Veterinary oncologists are often faced with making important diagnostic and treatment decisions based upon reports of tumor biopsies. Unfortunately, veterinary medicine lacks standardization of guidelines for tumor biopsy submission, trimming, margin evaluation and reporting. Earlier this year a consensus article on this topic was published in the Journal of Veterinary Pathology by a committee of veterinary pathologists and oncologists under the auspices of the American College of Veterinary Pathologists Oncology Committee. This is a significant step in standardization of guidelines but unfortunately is unlikely to be read by most veterinary practitioners. Many of the patients that are referred to oncologists have had a biopsy or surgical tumor excision by the referring practitioner and therefore this information is just as critical to general practice veterinarians as it is to specialists.
The following quote from the paper conclusion summarizes the advantage of having a standard approach to tumor pathologic evaluation:
“Optional management of the veterinary cancer patient requires a unified, interdisciplinary and highly communicative approach between clinicians, oncologists, and pathologists. Patient care is directed by the diagnosis and information provided in the pathology report. Accurate, thorough, and reliable pathology reports depend on reception of excellent specimens, complete information and appropriate trimming.”
An accurate pathology report is one of the most important pieces of information to the veterinary oncologist and obtaining this information begins at the time of initial evaluation of a tumor patient by the general practitioner. I encourage veterinarians to read this article in its entirety. Veterinary Pathology 48(10) 19-31, 2011. Please contact me if you would like a copy, Jerryw@vshcarolinas.com.

I recently returned from the Veterinary Cancer Society yearly meeting that was held this year in Albuquerque, New Mexico.  One initiative of the Veterinary Cooperative Oncology group is to develop consensus guidelines in veterinary oncology.  A current initiative is focused on chemotherapy safety.   This is becoming an area of increasing concern across the country.  Federal guidelines of chemotherapy fall under the guidelines of hazardous drugs but states are starting to look at specific chemotherapy guidelines with the aim to better protect healthcare workers.  The following link describes the situation in Washington State- http://invw.org/content/investigatewests-reporting-brings-health-care-worker-safety-focus-in-legislature.  I feel voluntary adherence to chemotherapy safety guidelines is lax in veterinary medicine.  The safety of our employees should be of paramount importance and if voluntary controls are not sufficient, then legislation action by states such as in Washington State may be needed.

Jerry R. Waddle, DVM, DACVIM

I wish I had known you were here earlier-

We hear this on a regular basis from owners of patients that we treat.  Since we operate our specialty services on a referral only basis, we often wonder what triggers our referring veterinarians to bring up referral in their conversations with owners.  As specialists the distinctions are easier for us.  It has cancer, it goes to oncology.  Fracture repair, it goes to surgery.  Liver disease, see the internist.  As a general practitioner, when does one refer to a specialist?  An easy answer is if the owner had a choice of a specialist or continued care at the family veterinarian, which would they choose.  If the choice is presented, and an informed decision made then one less regret for the owner and a greater likelihood a specialist can intervene at a time that will make a difference.

Jerry R. Waddle, DVM, DACVIM

As a referral hospital we have the opportunity to receive medical record information from many different veterinarians.   This information is critical to providing the best medical care for the patient as further decisions are made regarding diagnostics and treatment.  The client expects this communication from referring veterinarian to specialist has occurred and that the specialist is familiar with the patient’s history at the time of initial consultation.  Our goal as a referral hospital is to make this transition from the family veterinarian to the specialist as seamless as possible.  When this transition of information goes poorly the client can lose trust in both the referring veterinarian and the specialist.  Conversely, when it goes well, it reflects well on both sides of the referral and more importantly ensures that patient care and testing is optimized.

We offer a number of methods of making referral contact- fax, phone, and online via our website.  Once this referral is made, our front office staff will make sure that we receive records from the referring veterinarian prior to the referral.  This is sometimes difficult as we try to see patients as timely as possible and often this can mean the same day or next day.  We appreciate our referring veterinarians’ efforts in getting this pertinent information to us and apologize if we sometimes call repeatedly to get information.  Occasionally a critical piece of information is lacking (blood test or biopsy result) that we need to provide the best advice to the owner.  Information that is faxed to us is converted to an electronic format and emailed to the receiving doctor and saved to folder for the front office staff.  We would like to make this process as easy as possible for our referring veterinarians.  For those that have converted to paperless medical records, we would like to explore the best ways to send this information without the need for paper.  We look forward to the day of retiring our fax machines.  Your comments and suggestions are welcome.

Jerry R. Waddle, DVM, DACVIM

As small animal veterinarians we all strive to provide the best in patient care for our patients and their owners.  A review of veterinary hospital websites shows how important we feel state of the art compassionate care is as a core value of our practices.  Likewise many of our pet owners are seeking the best possible care and relying on us as trusted advisors to provide recommendations. Veterinary medicine has advanced to a point where it is not possible to deliver this care in one hospital.  Expertise in well patient care, preventive medicine, emergency care and various veterinary specialties are important components of total patient care.  As specialists we need to rely on our general practitioner colleagues to provide the whole patient perspective, maintain optimal preventive care and communicate effectively with clients and specialists when more specialized expertise is needed.  As general practitioners, specialists and emergency clinicians are needed to provide important components of care that are not completely possible in a general practice.     The relationships between these various components of care make all the difference in the level of compassionate care that is provided.  An understanding of the needs of the emergency doctor, the general practitioner and specialists by each other and effective timely communication can increase the odds of a successful outcome and a grateful client.  The advent of newer technologies and ease of communications makes building these effective relationships possible even when practices are separated by some distance.  We, at the Veterinary Specialty Hospital, have made a renewed commitment to forming these effective relationships and understanding the individual needs of our colleagues.  In addition to making frequent visits to our practice partners, we have established a monthly newsletter and now have added a blog site for two way communication.  We hope you will take full advantage of this forum to help guide us and help us shape the way veterinary medicine is practiced in the future.

Jerry R. Waddle, DVM, DACVIM

Communication between referring veterinarians and specialists is key to providing optimal veterinary care. We have started this blog to increase communications between ourselves and our referring veterinary community.