How far should we go in the treatment of animals?

RE: How far should we go in the treatment of animals?

Anthony Dennison — Mon, 24 Nov 2025 14:55:16 GMT

[quote userid="12150" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/247923#247923"]Re the CMA review and drug costs, it is truly appalling that the corporates keep stating that they cannot compete with the online pharmacies - when they own the blessed things! So all drugs could be bought at the same net-net price, or am I being naive?[/quote]

Actually, I'm a clinical director at an IVC practice and we can't buy drugs in as cheap as they can be purchased on petdrugsonline (owned by IVC). Don't ask me why, I've stopped trying to understand it.

RE: How far should we go in the treatment of animals?

Andreas Ege — Thu, 20 Nov 2025 20:22:09 GMT

I think some animals are overtreated or have unnecessary diagnostics run, while others are undertreated (dentals, anyone?).
One area where I genuinely think a lot of animals are overtreated is parasites. My own animals hardly ever had/ have fleas and I am quite confident I'll pick up on them fairly quickly, we only treat if they have them or we expect an increased risk in exposure. Similarly with worms, the dog gets wormed once or twice a year because we're travelling to Germany and back with her, rest of the time the wife does faecal egg counts - almost always negative. She also sees a lot of "alternative" oriented clients - some of those dogs come back with a high worm burden, but most have no to negligible levels even though some are not wormed for years.

Right now I got an almost 20yr old cat hospitalized we've been dealing with since July, going off food recurrently, dehydrating recurrently and consistently been loosing weight. Bloods in July were non-diagnostic. In my opinion the cat should be put to sleep. Alternatively repeat and probably additional diagnostics should be done rather then treating it symptomatically with no idea what we are treating and what our chances are.
Basically I think this cat is overtreated, but you could also argue it is underdiagnosed at the moment.

Like most on here, as far as I can judge, I go through the options on an individual base. First I lay out what I think we'd ideally do, then we go into the minimum I think is responsible/ acceptable and then in the maximum we could do but I'd think is not warranted.

I have no statistics but it feels most clients go somewhere along my initial recommendation with some opting for a more minimal and some for a more maximised option.
Pre-op bloods, for example, I inform owners that they are available and that they might make a difference for a small percentage of patients but that most studies looking into it found that in over 90% of cases it does not seem to change outcome or approach. Some go for it, others don't.
Similar to Clive Ansell, I can count the animals where pre-op bloods made a difference for the approach on one hand, mostly cats with diabetes or kidney issues. How much difference to outcome that would have made we'll never know.
I honestly rather have the cat/ dog with horrible dental issues have a dental without bloods and fluids then not having the dental because bloods and/ or fluids are the financial deal breaker.

I think it's been mentioned in this thread before, but what is amazing and really annoying is the amount of clients that (say they) can't afford diagnostics and/ or treatment even for relatively straightforward problems, have multiple animals, get a new one shortly after one of the old ones had been put to sleep and then want an individual cremation and amazingly manage to raise the funds for that rather than putting the money aside for the animals they have that are still alive.

In regards to referrals, I offer them for three reasons: mostly probably to cover my back, I find in those cases most owners are happy not to refer; because the problem is really above my confidence/ expertise level (e.g. spinal disc injury if the owner is considering surgery or the cat with chronic gingivo-stomatitis for full mouth extractions because we don't have dental x-rays - I still sometimes do them but then the owner is aware we might be missing something crucial); or because I am happy to do the procedure but there is probably a higher risk of complications because of lack of routine and I think the owner needs to know this(I guess that probably falls under covering my back). Couple of months ago I did my first and only oesophagotomy to remove a stuck apple that we couldn't get out or push down endoscopically. Alternative would have been a pts because the owner couldn't afford referral. Owner was aware I'd never done it before and we probably had a higher risk of complication, but in the end the dog didn't have to loose anything so we did go ahead and the dog's still alive and kicking without any complications.

One thing I found irritating ever since I came to Britain is how many animals get put through all kinds of diagnostics, just to find a reason putting it to sleep. Not quite sure why, whether it's people worried they are missing something or whether it's because the British communicate much more indirectly than Germans. If I think an animal should be put to sleep I tell my clients without running lots of diagnostics first and I find that most are grateful for the honest opinion, even if they don't agree with it. Most do, though, and often that was already on their mind but they didn't voice it until I got there.

