Veterinarians are no different.
Was abroad in a tropical climate to wait out COVID. Took our dog. 10 days before traveling back home, I see a engorged tick walking on the living room floor of our Airbnb. I was terrified because we have small children. But having grown up in a tropical country with a dog that would be full of ticks sometimes, I didn't think about our dog much.
On the 6 hour plane home, our dog is basically mute. He's very good traveling, but never that good.
We finally get home. He's not eating. He's sitting curled up by the door. I thought he missed the huge patio of our tropical house and the outdoors. Finally, when his favorite visitor came and he didn't even flinch, I knew something was really wrong.
Unfortunately, I had waited too long to take action: The day before the vet appt, my partner called me freaking out saying our puppy's eyes were rolling back and he was barely moving. I rushed him to a VEG clinic, where they ran all kinds of diagnosis.
I told the doctors where we had been, what I had seen, our dog's behaviour in the prior days etc. At this point i start requesting all the diagnostic results because a close person to me is a vet in said tropical country, and she could literally diagnose our dog.... over WHATSAPP. Her assessment was immediate and direct: My dog has babesia, and had gone into shock because the parasite had eaten all his white blood cells and platelets.
Doctors in the US were not quite on board yet. They first asked a million questions on what my dog had eaten. They were convinced that something was wrong with his stomach because he wasn't eating and also I believe there was tissue inflammation / sensitivity (which was also explained by other factors related to tick disease). They did run a tick panel and came back negative. They were not convinced by the babesia hypothesis. It detected no antibodies for it. (IIRC, My contact had told me that was common in situations where the virus had obliterated the immune system and the body had not had enough time to manufacture antibodies which could be detected by the test.)
Then starts the cachopony of errors. My dog breed is known to have heart murmurs. His murmur was present prior to the trip, and i had test results from the vet in the tropical country which showed the murmur had magically gone from a 1 to a 5 in about 1 week, so they started saying he had a heart problem. (nevermind that the heart behaves erratically when blood is poisoned by foreign invader).
Next day, they start saying it could be heart disease coupled with genetic issue. They want to do genetic tests. I say no.
At this point i have to discharge our dog because the clinic will close for the weekend. I take the dog to my vet. There they say its some kind of cancer (!!). They insist i do a biopsy...
By now my dog is stable but I still needed an Echo to be able to complete the diagnosis puzzle and avoid hospitalization at a major nearby hospital.. Took him to another VEG that was open, for diagnostics. This was covid, so i was sitting outside in the bitter cold with a sick dog. After a 5 hour wait they give me my results and sent me on my way, no directions on what to give our dog to keep him stable.
Next day, our dog deteriorated rapidly, and I was forced to do what I had been trying to avoid: get him admitted at the animal hospital. Signed off on a minimum admission of $2.5k. But hey, at least they didn't redo all tests (they wanted to).
Finally the resident infectious disease expert onsite requested a full tick panel (the IDEXX24 standard panel does not screen for babesia). Babesia is confirmed almost 5 days later.
Final bill $4500.
VEG did reimburse me almost $1000 because the managing director agreed it was borderline malpractice to discharge my dog from the 2nd location without a proper plan. I should be clear, although the doctors at the 1st VEG location were waaay off making up diagnoses as fast as they could think them, at least they did not hand me the dog and tell me... "good luck" , which is what the 2nd location did. And the experience with them from a financial standpoint was not adversarial. Both locations were forthcoming with costs. Very much unlike the hospital, which made me feel bad for.... trying to get any sort budget, before admission.
TL-DR: To a hammer, everything looks like a nail.
A clinic does well with broken bones, foreign objects in the belly, and the like. They don't do well with infectious diseases, even those that are quite common elsewhere, particularly for those that they never see at home.