Dog - Second Opinions and Referrals

Second opinions and referrals often cause great anxiety to owners, irrespective of whether suggested by the veterinary surgeon or considered as a possibility by the pet owner. Sometimes, despite every effort, things do not go as planned and the veterinary surgeon treating the pet suggests it might be worthwhile considering a referral for a second opinion. On the other hand having spoken with friends or neighbours sometimes the owner feels a second opinion would be worthwhile but is often too embarrassed to discuss this with the vet.

What is the difference between a second opinion and a referral?

Not long ago the terms were synonymous. The expression 'referred for a second opinion' was commonplace. The veterinary surgeon who undertook this was often a general practitioner sometimes in the same practice or one not too far away who happened to have a special interest in, or experience with, a particular condition or sometimes the type of pet, e.g. long haired cats, giant breeds of dogs, orthopaedics, intestinal conditions etc.

With the growth of post graduate specialisation and the acquisition of a Royal College of Veterinary Surgeons (RCVS) certificate or diploma in specialities ranging from dermatology to ophthalmology, small animal orthopaedics to diagnostic imaging, 'specialists' similar to consultants in human medicine have emerged and are recognised by the Royal College of Veterinary Surgeons.

There are currently less than 300 recognised RCVS specialists, although there are many more veterinary surgeons with certificates and diplomas, indicating their specialised knowledge and interest in their chosen subjects. (That is, holding a certificate or diploma is not the same as being a specialist, but it does indicate having undertaken further study and exams in a chosen topic)

Today a second opinion is still basically what it says. It can be suggested in the first instance by the veterinary surgeon who feels that two heads are better than one, and indicates that he would welcome another opinion on the case. These are sometimes carried out by another veterinary surgeon in the same practice.

Today 'referral' often means a second opinion from a veterinary surgeon who is a recognised RCVS specialist or a certificate/diploma holder in that particular field. It is often suggested initially by the first opinion veterinary surgeon, i.e. the practice treating the animal. Today as owners become aware of the availability of specialist veterinary services, many owners are requesting referral to a specialist. However, it is important to remember that this should be discussed with the veterinary surgeon treating the pet in the first instance and also to realise that a certificate or diploma holder may not necessarily be an RCVS recognised specalist.

What are the reasons for referral?

Pets can be referred to a specialist opinion for a variety of reasons. They fall into two main groups:

1. Sometimes this is very simply because specialised diagnostic or therapeutic equipment is required for diagnosis or treatment.
2. To seek more expert knowledge either in respect of the particular species, e.g. dog, cat, rabbit, etc. or because more specialised knowledge is required regarding the disease or condition, e.g. orthopaedic specialist, soft tissue specialist, etc.

Sometimes a referral will be made in order that specialised diagnostic techniques can be carried out, e.g. to a diagnostic imaging specialist for MRI.

What do I do to arrange a referral or second opinion?

We, your veterinary practice and you, the owner, have one thing in common, the welfare of your pet under our care. If you feel you would like a second opinion or a referral please feel free to discuss it with us and then together we can decide the best action for your animal. It is important at the outset that the specialist or second opinion vet has all the facts so that once you have discussed this with us, we will endeavour to make the appointment for you and ensure the full case history including any laboratory or diagnostic records are forwarded in time for your appointment.

Just like the medical profession, most recognised specialists prefer to make appointments through the first opinion practice. In this way they can discuss the problems with the referring veterinary surgeon as necessary.

What about cost?

Referral to a specialist is obviously considerably more expensive than a first opinion consultation. If your pet is insured the cost is usually covered by the insurance company but it is important that you establish this with your pet health insurer beforehand.

Most referral centres will try to give you an approximate estimate of likely costs involved. We are happy to obtain this information for you at the time of making the appointment, however it must be stressed that this can only be an approximate estimate of costs and not a quotation.

Is referral likely to involve considerable travelling?

This depends entirely upon the type of specialist opinion required. Referral to an RCVS recognised specialist may involve a visit to a veterinary school or specialised referral centre and sometimes travelling a considerable distance. Independent referral centres are increasing. These usually have a variety of specialists working under one roof. Please feel free to discuss this with us and we will do our best to help.