Case study: Client communication & informed consent

8 May 2024

A German Shepherd dog was taken to a veterinary clinic after its owner found it vomiting white foam and salivating excessively.

The veterinarian who examined the dog gave it Metoclopramide and Zantac injections. They made a presumptive diagnosis of acute gastritis, as the week before this visit, the dog had been prescribed Carprieve for arthritis, which can cause stomach irritation. The veterinarian advised the owner that if the dog’s condition worsened, the owner should come back to the clinic immediately.

Just a few hours later, they returned as the dog’s health had rapidly deteriorated. The veterinarian said the dog appeared to have a twisted stomach and organised an operation immediately. Upon examination, the dog was placed on shock rate fluids and an abdominal radiograph was taken. Due to the urgency of the situation, the vet said that they did not have time to thoroughly explain the condition and the need for operating to the owner, but obtained verbal consent to proceed.

While performing a laparotomy, the veterinarian discovered that the dog’s gastrointestinal tract was dilated and black in colour, and diagnosed it with Mesenteric Torsion. The veterinarian tried to contact the owner but was unable to reach them. They determined that, on animal welfare grounds, the dog should be euthanised.

The dog’s owner made a complaint to the Vet Council, which was then sent to the Council’s Notification Review Group (NRG). This group screens notifications to identify areas of concern and see if further action is required. The process is less formal than the Complaints Assessment Committee (CAC) and has a focus on education and guidance to improve future practice.

The dog’s owner was worried that the veterinarian made an incorrect diagnosis during their initial consultation, and questioned why they did not do any further treatment (including radiographs) when the dog was vomiting and salivating. The owner complained that the veterinarian did not communicate effectively with them.

The Code of Professional Conduct requires veterinarians to practice in a way that promotes effective communication and trust; meets confidentiality and consent requirements; and recognises a client’s right to choose. Veterinarians must act in a manner that promotes public trust and confidence in the profession, and must strive to provide a high standard of veterinary practice.

The NRG felt the veterinarian followed suitable steps during the initial consultation. A clinical feature of Mesenteric Torsion is that the patient will not likely be vomiting. There was nothing to indicate that x-rays were needed, and the injection use was appropriate in the circumstances. Overall, there were no clinical cues to suggest that a diagnosis of Mesenteric Torsion was identifiable during this consultation.

However, the NRG mentioned that the veterinarian’s clinical notes did not indicate if a thorough examination was done to determine if the dog was actually vomiting, e.g. showing signs of abdominal effort and not just regurgitating.

Regarding the second consultation, the NRG noted that the dog had suffered a rapid deterioration in condition. Overall, the NRG found that the surgical approach was appropriate in the circumstances, and verbal consent was obtained. It also felt that because of the very high mortality rate associated with Mesenteric Torsion, an earlier diagnosis would have been unlikely to change the outcome.

The NRG found that veterinarian’s communication met the standard expected of the profession, with the vet going above and beyond to support the dog’s owner, who had a long history with the practice.

The NRG decided that no further action was required, however there could be learnings taken from this case. The NRG suggested that the clinic involved could use an emergency consent form to document the consent process used for urgent cases. This form, once signed by the client, could create an agreement to cover the initial stabilisation of an animal in an emergency and include consent to undertake work up to an agreed value, such as blood work and x-rays.

The NRG also suggested that some education about ensuring clients are offered all treatment options, regardless of their financial situation, could be beneficial. The NRG noted that veterinarians need to ensure that background knowledge, especially regarding a client’s finances, does not influence the treatment options they present. The NRG said that veterinarians must avoid prejudging a situation and make sure that even if an expensive treatment option, such as a referral to a specialist, is likely to be declined, it is still offered and discussed when appropriate.