I don't go through a week of general practice without the issue of consulting a specialist coming up in a conversation with a client.

In today's world of specialization in medicine, veterinary medicine is keeping pace by offering a variety of specialties if veterinary clients desiring a higher level of expertise as opposed to that given in general practice. The question is, when should a veterinary case be referred?

In a nutshell, the answer varies according to: the comfort zone of the veterinarian in providing care for a case, the desire of the client to seek a level care above and beyond what is offered by the general practitioner, and the economics of the situation.

As one would surmise, good communication between the veterinarian and the client is essential in order to provide the pet owner and ultimately, the pet what is desired.

Let's address the comfort zone of the primary veterinarian. There are general practice veterinarians with varying levels of expertise and experience in a given discipline. Whether cardiology, orthopedics, ophthalmology, oncology or neurology, there are options to "treat at home" or refer according to the comfort zone of the general practitioner.

Two factors usually come into play here: Is there a specialist in a needed discipline for this case within a reasonable distance? Furthermore, does the primary veterinarian have experience with those types of cases? My personal approach is to make the offer to refer to the best regional specialist in a challenging case (even if distance is an issue) as the first choice, with my clinic locally treating here at home as the second choice. That way, I have the client's blessing on treating a tough case if they choose not to take my offer to refer, with their understanding that I'm not the best in the region, but I do have experience with that particular type of case.

As for the distance issue, it truly is an issue here in South Mississippi. With no board certified specialists in practice south of Jackson in Mississippi, there is a need to go north into Mississippi, or to cross into Alabama or Louisiana to seek certain specialists in some fields. To more and more pet owners, I see the choice to seek the best specialists on a given case opted for (despite distance) in recent years.

Finally, I must mention the economics of these situations. The truth is that seeking assistance for your pet from specialists can be expensive. Trips to see veterinary specialists involve commuting time and money, often times after clients have already paid the primary veterinarian for initial care. Yet, if top-notch care from the best minds and/or equipment in a veterinary discipline is the goal, then referral of a case is a good option. Your veterinarian has you and your pet's best interest in mind when a recommendation to refer a case comes about.

Dr. Chris Duke is a veterinarian at Bienville Animal Medical Center in Ocean Springs, Miss. Questions for this column are encouraged. Write to South Mississippi Veterinary Medical Association, 20005 Pineville Road, Long Beach, MS 39560 and include a self-addressed stamped envelope.