Dr. Lord is an excellent veterinarian. He's a social, outgoing person who loves his pet patients and their owners. When he
first walks into an exam room he says, "Hi, I'm Dr. Jack Lord. Please call me Jack." He then proceeds to address the client
by his or her first name to make everyone feel at ease. Dr. Lord thinks that this familiarity makes the pet owner more comfortable
and relaxed during the visit. After all, he addresses his patients by their first names.
One Friday evening Ms. Jane Fisk comes to the clinic with her dog, Sunny. Sunny has a gagging cough that has persisted for
the past three days. Jane proceedes to tell Dr. Lord that she's afraid the cough is very serious and might even be the start
of early lung cancer. She's concerned because her husband is a smoker and the dog has been exposed to the secondary smoke
from his cigars.
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Dr. Lord conducts a full examination and determines that Sunny in fact has tracheobronchitis and not lung cancer. He assures
Jane that this condition will resolve itself in the next seven to 10 days. In his traditional congenial way, he gives the
pet owner his cell phone number in case she has any concerns over the weekend. Jane says to him, "Jack, thank you very much
for saving my dog's life."
At 11:30 that evening, Dr. Lord receives a call on his cell phone from Jane. She says, "Jack, this is Jane. I think Sunny
is choking to death."
Dr. Lord assures her that this isn't the case but that this particular virus infects the trachea or windpipe and often leads
to some disturbing gagging. Jane listens but isn't convinced. She proceeds to call Dr. Lord at home on his cell phone twice
more, at 1 a.m. and 3:30 a.m., because Sunny is still choking. At this point, Dr. Lord thinks he should tell Jane that she's
overreacting and the late night calls aren't helping Sunny. He goes on to tell her that he needs some sleep and that he'll
check in with her the next day.
Suddenly client Jane reverts to Ms. Fisk. The following day she calls the clinic and talks to the hospital director about
Dr. Lord. Ms. Fisk feels that Dr. Lord encouraged her to call him on his personal cell phone should she have problems. She's
disappointed that he has suddenly become distant and "unprofessional" because she called him at home with her emergency.
The hospital director assures Ms. Fisk that her pet is very important. He adds that there's an after-hours emergency number
available to all clients at any time. But Ms. Fisk feels betrayed by Dr. Lord. She acknowledges the help the hospital director
has given her, but she never returns to the clinic for veterinary care in the future.
Dr. Lord maintains that his first-name relationship with clients and personal after-hours accessibility are practice-building
tools. He concludes that Ms. Fisk is overreacting and that her behavior is inappropriate. He thinks her decision to leave
the practice is her loss in the long run.
On the other hand, the hospital director thinks it's in the best interests of all concerned to maintain a professional demeanor
and distance between doctor and client. This helps the veterinarian speak honestly and unemotionally when addressing the medical
needs of the patient. When these boundaries are blurred, misunderstandings in stressful situations can rapidly escalate and
damage the client-doctor relationship.
Dr. Rosenberg's response
When a pet owner visits a veterinarian, the expectation should be that of a relationship between a professional service provider
and client. It's inappropriate for the clinician to assume that a client wants to be addressed by a first name in what essentially
is a business relationship. The veterinary professional should be viewed as a caring health service provider who may be friendly
but is not a friend.
These boundaries allow both the client and clinician to speak freely and objectively without the clutter of friendship. This
ultimately allows the pet to receive optimal health care. Private after-hours access and a first-name relationship are often
initially comforting to a client, but these can be intentionally or unintentionally abused, leading to a doctor-client relationship
risk that's not worth taking.
Get in touch
How would you have handled this ethical dilemma? We would like to know. E-mail us at firstname.lastname@example.org
or post your thoughts at
is director of the Voorhees Veterinary Center in Voorhees, N.J. He is a member of the New Jersey Board of Veterinary Medical