General practice veterinarians see a huge case variety each day, from puppies and kittens, to sick pets, to surgeries, to preventive care, and everything in between. You were trained to handle everything that walks through your practice door, but sometimes you need a little extra help. Determining some cases that need referral, such as specialized surgery, diagnostics, or complex procedures, is a no-brainer, but what about the more common “everyday” cases? If your itchy dogs or vomiting cats aren’t responding to first-line treatment, consider recommending referral earlier in the process to prevent client frustration and achieve better case outcomes. At VESPECON, we offer services to improve specialty care access for general practitioners, so you can refer more patients for better outcomes. Here are five cases that general practitioners commonly encounter that can benefit from earlier referral.
#1: Complicated corneal ulcers
Most pets’ superficial corneal ulcers heal in a few days. If your patient returns for their recheck exam and is still fluorescein positive, their ulcer qualifies as complicated, and is unlikely to heal properly without an ophthalmology referral. Indolent (i.e., age-related) ulcers can persist or recur for months and often respond poorly to superficial debridements in the primary care setting, but an ophthalmologist can usually resolve the issue in a single visit. Ulcers in brachycephalic breeds can quickly—sometimes overnight—progress to deeper, infected lesions, or threaten vision, and the sooner the referral, the more likely an ophthalmologist can save the eye.
#2: New heart murmurs
You probably see patients with heart murmurs on a daily basis, but how many do you refer for a cardiology consultation? Most murmurs in older pets represent relatively benign valve changes, but murmur intensity does not always indicate disease severity, and disease in some pets can quickly become serious or progressive. By recommending referral for all patients with a new murmur, you can help detect heart disease or heart failure sooner, and increase survival times. A cardiologist can also determine whether the murmur increases anesthetic risk, and how protocols should be modified if your patient requires dental work or emergency surgery.
#3: Chronic skin and ear disease
Itchy dogs and smelly ears are the bread and butter of any primary care practice, and most general practitioners have the tools and knowledge to effectively manage these cases. However, treatment options for skin and ear disease have dramatically increased in recent years, and finding the right combination of medications, supplements, topicals, and diet for some patients can be challenging. If you are not making progress, consider a dermatology referral rather than trial-and-error treatment. Clients start to become frustrated after three unproductive visits, or spending around $900, and at that point are less likely to return to your practice. Referring sooner gives you better control of the pet’s condition, and builds a stronger, more trusting relationship with your clients.
#4: Difficult-to-control diabetes
Let’s face it—diabetes is rarely easy to control. What works for one pet won’t work for another, and navigating the huge array of insulin types and diets can be difficult. Many diabetics also suffer from complicating conditions, including DKA, Cushing’s disease, pancreatitis, urinary tract infections, cataracts, dry eye, hyperlipidemia, hypertension, and elevated liver enzymes. Internal medicine specialists can better manage patients with multiple conditions, control blood sugars faster, and help avoid some of the long-term consequences of uncontrolled disease.
#5: Vomiting and diarrhea
Many clients don’t understand that a “sensitive stomach”—chronic or recurrent vomiting and/or diarrhea—can indicate much more serious disease, and they probably have already tried a number of different foods and home remedies before they visit you. Repeated antibiotic courses or prescription diets might help in the short-term, but patients who keep coming back with the same GI problems every few weeks or months, and whose blood work is normal, will likely benefit from internal medicine referral. Internists have a lot of tricks up their sleeves to diagnose and treat GI disease, and know how to identify which cases will respond best to which treatments. Receiving an actual diagnosis, rather than a presumed one, can help the client recognize that their pet’s issues aren’t normal, and may improve compliance with long-term management.
Regardless of the cases you encounter each day, VESPECON can provide you with the services you need to connect with specialists and provide your patients the best possible care. Our team of consulting specialists can co-manage your complex cases in house, connect you with local in-person specialists for referral, and help simplify the referral process for your clients. Contact us to learn more about our services or to connect with our consultants to get started right away.