Dr. Patty Khuly has been on an amazing tear over at Dollitler. Her blog posts are always well-written, engaging, informative, and substantive, as well as frequently amusing. Her two most recent posts touch on issues of veterinary ethics (and her recent post on vaccine philosophy is closely related) and are highly recommended (and not just by me: over at the Pet Connection Blog, Gina Spadafori has nice things to say about Dollitler).

Yesterday Dr. Khuly wrote about the use (or rather, nonuse) of specialists by generalist veterinarians:

Far too many vets, IMHO, fail to offer the option of a specialist. They either assume their client would prefer not to go, their client can’t afford to go (usually it costs 25 to 50% more to see a specialist) or they’re not used to referring clients for difficult cases. Some simply don’t want their clients to go—for reasons of professional pride or income, I have to assume.

Undoubtably a touchy subject. Catmanager was interested to note that, as of yet, the responses to this post (including his own) have mostly avoided the topic at hand. Perhaps regular veterinarian readers of Dollitler haven’t seen the post yet, or perhaps they all agree with Dr. Khuly’s opinion. Three other reasons for nonreferral occur to catmanager: lack of specialists to refer to (especially in rural areas); previous bad outcomes with a particular specialist (being a specialist doesn’t necessarily mean one is a good specialist); and ignorance of the existence of specialists in the area (although a veterinarian ignorant of local specialists raises more general questions about the sort of medicine that veterinarian might practice).

Today Dr. Khuly writes about vets who “steal” clients. Catmanager’s wife had some first-hand experience with this last year when we heard from a client that the vet at a local emergency hospital had said some unflattering things about our clinic and advised the client to take their cat to a clinic across town whose owner used to work for the emergency hospital. After some investigation we found other clients who’d heard the same thing, including one who left us for about a year for the vet across town. Examples like that seem ethically cut and dry. Dr. Khuly explores some grayer areas, such as the vet who sees a patient on referral for a specific procedure who then tries to also treat the patient for other problems. Are veterinarians obligated to send that patient back to the original vet? Should they tell the client if they find a new problem (indeed, are they legally obliged to share any findings with the client?), or should they contact the original vet? What if the client asks the new vet to treat?