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Thursday, December 8, 2011

Medicine Vs. Money

Abby emailed me recently....

I am a pre-vet student and have worked in the veterinary field for close to 5 years now, and am heavily invested in the world of veterinary medicine. That's why I was alarmed and upset to read this article, a "shocking exposé of the profession that puts pets through 'painful and unnecessary treatments to fleece their trusting owners.'"
I think the the author is swinging things unfairly against veterinarians. Preventative medicine is advised, not forced, and for good reason. Complications down the road can cost way more money that preventing problems in the first place. It's articles like these that make owners suspicious of our motives. I'm completely for owners educating themselves, but this guy makes sweeping and horrifying generalizations on the whole of the profession from just a few bad eggs. There are a number of other issues I see with the article, but I'd like to hear your opinion, if you don't mind.
 
This article is from 2009, and I've read it before.  In fact, I could swear that I've commented on it on this blog.  However, I'm too lazy to search my own blog, so I'll just comment again!
 
I have very serious criticisms of this author's article, and feel that he is unduly biased as well as has opinions that are contrary not only to most vets but also to many pet owners.  His statements and opinions also do not represent the veterinary profession from what I've seen in 28 years in the field.  Now, he is specifically talking about UK vets, but I don't believe that the standards and beliefs are significantly different in the US than there (and my experiences with this blog over the last several years has only reinforced my opinion that vets across the world share common goals, outlooks, and experiences).  Let me discuss and refute several of his comments, all quoted from the article.
 
No, instead, its leg was going to be amputated and then a course of chemotherapy would be tried to ensure that 'all was done to save the dog's life' - at a cost of £1,000 to £2,000, or even more.  I have no idea what the owner thought of this. But, as the majority of pet owners want to do the best by their beloved dog, I can only imagine he or she took this 'chief' vet's expensive advice to try to 'save' the pet.
 
Right here the author shows his igorance of the situation by admitting that he didn't know the owner's opinion, and imagining what had actually happened.  He is assuming the owner's thoughts without knowing them.  Is this a good way to form an opinion or make a decision?  Yes, most pet owners will listen to their vet's advice.  But most vets also discuss options and have the client make the decision.  I run into this every day, where I give clients the information and let them make the decision.  Sometimes they don't go as far as I'd like (actually that's pretty common), but sometimes they surprise me or even push me towards more serious treatment. 
 
As a writer I also have to comment here on the author's deliberate use of inflammatory language.  He uses words intended to sway the reader to his rather extreme way of thinking, and uses quotes around "chief" and "save" in a way that can only indicate skepticism as to whether the vet was really the lead one and if the treatment was actually going to save this pet.  This is a very, very opinionated piece, and because of the writing style should not be intended as an objective assessment of a situation.  The entire article is designed to convice the reader in the most graphic way possible of how bad veterinary advice is. 
 
And even if it did give that greyhound an extra year or so of life, how could anyone explain to it that the suffering was for a reason? That lying in a small cage, surgically maimed, and hooked up to a drip for weeks, perhaps months, would be 'worth it'.
 
"Surgically maimed"?  Really?  Again, very deliberately inflammatory comments.  And I've never seen conditions such as described, where the pet is hospitalized in very confined and stressful conditions for months on end.  This is absoultely a false representation of what actually goes on.  Amputations normally go home within 24 to 48 hours of the surgery.  Chemotherapy patients normally spend a few days at a time in a hospital (if that long) as long as they're otherwise stable.  The author is misrepresenting what happens, and I believe deliberately and knowingly so in order to promote his particular viewpoint.
 
Also, I take issue with the author's apparent opinion that because we can't explain the pain and hardship to the pet, we shouldn't be doing the service.  If we could ask the pet, they wouldn't come in for ANY service!  Ask that kitten if it wants a shot.  Ask that dog if it wants to undergo surgery to get spayed.  Animals cannot be reasoned with or comprehend the long-term meaning behind anything that vets do, and because of this we cannot rely on their desires of whether or not to go through the treatment.  Pets are under our care, and as guardians it is up to the owner to make the right decision, just as for an infant human.
 
One might imagine that because there are so many more vets that animals need more medical help than ever. But the truth is far simpler. A whole industry has arisen out of squeezing the most money out of treating family pets.
 
Once again, deliberately inflammatory language..."squeezing the most money".  There are increasing vets because the population is increasing and more people want to go into the profession.  And most veterinary students know that they will make a pittance compared to their human counterparts, so it's certainly not about the money.  Clients are also expecting and demanding a higher level of care than they did 50 years ago, as well as more personalized attention, so vets are really just providing what the client wants.
 
It is not unheard of for vets to Google a pet owner's home to see which area the family live in. Big house in a posh road  -  well, you can offer more treatment to that pet owner, of course. I never witnessed this in my practice, but I heard of it happening. Charge more for your services so a vaccination that costs a few pence becomes a £35 'consultation'. And that isn't all.
 
Here the author once gain subverts his own creditability.  "I never witnessed this...but I heard of it..."  And a rumor passed from person to person is enough to form an opinion about an entire profession?  Until reading this article I had never heard of this and have never considered it as happening.  I've known dozens to hundreds of vets in my career so far, and I've never heard any of them talking about anything even remotely like this.
 
While the owner might believe he or she is only taking their cat for a vaccination (and I have no problem with sensible preventative healthcare) for the vet, this visit can be a way to make even more money out of a perfectly healthy animal.  During the 'health check' which accompanies the vaccination visit, it is amazing the potential 'problems' the vet might find.
 
