"Vet 1 did not advise
me to get an X-ray to
check whether the
cause of blood in my
dog's urine is due to
urinary stones," the
owner said to me. I
had reviewed Vet 1's
medical records of
this poodle and Vet 1
had not written his
advices to get X-rays
done. Earlier, I had
asked Vet 1 whether he
did advise X-ray since
the owner told me he
was not told. "I
always advise X-ray
and urine test when a
dog passes blood in
the urine," Vet 1 said
to me. "The owner
wanted to wait and see
after a course of
antibiotics."
A urine test was done
as there was a report
which showed "No
crystals in the
urine." I told the
owner that I had
written "owner does
not want radiography"
on the urine test
report as I had
reviewed this case
done by Vet 1 and had
asked him why he did
not advise X-ray
during the
consultation. Vet 1
had said that the
owner did not wish to
have X-ray. However
there was no AMA in
his medical report and
I had not pursued the
matter further. I was
present when the owner
came as his dog had
passed blood in the
urine after the course
of antibiotics.
Sometimes, I don't
record every medical
advice to the owners
too and this can be
held against me when
there is a negligence
complaint to the
authorities or in
litigation.
It is one man's word
against another. Who
to believe? I got the
owner's permission to
do a blood test, X-ray
and urine test. I
asked my assistant to
use "Whats App" from
his mobile phone to
send him all the 3
results. The owner
replied instantly with
queries and this
showed that he was
much concerned about
his old dog's health.
Many old dogs are
family members. This
case shows that the
vet must be proactive
and consistent in his
veterinary process,
protocols and systems
to provide
evidence-based
medicine. Many times
we want to save money
for the owner by not
doing tests. But such
kindness could turn
against the vet if the
dog dies. By recording
AMA (Against Medical
Advices) in the
medical records during
consultation, no
ambiguity arise when
there is litigation or
complaint to the vet
authorities.
I usually write as I
talk to the owner.
Some vets do their
writing at the end of
consultation and this
is where he or she
forgets to record
medical matters and
advices. If the owner
has been given the
X-rays or lab test
reports, this should
also be written down
in the case sheets.
Nowadays, Singapore
owners are more
sophisticated,
veterinary competition
is more intense. Vets
have to deliver
results or justify
their treatment and
this can be done by
being meticulous and
aware of the need to
have a proper process,
system and protocols
in veterinary
diagnosis and
treatment of diseases
in pets. This case
illustrates the
importance of AMAs in
the practice of
medicine and the need
to practise defensive
and evidence-based
medicine in a
developed country like
Singapore.
P.S. The dog will be
operated by me today,
Jun 14, 2013 after
another course of
antibiotics and when
she eats and is
active. The blood
tests showed a high
total white cell count
of 25 and very high
number of neutrophils
indicating a bacterial
infection at the time
of consultation with
me.
Urine test this time
showed struvites
crystals. X-rays of
the female dog with
urethral catherisation
and 30 ml of air
showed a big urinary
stone and no bladder
tumour. The owner has
been told that kidney
stones are also
present in the left
bladder. Only the
bladder stone will be
removed in today's
surgery.
Every old dog
anaesthesia is high
risk and this dog is
10 years old and much
loved by the family.
Pressures are high for
any vet as nobody can
guarantee no
anaesthetic death on
the operating table.
TOA
PAYOH VETS
