Veterinary Medicine - November 2008 - (Page 587)

tion by the specialist who may uncover historical information, a physical examination ﬁnding, or another diagnostic clue that had not been considered. It may result in the recommendation of a diagnostic test that differs from the one recommended by the primarycare veterinarian. For example, a dog that was referred to me several years ago for a liver biopsy never underwent the procedure because I obtained an extensive history that revealed that the client was unknowingly poisoning her dog and husband with comfrey, which she was making into a tea. Regardless of the anticipated procedure to be performed, the goal is always the same: Provide the best possible care to the pet. • Advanced surgical or procedural skills are required. We all should be cognizant of our ability level when it comes to surgery and recognize when a procedure should be left to someone with more training. Procedural complications can happen to anyone, but when they happen to a general practitioner, the question of whether the surgery performed exceeded the veterinarian’s expected skill level may be raised. However, this question cannot be raised when a board-certiﬁed surgeon performed the surgery. Recently, a veterinarian asked me if I thought he could instill clotrimazole into the nasal cavity of a dog with suspected nasal aspergillosis without performing rhinoscopy. Assuring him that this approach would not work and after successfully encouraging him to refer the patient, I spent two hours endoscopically removing fungal plaques from this dog’s nasal cavities and frontal sinuses before infusing clotrimazole. The entire procedure took nearly four hours, but the dog was cured after just one treatment. That kind of time investment would not be cost-effective for a general practitioner. • A diagnosis remains elusive. In the absence of a diagnosis, how long do we give empirical therapy before realizing that the case exceeds our diagnostic abilities? In some patients the answer may be 24 hours, in others it may be four weeks. General practitioners are expected to know about a lot of things, but they are not expected to have the same level of expertise as specialists trained in ophthalmology, dermatology, cardiology, internal medicine, or any other specialty. And although specialists can’t do it all, they on the phone consulting on cases with primary-care veterinarians. Most of the time, all that is needed is someone to bounce ideas off of or to concur with the diagnosis or treatment plan. Sometimes it requires a reassessment of the history or test results. Phone consults are fraught with limitations, however, such as the inability to see and touch the patient, view the radiographs, and question the client. Just because an answer is not readily obtained over the phone does not mean a diagnosis cannot be achieved if the patient is referred to the specialist. In fact, when possible, this situation should Sometimes it just takes a different perspective to uncover a cryptic diagnosis. are proﬁcient in their area of expertise. Clients are often surprised when a diagnosis is achieved in one day for a problem that has eluded deﬁnitive diagnosis for weeks. But the value of the collective expertise in a referral practice along with the contributions of the primary-care veterinarian has to be appreciated. Sometimes no diagnosis can be achieved, but that should also reassure the primary-care veterinarian. And knowing what the problem isn’t can lead the specialist to make additional recommendations for empirical or symptomatic therapy that may resolve or palliate the patient’s signs. prompt the primary-care veterinarian to encourage the client to seek the referral. MAXIMIZE YOUR TEAM POTENTIAL Board-certiﬁed specialists are an important part of the veterinary healthcare team and should be used to their maximum potential. The American Animal Hospital Association recently developed guidelines to help companion-animal practitioners and specialists communicate optimally and enhance referral relationships. You can read the guidelines at www.aahanet.org/PublicDocuments/ AAHAReferralGuidelines.pdf. Clients are becoming more demanding, and the Internet has opened up their eyes to what is possible and expected. Clients appreciate that the primary-care veterinarian has the patient’s best possible care in mind when a timely referral is made and will remain loyal clients in the future. PHONE CONSULTATIONS Sometimes referring is not an option. A client’s ﬁnancial constraints, the distance to a referral center, and a client’s refusal to accept the referral are common reasons. I spend a lot of time VETERINARY MEDICINE November 2008 587 http://www.aahanet.org/PublicDocuments/AAHAReferralGuidelines.pdf http://www.aahanet.org/PublicDocuments/AAHAReferralGuidelines.pdf

Table of Contents Feed for the Digital Edition of Veterinary Medicine - November 2008

Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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