Q It seems to me that the cost of medical care for pets has gone sky high. I understand that the quality of care available for pets is also at an all-time high, and that the care available in the U.S. is the best in the world. I would like to know if you have any advice on how to best balance high-quality care for my pets with a reasonable level of expense.

A: It can be very difficult to navigate the range of offerings available. I (Dr. Henri Bianucci) had a case recently of a Dachshund who had formed a urinary stone, which had lodged in his urethra. The client was from out of town and his veterinarian had attempted to remove the stone using laser surgery.

Sadly, basic surgical principles were not followed, and the dog was left with a horribly scarred and narrowed urethra. He was barely able to urinate.

The vet had made three attempts at surgery, each worsening the injury caused by the previous surgery. There was nothing left to do other than to surgically create a new opening.

When the client looked at the estimate he said, "That's twice what my veterinarian charged! And you aren't even using a laser." He was correct. It was twice the price, but his vet did the procedure three times.

So, my first recommendation would be not to allow yourself to be dazzled by things that sound high-tech. Be objective and ask questions. Go beyond fancy terms and creative descriptions. The core questions should involve the experience of the veterinarian. That is the single greatest determinant of a successful outcome.

Secondly, on a related note with the concept of experience, is the issue of price. This is a very confusing issue, especially when comparing prices between facilities.

For example, I had a call the other day from a vet asking for an estimate on a fracture repair. As with most surgeries, there was certainly more than one way to repair this fracture. However, there was only one reasonable way to go, which was to apply a bone plate. This is one of the most expensive ways to repair a bone, but in this case, it was by far the one with the greatest chance of success.

Another facility gave a quote that was almost half the one we had given. Their quote was to repair this with a pin, which seemed to me next to impossible. Needless to say, the patient went there, and ultimately had a plate repair. The point is that when you compare quotes, be sure you are comparing apples and apples. The prices may include blood work, hospitalization, medications, etc., on one quote, but not on another. Just be sure that the quotes you are comparing, contain equivalent services.

The third and, possibly most important, is to critically evaluate diagnostics.

As a veterinary student at the University of Illinois, I remember the impact that was made on me by the logical, and stepwise, approach that the clinicians had towards diagnostics. Cost containment was part of the issue, but as important to them was the practice of the art of medicine.

They would first perform a true physical examination; their feeling was that your diagnostics should support what you already suspect from the patient history and the physical exam. You don't just X-ray the whole dog. Find the area that seems to be the trouble and focus on that to confirm your suspicions.

Today, there is far too much reliance on diagnostic equipment and laboratory results, and too little emphasis on an actual physical exam and medical reasoning. Undoubtably, malpractice liability has crept into veterinary medicine, and some feel that there is too much risk in not performing certain tests. So, for each case, a battery of standard tests are performed, with little thought as to how their results will guide the case or how likely they will yield any relevant data at all.

One big problem with this approach is that there is no third-party payment system in veterinary medicine and the funds available to diagnose and treat a case may be limited.

The take-home message is this: For every diagnostic, there should be the expectation that the result will guide the case one way or the other.

There should also be a rational explanation for why that diagnostic is important at that time, and it should be in a proper sequence. If you know you have to do a $50 test and a $100 test, but doing the $50 test could make the $100 test unnecessary, why not do the $50 test first?

Physicians and veterinarians need to practice the art of medicine. This is ultimately what leads to the most efficient, and economical, case management.

Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to petdocs@postandcourier.com.