Dear Kat:
 
>anyway...we finally had to give up and help him to the bridge...and we
>asked for a necropsy...the one that would have included the brain and all
>would have been $200.00 or more...and after all the $$ spent trying to
>SAVE him...we could not afford that...[as it would be for most people...]
>so should this be the vet's responsibility?  ...don't get me wrong..i love
>my vet...but we still don't know why Char died...[i know..WE had him put
>to sleep...but i mean, well..you know what i mean!]..she he have just done
>it for the knowledge of what caused this in charlie???...
 
Probably I'm not the best person to ask about setting prices - probably the
main reason I left active daily practice and became a pathologist was the
pricing issues.  I wanted to do everything for free, and I kept losing
money.  I had a real problem charging clients.  I did better when I went in
the Army as a vet - all I had to do was break even - so I made money on the
shots, fleas and heartworms, and gave it all away on the low cost spays,
the adoptions, and the surgeries (oh, those $10 orthopedic surgeries!)
 
Yes, I have to agree with you that she should have wanted to do it for the
knowledge.  Whenever I lose a patient, I want to know why - but not every
vet is like that.  To look at the veterinary literature today, it would
seem that practice management has become more important than the practice
of medicine.  Most vets price out procedures by how long it would take
them to do it - they figure up their time, factor in a little bit for their
"expert knowledge", and voila! a $150 spay or in this case a $200 autopsy.
 
Autopsies are not difficult, they don't take specialized equipment, and the
materials are cheap (a scalpel blade, and a small jar with formalin in it.)
However, they do take about an hour to do if done right (removing the brain
and eyes), and documenting the findings etc.  30 minutes to do a simple
one, and 10 minutes just to take tissues and not trying to figure out what
was going on (just letting the pathologist tell you what he/she saw on the
slides.)
 
Autopsies aren't money makers for practices, but they are important, from
the aspect of improving one's ability to practice medicine, being able to
learn from mistakes, and I think most importantly, providing answers for
an owner in a time of great distress.  Owners don't get their pets back,
but they don't have to struggle with questions for years afterward.
 
What should you do?  Be honest with your vet.  Ask her why she didn't want
to get an autopsy on a case in which she couldn't diagnose or treat.  It's
one thing not to get an autopsy on an insulinoma where you know what to
expect, but totally different in this case - it at least gives the
appearance of indifference or greed, or both.  I know that you don't want
to spoil a relationship with your vet, but relationships go two ways.....
 
With kindest regards,
 
Bruce Williams, DVM
[Posted in FML issue 3199]