This is another story illustrating the advantage of seeking a second battery opinion (see earlier story). It is an important subject I feel. Perhaps we sometimes rely too heavily on our vet to get things right every time. If treatment does not go as planned and our cat does not get better we might think that the problem is that the illness is chronic and difficult to cure. This may be the case but it might not.
The failure of medical treatment could be due to a misdiagnosis. Or the diagnosis might be correct but the treatment of the correctly diagnosed health problem might be incorrect. It is complicated obviously.
Perhaps the lesson is that clients should not automatically assume that their vet has made a correct diagnosis. Enquire politely about the diagnosis and treatment if you have a hunch that something is wrong.
Vet in dominant position
There is an issue here. In the vet-to-client relationship, the vet can take a dominant position. The client can tend to accept everything that the vet says about your cat’s medical condition. It might not be wise to do this in every case as misdiagnoses are not uncommon.
Man spends thousands on cat before finally finding cure for ear issues
A charming man, Michael Ingraffia, in a very close relationship with his therapy/support cat noticed that his cat’s right ear was swollen and there was a haematoma (collection of blood under the skin). The ear was bloody. There was inflammation and clearly an infection deep inside the outer ear on the basis of what I read.
There was an estimate by the veterinarian of around $1000 to treat the ear. He paid the bill but within 24 hours the ear was not improving. The treatment, as I understand it, was to drain the ear (I guess of pus and blood). The underlying condition remained untreated.
He had to return to the veterinarian to have the ear drained again at extra cost ($300). Michael Ingraffia decided on a second opinion where there was a different diagnosis. Rather than draining the ear and simply treating the symptom, the doctor there decided to operate to remove the fibrosis. This has not been explained in the story but a bit of research indicates the following.
His cat was suffering from what is called otitis externa which, on my assessment, in this instance, resulted in a change to the normal environment of the ear canal. The outer skin (the epidermis) and the inner skin (the dermis) created excessive fibrous tissue (fibrosis) causing the canal to become narrowed and of course causing pain, itching and redness.
As I understand it, the second veterinarian operated to remove the fibrosis which removed the underlying cause of buildup of fluids requiring drainage.
The exact mechanics of what happened is unimportant. What is important is that Michael Ingraffia decided on a second opinion because he had a hunch that things weren’t going as planned. Rather than simply pressing on with further advice and treatments from the same veterinarian, it was wise in this instance seek a second opinion.
It wasn’t cheap because in all he had to pay $3,000. The first payment of around $1000 for the initial diagnosis and treatment was, on reflection, a waste of money because this was a mistreatment. You might wonder whether he could request that the veterinary clinic give his money back!
Medical negligence
You might think that in every case when a veterinarian misdiagnosis a health problem that you have the right to sue for compensation under medical negligence but you don’t. It’s a very complex area requiring professional assistance.
Perhaps the most important point to make about medical negligence – either veterinary medical negligence or by doctors treating human conditions – is that society has to expect some mistakes by veterinarians and doctors. The required standard isn’t perfection.
In short, a veterinarian or doctor can make a mistake including a misdiagnosis and still be regarded as a good and competent doctor or veterinarian. We have to accept a certain amount of error. It is only when a veterinarian goes beyond a certain limit that they can be sued for compensation. A reasonably competent veterinarian is allowed to make some mistakes.
How many mistakes do vets make?
A study published in 2019 entitled: “Medical Errors Cause Harm in Veterinary Hospitals”, Discusses incorrect treatments by veterinarians and they start off with “errors in veterinary medicine are rarely discussed, and there is little known about the nature and frequency”.
Surprised? I’m not. The study is useful nonetheless. They investigated 560 incident reports. Drug errors were the most frequently reported in the three hospitals they worked with. This was followed by failures of communication.
On my reading of the report, in 45% of the cases where errors were made there was no harm caused. However, in 15% of the cases harm was caused to the patient. In 5%, the patients were harmed severely causing “permanent morbidity or death”.
A higher proportion of bad treatments were reported in the small animal teaching hospitals. The survey concludes with the following statement:
“This study demonstrates that medical errors have a substantial impact on veterinary patients. Establishing that drug and communication errors are most frequent in a variety of hospitals is the first step toward interventions to improve patient safety and outcomes in veterinary medicine.”
In another study, the scientists compared what they found wrong with the cat or dog after the animal’s death (pathological diagnosis) compared to the animal’s clinical diagnosis by veterinarian when they were alive. And they found that there was a 65% discrepancy in all, both major and minor. The most common misdiagnosed cause of death was pneumonia. Encephalitis and myocarditis were other causes of death that were missed by the clinician.
Comment: this doesn’t paint a clear picture but it does clearly state that misdiagnoses by veterinarians are not uncommon. The study referred to has the title: “Assessment of misdiagnosis in small animal intensive care patients using the Modified Goldman criteria.”
Humans and doctors
The Web MD website tells me that on average an estimated 11% of human medical problems result in a misdiagnosis but the error rate depends on the disease. I think we can take this as a good guideline as to what happens with veterinarians. Although I would expect there to be a higher misdiagnosis rate by veterinarians than doctors. Why? Because veterinarians deal with animals and animals have less rights than humans and therefore, I would expect there to be a slightly higher carelessness rate among veterinarians compared to doctors treating humans.
