Turning death into a wake-up call

The chart said it all: new client, sick old dog. I stepped into the exam room and was greeted by the sound of a matted tail tapping against the wall. Attached to the tail was Elsi—thin, dehydrated, covered in fleas, teeth rotten. I asked the client when Elsi had last been to a veterinarian.

"Twelve years ago, when we had her fixed," he replied. Lab work indicated heartworm disease and chronic renal insufficiency. I stroked Elsi's head and broke the news to her owner, painting a grim picture. That's when he dropped the bomb: "Well, doc, she's our girl. Do everything you can."

What? Do everything I can? What about wellness exams, routine dental care, and heartworm prevention? I glanced around the room searching in vain for my hero's cape as I faced yet another "end-of-life" client.

You know the kind. These pet owners skip routine and preventive care, then show up at your door expecting you to save the day when their pet's dying. Or they spend years getting nominal care from the discount clinic and visit you only when things get serious. Somehow it seems unreasonable to ask the veterinary team to get involved at such a late stage in a pet's life. Or is it?

After all, common sense says this client, who's apparently been neglecting his pet for years, won't adhere to your therapeutic recommendations. Does he really deserve your full attention after showing only minimal concern for his dog's health up until now? Your waiting room is full of loyal clients with pets you've been treating for years. With a poor prognosis and no previous relationship with this pet owner, it's tempting to dismiss his wishes, advise euthanasia, and move on. But in doing so, you may miss a great opportunity.

Maybe you can't save this pet, but you can demonstrate your expertise, show compassion, and focus on education. Perhaps the pet owner couldn't seek your advice because of lack of money, lack of transportation, or a controlling spouse. Maybe the client just hasn't learned about proper pet healthcare. The quantity and quality of veterinary care a pet receives in its lifetime doesn't always correlate with its standing in the family or how much it's loved.

Regardless of how negligent the pet owner might have been before now, at this moment he's standing in your exam room listening to what you have to say. And he deserves to hear the same diagnostic and therapeutic options you'd offer established clients—without being made to feel guilty.

So if you'd tackle this case if the pet belonged to one of your stellar clients, give this new client a chance. Don't run unnecessary tests or recommend futile therapeutics, but do explain your diagnoses clearly and provide accurate estimates along with an honest prognosis. Discuss the necessity of follow-up visits that include diagnostic testing to monitor progression of the pet's condition.

Then put the ball in the pet owner's court. You may never see him again, but then again you may gain a dedicated client and help the pet live a longer, better-quality life. One day this "end-of-life" client may turn up in your exam room with a travel sheet that reads, "New puppy wellness check and vaccinations."

Dr. Melody Heath is an associate veterinarian and freelance writer in Hickory, N.C. Please post comments on the dvm360.com Community message board or e-mail ve@advanstar.com.