from the berner-l

I have been asked privately about what things one might consider when deciding to switch veterinarians. I know I do not have all the answers, but will provide information based on my experiences and hope others will add theirs.

A good start is to spend some time thinking about what is important to you in a veterinarian and his/her practice. For example, I prefer female vets and I absolutely must have a vet that will listen and discuss things with me -- not just impose "wisdom." I need a vet who has the confidence to deal with someone (like me) who may not always want to do things the traditional way, and who will want answers based on evidence -- so I need someone who keeps up with the literature in his/her field and has good communication skills.

I want a veterinarian who is accessible -- will return calls, for example. I also want someone who has good back-up for after-hours emergencies, and proximity has to be somewhat of a consideration. I expect clean and nice looking facilities, and receptionists and technicians who are not airheads. If the animal needs a procedure, I want to be able to go back with him/her as desired. Price is not a consideration -- not because I am rich because I am a professor so therefore am poor :) but because I am not going to determine who provides care based on the difference of a few dollars.

So, armed with the qualities I wanted in a veterinarian when I moved to Utah a few years back (since I could not convince my previous vet to move with me), I found an all-female practice and phoned for an appointment to interview the owner -- they acted like I was crazy for wanting to interview the veterinarian but agreed. I went in for my appointment and while the clinic was clean, nice, and all that, the veterinarian did not seem like someone I could work with so I kept looking. Based on a recommendation, I started going to a man I liked very well. He was everything I liked in a veterinarian -- unfortunately his partner was not. After some significant disagreement with his partner over some sloppy work done by their technicians on more than one occasion (x-rays), I stopped providing income for that clinic.

I went back to the all female clinic with a new vet because so many of my berner friends are happy at that clinic. I was relatively happy until I called to confirm the appointment for dewclaw removal of my litter of nine and they informed me that they were busy and would fit us in but we would wind up waiting while they took the puppies back as time permitted for the procedure. Since I had made the appointment in advance, was very clear that I wanted to be in and out fast with minimum amount of stress to the puppies (they had declined my request to do a housecall), and planned to be with the puppies when the work was done, their response to my concerns was not satisfactory, even after telling them all that. I let them know that I would not be bringing the puppies in.

When Abra was having the puppies, we had her x-rayed to ensure all puppies were delivered (last one was born on the x-ray table!) and since it was 5 am, we had gone to an all night ER clinic for the films. They were great -- let me go back with Abra, very good with tired people and the mom and puppies, and the clinic was nice. I called them, found out they had a female vet, had her out for a housecall to remove dewclaws, and she was great. Good with the puppies, answered questions, disagreed with me as necessary, smart, not in a hurry to intervene about things, and always available for phone calls with new puppy concerns -- even after the puppies had gone to their new homes. She took excellent care of the puppies while they were with us.

So what I am saying is that the most important thing is to be clear about what you want/need -- all of us are different and so different things are important to us. Some things to think about are: ability to communicate, specialties of the vet and his/her colleagues, skill and knowledge level, experience, any board certifications, availability of the vet and his/her back-up, quality of support staff at the clinic, appearance of the clinic, policies about owners being present for various procedures, proximity, willingness to support things like homemade diet, limited vaccinations, and other non-traditional ways of caring for pets, ability to tolerate disagreement, and one's own "gut feeling" about a person. I know I am missing things -- so what else?

Interviewing a vet is a good idea -- or even an appointment that is just a check-up can give you an idea of how that vet works with you and your pet. Make a list in advance, and then review it when you are done to assess whether or not your needs are met. It is also a very good idea to let the vet know you are assessing him/her -- and be direct in telling him/her what you need/want and ask if s/he can provide those things. You will learn a lot just from that kind of dialogue.

We are talking about a person that might someday need to save the life of your friend -- and comfort you in times of crisis -- we have every right to make sure we have confidence in the professional who will play such an important role in our lives.

Here are the things I seek in a vet (man or woman does not matter to me at all.)

1) Common sense and a pragmatic approach to everything related to his practice a) reflected in his it PRACTICAL or does it cost him a fortune to "look good" or is it a dump. b) is his staff competent? If not they're costing him dollars and clients. Is he savvy enough to realize his staff's quality? c) is the place clean. It doesn't have to shine but I don't want to see dried blood and guts in the examination area. It should not smell like urine. It may smell like dog dip....but not urine!

2) Will he take the time to answer my questions and LISTEN and can I LISTEN to him? Does this vet communicate with me on MY level. If not, he'll drive me nuts. Is he smart enough to realize this and CARE?!?

3) Excellent diagnostic ability based on experience a) such a vet hits the right tests the first or second time and reduces my costs for diagnostics b) such a vet can address the problem quickly and efficiently and increase chance of success c) I want a well 20% of his class vet. He'll have to be sharp to meet my other criteria

3) Does my vet's clinic handle its own emergencies routinely. If not I don't want to use them for my primary vet.