I would agree with most things that had been said about OOH providers and service. Part of the reason I started in the practice I'm in now was, that they were still doing their own OOH at the time. By now, we've given it up. It started with the week-ends while we were short staffed - 1 vet on maternity leave, one had left and the clinical director had reduced her work to one day a week while being on the jump to her own place. From there on it was a slippery slope and if we hadn't given it up we might still be short staffed. I'm the only vet in the practice who would have preferred to keep it.
I totally think these OOH provisions are at least very close to breaking part of our veterinary oath - "... and that, ABOVE ALL, my constant endeavour will be to ensure the health and welfare of animals committed to my care." I just don't think that being shipped about twice a day, sometimes for days in a row and sometimes with painful conditions, is good for the welfare of the animals.

Also the provision of these "specialised" OOH providers stand and fall with the staff they got, like every other place. Just the other day I was getting a dog send back that, according to the OOH duty vet, was 8% dehydrated, but they didn't think to replace the iv that had blown over night with a spectacularly swollen leg. Luckily, the dog was not dehydrated at all, which their own blood results did confirm. I.e. there was first a false diagnose (severe dehydration in a non-dehydrated animal) followed by no action even though the vet thought there's a serious problem - definitely not overtreated, but possibly overprized.

On the other hand, OOH work has become more busy and more demanding in regards to clients expectations than it had been when I started working. Almost 20 years ago I still would have weekends in mixed practice where after Saturday morning consults I would not get one call for the rest of the weekend. Last few years I was doing OOH I would get nervous and check phones/ answer service when I didn't get a call by Saturday evening. And being more busy and having higher demands puts a strain on the traditional OOH system with vet staff working day - night - day. Even when we were still doing our own OOH we had provisions in place for intensive care patients because spending most of the night awake between working days is not sustainable if it happens too frequently.

On the other hand, while I appreciate that people like to have a or multiple pets, at the end of the day owning a non-working or non-support animal is a form of luxury. It's nice to have, there might be some benefits mentally and physically, but we wouldn't need them to survive or (probably at least for most) to prosper.

RE: How far should we go in the treatment of animals?

Martin Hamilton — Thu, 20 Nov 2025 17:38:48 GMT

Maybe animals in Canada, or perhaps those seeing a dental specialist at a young age, are less thrifty, but I've detected 2 somewhat major issues in the last month on pre-op bloodwork in young animals. One being a bouncy Lab that has now been diagnosed as having renal dysplasia with significant proteinuria, and the other a shunt in a grumpy wee Yorkie with a shark mouth. In both cases our anesthetic plan has changed/has been put on the back burner while clients pursue more workup (Lab had an ultrasound and further urinalysis, started on telmisartan, Yorkie going for shunt surgery next week). I must say that it's not often we see life altering changes on bloods, but when we do owners are always very grateful. And in both of these cases, the animals were outwardly healthy.

Culturally pre-op bloodwork is the norm here, but it's also common for a GP doctor to perform frequent blood panels in people so perhaps it's just seen as more *normal".

RE: How far should we go in the treatment of animals?

Clive Ansell — Wed, 19 Nov 2025 16:35:43 GMT

[quote userid="9515" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248034#248034"]For the individual patient it may make the difference between life or death (e.g. an asymptomatic thrombocytopenia that is going to bleed to death with surgery or the asymptomatic young dog with renal dysplasia that a GA would push over the edge).[/quote]

But these cases are exceeding rare.

In any event, many pre GA blood tests do not usually test for things that may be immediately life threatening; such as coagulation studies or electrolytes. The often found very slightly raised ALT, ALKP, BUN or Glucose are not game changers, other than a spring to peddle prescription diets in some practices.

In my 29 year career I can only think of 2 cases (out of 1000's) in outwardly healthy aninals where a pre op blood test has detected anything; one was young collie with very low glucose that turned out to have an insulinoma, the other was a cat with rasied glucose that tunned out to be diabetic. In both cases the conditions were detected earlier because of pre GA blood tests, but they would have shown themselves eventually and outcomes would probably have been the same anyway

RE: How far should we go in the treatment of animals?

Clive Ansell — Wed, 19 Nov 2025 16:23:38 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248042#248042"]

o explain what I mean more, my dog is ill, needs surgery, and there is a 100 billion to one chance that it could have something else going on which could cause it to die, and which a test costing £200 may identify, and save the animal.

