Monday, 10 August 2020

Real talk: Does a veterinary hospital have to see your pet?

An industry under attack: Before you start harassing a veterinary hospital, you should read this
  
An industry under attack: Before you start harassing a veterinary hospital, you should read this

When I start writing posts like this I know I'm going to ruffle some feathers. I get it, it will probably sound harsh to those who aren't empathetic to both sides. This needs to be discussed in the open. While those in the veterinary industry know this, most people are unaware. They may attempt to destroy the reputation of a clinic just doing their job. With the increased number of deaths by suicide in the veterinary industry, this behavior is unacceptable. 


I truly believe that people just need to be educated about the obligations of veterinarians, and I'm going to help. I see posts on social media in lynch-mob 24/7 yard sale groups, gaining traction with shares and comments from strangers, calling for news coverage, and swift justice against a vet clinic that won't see their pet after-hours because they're not a client. Do you know why the news doesn't cover these stories? Because veterinary hospitals (in Ontario at least) are within their rights as medical practitioners and fully covered by the regulations set by their governing body, The College of Veterinarians of Ontario (CVO) to not see a patient they don't have an existing VCPR with. VCRP means veterinary-client-patient relationship, and if you don't have one, they are not obligated to book you in. If you feel triggered by this, you should read to the end.

What does it mean to be called a veterinary 'hospital'? 

First of all, let's clear up some odd confusion surrounding what a veterinary practice is named. Some assume if the practice is named a 'hospital' they are obligated to provide emergency in-hours or after-hours care. This is incorrect. 


The name of a veterinary clinic has more to do with what type of services they potentially offer. Think of it this way: The human hospital isn't exclusive to an emergency room only, right? They can also offer diagnostics like ultra-sound and bloodwork, surgery- some even have walk-in clinics for general practice. However, some human hospitals don't offer emergency room services or only offer them during specific hours. Why would you expect a veterinary 'hospital' to be any different than a human hospital? Maybe you've only visited the human hospital for emergency care. But that's your bias affecting your opinion, and the only thing that should affect your opinion is facts

The name of the practice does not obligate them to offer anything, it just gives you a better idea of what they do offer, so you can manage your expectations. 

Clinic, centre, practice: Typically offers general practice veterinary care and may not perform surgeries or extensive diagnostics- or anything above and beyond that. Like a plain hamburger- just the basics,

Hospital: Offers general practice veterinary care (vaccines, basic physicals, preventative medicine) as well as some diagnostics and some surgery services. Don't always offer emergency care, after-hours, or specialists. These are your cheeseburgers.

Emergency hospital: Offers emergency care, most likely in-hours and after-hours. Usually have specialists. Have diagnostics and some even offer general practice services. Still entitled to decline appointments if they can not handle anymore, like all medical facilities. Your Double Big Mac.

Now that we've cleared that up, let's get into the meat patty of the Q&A!

Ontario veterinary clinics and what their obligations are: Q&A


Question: Is a clinic I don't take my pet to regularly obligated to provide me with after-hours, on-call services?

Answer: No. According to the CVO, veterinarians can perform that service "for animals that they have recently treated or that they treat regularly." Just because a clinic offers after-hours services to their clients, doesn't mean everyone qualifies for those services. Working on-call is difficult. Vets and techs work late nights and are expected to go to work the next day. It's selfish to expect them to come into work in the middle of the night and meet a total stranger with only one or two people in the clinic. It's extremely unsafe. Veterinarians will only meet people they know after hours, you may not like it but you don't decide when they put themselves in potentially unsafe situations. You are not entitled. It's their life. THEY decide. You can bark all you want about it. But you shouldn't bark about it- that's rude. 


Real talk: Does a veterinary hospital have to see your pet?

Question: If my pet has an emergency and needs to be seen, does a vet clinic I've never visited have to see me right away?

Answer: No. Even your own vet clinic has the right to book you as per their soonest availability, which may not be until the next day- or week. If you have established a valid VCPR. For some clinics, an 'active' patient can be a pet seen in the past 12 months, 18 months, 24 months, ect. It differs from practice to practice, but typically it's a pet seen within a year minimum. You have to be an active client, and if you haven't brought that pet in to see them in years then you're likely not active anymore. Companion animals require annual vaccines, so if you are up-to-date on vaccines your pet is likely still an active patient. 