4) Can I afford the charges and are they fair from this vet's practice?

5) Am I treated with respect and is my animal treated with respect?

6) Is the vet practice within an hour's driving distance from my home?

7) Does the vet do most of his own surgeries and procedures I might need ie bloat, rads,c-sections?

10) Is the vet a general practitioner? I do not want to routinely use a specialist or someone who doesn't do his own procedures as this kind of a vet will put me in the hands of a stranger in my time of greatest need. Besides I think specialists will not meet my other criteria because they are not well rounded in their daily practice of vet medicine.

11) Ideally my vet will have had extensive experience with large animal medicine. This experience on farm animals gives those who love it a perspective about animal medicine I value. This is not a requirement but a plus on my list of criteria.

12) I want a vet with interests outside his a family or hobbies. I want a WELL ROUNDED individual who has a reasonable perspective about life, its value and respects the fact that other people value it differently than he might.

13) And last....lucky 13....I prefer to use a vet whose practice of the ART of vet medicine is evident and abundant. Knowledge and skill are requirements in a good doctor. The gift to practice the ART of medicine is the icing on the cake and the mark of a doctor of excellence. The ART is the application of recalled experience with knowledge and skill. Not all doctors do this well. The BEST practice it routinely. It is observed in their discussions during the diagnostic process. HOW do they come to the conclusions they do?

I have developed these priorities by using and working for several vets over the years. As a owner many of you will not have this opportunity to learn these things about a vet due to sporadic and limited contact. So an idea for you follows.

Breeders use vets routinely....much more often than the typical dog owner. I recommend that people seeking a vet for their Berner get in touch with the local kennel club in their area and get the names of 6-8 breeders of large breed dogs...preferably working group breeds. Call those people and find out who in the area they use for their vet work. Take notes. SOMEONE's name will come up over and over. Call the breeders back who use that vet and try to discern if your criteria will be met by this individual's vet practice.

Good dog breeders value a good vet and will appreciate a novice's attempt to secure reliable, affordable and adequate veterinary care for their dog. Use this resource. From it comes the value of experience that cannot be bought.

Probably what I feel is the most important thing is that you feel comfortable with your vet - with the level of care he or she provides, the quality of medicine practiced, openness to new ideas and suggestions, and most of all, that you feel you can ask questions without feeling like you're imposing or being stupid. (For example, one of my clients called me this morning - her kids keep passing back a strep throat infection and several people mentioned to her that the kids were probably picking it up from the cat. Rather than panic or worry over it, she called "her vet" to see if it was true. BTW - it's possible but highly unlikely unless the person has some sort of immunesuppressive disorder.)

Just a couple of comments to some of Ruth's points. I absolutely agree with Ruth that the vet have good diagnostic skills and be well educated in vet med, but I disagree on judging that by a number. First of all, you will be hard pressed to find out where a vet ranked in the class - you could ask, but how would you check the answer. Second, I know from my own experience that the tops in the class do not necessarily make the best vets - I have quite a few classmates that were in the top 20 if not the top 10% that I would never send a friend or family member to. They may have the booksmarts, but are either lacking the ability to use that practically, or don't communicate very well. On the other hand, some of my classmates who ranked in the bottom half of the class are some of the best vets I know. They are well-rounded individuals who had outside interests during vet school (families, hobbies, etc), so did not devote every waking moment to hitting the books. But they also know they do not have every possible disorder memorized, and don't hesistate to hit the books or confer with a specialist to make sure they have the right diagnosis and treatment. And because they had a life outside of school, they, for the most part, are better communicators. Now this does not mean that a vet in the top percentage can't be good (a lot are, including some very very close friends of mine that I wouldn't hesistate to refer to), nor that the bottom ranked vet can't be a poor vet too (had some of those in my class too, as does every vet class). It merely means that I don't place too much stock in the numbers. And while I wasn't in the top rank, I wasn't in the bottom either - somewhere in the middle, though I don't think I ever bothered to find out my specific ranking. Keep in mind that to get into vet school in the first place, you have to be the cream of the crop - it's harder to get into vet school than med school as there are only 27 vet schools in the entire US.

Okay, about specialists - you need to check what kind of specialist. One of the best vets I know is a board certified practioner - which is a specialist. He is boarded by the American Board of Veterinary Practitioners in the speciality of canine and feline practice. I would swear he knows EVERYTHING about vet med. (smile) In the company where we worked, he was referred to as the walking encyclopedia of veterinary medicine. Ruth - you'd love this guy, despite his "specialist" status: he has his own herd of dairy cows plus some horses, which he vets himself, and I've never met anyone better versed in the ART of vet med.

