Everything Else Veterinary

Where next? Referrals and Second Opinions

I often find that the difference between a second opinion and a referral is a little grey in peoples’ minds. They are two very different concepts, but both with a similar aim – getting the best diagnosis and treatment for your horse.

 

Referrals

This is when your vet has exhausted the limits of their facilites, equipment, ability or knowledge and suggests that your horse needs to be seen by someone who has better (often more specialist) knowledge, facilities or expertise.

For example:

  • I work as an ambulatory vet which means I only visit horses at peoples’ yards. For some things, like repeated nerve blocks, it is just not practical or cost-efficient for me to sit at someone’s yard all day trying different blocks and hanging around to wait for them to work. Instead I would refer you a clinic where you could take your horse and the vet could be working with several horses at once, increasing the practicality and removing the waiting around.
  • I may see a horse with colic which I think will need surgery, or at least require close monitoring and nursing. In this case I would refer the horse to a hospital where they have surgical and 24hr nursing facilities.
  • I may discover during a routine visit that a horse has a heart murmur. I would then refer the horse to a cardiologist to have an echocardiogram and ECG.

I will make the initial contact with the referral vet and send them a letter (email usually) detailing the horse’s clinical history in general and specific to the current condition. Usually the client then makes an appointment for a convenient time. In case of an emergency referral (for example the colic above) we dispense with the written history and discuss the case details on the phone directly with the referral vet. They then know whether to have an anaesthetist etc. ready for when you arrive at their clinic with your horse. It also means that they know important information such as the drugs the horse has had and the gut sounds and heart-rate before travelling so that they can assess the degree of deterioration (or improvement!) on arrival.

Second Opinion

This can be initiated by the vet, but is more often sought by the client, usually where there is a degree of frustration or dissatisfaction with the current treatment. Usually the client will approach another practice and ask for them to give a second opinion on a case. They are more often sought from vets at a similar sort of level to the original vet, rather than going to a specialist.

There are no restrictions on seeking a second opinion without the consent of your vet, but the second vet will need to contact your normal vet to obtain treatment information. This is so that conflicting treatments are avoided, and is in the interest of your horse. It is also a professional obligation for veterinary surgeons.

After the second opinion, you may return to your original vet or you may choose to continue treatment with another vet.

 

I hope this goes a little way to explaining the confusion between the two. I find it incredibly frustrating to read horse forums where the standard piece of advice when any diagnostic or treatment plan is not progressing as expected is ‘get a second opinion’.  You will often get further and faster by speaking first of all to your original vet and discussing your concerns. There is nothing wrong with saying ‘I’m not happy with this plan’ or ‘I don’t think this line of treatment is best for my horse’. Working with your vet and then referring to a relevant specialist if necessary can be far more fruitful and successful in the long term than turning your back on them and trekking off elsewhere. Even if you do want a second opinion (and they certainly have their place) it is a good idea to get in contact with your original vet and discuss why and what you’re unsatisfied with – feedback, either negative or positive, is vital to ongoing professional and business development. If you don’t feel able to do this face to face or on the phone a letter or email will work just as well.

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The Eventing Vet

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