To provide the highest level of care, veterinary clinics can only book their schedule to a certain capacity. Otherwise, things could become unsafe and patients may not receive the quality of treatment they deserve. Veterinarians have a duty of care to their patients, not strangers. In the case of an emergency, you should visit your local 24hour emergency animal hospital. They are obligated to treat your pet even if a VCPR hasn't been established and they're staffed and equipped to do so- unlike general practice. BUT even they are entitled to decline appointments if they too are booked to capacity and can't safely treat any more patients. 


Question: Can my veterinary clinic refuse me service?

Answer: Yes, in fact, your vet clinic can fire you as their client! CVO states reasons a vet clinic can fire a client include "client’s persistent non-adherence to proper treatment plans, resulting in potential threats to the welfare of the animal; a difference in philosophy as to the approach taken for diagnosing and treating animals; verbal abuse and/or threatening behavior of a client towards the practitioner and/or hospital staff; unreasonable demands for unnecessary medications and services, or for illegal or unethical actions (e.g. asking the veterinarian to alter a medical record); and non-payment of fees owed for services rendered." A veterinarian can refuse to perform services they deem harmful. They can refuse service if the pet owner is too young (under 18). They can refuse walk-ins and scheduling appointments if they are fully booked. Showing up somewhere unannounced is inconsiderate anyway. If you waste vital time by showing up unannounced to a clinic that can't fit you in, and your pet suffers, sadly that's on you. 



Question: Can my vet refuse to euthanize my pet?

Answer: Yes, your vet can refuse to perform euthanasia. If your pet has bitten a human and broken the skin, the vet has the right to refuse euthanasia and you are obligated to contact local public health officials and follow their guidance before euthanasia can be performed. If they believe a pet has been neglected or abused, according to CVO the vet "has an obligation to report animal abuse or neglect to an inspector or agent of the Ontario Society for the Prevention of Cruelty to Animals." Like all businesses, general practice animal hospitals have the right to refuse service to anyone.


Real talk: Does a veterinary hospital have to see your pet?

Question: Can a vet clinic dispense me medication if they have never examined my pet?

Answer: NO! Can a doctor's office write a prescription for you if you have never had a physical? Even when it comes to refilling a medication, the veterinarian uses professional judgment and can decline filling it. Most vets require pets to be examined every year because pets age faster than humans. CVO states you must have an existing VCPR to prescribe medications- this includes most flea and tick medications. This also includes medications like sedatives intended to calm the pet before their vet visit. CVO says they can't prescribe those either. They can't act as pharmacies for other vet clinics if they haven't examined your pet, and if you request a written prescription for an online pet pharmacy your vet can provide it if you have an existing VCPR with an up-to-date physical, BUT CVO says they have the right to charge a prescription writing fee. Side note, they legally can't return medications that have left the practice. Even if they are in sealed bottles or blister packs.


Question: Can my vet clinic refuse me service if I'm unable to pay?

Answer: This question blows my mind. Does your grocery store have the right to stop you from taking food without paying? Does hydro have the right to turn your lights off if you fall behind on payments? Do you go to the gas station, fill your car up, and tell the cashier that you will pay at the end of the month and drive away? Receiving services or goods without paying for them is stealing. So YES, your vet has the right to refuse service if you're unable to pay. Vet clinics typically do not provide payment plans because what payment plans really are, are small personal loans you take out with the practice owner. Are you in a position to provide a personal loan? I'm not. It's unfair how horribly veterinarians are treated when they won't provide their services for free- and absurd that they're expected to. It's the pet owner's responsibility to budget for their pet's care. Vet clinics have the right- and it's perfectly reasonable- to charge additional fees for walk-ins, urgent care, emergency, and on-call services. They have the right to ask for a deposit on large estimates. Clinics that provide surgeries, radiology, laboratory diagnostics, and a fully stocked pharmacy have HUGE overhead, inventory, payroll, loans, mortgages, licensing bills, ect. When you pay for a 20-minute appointment with the doctor, you are paying for the 7-10 years of education it took to train that doctor to be able to provide that appointment in 20 minutes. Your pet is not the vet clinic's financial responsibility- it's the pet owner's responsibility. 




Question: How has the COVID-19 pandemic affected vet clinics?

