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Friday, December 11, 2009

A Few Bad Apples

Over my lifetime (all 40 years of it so far) I have seen many people do reprehensable things.  Professional businessmen and CEOs who embezel and drive companies into the ground.  Ministers who steal or hire prostitutes.  Teachers who seduce and sexually abuse their students or other children.  Police officers who abuse their charges, physically beating them.  Respected officials who abuse their power.  Celebrities who are supposed to be role-models falling to drug and alcohol addiction.  And don't even get me started on the problems with politicians.

There's the old adage that a bad apple will spoil the whole bunch.  And I guess that it's human nature to see a prominent figure as a representative of their "type".  But is that really fair?  In recent news we're seeing a barrage of apparent infidelities performed by Tiger Woods.  Does this mean that all professional golfers are likely to be adulterers?  Remember Debra LaFave, the Tampa teacher who slept with her 14 year-old student?  Does this mean that all of my son's teachers secretly want to have sex with him?  Back in the '80s the televangelist Jimmy Swaggart infamously was outed over a relationship with a prostitute.  Should we assume that all preachers are secretly hiding scandalous behavior?

My recent discussion on the potential ramifications of increased legal awards in veterinary malpractice suits has brought this home to me because of similar views of my profession.  Most of the commenters on that entry appear to have a very strong view against veterinarians.  Reviewing some of these people's web sites makes it appear that veteriarians as a whole should not be trusted (and please forgive me if I'm mischaracterizing anyone's comments).  One web site seems to proudly boast that they have received "hundreds" of similar reports of horrible veterinary malpractice from around the world.  Reading these sites you would almost never want to take your pet to a vet again.  And I'm sure these people probably feel that way themselves, as the circumstances they describe seem particularly and legitimately heinous.

But let's put a bit of perspective on this.  Okay, so there are "hundreds" of reports.  Can we assume 500?  Just for the sake of numbers.  And that's from just one web site, so we can assume that only a small number of people contacted that webmaster.  It's also a safe bet that only a small percentage of malpractice concerns are ever reported.  So we need to increase that number many times.  Do you think that a 10-fold increase (5,000) is to small?  Let's go with a 100-fold increase, and say that there are 50,000 malpractice cases that happen. In the US alone there are approximately 200,000,000 veterinary visits annually by all pet owners.  So our 50k malpractice cases represents 0.025% of veterinary visits.  Well, maybe only 1 in 1000 malpractice cases are reported, so there are actually a half-million horrible and malicious veterinary visits annually.  Pretty big number, right?  But that's still only a fraction of one percent of all visits in the US alone, let alone the world.  Suddenly "hundreds" of reports from around the world is a prety miniscule number.

Please understand that I'm not trying to belittle the people who have had truly horrifying experiences with their pets, or who have to deal with someone who should have their medical license stripped from them.  I honestly feel regretful that someone with the same title as I have caused them and their loved ones so much unnecessary pain.  But let's not throw the baby out with the bathwater.  I fully agree that anyone (regardless of profession) who behaves abusively and unethically needs to be fully prosecuted and probably deserves anything they get in the process.  However, it's wrong and unjust to assume that all members of a given profession are automatically guilty of the same behaviors. 

I can honestly say that the huge majority of veterinarians that I've known and worked with are honest, ethical, compassionate, and thorough people.  Yes, there are bad apples in my profession, as there are in EVERY profession out there.  Unfortunately, some people fall victim to laziness, greed, anger, and any other sin.  That most certainly does NOT excuse their behavior, and they need to be faced with the consequences of such actions.  However, I would ask people to exercise some common sense and discretion and not let these people spoil their view of the whole bunch.

8 comments:

  1. I am one of those commenters, Dr. Bern.

    I have a vet. I like her. I even guardedly trust her. I will always be guarded, even with her. It's just what this experience has done. But as far as I can tell she is good and ethical. As far as I can tell.

    I no longer extend that assumption to your entire profession, however. I look to VERIFY the basis on which I am extending my trust. I get records every time I leave, and I go over them. I review bloodwork. I ask lots of questions about anesthetic protocols and monitoring. I go a place that uses licensed techs. I make specific requests.

    I also know one other vet I like and, guardedly, trust. No, actually two. Wow, that's three!

    But here is the difference:

    I used to give trust on the assurances of people like yourself that the profession is by and large peopled with good and conscientious animal lovers. I learned the hard way that this blind trust led me into a situation where my best friend was nearly killed and irreparably brain damaged.

    I do not recommend that anyone trust BLINDLY, and I would be very skeptical of anyone who seemed to be encouraging me to give blanket, and blind, trust to an entire profession. That's naiive.