100 billion to one? I'll take my chances.

If there was a 1 in 50 chance or if the test cost 10p, well the dial moves and the test becomes more worthwhile again.

[/quote]

Too simplistic, where would the cut off point be?

Billion to 1?, million to 1?, 1000 to 1, 100 to 1 , 10 to 1? 37.3 to 1?? , but as Sarah points out if you are "the 1" it will matter to you

10p?, £10? £100 ???

Down on planet real world it isn't like that though.

We can almost always get more useful information from taking a good history and a full and thorough clinical examination. Based on that we can advise whether or not a pre anaesthetic blood test would be useful, or would change the course of events (Almost always it doesn't, and I rarely advise them)

RE: How far should we go in the treatment of animals?

Arlo Guthrie — Wed, 19 Nov 2025 12:05:20 GMT

[quote userid="9515" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248034#248034"]The difference between publically funded population level medicine and private, self-funded medicine. Yes, the likelihood of a pre-anaesthetic blood test of finding something that needs action is low but this is on an overall level for all the tests done in this way. For the individual patient it may make the difference between life or death (e.g. an asymptomatic thrombocytopenia that is going to bleed to death with surgery or the asymptomatic young dog with renal dysplasia that a GA would push over the edge). For the individual client in front of you, THEIR individual pet is what matters and for that piece of mind that it could be the one in 100 that has something hiding, the blood test is a good option for private medicine. But that doesn't make it compulsory.[/quote]

Hi Sarah Keir, yes, but surely the maths hasn't changed? In other words, the chance of the lightning bolt hitting the private patient is the same as the NHS one. So therefore, the blood test has exactly the same (very low) chance of providing useful information for the private individual as for the population level purchase.

In simple terms, as an owner, I want to know what the chances are of the thing I am buying producing actionable results. The difference between life and death is not important on its own. It can only be viewed in combination with the likelihood of having a preventable death outcome.

To explain what I mean more, my dog is ill, needs surgery, and there is a 100 billion to one chance that it could have something else going on which could cause it to die, and which a test costing £200 may identify, and save the animal.

100 billion to one? I'll take my chances.

If there was a 1 in 50 chance or if the test cost 10p, well the dial moves and the test becomes more worthwhile again.

These things are surely absolute, and it makes no difference whether they are performed in private practice or at a publicly funded level?

RE: How far should we go in the treatment of animals?

janine redman — Wed, 19 Nov 2025 11:46:06 GMT

I actually cover 90% of the ooh cover as well,as days. I have a brilliant second vet and if I need a break the local MiNight vet practice are brill. I try and keep clients informed of the out of hours provision and most clients are very understanding. Where possible I discharge patient late evening as they are often happier at home if critical care not essential overnight

it is hard work and interrupts my sleep pattern but it saves so much time in transferring out and back with out of hours ! The problem is the stray dogs without chips as most locals know I live on site out of hours

RE: How far should we go in the treatment of animals?

Clive Ansell — Wed, 19 Nov 2025 11:30:39 GMT

[quote userid="13891" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248039#248039"]

janine redman said:
I cannot achieve the level of monitoring in the local 24/7 ooh where I offer to send patients.

I would dispute that.

Your patients do not have to be transferred in alien environments with no monitoring in transit, on sometimes quite long journeys.

They are cared for by the vet who has treated them, both on that day and probably for most of their lives with full access to history and clinical records.

They might not have a box ticked to say their obs have been checked every hour but that can be less than perfect.

They may be less likely to have surplus interventions during their stay.

The clients who choose that option may not have done it on price alone, but on trust.

It seems to me that animal and client welfare are well served - hope the vet welfare is good.

[/quote]

I would agree with all of that.

I've worked in practices that do their own OOH as well as those that do not. In the ones that do, the standard of care varies massively

Without a doubt, a practice that does its own OOH work well with monitoring as needed will give the best patient care.

I've worked in OOH clinics that are so busy that patients hardly get looked at, let alone monitored regularly through the night. It is not unusual to have around 20 inpatients, with just 1 vet and 1 nurse, manning the phones and seeing an endless stream of trivial ailments front of house. OOH providers do a great job of marketing, but the reality is often very different.

