche
See dog for details
I’ve been told (by equine vets) that their overhead is much lower. However, practice management is an area I stay away from, leaving it to a practice manager.
Back when I was doing some ostrich work, I did a proventriculotomy in an ostrich hen. Sorta the avian equivalent of colic surgery. We worked out an agreement with a local equine hospital for use of their OR and a stall, and I did the surgery.
Post-op the bird’s owner asked my what he owed me. It was during my free time, so I just kinda picked a number out of the air. He paid me. Later he told me that my charge was a tiny percentage of the total bill. For 2 hours of OR use and a recovery stall that the owner had to clean the bill was much higher than my surgical fee!
Vetbridge, if you’re a doctor and you’re willing to clean up after yourself, our mileage definitely varies. And if you can actually get all the shit you’re going to need ready to go ahead of time and do surgery beyond the basic spay/neuter without bellowing for extra stuff a few times, our mileage REALLY varies.
And could you come give every vet I’ve ever worked with some lessons?
Ok this makes more sense to me. My little Ex-EMT brain was boggling that an emergency service facility would be so dependent on referrals. There are half a dozen such places in my town (Fresno, CA) and I know people who have used them and rarely did much shopping around.
I have a co-worker with a horse, she told me that if her horse needed colic surgery the equine surgery center would not even see her horse without $3,000 down and that doesn’t even cover the whole surgery, that’s just the down payment. We do a GDV surgery for about $2,000 to $2,500 and that covers everything from the initial office call/exam, x-rays, anesthesia, surgery, IV catheter/fluids, blood work, ECG’s, the surgery itself, gastric lavage, hospitalization, antibiotics and pain medication. It usually runs to the higher end of the scale if the dog is in bad shape and needs intensive care, additional medications for complications or a splenectomy.