Questions to Consider when Choosing a New Vet

If you want to do a thorough evaluation of a vet, there are a number of things you might want to consider before committing yourself to long-term. Obviously, you want to have confidence in the vet himself, and the other people who will be handling your cat. The best starting point, if possible, is recommendations from people that you trust. If possible, try to find a vet who has experience in long-term treatment of crf and geriatric cats. Use your instincts to judge as far as sincerity, etc. -- do they seem to be motivated by a true love for cats, or are they just running a business.

Ask what the payment policy is... practically all will say that they expect payment in full at the time of treatment, because vets have probably gotten stiffed a lot. However, it doesn't hurt to ask if payment can sometimes be deferred a little, especially in an emergency or for expensive hospitalizations. I have been told by at least two places that for major expensive treatments they would accept half now and a post-dated check for the balance. Some vets have still been known to make payment arrangements in installments. You may not be concerned now, but it's possible at some time in the future you may want to run up a bill of $1000 or more. Ask.

Make sure that they will write and refill prescriptions for supplies... quite often you can get medications like Ringer's and amphojel much cheaper from other sources. You don't want to be locked in to inflated prices.

Confirm that you will only be charged for an appointment with the vet if you actually see the vet, and find out if the charge is greater based on the length of the visit. Many charge a little more for a long consultation than a routine examination, and they have the right, but you should know. If a technician draws a sample and you don't see the vet, you should not pay for an office visit. In this case, they may or may not charge a drawing fee. One vet, in a desperate attempt to build his business back after a nasty breakup with his partner, tried charging a "dispensing fee" for putting pills in a bottle. That was the last time I darkened his doorstep except to pick up copies of Coco's records.

So much for the stuff that makes no difference if you light cigars with $100 bills even though you don't smoke.

The layout and operating policies can be very important for a comfortable visit to the vet. Don't be too shy to ask for a guided tour of the entire facility. Remember, they may have the expectation of $1000/year or more of your patronage, 10 times that of most of their patients. If it is not a hospital for cats only, do they have seperate entrances and waiting rooms for dogs and cats? Not essential, but nice... and indicates a certain sensitivity on the part of management. Are there enough examining rooms so that patients don't pile up in the waiting room, or is it always crowded? Sometimes the waiting room experience can be very stressful, you want to be able to get into a quiet room ASAP, even if you have to wait there. Are the examining rooms large enough and well furnished? Coco had a reputation for hating vets and drawing their blood even at her sickest, and part of it was due to the stress. Most examining rooms only have one or two chairs and a table. The only place for your pet is standing on stainless steel, with you trying to hold him down so he doesn't run out the door when it opens. Coco's last vet had examining rooms with couches, so Coco could sit next to us with just a light hold on her leash. There were also dutch doors, which help prevent claustrophobia because people going by could be seen, not just heard. Some of the rooms even had windows, which was a great distraction for Coco while she waited. Coco never bit anyone in that hospital, and only hissed once or twice to let us know that she knew where she was. Nobody there wore white jackets or smocks. They wanted to look like people not doctors. (And it was by design, not lack of dress code -- this hospital caters to a very expensive clientele).

Are the examining rooms well separated from any kennel area for recovering patients that may be the source of loud noises? Coco had to spend half a day once in a cage in a room full of parrots and barking dogs while recovering from a procedure requiring anaesthesia. Fortunately, she was younger and not really sick. Ideally, recovery and treatment areas should be down the hall and well seperated from the examining rooms. Some vet's offices don't have the floor space to afford that luxury, but it is important.

When checking out a vet hospital, the first and most important question that I always asked was whether I would be allowed to be in the room and assisting as much as possible whenever Coco was treated or examined. I have had several friends who had vets come back in the room and explain why their cat died in the other room, once from a flea bath! I would never let anyone lay a hand on Coco unless my hand was there too, even if it was just a finger stroking her forehead. Since I started asking this question, I was never refused... though it is also important that you have the vet write an instruction in the chart, so that you don't have any problem with a technician trying to follow policy or an alternate vet when your regular vet is not available on a Saturday. The only exception to this is in the sterile area where they do operations and x-rays. You will probably not be allowed in there because it is not covered by the hospital's liability insurance. They generally will not budge on this point, because other patients may be in there at the same time. However, they may be able to do some procedures, such as drawing blood, in the examining room.

The other question to which I attached special importance was whether they routinely take blood from the leg, or only the neck. Drawing from the leg, while not as easy to get a large sample, is much less threatening to your cat. Think how you would feel if three people held you down forcibly and tried to stick a needle in your neck. For the cat, it is a life or death struggle. To draw from the leg, the head can be covered with a towel, which has an automatic calming effect. It may not be possible to find a vet that has this skill, but it is worth trying. All the vets that I have met that graduated from UC Davis are quite good at it, and generally use it as the avenue of first choice.

Finally, and probably most importantly, find out what experience they have with the long-term treatment of CRF. Try to speak with the one of the vets if possible, at their convenience, either in person or on the phone. Don't just ask if they have had many patients with CRF -- all vets have. Most are diagnosed, the owners told their pet is terminal, and "do you want to put her to sleep now or take her home to suffer a drawn-out deterioration ending in a terrible death." Many people think they have no choice, so they go for immediate euthanasia. You don't want a vets that have "put down" a lot of CRF cats, you want to know how long most of their CRF patients have survived and what treatment and support they are prepared to give. Ask what complications might arise during long-term treatment. It doesn't matter if you understand the answer, just how long it is. If they go on and describe a lot of specific things that may happen, like heart or liver involvement, and touch on how each might be handled, they either are experienced or can at least read, and you have probably found a good candidate. If the answer is a couple of vague sentences, "like it gets worse and worse and then they die", or "...we can't really give you any statistics because most people decide to end the suffering", then you probably have not found the place for you. Let them know from the beginning that you expect to participate fully in the treatment, and that you want to be fully informed of all of your options.

Even the best may start out with the euthanasia speech, because not everyone is willing or able to make the commitment that a CRF kitty needs. Let them know that you are one of those people. Regardless of who has the diploma, YOU ARE THE PRIMARY CAREGIVER. Good vets will respect this, and treat your cat like the family member that he/she is. If they know that your finances are tight, they will help decide on which tests are actually necessary to choose a course of action, rather than go with a full panel, urinalysis, etc. every time when the blood chemistries are all that you need. They might even occasionally "take a peek" with the ultrasound without charge to see if it is necessary to do a full one on the record. They are also more likely to spend extra time and effort at closing time in the event of an in-house crisis, rather than bundling you off to some emergency hospital that doesn't know you.

It is also a good idea to discuss the vets' policy on euthanasia in advance. For some kitties with crf, after months or years of maintenance, deterioration comes to the point where this decision must be made. When this happens, there may be some urgency due to the sudden onset of suffering. It is best to know ahead of time that you will be comfortable with the vets' policy. Ask about the possibility of a house call if need be for this purpose. Make sure, at any rate, that you will be allowed to be present, to say your last goodbyes. Some vets will use a catheter for the injections, making it possible to hold and comfort your kitty during the process. It is important to know in advance that your friend of so many years will not just be taken away from you and never seen again, as has sometimes happened.

In short, talk to the vets, and make sure that they are willing to talk to you.