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Tuesday, January 26, 2010

A Client's Bad Decision

Today I had a client who really frustrated me.  And this was a situation that I really haven't been faced with before, making it even more difficult to handle.

The client has a deaf boxer a little over a year old who has separation anxiety issues.  A few days ago he noticed the dog drooling, looked in his mouth, and saw that he had broken a tooth.  Today he brought him in for evaluation.  The dog was in overall good condition, but had broken off the tip of his upper right canine tooth.  The fracture was fairly close to the gum line and the pulp was obviously exposed.  So I began to work up an estimate for him.  A healthy canine tooth has a long, curved, thick root and is pretty hard to remove.  Generally the best way is to use dental drills to remove part of the bone away from the outside of the tooth, allowing it to be loosened and removed more easily.  Such a procedure also requires lifting part of the gum away from the bone and then suturing it back over the whole.  All of this requires general anesthesia since it is painful and can take quite a while to do.

I gave the estimate to the client.  He declined, but not for the reason I expected.  Instead, he said that his sister was a dentist (for humans), had removed broken teeth from his Rottweiler, and he was going to have her fly in to remove this dog's tooth.

WHAT????

This was wrong on several levels.  First of all, a human dentist is no more qualified to work on a dog's teeth than I am to work on my wife or children's teeth.  Just because you know about one species doesn't mean that you know about others.  There are certain similarities between teeth of various species, but the structure is certainly different.  Also, and most importantly, a human doctor is absolutely unqualified to perform anesthesia on an animal.  Drugs, dosages, and complications are all different.  What might be safe for one species doesn't mean that it's safe for all.  And dosages can be VERY different.  As an example (a non-lethal one), a human adult's correct dose of diphenhydramine (Benadryl) is 50mg.  In dogs we dose it at around 1mg per pound (2mg/kg).  That means that an adult human's dosage would only be enough for a medium-sized dog!  I would have no clue how to dose anethesia safely in a human.  So why would a human doctor feel that they can properly dose anesthesia in a dog?

The second issue is a very legal one.  Medical professionals are very specific in the species that they are legally allowed to see.  Human doctors are legally only allowed to work on humans.  Veterinarians are legally allowed to work on every species except humans.  So if I try to do a medical procedure on one of my kids, I can be arrested for practicing medicine without a license.  Similarly, when a human doctor works on an animal (say by, oh....doing a dental extraction on a dog) they are just as guilty of practicing medicine without a license.  If this dentist was ever confronted, she could potentially see jail time and lose her medical license.

I have no problems with a client wanting to save money.  But doing it in this way is putting the dog at a high risk of complications.  There is a right way and a wrong way to lower costs...and this is most certainly the WRONG way.  Also, I have no respect for the owner's sister at this point if she actually does this.  She is acting recklessly and extremely unprofessionally and should really know better.

When a client makes a poor decision, it's not them who suffers.  It's their pet.

4 comments:

  1. How frustrating for you....

    We used to get a human dentist to come in and do root canals on our dogs with broken canines... perhaps you could offer to supervise the anaesthetic and attend the procedure? work together?
    good luck
    fi

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  2. Oh my gosh.

    So what did you say to him? I just can't imagine being in that situation at all.

    I think I would have insisted almost aggressively that that's like... really dangerous.

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  3. I'm still trying to figure out how much benedryl my dog would need. Good points!

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  4. I know that human dentists have worked with veterinarians on various procedures, especially in zoos. But there is now a board certification in veterinary dentistry, so I don't know how much longer that would work. And the client wouldn't really save much by allowing me to do the anesthesia and his sister to do the dentistry.

    All I could do was tell him that I strongly advocated against it and the physiology of humans and dogs was different enough that you shouldn't try working on a given species without training. In the end, the decision is his, no matter how much I disagree with it.

    ReplyDelete

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