Euthanizing a patient with a treatable condition because the owners couldn’t afford the treatment can be agonizing. As an associate or relief veterinarian, I often have little power to offer flexible payment options beyond what the clinic where I’m working at the time offers. (We’ll come back to this in a future post).
My personal power to prevent economic euthanasia comes from my willingness to be flexible and offer a range of options to my clients. While there are times where this isn’t enough to prevent euthanasia, in many cases, it is. However, my comfort with what options I offer to clients has greatly evolved in my 11 and a half years of practice.
You see, once upon a time, I euthanized first-time blocked cats.
This was early in my career, and I truly thought I was doing what was best for the patient at the time. It’s not something I’m proud of, but it is something I share in the hopes that I can help other veterinarians rethink the way they approach these cases.
My Perspective as a New Grad
This is what I believed about blocked cats when I graduated from vet school.
- They are a life-threatening emergency.
- They are treatable.
- They can recur.
- Placing an indwelling urinary catheter and hospitalizing these cats on intravenous fluids is required.
It’s point four that led me to recommend humane euthanasia for blocked cats whose owners didn’t have the means to hospitalize. I truly believed that hospitalization and an indwelling urinary catheter were a necessity to successful outcomes in these cases. I believed that if I simply relieved the patient’s obstruction and sent him home, I would be sending him home to re-obstruct and suffer.
And so, in these cases, I recommended euthanasia. Even when my team members questioned me, I insisted this was the best option. Thankfully, this only happened a couple of times where finances were so tight that no hospitalization was feasible. But, in hindsight, it was still a couple cases too many.
Evolution through Mentorship
My opinion on treatment options has changed thanks to the wisdom of a wonderful ER mentor I worked with a couple years out of school. When faced with a blocked cat with a severely financially constrained family, she encouraged me to consider outpatient treatment as an option. We discussed my concerns. She shared that she had successfully treated cases in this way. She coached me on how to discuss the risks with the clients.
So I offered outpatient treatment for the first time to a patient whose family had severe financial constraints. The cat did well. My confidence in offering this as an option in the future grew. It will still never be my preferred treatment plan, but it is something I consider for stable cats when clients can’t hospitalize.
Are you comfortable with these options as a doctor?
This is the question that I often come back to when considering spectrum of care options, and I encourage others to do the same. As a new graduate, I wasn’t comfortable with an outpatient option. After encouragement and support from a mentor, careful case selection, and some successful cases, I became more comfortable with this option.
But I still don’t offer it in every case, and I never offer it as a first line treatment. My first line treatment plan still includes a full workup with bloodwork, imaging, and urinalysis, unblocking, and hospitalization. I can whittle this down a bit by adjusting diagnostics and amount of time in the hospital to fit many client’s budgets. I mean–when has a CBC actually changed your treatment plan in a blocked cat? It’s only if these initial plans have been declined–or a client has upfront told me what their budget is (often because I asked)–that I consider outpatient.
However, my physical examination and history are a critical part of assessing if outpatient therapy is a viable option. The cat that presents with multiple days of symptoms, is laterally recumbent, bradycardic, and hypothermic is not a patient that I’m comfortable with outpatient therapy for. I will try to trim the estimate down as much as possible and discuss ways to collect funds, but I’m just not comfortable sending a super azotemic, hyperkalemic patient home, even if we have relieved the obstruction.
There is a lot of communication that happens with these clients–advising them of the increased risk of reconstruction with an outpatient plan and what we might be missing if we eliminate diagnostics. We discuss monitoring and next steps if the outpatient plan fails. We discuss risks of recurrence and plans to prevent them.
Hope for the future
When I lecture on spectrum of care, I often use a blocked cat as a case example. When I speak to veterinary students, I present the range of options from full diagnostics and hospitalization to a modified in-patient plan to outpatient treatment to euthanasia. Then I ask them what options on the list make them uncomfortable.
I expected that I would hear outpatient therapy, because that’s how I felt as a student and early career veterinarian. And I did hear that from some students. But I also heard a fair number of students ask: “why would we euthanize the cat when we could give him a chance with outpatient therapy?”.
And this brings me hope for the future of our profession. Because these students already see that there is always more than one way to treat a cat.
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