The biggest issue to me with using OOH providers (I avoid the term ECC as most OOH clinics do not have staff with further training or status in emergency or critcal care, and almost all of the work is not emergency cases at all) is the transport of very sick or injured patients, and it is not unheard of for them to die in the footwell of a car between day and night practices.

I once did a locum where the vets-now clinic they used was 45 miles away; so someone travelling there, leaving their pet, then collecting the next morning would have to drive 180 miles. Add to that, sometimes OOH clinics close at short notice because they cannot get staff and clients are offered telephone triage before being directed elsewhere.

[quote userid="13891" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248039#248039"]hope the vet welfare is good. [/quote]

That is a big ask.

It is a hell of lot to expect staff to be on call in addition to working all day. After a full 10 hour day I am about bushed, and there is no way I would or could be on call in addition to that.

RE: How far should we go in the treatment of animals?

Judith Joyce — Wed, 19 Nov 2025 10:55:22 GMT

[quote userid="9440" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248036#248036"]I cannot achieve the level of monitoring in the local 24/7 ooh where I offer to send patients.[/quote]

I would dispute that.

Your patients do not have to be transferred in alien environments with no monitoring in transit, on sometimes quite long journeys.

They are cared for by the vet who has treated them, both on that day and probably for most of their lives with full access to history and clinical records.

They might not have a box ticked to say their obs have been checked every hour but that can be less than perfect.

They may be less likely to have surplus interventions during their stay.

The clients who choose that option may not have done it on price alone, but on trust.

It seems to me that animal and client welfare are well served - hope the vet welfare is good.

RE: How far should we go in the treatment of animals?

Malcolm Ness — Wed, 19 Nov 2025 09:55:48 GMT

[quote userid="9440" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248036#248036"]However many clients cannot afford ooh fees but accept the level of service I can provide [/quote]

It's all about transparency and communication ... or the lack of it. We ran a 24/7 hospital facility with a string of primary-care satellite surgeries. OOH at the hospital we saw a steady trickle of very pissed-off clients from some of our neighbouring/competitor practices (a mix of independents, corporates and franchise businesses) who, following routine neutering surgery needed advice 'after hours' from their own practice only to encounter an answering machine directing them to a VetsNOW facility some 25 miles distant. Their annoyance was exacerbated by the fact that in almost every case this was the first they knew that 'their' vet went off-grid in the evening and subcontracted that part of their professional duty. They were further and consistently angered to discover that merely stepping across the threshold of the ECC facility (how I hate the pomposity of that terminology) would cost them more than the surgical procedure for which they had paid earlier that afternoon and that was now becoming complicated.

There is a level of dishonesty with clients systematically misled about the level of professional service on offer at many practices. When we had a 'Guide' rather than a 'Code' of professional conduct, such businesses were recognised as 'Limited Service Providers' and the onus was clearly on the individual VS to explain the limitations of their practice to a prospective client. A veterinary surgeon undertaking routine neutering surgery during daylight hours should at the very least - as part of the consent process - explain the limits to their service and the possible financial consequences in the event of concerns/complications occurring OOH, and ideally they should indemnify the client against the cost of any complications that develop following their surgery.

I do not know Janine R's practice but I wager that her clients and her patients are far better served than those of a vet working in a lock-up shop practice that subcontracts anything after dark to an ECC subcontractor.

RE: How far should we go in the treatment of animals?

janine redman — Wed, 19 Nov 2025 00:54:48 GMT

I do my own ooh , and in fact although technically on holiday this week I have two HGE inpatients. Both on fluid and being monitored by camera in the practice 10 metres from my house . Last check , hopefully, just completed hence it’s nearly 1am . I cannot achieve the level of monitoring in the local 24/7 ooh where I offer to send patients. The owners have the choice of service and cost - although I cannot manage high levels of in patients and stay functional for daytime work. However many clients cannot afford ooh fees but accept the level of service I can provide

RE: How far should we go in the treatment of animals?

Alistair Graham-Evans — Tue, 18 Nov 2025 21:43:09 GMT

I have never seen an asymptomatic dog where a pre Ga blood would make any difference and never seen a case where blood gases done at Emergency Centre have changed the outcome or treatment ( I concede that lactate may assist with prognosis). Although I have had a few clients want to pay for pointless tests and if not harmful to the animal agreed -their choice - they may want a Ferrari to pop down the road to the supermarket!

