"Very smelly flow of blood and pus from the below for over 2 weeks," the man in his late 30s told me. "I sent it to my vet (Vet 1) I trust, but he did not want to operate. He referred me to XXX (a brand-name vet surgery) but the vet fees would cost me more --- two thousand dollars. So, I checked out the internet and came to you."
The 9-year-old dog was no longer able to stand as there was at least 2 weeks of delay and the dog was not eating. Blood tests showed kidney disorder as well as high white cell count.
"How much is your operation fee?" the father asked me as I reviewed the dog's case with him and his son.
"$500," I do give discount to pet owners who are in need of lower vet fees for a pyometra surgery. Usually it would be nearer to $800 for the anaesthesia and surgery, excluding IV drips, medication and hospitalisation. There is no means testing in Singapore but this case appears to have been delayed considerably due to financial reasons.
"Can you reduce it?" the father asked me.
"It is as low as I can give to you," I replied. "This is not the normal cost. It would be around $800 - $1,000."
"However, you must know that the dog has around 40% chances of survival since she is very ill due to delays in seeking veterinary surgery." I had to be frank with the owners.
As I am responsible for the reputation Toa Payoh Vets, it is my duty to make sure that my associate vet handling this case do provide this risk assessment to the owner and not just to operate. If the dog dies, the owner will still be angry as he has to pay the bills when the outcome is not good. So I told my associate vet that I had given the 40% chances of survival to the owner and that the owner must be informed accordingly.
Any other options? I did not suggest euthanasia. The father said: "Since it is not 50:50, I will want the dog to be put to sleep."
If the dog had been operated 2 weeks ago by Vet 1, the chances of survival are very good. Unfortunately, the family vet did not want to operate on big dogs. I know Vet 1 always refers difficult cases to a brand-name veterinary surgery as a routine over the past century, without considering that his clients may not be able to afford the "Mount Elizabeth Hospital" type of fees. So some of his clients seek other practices.
Vets must understand their clients' financial situation and do what is good for them and their pets. A dog's life that could be saved was lost due to Vet 1's one-track mind to refer all cases to this brand-name veterinary surgery, on the erroneous assumption that he or she would not lose their clients as this brand-name surgery would not poach his clients.
In my opinion, once you refer to other vets, it is likely that you lose your client. Maybe, the client can't afford the brand-name veterinary surgery the second time and so you presume the client will return to you.
Why not find out what is the financial situation of your client, network with some vets who can perform the surgery competently but at "affordable" cost, get the quotations for your client. In this way, your service will be considered excellent. You will gain the gratitude and retain the loyalty of the client who has had used your services for many years? It is most likely your client will come back to you as he has had been doing for years.