Saturday, October 20, 2012

Big sick vs. little sick - and all about the benjamins

I feel like I'm starting to develop a sense for what cases are within my (and my clinic's) capability and those which require more expertise.

Recent case in point: 11 year old dog from local boarding facility presenting for lethargy and bloody diarrhea. Physical exam - hemorrhagic diarrhea leaking from her anus, weakness in her pelvic limbs, and an abnormally large firm mass-like object in her cranial abdomen (huge liver? hard to say).

At this point I knew in my gut that this was a "big sick" case - i.e. something requiring overnight hospitalization and intensive care, plus some diagnostics to decipher an underlying cause.
I offer to the clients to start the workup and hospitalization, knowing that she would have to be transferred overnight to an emergency clinic (we do not hospitalize patients overnight), then transferred back in the morning - lather/rinse/repeat until she gets better - OR to transfer her to a nearby 24-hour facility. The clients elected to have her transferred to the the 24-hour facility for workup and hospitalization.
Diagnosis - pancreatitis. She was hospitalized for 3 days and then discharged.
Score one for the doctor, right?

Not so fast. The boarding facility questioned why I sent her over to a different (i.e. in their mind more expensive, although it really wasn't) facility. I explained the above. They asked me if pancreatitis is serious. I said "yeah, they can DIE from it."

Let me clarify this by saying that the local boarding facility is housed in the same building as the clinic where I work and is owned by the same company.  People above my pay grade in same company are ridiculously finance-focused. Get the picture?

On one hand, I'm happy that I can pick out what needs to be done and to know enough to give clients options. On the other hand, I'm still very frustrated that I work in a facility that is realistically only equipped to treat "little sick" cases like abscesses and minor lacerations or gastroenteritis, yet am expected to tackle these "big sick" cases in the name of money - even if it isn't what is best for the animal.

Some day I will probably get in trouble for offering the best care for my patients, and that makes me sad.

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