Have seen a fair number where a full history and exam indicates a GA risk though - and that costs little. I think transparency is the issue - we still have vets here that quote for neutering with additional fees for fluids and pain relief but recommend bloodwork! Our neuters have compulsory fluids and analgesics as standard in the fee but rarely do bloods which are only offered due to peer pressure!

RE: How far should we go in the treatment of animals?

Sarah Keir — Tue, 18 Nov 2025 18:14:31 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248008#248008"]pre-anaesthetic blood tests with little evidence that they are actually worth it (ie they rarely produce actionable results), and for that reason didnt someone say the NHS had reduced them significantly? [/quote]

The difference between publically funded population level medicine and private, self-funded medicine. Yes, the likelihood of a pre-anaesthetic blood test of finding something that needs action is low but this is on an overall level for all the tests done in this way. For the individual patient it may make the difference between life or death (e.g. an asymptomatic thrombocytopenia that is going to bleed to death with surgery or the asymptomatic young dog with renal dysplasia that a GA would push over the edge). For the individual client in front of you, THEIR individual pet is what matters and for that piece of mind that it could be the one in 100 that has something hiding, the blood test is a good option for private medicine. But that doesn't make it compulsory.

RE: How far should we go in the treatment of animals?

Martin Hamilton — Tue, 18 Nov 2025 17:30:42 GMT

[quote userid="5012" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248027#248027"]

I suppose one argument in favour of OOH clinics is that ill patients will be checked and monitored overnight, or at least they should be, by staff that are present all of the time.

Compare with the traditional practice that does their own OOH work, where patients would be given a couple of shots and put in a cage or kennel overnight in an unmanned building, sometimes for up to 14 hours unattended, and often/sometimes be found dead the following morning. Not saying you work like this, but many practices have/do.

[/quote]

This was almost 10 years ago, but maybe things have changed. First job was in semi rural Yorkshire, we did our own OOH, but many surrounding practices didn't and sent patients to VetsNow about 45 mins away. Some of our own clients changed their minds about using our in house on call when they realised that there wouldn't be a vet in the building all night. Likewise, many clients shocked by the fact that the on call vet was going to be the same one that had been working a full day, and was working again the following day (which from what I hear may be less common nowadays). I remember we had a client switch practice as they felt that the overnight service we provided was substandard due to a lack of staff in the building and "overworking" the vets. Left a nice Google review too.

With prices having risen so much are UK clients are more accepting of the traditional OOH model and the optics some may have of it? My experience was in a larger, but mostly rural, Northern town, so it wasn't exactly a wealthy area.

RE: How far should we go in the treatment of animals?

Beats — Tue, 18 Nov 2025 07:54:03 GMT

[quote userid="5012" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248031#248031"]USS (ultrasound scan) if we want to stick with using TLA's[/quote]

A TLA would be better still than typing the whole word ultrasound if everyone could agree on one and it was familiar to all.

I think urine sample has been the nemesis of a good abbreviation for ultrasound

USS could be urine sample sediment.

ULT, USX, U-S... I'm struggling with anything that could lack ambiguity and take a positive trend.

I can't abide a lengthy abbreviation for an irrelevant phrase with the word trauma in it to describe what we have all been doing for years...

POCUS is slightly better, but again we are using an additional 3 letters to insert the pointless phrase "point-of-care" for no benefit to meaning.

Maybe that would bring a relevant abbreviation back to simply US and urine samples will have to take a back seat and suck it up.

Meantime, I'm sticking with "ultrasound".

RE: How far should we go in the treatment of animals?

Clive Ansell — Tue, 18 Nov 2025 07:41:10 GMT

[quote userid="12930" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248030#248030"]

Clive Ansell said:
afast/tfast scans

can we go back to calling it ultrasound?

It is actually shorter to type and so much more obvious to read!

[/quote]

Yes, sure, good idea

Or we could call it USS (ultrasound scan) if we want to stick with using TLA's (Three letter acronyms) or MLA's (Multi letter acronyms)

RE: How far should we go in the treatment of animals?

Beats — Mon, 17 Nov 2025 23:13:48 GMT

[quote userid="5012" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248026#248026"]afast/tfast scans[/quote]

can we go back to calling it ultrasound?

It is actually shorter to type and so much more obvious to read!

RE: How far should we go in the treatment of animals?