Notice the quotation marks indicating skepticism and derision?  Yep, the author is predictable.  I'm sorry to say but the client is not always observant or aware of health problems.  The point of the exam is to check for any problems, and if the vet isn't doing their job properly an issue might be missed resulting in a lack of treatment.  The two most common health issues I see are dental tartar and weight issues.  I would say that 70-80% of my patients are either overweight or have some form of dental tartar.  Am I trying to gouge a client by talking to them about treating these issues and recommending products or services that might help?  I've noticed loose teeth due to periodontal disease that the client never did.  I've found cancerous masses, bladder stones, ear infections, fleas, arthritis, and numerous other problems on an apparently "healthy" pet (yes, I use the quotation marks myself on purpose).  Finding these things has nothing to do with wringing money from clients.  Instead it is about trying to catch health problems early, before they turn into life-threatening issues, or finding problems that the owners never noticed.  I have prevented many serious problems by informing the owner what I found on a routine exam.
 
Sadly, the best way to deal with many problems is not to treat at all. Small animals such as guinea pigs and rabbits should be put to sleep if they present with an illness that can't be easily rectified with a dose of antibiotics. Their lives should not be prolonged at all cost.
 
Wow, what an absolutely shameful comment!  I do agree that we shouldn't prolong life at any cost.  But to say that a pet isn't worth saving if it doesn't respond to antibiotics alone is being extremely jaded and uncaring.  I've known people to spend hundreds of dollars on their hamster or guinea pig and were very happy afterwards because their beloved pet was still alive a year later.  These pets have just as much emotional worth to some people as a dog or cat would.  Recently I've been treating a small parakeet for chronic egg-laying, including hormone injections.  This client has spent almost $400 in the last four months on a $30 bird, and is now getting ready to go to an avian specialist.  According to this articles author I should have already recommended euthanasia, even though this bird is this owner's best friend and she is very willing to spend the money. 
 
 Nor should cats that are run over and experience a complex injury or bladder problems - sadly an all-too-common feature of road accidents as the car catches the back of the cat as it tries to escape - endure lots of operations in the hope that the problems can be cured.   Even if they can be - eventually - I believe putting any animal through this is barbaric.
 
Wait.  We shouldn't do life-saving surgery even if there is a chance of the surgery fixing the pet and that pet going on to live a relatively normal life?  How is that kind of treatment "barbaric"?  We're putting the pet through temporary pain and inconveience to safe its life and give it longer term relief.  Of course, by this point in the article I've completely lost any faith in the author's credibility and have chalked him up to a biased lunatic with an agenda he is trying to foist on an unsuspecting public.
 
Expose my left butt-cheek!  This is nothing more than an opinion piece by someone who doesn't have any proof of his viewpoints (how many times did he admit that he had never seen something that he was stating was reality?) and is trying to convince people of his radical view.  You can summarize this author's belief system very simply....if an animal get sick or injured past the ability for cheap oral medications to cure, that pet should be euthanized regardless of a client's wishes or our medical ability to treat the problem. 
 
Now stop and think about the consequences of this viewpoint, and follow the thought to its logical conclusion.  The author claims to be only looking out for the best interest of the pet, and not putting it through any unnecessary procedures.  However, by saying that we should never do anything complex or protracted, he is demeaning the value of pets to their people, and saying that they really aren't worth treating.  How is this a compassionate view?  In essence, he views pets as disposable and not worth the money it might take to make them better.


I could go on and on and pick the article apart line-by-line, but this is already one of the longest blog entries I've written and the more I read that article the more I am infuriated by the author.  So I'm going to stop for now.

Abby, you asked for my opinion, and there it is!



3 comments:

  1. I appreciated the comment from the UK vet: Our job is to give all the options and help the owner come to a decision that they both understand and are comfortable with. For most things that I treat, I give at least two options. Different people have different values. And, like the UK vet said, what happens if you don't give all the options? What happens when you make a value judgement on the owner's behalf? What happens when it's wrong? You get hauled before the state board and possibly get sued. Would I do all the diagnostics and treatments on my own animals that I give to owners as options for their pets? No. But that's my call. I'm the owner. And I will always give my clients the same chance to choose what is right for them and their family, furry or otherwise.

    I had the opportunity, as so many of us do, to guide my family through a tough decision when our Great Dane got osteosarcoma in her metacarpal. We discussed all the options: limb amputation, toe amputation, no surgery, chemo or no... Ultimately my parents chose toe amputation with chemo (no side effects her entire treatment, btw). Two years later and she is still cancer free. They had to be able to make that decision themselves and I was only there to guide them and give them all the info they needed to be comfortable with whatever they decided. They're extremely happy with the outcome.

    Oh, and I've never even heard of Googling someone's home to determine how much to charge them. Whaaaat? Who does that???

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  2. And that's how we're supposed to treat our cases. Go over all of the options, give the client the information, and let them make an educated decision. The big problem that I have with this article's author is that they don't think we should ever offer these options because the pet may suffer. According to the author, you should have only offered euthanasia because surgery and chemo are cruel. But if that was done, this Dane's owners wouldn't have their beloved dog two years later! You have just successfully disproved the article's main premise.

    And remember, the author says he's been told of Googling a client's house but has never actually known anyone to do it so it's just a rumor that he's passing off as truth.

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  3. The Daily Mail has a reputation for being badly researched or very one-sided (or both).
    I'm sure there are money-grabbing vets out there but I'm almost certain they're not in the majority as the article suggests.

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