Answer: By making it a thousand times busier and more difficult to do routine things. The phones never stop ringing. Emails flood the inbox. Curbside service and telemedicine style communication slow everything down. Not to mention vet clinics were restricted to only providing urgent care for a long time. More people working from home means they're noticing illness and behavior in their pets they wouldn't notice when absent 8 hours a day. Sick pet after sick pet can make for an exhausting and emotionally draining day. No healthy puppies and kittens to brighten the mood. Because of the pandemic, there isn't time to squeeze in extra appointments. Clinics are understaffed, teams are suffering from burnout, and then there's the 200 lb Great Dane in the room- an increase in verbal abuse by clients and (especially) non-clients. COVID-19 has brought out the best in some of us, challenging us to become more innovative and creative. It brought out the worst in others, reinforcing bad behavior, increasing angry and emotional reactions when they don't get their way, and creating a growing population of selfish 'the world revolves around me' folks. And vet clinics are taking the brunt of it. If clients don't get the appointment they want, or non-clients are told they can't be seen, they are yelling, swearing, and even physically harming veterinary staff. Not to mention the toxic and disgusting online attacks. It's shameful- and if you have participated in it, you could have directly contributed to someone ending their life.


Real talk: Does a veterinary hospital have to see your pet?

Why are some clinics attacked, while others aren't?

I believe people want to be good, they just don't know how the vet industry works. In larger cities like Ottawa and Toronto, online attacks are rare because there are so many emerg clinics, most general practice doesn't offer after-hours care and people are used to being referred. In smaller communities, vet clinics have been viciously attacked. Not seeing non-clients is standard practice. Just like stopping at a stop sign, or going on the waiting list for a doctor, or most recently wearing a facemask in public indoor spaces: You don't make the rules. Remember, you are entitled to your own opinion, you are not entitled to your own facts. The only thing that should affect your opinion is facts, and if you're not trying to learn the facts before complaining about a clinic online, then you're not actively trying to find a solution. And that makes you a bully. Sorry, not sorry. 


You have a responsibility for your pet. Most folks who learn more about the industry are grateful for the knowledge. A small percentage of people who are educated on these facts say things like "I don't care about the facts, the vet clinic should care about animals enough to see them." They continue to be bullies, and I have no respect for bullies. I'd like the bullies to ask themselves this: What kind of inflated sense of self-entitlement do I have to believe that I alone should determine the regulations of an entire industry (that I don't even work in) and the policies of a business (that I don't even work at) based on my personal opinion? This is typical of someone with narcissistic personality disorder. To maliciously bully a person or business online regardless of the facts is cruel and sociopathic behaviour. Ignorance is a choice. So is kindness! 


Real talk about suicide in the veterinary industry

One devastating by-product of veterinary professionals being subjected to so much harassment, and verbal abuse by clients, is an increase in mental illness and substance abuse. That coupled with performing euthanasia, treating sick and terminal pets, mountains of student loan debt, working long hours, and being accused of 'being in it for the money' has created an increase in suicide rates among veterinary professionals. 


398 veterinarians died by suicide between 1979 and 2015, according to a CDC study. The study examined 36 years of death records covering 11,620 veterinarians and determined the likelihood of suicide deaths of veterinarians is higher than the rest of the general population. The suicide rate in the veterinary medicine profession is disproportionality high. Three vet professionals died by suicide in March of 2021- three in one month! 


Before you encourage people to light torches, grab pitchforks, and write harassing comments and poor reviews about vet clinics, even some they've never visited, think of the lives you're impacting. The humans. The human who worked 12 hours with one 30 minute break to squeeze in an extra appointment. It meant missing her son's basketball game. Or his daughter's first play. The receptionist you yelled at on the phone? She makes minimum wage but works at an animal hospital because she loves helping pets. You were the fourth person to swear at her that day. She's just doing her job- she worked an extra hour because she wanted to hand-feed a sick cat. She missed dinner with her family, while you had dinner with yours. 


Writing those things online or yelling at people on the phone could be the catalyst for someone to take their life. You could be the last straw. The reason they give up. The reason they lose faith in humanity. Do you want to be the reason?


An industry under attack: Before you start harassing a veterinary hospital, you should read this

I will always be an advocate for the veterinary industry, even if it makes you uncomfortable

You can be an advocate too. Visit Not One More Vet and find out how you can support veterinary professionals struggling with their mental health and help with suicide prevention efforts. 


If you are struggling with suicidal thoughts please reach out to your health care provider, a mental health professional, or a friend or family member for help. Please contact The Canada Suicide Prevention Service 24/7 by phone at 1-833-456-4566 or text them at 45645, available from 4:00 PM - 12:00 AM, EST for support. You can call 911 or visit an emergency room if you require immediate attention. Mental health is physical health. You are never alone. 


To the animal hospitals struggling with harassment and abuse, you have support. Stay strong, and know your life has value. 


The opinions in this piece are my own and do not reflect the opinions of my current or past employers, or organizations I'm affiliated with.


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