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On February 25, 2008, a Los Angeles NBC affiliate aired an "investigation" of local veterinarians by undercover reporter Ana Garcia. The investigation began when a veterinary hospital manager, who was interviewed with his identity hidden, claimed that the hospital he managed used scare tactics to get pet owners to spend money unnecessarily.
Anchor Ana Garcia and Producer Fred Mamoun responded to the complaints they received about the story here.NBC used three dogs with "common ailments" that "usually have simple and inexpensive solutions," according to Dr Jeff Werber of Century Veterinary Group, a private practice veterinarian who's claim to expertise is that he is the official veterinarian of the "legendary Lassie franchise." (With his own TV show) .
Michi, a 3 year old Shih Tzu and Rock, a one year old yellow lab both have waxy ears. According to Dr Werber, black waxy debris is usually caused by yeast. He would perform an ear cytology and clean the ears. He describes yeast in the ears as a "minor condition, which if untreated could lead to an ear infection." The video doesn't report whether Dr Werber actually performed any diagnostic tests on any of the 3 patients, as he advised the other veterinarians "should have done."
Yeast only grow (and cause infection) when the conditions allow them to do so. This condition usually has an underlying inflammatory cause, such as allergies of some type. Yeast can also be a secondary invader with other more severe bacterial ear infections.
Malassezia Otitis Externa
Conducting an ear cytology is the Standard
Diagnostics for Malassezia
Guapo is a one year old French Bulldog who is healthy, except he vomits "every once in a while." Dr Werber suggests this could be caused by eating grass or heartburn and recommends over-the-counter antacids. Dr Werber says x-rays or blood work are "overkill." He advises the doctor should not perform any diagnostics to evaluate Guapo.
Guapo visited 11 clinics in Southern California, in Los Angeles and Orange County. Four of the 11 clinics recommended screening blood work for Guapo. What we don't know from the story is how often "occasional" means. Does Guapo vomit once a week? Once every 3 months? Once a day? Vomiting is not normal!! A thorough history might help determine whether this patient's vomiting is truly incidental from dietary indiscretion or warrants further specific investigation such as food allergies, gastritis, esophagitis, inflammatory bowel disease, liver disease, kidney disease, etc.
See "What makes a good Vet?"
"Call if it continues" isn't an action plan, it's an inaction plan. Presumably Guapo has continued to vomit, or the client wouldn't mention it!
One doctor diagnosed Guapo with a severe ear infection. The investigative reporter took Guapo to another of the clinics and consented to having the ears cleaned manually there. They then returned to the first doctor, who (probably without re-examining the ears) recommended anesthesia to manually flush the ears out. They have him on hidden camera saying how he has to anesthetize the Guapo to use his power flushers so any movement would perforate the ear drum. The reporter declined his recommendations and he refused to speak on camera after they disclosed their identifiy.
One doctor recommended an "eyelid scraping." A procedure she later acknowledged off-camera isn't done in the United States. She claims she has performed the procedure in Austria. The condition she's supposedly treating isn't mentioned.
So out of fifteen doctors, one doctor exaggerated a condition to justify further treatment (or failed to thoroughly re-examine the patient) and one fabricated a condition to justify procedures that appear blatantly unnecessary. Thirteen percent is certainly too high a number for our profession to accept of "bad apples." The report however, almost made it sound like all the doctors were recommending questionable procedures. Indeed, Dr Werber suggested that nothing should be done for Guapo. Best practices, however would dictate at least a baseline blood profile, if the history failed to provide a specific cause of the vomiting. Shame on Dr Werber and NBC for trying to make "guessing" or doing nothing the Standard of Practice.
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