Asking for a second opinion

Veterinary medicine has expanded hugely in the past 20 years, with many new diseases and injuries now recognisable. New keyhole surgical techniques have been developed and methods of imaging have been introduced, including ultrasonography, nuclear scintigraphy (bone scanning) and magnetic resonance imaging (MRI).

For many common veterinary problems, a general practitioner is highly competent to treat your horse. Nevertheless, there are times when more specialist knowledge is needed or more sophisticated equipment is required.

It is crucial to recognise that your vet is not inadequate because they suggest referral.
Similarly, a vet should not feel insulted because their client requests another opinion.It is every horse owner’s right to request a second opinion whenever they want, either from someone of their choice or someone suggested by their vet. This may depend on the nature of the problem and whether it is an emergency situation or elective referral for further investigation.Why a second opinion?It is obviously important that you establish a good relationship with a local vet who will be able to attend quickly in an emergency. Fellow horse owners in your region will also usually have an opinion on which vets in the area are particularly experienced, which is always useful.There are “horses for courses”. Surgery, other than routine procedures such as castration, should ideally be carried out by a person who has had specialist training. Likewise, the horse should be anaesthetised by someone with specialist training in anaesthesia.It is important that a general mixed or equine practitioner should recognise when a horse has a problem they cannot deal with, either through lack of experience, lack of specialist equipment or when they know that a better service could be provided by a vet with greater knowledge and expertise.Most owners will be very grateful that their own vet had the foresight to refer their precious horse earlier rather than later, when it may be too late to alter the course of an injury or disease.The practicalitiesWhen a horse is referred for a second opinion, there should be a two-way exchange of information. Your vet should supply a history of the horse, describing what clinical investigations have been carried out and the results.Any images obtained – such as X-rays – should be sent so that the consultant can decide if additional X-rays are required.If the horse is a medical emergency, the referring vet should describe what treatment has been carried out so that the consultant can interpret what he finds. For example, if a horse has severe colic and was given a large dose of a specific anti-inflammatory painkiller on arrival at the clinic, it may appear misleadingly well. But if the consultant vet knew about this treatment and how ill the horse previously appeared, he would know that surgery was probably indicated.When the horse has been examined and a diagnosis obtained, the consultant may recommend a specific treatment and inform the referring vet. A management strategy may be determined between the referring and consultant vets.The consultant vet may elect to repeat some tests. Obviously the consultant has to consider cost to the client, but any repeat tests will be based on clinical evaluation of the horse and critical appraisal of what has been carried out.Competition horses are like human athletes and may require specialist input from several different people working together as a team with your own vet. A footballer with a knee injury would consult an orthopaedic sports consultant and a physiotherapist, perhaps with input from a radiologist skilled in interpreting MRI scans. The same should apply to equine athletes.
Vets generally list their qualifications on their practice notepaper. In order to practice, a vet must have a veterinary degree, the name of which differs slightly between the different veterinary schools here and abroad (eg BVSc, BVetMed, VetMB, DVM).
All vets must pay a registration fee to the Royal College and thereby be a member (MRCVS).
Those vets with postgraduate qualifications will also use those (eg DipECVS, Diplomate of the European College of Veterinary Surgeons). If you want to find out who has specialist qualifications, you can contact the Royal College ( www.rcvs.org.uk).