Dr Liesel van der Merwe is a small animal medicine specialist. Send her your questions: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Dr Liesel van der Merwe

I was browsing social media the other day and came across a post on a practice website, complaining bitterly about how the client was treated by the veterinarian. I read the whole story, as I knew the vet as well as the patient.

The recent Carte Blanche episode on vets’ fees ruffled feathers, so I will touch on both as I believe they boil down to how the public perceives veterinarians. 

The upshot of the complaint was that a vet had refused to provide the specific treatment a client wanted for a dog and recommended returning the next day when the client’s usual vet was on duty. The little dog had severe right heart failure and suffered from fluid build-up in the abdomen, which needed to be drained regularly.

The heart is divided into two parts: the right heart receives blood from the body to pump to the lungs; the left heart receives blood from the lungs prior to pumping out to the body again.

Left heart failure is more life threatening, as fluid builds up in the lungs, affecting breathing. Right heart failure causes fluid build-up in the abdomen and intermittent drainage is a recognised treatment.
The dog was a typical old, small dog and not in any undue discomfort. I would not have had a problem performing the procedure, as it is not painful and improves quality of life.

Why did the vet refuse to treat the patient? She felt that the patient was suffering and already should have been euthanized. Clearly the other vet and the owner did not feel the same way. 

Can a vet refuse to treat a patient? The short answer is yes. As vets we are obliged to offer medical advice and treatment to any animal in an emergency situation, even if the owner is not immediately available or owes us money, or might be unable to pay, as often happens when a dog is hit by a car.
It is unethical for us not to apply minimal pain control, treat shock and stabilise the patient until the owners can be found or can make a decision about treatment, referral to the SPCA or a low-cost practice, or to a specialist facility for surgery or euthanasia if the injuries are severe.

We are allowed to refuse to do certain procedures of a non-emergency nature based on what we feel is ethical. We are not “coin-operated, press-the-button-and-get-the-task” machines.

We are trained as medical experts and we have to take the welfare of the patient into account as much as the wishes of the owners. In many situations the two are not compatible. Sometimes we can live with this and other times it is hard seeing our advice being ignored either due to ignorance, emotions, arrogance or financial reasons.

We often try “next best diagnostics and treatments” and sometimes in the process risk compromising our professional integrity in our efforts to help the patient or the owner. The line becomes very blurred.
I have had situations when clients will not visit the patient, because it distresses them too much, but will also not make the decision to euthanize. If we can get them in long enough to see how the pet is suffering, then they will normally decide on euthanasia.

Other times it is the other way around: a client will not treat a pet which we think has an excellent chance of recovery. This may be due to cost constraints or sometimes even aesthetic considerations about how the dog or cat will look after an amputation or removal of an eye.

Clients sometimes think we are there to do what they want us to do. Obviously that is an important part of our job, but we are there for the patient’s welfare.

Individuals might differ on when a patient is suffering too much, when the chance of recovery is too poor, or at what stage we feel a procedure is unnecessary or too risky. We are entitled to this opinion, as long as we are polite to the client, explain our reasons, give the client an alternative solution and treat animals in an emergency situation.

If you don’t fundamentally trust your vet then you need to go to someone else.

Regarding Carte Blanch’s representation of the veterinary profession on 3 August: Unfortunately it seems as if the experience of a single high-profile client was sensationalised.

I think the average veterinary fees are fair. The expenses of running a hospital with knowledgeable staff and expensive equipment are very high. Veterinary care is unaffordable to many people with lower incomes, just as private health care is.

There are no government-funded animal hospitals. Even the SPCA is struggling with funding. Medical aid is available for pets and is quite cost effective.

Owning a pet is a responsibility that requires some financial input. Vets often help with reduced rates, but we cannot pay our bills with this and so set a limit. Many vets help out at the South African Vet Associations (SAVA) community veterinary clinics (CVC) where veterinary care is brought to disadvantaged areas.

The majority of vets I know try very hard to do what is right for their patients and clients. If you truly have a problem with how your veterinarian has handled a case you can lodge a complaint at the South African Veterinary Council (SAVC) at savc.org.za.

Try to talk to your veterinarian first, after tempers or emotions have settled. Most cases reported are due to poor communication about costs. Even I hate talking about costs, but it needs to be done, preferably up front. As we progress, the diagnosis, prognosis and costs may change. Remember that the costs don’t evaporate just because we are unable to save your pet.