Michael Woodhouse — Mon, 17 Nov 2025 22:14:29 GMT

[quote userid="5012" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248027#248027"]Compare with the traditional practice that does their own OOH work, where patients would be given a couple of shots and put in a cage or kennel overnight in an unmanned building, sometimes for up to 14 hours unattended, and often/sometimes be found dead the following morning. Not saying you work like this, but many practices have/do. [/quote]

Not on call tonight. Have a dog in from an ex lap I did this AM. Duty vet has been in and just left, I can check on the cameras as often as I want, and will do so until 1am ish. Duty vet will check camera some point in the night or if up for anything else. Dog has head up. Can talk through camera, can see drip running or hear if vocalising etc. I do plan meds as best as I can to reduce need to treat at especially unsocial hours.

Whilst I have found a few dead in the morning, it's very rare - guessing 1 animal every 5 years or less. I know from doctors that human patients are found dead in their beds at checks. I'm 100% sure that dogs are found dead in kennels in OOH centres when the vet and nurse stuck with a GDV/bitch caeser and fully occupied for an hour or two.

My question on outcomes - how many of those very few animals found dead, would have survived to discharge at an OOH centre vs my practice? I don't think any, I just think an owner may find out an hour or two sooner their pet had passed, or a few £100 extra had been spent on a futile resus attempt......

RE: How far should we go in the treatment of animals?

Dinu Catilina — Mon, 17 Nov 2025 21:55:15 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248024#248024"]don't you see a risk in that 'offer all options to everyone, rich or poor' approach? Can you imagine it being a problem when all options routinely range from £100 to £25K? Do you agree or disagree that when poor (or even sometimes rich) people are offered wildly expensive options, it is damaging to trust in the profession? [/quote]

I don't think it is if we are clear that they should not feel guilty for not taking the most expensive option. What I tell them is that whatever they decide is the correct decision as long as we don't just leave the animal to die in pain unattended. Some clients with money don't want referral and some without will take a loan and will not accept not to be referred.

I consider it extremely patronising to assume what a client should or should not spend.

The title of this topic is how far should we go in the treatment of animals and not how much money should we spend in the treatment of animals. Let's not conflate the two because you can spend lots of money for basic care or less money for advanced (dare I say experimental) treatments.

[quote userid="5012" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248027#248027"]

I suppose one argument in favour of OOH clinics is that ill patients will be checked and monitored overnight, or at least they should be, by staff that are present all of the time.

[/quote]

Two extremes but many who do their own out of hours are somewhere in between and go back to check inpatients in the night or spend the entire night on site with an unstable patient. We also have cameras with motion sensors and night vision through which you can check on an inpatient from home.

Michael Woodhouse is right. The profession has changed without asking clients what they want and then we are surprised about the increasing resentment.

RE: How far should we go in the treatment of animals?

Clive Ansell — Mon, 17 Nov 2025 21:32:58 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248021#248021"]Do you think a single client prefers going to an OOH centre and seeing a stranger, versus going along to their usual practice? [/quote]

I suppose one argument in favour of OOH clinics is that ill patients will be checked and monitored overnight, or at least they should be, by staff that are present all of the time.

RE: How far should we go in the treatment of animals?

Clive Ansell — Mon, 17 Nov 2025 21:22:21 GMT

[quote userid="6765" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248025#248025"]

A recent cracker was a dog with retching and difficulty swallowing being quoted for CT.

Back to us as owner worried about price - sedation and mouth exam revealed large vascular inoperable tumour of hard palate straddling midline - palliative care provided and advice for euthanasia soon. To be fair this particular ER vet loves CT and is a bit of an extremist.

[/quote]

I'll raise you on that one.

Earlier this year, an aging cat (10-12 years I think) with no history of trauma or any recent or relevant history, was presented to an OOH clinic (side arm of referral centre) with acute onset neurological signs. The usual blood tests, bloods gases and afast/tfast scans yielded no answers. Referred as an emergency in house to neurology, £650 for an OOH specialist consultation. MRI scan, large brain tumour occupying around 20-25% of skull. cat almost comatose by now and bill running at £7000. Offered and strongly advised decompressive craniotomy (for the non vets that is a hole drilled in the skull to relieve excess pressure around the brain), which fortunately and in the best interests of the cat was sensibly declined. So, £7k and dead cat.

RE: How far should we go in the treatment of animals?

