Practice in the Real World - The bouncing client

Defending a tenuous position can leave a DVM with a short-term victory
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Jul 01, 2005

Sue Swift waited with Charlie. Charlie has been seen at Academy Vet Clinic numerous times, and Sue has had a good relationship with Dr. Swanson in the past.

This time might be different, and Sue was a little apprehensive.

In the other exam room, Dr. Swanson was removing the sutures on another cat. Sue could hear the cat "hiss" through the thin walls.

As Dr. Swanson exited the room, Janet Williams pulled Dr. Swanson aside to inform him that Sue Swift is in the next room and she has various issues to address about Charlie.

Dr. Swanson knew Charlie well and was anxious to see how he was doing. As he inspected the chart, he instinctively knew something was wrong.

"That is what I want to tell you," Janet said in a hushed voice. "Sue is a little upset, and she has always been very nice."

Dr. Ben Swanson carefully looked at the history. He and his associate had been seeing Charlie for the past six to seven weeks for an undermined vomiting and diarrhea problem. They had run blood tests, multiple X-rays and had even done a barium series. They had tried various medications with limited success.

Dr. Swanson suddenly realized that the associate had seen Charlie on the past few occasions, and he had been "out of the loop" regarding Charlie for about three weeks. The associate had even called the university for some help. They had suggested several more tests. The medical record showed three pages of notes about his recent problem.

At the end of all those notes it was written that Charlie had recently been to "Elsewhere Animal Hospital" and had seen Dr. Fred Smothers, one of the "older" doctors on staff there. Today it appeared from the notes that Charlie is now cured. Sue wants some of her money back.

Dr. Swanson begins to sweat. His auto-nomic nervous system is on high alert, and he wondered if the sulfasalazine his own doctor told him to use two years ago will be effective today. Dr. Swanson's cramping and diarrhea return from time to time, especially during stressful episodes with staff or clients. Naturally, he has been using his own medication from the shelf of Academy Animal Clinic pharmacy.

"Hello, Mrs. Swift. It is good to see you and Charlie," he chimed with a sudden dryness in his voice. He nervously moved to pet the animal. Charlie seemed very happy to see the doctor.

"Dr. Swanson, (a moment of hesitation) ... I am very unhappy with your clinic. I have always thought that your facility here was a great place to bring Charlie but Dr. Smothers at the other hospital cured Charlie in no time. I took him there for a second opinion and seemed to know what his problem was right away."

"What did he find out?"

"Oh, he didn't have to take any tests or anything. He just seemed to know after we had talked a while. He said, "Charlie was just under a lot of stress."

Dr. Swanson knew what she was talking about — at least about the stress issue.

"How did he treat the problem?"

Dr. Swanson knew that answer to the question because Fred was known among his colleagues as "Fred Pred" because he liked to use any drug that ended in "sone" as his initial approach to a problem. Dr. Swanson had asked the question anyway.

"He gave some sort of cortisone shot and within 24 hours he was just 'good ole' Charlie again."

At this point, Dr. Swanson knew what was coming next but had always been emotionally unprepared for an answer.

"Dr. Swanson, I really want to continue coming to your office, but I would like to have a refund for the money I have spent on Charlie's problem over the past few months.

Janet had already detailed the money side of the issue, and Dr. Swanson knew that she had spent about $600 or so over the past several weeks.