One other thing I'd add - you want a vet who is willing to admit when he or she is wrong or just doesn't know. Some of the worst cases I've seen or heard of were from vets who couldn't admit that they really didn't know what was going on or who couldn't see that just maybe the treatment wasn't working because they had come to the wrong diagnosis. If you've got a vet who gets all uptight when you say you want a second opinion - you might want to think about why.

It has been interesting and valuable reading what people value in their vets. For what it's worth, here's my story. First, is why I like the clinic I work with and second is the reason I chose the vet I did at that clinic. As I'm rather longwinded in email, I also started going off about being the vet's client, but I put that in a separate email. That's next.

I go to a clinic 45 min - 1 hour from my house, for several reasons. There are many clinics closer, but I have been going to this clinic for almost twenty years, and really feel at home there.

Reasons I like this clinic:

Everyone is personable, friendly and efficicient. The vet techs always come out to say hello, and have a personal comment on how any animals that had to spend the night, or part of the day, are doing. To me, this shows that they view my pets as the individual clients that they are, not just file #1101H and 1101G. The receptionist always remembers me, and my animals, and asks about the last one that was in. Recently, going in with a cat that peed in the carrier on the trip down, my soggy towel in the carrier was replaced with a fresh one of theirs for the trip home, and the carrier was rinsed out. No questions (other than "is that alright if we swap towels with you"), no hesitation, just courtesy and good business sense.

The clinic does most of their own work on site. Not just surgery (I couldn't believe it when I found out there were vet hospitals that shipped animals out for surgery - much more stress for the animal), but also blood work. They don't (or didn't three years ago) do cultures on site, but I don't know anyone that does. They are also doing laser surgery now, which shows me that they are continuing to learn and expand their practise.

In addition, they are considerate of me and my time. Recently, my vet stayed late to do a urinalysis immediately for me, so that I wouldn't have to make another trip for antibiotics the next day. I really appreciate this extra courtesy, and it means a lot to me that she would do this, especially on the night of their office Christmas Party!

Lastly, they are willing do do housecalls for euthanasia. When Sophie, my golden that I grew up with, was put to sleep, the vet came to our house to do it. In addition, when we returned from burying her out of town, there was a floral arrangement from the vet waiting on the front step.

The reasons I choose to see "my" vet: 1. Vet #1 always refers to my dog as "he". Cessi is a girl! Not that this is a huge issue, but if the vet doesn't pick up on the fact that I am saying "she" and "her", what else is she not listening to? Not to mention that my file is always open on the table in front of her. Not a big confidence booster.

2. Vet #2 has been a vet for a very long time, and although I respect his expertise, and have benefitted from it, there are some issues where he has not kept up to date with areas outside his field of interest. That's fine, and if I have an avian question, or a surgical question, I am interested in his opinion and respect his advice. Also, he is somewhat detached, and gruff, and I frequently feel like he is secretly consulting his watch when I am talking to him. He was my mother's vet of choice, but isn't mine.

3. Vet # 3, who came to the clinic to replace a vet I just loved (she moved to a clinic that was just too far to be practical - 3 1/2 hours round trip), has been fantastic. She is empathetic, which is very very important to me, *listens* to me, respects my feedback and opinions, is really interested in continuing to learn more about various aspects of veterinary medicine, and admits what she doesn't know/isn't familiar with and *gets* that information, either through consultation with other vets, or from her texts.

She has photocopied notes from seminars she has attended that she knows I'm interested in, copied sections of her textbooks/reference books for me and even given me the telephone number of a friend of hers who has horses when I was having a difficult time getting good quality timothy hay for my rabbits. She always answers any questions I have, encourages me to ask more, and doesn't talk down to me, nor does she talk "above" my level. If an animal's surgery has been more difficult than anticipated, or if complications arose, she will tell me, not just pat me on the head and tell me that everything is fine. She is comfortable telling me what she is doing, and why, and tells me what conclusions she draws, and what lead her to those conclusions.

She respects my decisions (i.e. not to have an animal spend the night if I feel I can manage at home), and encourages me to learn as well. She respects my observations, and takes my concerns seriously. I have taken a rabbit in to see her, on the basis of "didn't go nuts when offered pellets tonight" -- and she understood, and did the x-rays which showed that we were heading off a major problem, one that could have been fatal to the bunny.

In summary, assuming all basic considerations of competence and facilities are met, the most important factor to me is my personal relationship with the vet. Given that I am probably going to make some of the most difficult decisions in my life in conjunction with this person, I want my vet to understand ME, take my concerns seriously, and to understand that my decisions are possibly different from other pet owners. I want my vet to be someone I can question, without them taking offense, and someone who will not be afraid of being brutally honest with me. And, I want my vet to be someone I feel comfortable discussing things with, having a two way conversation with, and for her to be unafraid of appearing unprofessional by being empathetic.