    The reason that I guardedly trust only three vets is:

    1. I will always be guarded, as in perpetually verifying as much as I can, and being as actively involved as I can. Although bad experiences have done this to me, I recommend this attitude to everyone. Proactive and vigilent.

    2. I only know three vets well enough to have a history, a track record, that is consistently positive enough to earn some degree of trust. Again, I recommend this attitude to everyone. You should just give your trust to people you don't know. You should KNOW who it is you are placing trust in, because you are placing lives that are dear to you in their care.

    Blind trust = blindsided.

    It is very important to realize that if your trust is misplaced and your pet is negligently harmed, the vet will likely pay no price (no accountability) but you and your pet will pay dearly in every sense of that word.

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  2. That should read:

    You shouldn't just give your trust to people you don't know. e

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  3. Stefani, I do believe in the Reagan-era adage "trust but verify". I will generally extend my trust to people unless given a reason not to, but I also want some assurances, and will ask questions and check up on them. Verifying records and asking questions are good things that I whole-heartedly agree with doing so! I also can't say that I disagree with any of your comments in any significant way. Trust can be extended, but true trust must be EARNED. I'm glad that you have great vets that have reached that point with you.

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  4. Isn't working with the public grand. I love paying for another veterinarian's mistake or competing with internet knowledge. Sigh.

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  5. Dr Bern: That is where you have misread or misinterpreted our comments.

    I have gone to veterinarians for 35 years, with complete trust and even overlooking small mistakes in diagnosis.

    But when you run into the "bad apple" that feels NO repercussion or accountability from authority resources, something is "terribly wrong" and I think you would agree.

    Do you think that I have discontinued vet care for my remaining 5 pets? No, and I have many, many examples of good-superb care.

    But with large internet groups and email communications, an individual finds that they are NOT alone running into unethical, incompetant, or negligent care.

    Read "badvetsdaily" and find the public records of bad apples, all without meaningful deterrment, still abusing clients/patients over the course of decades! You have to wonder, why?

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  6. Nicki, compteting with the Internet knowledge? Why is there a "sigh" at the end? In my unfortunate encounter with the vets who missed my cat's congestive heart failure, resulting in his going without treatment, suffering, and most likely dying before his time, I had to be the one to come up with the idea of putting him on Lasix and Enalapril, which one of the vets "agreed" with. How did I come up with the idea? Through the Internet, when the two vets treating my elderly pet, who was wasting away, gurgling with each breath, showing an enlarged heart and fluid on the lungs on an X-ray, did you know what? Nothing. I trusted them to have the knowledge, and at that time it didn't occur to me that competence of a veterinary professional would faulter to the degree that it did with my cat, RIP.

    One of the vets who did nothing received a formal letter of censure from the State Vet Board, and it turned out, actually, that I diagnosed Smokey's condition correctly based on the symptoms he had, the snippets of information given to me by the vets, and yes, my reading of the Internet. My treatment plan began helping Smokey right away. Unfortunately, the results were not good because three weeks had gone by before my (Internet-based) treatment plan was implemented, and during this time, the condition progressed to pericardial effusion. Smokey died at the ER after being sedated.

    The point is Internet knowledge is nothing to sneeze at because as Stefani aptly put it, there is a growing contingent of pet owners, who do not blindly trust their vets. I wish this knowledge didn't have to come to me at the cost of Smokey's life, but I will never again blindly trust any vet.

    To Dr. Bern: the point of our posts is not at all to discredit veterinarians, or to suggest that none of them should be trusted. Like Stefani, I now have a vet whom I cautiously trust. The point is: no vet should be trusted completely and blindly just based on the fact that he or she has the "appropriate" training and he or she has not given us reasons not to be trusted. Our pets' lives are too precious for any vet to be trusted blindly. With Smokey I did, and he paid the price. He went without treatment for an obvious disease because the vets hadn't given me reasons not to trust them, and my mindset at that time didn't allow for the posibility that two trained professionals would miss an obvious condition, which an economist (that's me) was able to "diagnose" on the Internet.

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  7. I misspelled my site address last night. My apologies. Also, thank you for the opportunity to make our voices heard. The memorial site to my beloved Smokey is: http://cpahclientsbeware.blogspot.com/

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  8. I've had to ask my doc to do something I found on the Internet (human doctor in this case), but it wasn't some crystal-gripping "treatment" I found on some random "alternative health" website. I got my information from the Mayo Clinic and the AMA.

    If I look up pet health online, it's on the ASPCA or AVMA websites. You better believe if my vet disagrees with what those organizations recommend, he or she is going to have to explain why.

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