From time to time, I go out on a limb and risk upsetting colleagues and/or clients . This is one of those times. Please read all the way thought before sending me nasty emails. Should you decide to send me a nasty email, I have included a special email address at the end.
In our practices (online and traditional) we are seeing a concerning rise in veterinarians who are “holding on” to cases for a little longer than they should and/or performing imaging studies that they are not fully trained to do. Concurrently, we are seeing a growing number of disaster cases. I suspect that the economic downturn has something to do with this trend.
Perhaps veterinarians have been advised by well meaning consultants to “keep things in house” to raise the average client transaction (ACT) or by well meaning sales people who urge them to buy imaging equipment in order to “keep the imaging dollars in house” or because clients are not willing to pay for referrals. For the purposes of this article lets assume the latter is not an issue.
There are certainly ways to “keep cases in house” without compromising patient care. Case selection is essential and your radiologist is a great resource. radiologists do not have a vested interest in case referral and therefore offer an unbiased perspective.
Your radiologist will never tell you to refer a case (unless you ask).
“Keeping cases in house” and managing them without referral is an effective way to raise the ACT. In other situations, cases should be referred to a tertiary care facility. The trick is to know which ones will have a bad outcome if you keep them in house.
One of the primary functions of a radiologist is to help veterinarians manage cases that are kept in house. By sending films for review, radiologists are able to help veterinarians assess the case and determine the best course of action. The one sentence you will, however, never see on the bottom of a radiology report is “this case should be referred.”
Placing that sentence on the report is professional and legal suicide. Think about it. If anything goes wrong with the case and the radiologist recommends referral but the case does not get referred we have effectively sealed the fate of the referring veterinarian at a board hearing. Radiology reports are carefully worded. Therefore, you will never hear mention of referral on a report without directly asking for that bit of information.
Remember, radiologists see hundreds of cases from all around the country. We see the follow up imaging studies when things are tanking; and get the frantic STAT calls from veterinarians asking what to do when a patient is crashing. Many times, we know which cases are likely to go South on you. You just need to ask.
The bottom line: the economic environment is tough right now but you should think about the long term prospects of your practice and the pet and pet owner before you hold on to a case. If you decide to keep a complicated case, sending the radiographs for referral and asking your radiologist point blank “should I refer this case” may be a prudent first step.
All joking aside, this was a very difficult article for me to write. I sincerely understand the situation at many practices these days but we need to do the best we canas a profession and always remember to put patient care before financial incentives that may encourage us to do otherwise.