That's what works for me. My clinic's drawbacks are that they do not have someone on staff overnight, and do not offer emergency services. I have planned alternate arrangements for those situations, so that's okay by me. I'd prefer otherwise, of course, that's the way it is.

My two cents worth on establishing a good relationship with your vet: I think that is important to listen to your vet, be receptive to their insight, respect their experience and expertise, but also understand their limitations, and to be unafraid to ask questions, and to listen to your own judgements.

I think that as clients of the vet, we need to be respectful of the time and needs of the vet. For example, if I am taking one animal in for vaccinations, but have questions about another, I'll tell the receptionist this on the phone, so that the vet knows that I may need a little extra time beyond the standard 5-10 minute vaccination visit, and can plan for that. To not tell them is to inconvenience the vet, the next client, etc. and to frustrate myself. Also, I'll ask what I need to bring with me (fecal sample, urine sample etc) to save time and multiple trips.

Don't be afraid to question your vet, and be aware that you may be better informed/more up to date on some issues. Doctors deal with one animal, the human, vets deal with many many different types, and different breeds within those different types of animals. It is simply not possible for all topics pertaining to all animals to be covered in vet school (My cat-loving vet student friend is amazed that they will not even touch on feline reproduction in her four years at vet school.) Educate the vet, provide references if possible, and help your pet, and others that will follow. Case in point, rabbits cannot vomit - they are physically incapable, and it is of utmost importance that they not be fasted because their gut needs to be constantly processing food, otherwise the GI tract fills with air, which can be fatal. Still, many vets recommend that a rabbit be fasted the day prior to surgery - a standard practise for most animals, but one which is unnecessary, and sometimes injurious, to rabbits.

Don't be afraid to question standard practises. For example, standard practise is to leave an animal overnight with a vet following surgery. I will not leave a bunny overnight, did not leave my first two cats overnight when they were spayed, but did leave the next two cats overnight when they were spayed/neutered. With the bunnies and the first two cats, I knew that they would be more comfortable at home, away from strange noises, smells and barking, whining, howling dogs, and that *I* could keep an eye on them, keep them quiet and calm, and that they would be better served to be with me. The second two kittens, however, were in a more multipet household, and I would probably not have been able to keep them quiet, especially considering that they are exponentially more active than the other two. They are also more brazen, and unfazed by most goings on. They are two crazy kittens, still!

Don't be afraid to say "no" to a vet if what they recommend is contrary to your best judgement. The Cessi monster got into a scrape with a porcupine shortly after she came to live here. When we went to the local vet (this was out of town) they wanted to sedate her, put her in a crate, and have her wait until they returned from another housecall. Then they would have a go at the quills. There was no way I was leaving my baby in a strange place, in a crate, with quills sticking out from her whole muzzle. So, we took her home, got out the peanut butter and the needlenose pliers, and did the best we could until the vet called to say she was back from her other call.

Only *you* know your animal the way you know your animal. Yet another Cessi story... (She got into a lot of mischief in the beginning.) Cessi had an intimate encounter with a big bowl of icing before I was aware of how skilled she was at counter surfing, and just how high/how far she could reach. Her belly bloated up (sending me into a panic!), she was obviously uncomfortable etc etc. Off to the emergency clinic, and they really wanted to keep her overnight for observation. She was bloated, but it wasn't Bloat (capital B=gastric torsion). Knowing that stress is a major factor for bloat, there was no way I was going to leave Cessi, who is an attached-at-the-hip type of Berner in a strange place, with strangers, doing strange things to her. Maybe Cessi would have been fine, but I felt strongly that the risk was not justified by the benefits and I was concerned it would exacerbate her condition, so we got some subQ fluids to keep her hydrated and off we went.

Both of the last two incidents occurred away from my regular vet. However, having said these things, I have to say that I *do* have confidence in these vets. Obviously I wouldn't have taken my animals there if I didn't. I do think that similarly to our relationships with human doctors, many pet owners do not feel comfortable in questioning the doctor, and establishing two way communication. I'm speaking from personal experience, because I used to be like that, prior to my experiences with the rabbits. A friend recently had a frustrating experience with her lab, with the vet treating the same problem over and over the same way, without success, and wouldn't listen to her when she said the treatment wasn't working. This friend is much more assertive than I am in general, but given that the vet was the expert, she uncomfortable questioning him. Once she finally got frustrated and went for a second opinion, the problem was cleared up.

Vets are human, have good days and not-so-good ones, but they *are* trained professionals who are here to enhance our lives with our furry family members. I value them as a part of my extended "family", and am grateful for the great advice, the great treatments, and being the great people they have been.