Alistair Graham-Evans — Mon, 17 Nov 2025 20:34:30 GMT

A recent cracker was a dog with retching and difficulty swallowing being quoted for CT.

RE: How far should we go in the treatment of animals?

Arlo Guthrie — Mon, 17 Nov 2025 19:40:52 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248021#248021"]I'm not sure I love your solution to the problem, but you are absolutely correct on this. Vets glibly saying that they know what their clients want, faced with the paradox of what we have decided to provide them. Do you think a single client prefers going to an OOH centre and seeing a stranger, versus going along to their usual practice? I've had lots of people join my practice, because they don't want to use a corporate. Do owners really want the standards raising, or were they happy with the similar results in the past?[/quote]

I think you're mellowing Michael Woodhouse! . I'll take 'not sure I love your solution'! And you wrote a particularly sensitive (good) post the other day, I noticed. What's going on?!

Joking aside ... ok - well maybe my idea is crap. I still fail to understand how it can be a BAD thing to ask clients what their attitude to treatment is in advance, because even if (of course) doesnt help in every case, I would bet on it being a positive thing in many cases.

Anyway ... maybe I should listen to Dinu Catilina

[quote userid="9239" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248020#248020"]Arlo I think it would help a lot if you spent one month in a practice. [/quote]

Yes, although I have had the benefit of talking to hundreds of vets over many years, and it really doesn't take a huge stretch of the imagination to understand the complexities of the job and how difficult clients can be.

[quote userid="9239" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248020#248020"]I know many of our clients because I have seen them for over 10 years but I don't need to know them. My treatment suggestions will be the same for the poor and for the rich and for my friends and I will give them all the options including the compromise one or the cheapest if it's good enough. It is their responsibility to decide what they want or can afford to do. [/quote]

I always think your posts are very wise, Dinu Catilina, so I am really interested ... don't you see a risk in that 'offer all options to everyone, rich or poor' approach? Can you imagine it being a problem when all options routinely range from £100 to £25K? Do you agree or disagree that when poor (or even sometimes rich) people are offered wildly expensive options, it is damaging to trust in the profession?

RE: How far should we go in the treatment of animals?

Malcolm Ness — Mon, 17 Nov 2025 14:12:36 GMT

Similar experience/feelings to Ian P and Alistair G-E with OOH providers gilding the Lilly. One memorable case was a 2 yo Border Collie that was seen being hit by a car early one evening and then running off of three legs. Fifteen minutes later, it was caught 3 miles away, still on three legs due to. An RVN, the neighbour of the unfortunate owner assisted in the capture and felt that the lameness was due to a closed mid-shaft fracture of the Tib-fib: I saw the dog the next morning, confirmed the nurse's diagnosis and put a plate on the fracture before the dog was discharged back to the owners' care (on four legs!) later the same day. My fee was (considerably) less than the charge review at the OOH facility for services that included fluid therapy; radiography of chest (repeated 4 hours later??), abdomen and both (!) hind limbs; full blood biochem and haematology plus multiple blood-gas analyses as well as fluid therapy and 'Intensive Care Protocol'. I don't know how many dogs might be able to run 3 miles in 15 minutes on three legs, but I do know that they all have an excellent level of cardiovascular fitness and function, the understanding of which will not be materially improved with chest radiography and blood gas analysis.

RE: How far should we go in the treatment of animals?

Ian Paterson — Mon, 17 Nov 2025 09:05:17 GMT

[quote userid="6765" url="~/f/non-clinical-questions/31262/how-far-should-we-go-in-the-treatment-of-animals/248015#248015"]Over-treatment at emergency centres is rife and makes me uncomfortable[/quote]

Two experiences to illustrate Alastair’s point: first was when an OOH emergency service provider performed a caesarean on a breeder’s cat. The vet then felt unsure if she had left any kittens inside and so performed radiography…at the breeder’s expense. Procedure justifiable for an inexperienced vet lacking in confidence, but passing that charge on to the client? The second was when an emergency OOH service provider saw a sudden onset quadriplegic dog with severe neck pain which they promptly referred on to a specialist neurology practice…after having first performed bloods and the ubiquitous AFAST/TFAST scans to rule out a ‘metabolic cause’. Scans not justifiable economically for the owner IMO when much larger costs lie ahead and we’re almost certainly not going to alter the direction of travel.