In a discussion I moderated at the recent Western Veterinary Conference (WVC), the following questions were posed to an audience of 150 colleagues:
1) Do financial constraints limit your ability to provide the quality of care you would like for your patients?
YES = 94% NO = 6%
2) If yes, is this a source of frustration for you?
YES = 91% NO = 6%
Overwhelming conclusion: Houston, we have a problem.
3) Do you routinely discuss vaccination protocols and the need for neutering with all your clients?
YES = 94% NO = 6%
We take the time to discuss medical procedures that prevent life-threatening illness in the individual pet (vaccines), and that contribute towards curbing pet overpopulation (neuter). Excellent.
4 ) Would enhanced financial coverage reduce the frequency of "economic euthanasias"?
YES = 75% NO = 25%
Conclusion: Our clients would benefit from either financial assistance, or the knowledge of the costs of care for a major medical illness.
5) Do you routinely discuss the costs of emergency or specialist care for pets with your clients?
YES = 25% NO = 75%
6) Do you routinely discuss pet health insurance with your clients?
YES = 15% NO = 85%
The problem If these responses are at all representative, there are some real inconsistencies here that we need to consider. How do we reconcile that financial limitations are a significant burden to our patients, that these constraints sometimes mean the difference between the life and death of the animal (as well as affecting our own sense of career satisfaction), yet we seem unwilling to take the time to forewarn or inform our clients in advance of the rising costs of veterinary medical care or provide them information about insurance coverage. As specialists invest in laparoscopy, CT and MRI equipment, do you think these costs are diminishing?
I know what some of you are thinking: "Most of my clients don't see a specialist for the lifetime of the pet, so what's the big deal here?" In fact this was a comment I received at WVC. I would venture to guess that a majority of your patients receive emergency care during their lifetime, and the concept clearly applies here.
Over my 15 years associated with 24-hour centers, I know that when an old dog with gastric-dilation/volvulus (GDV) comes in at 3 a.m., you can bet that a discussion of the value of the money spent out of pocket versus anticipated future years of the dog will ensue, as the owner decides if it's "worth" saving the dog's life.
In addition , I've heard colleagues justify their inaction by claiming that "since my clients don't complain about my bills, this isn't an issue I need to handle ".The present burden of financial constraints on client's decisions at specialty/emergency centers sometimes results in the general practitioner blaming the referral center either for fees that are too high, or for being financially inflexible or inconsiderate of their clients' emotional needs.
In fact, the shoe can be placed on the other foot; that is to say, if clients were better prepared by their family doctor, the costs at 24-hour facilities may not come as such a shock. Clearly, we all deserve to be well compensated for our work, and we all would like to practice in a world in which pet care could be provided without sensitive discussions regarding cost.
I would venture to say I've seen far more animals die as a result of their owners' inability (unwillingness?) to afford our recommended care, than due to fleas, prostatic disease, pyometra and breast cancer combined. Yet, we seem to have no problem spending our valuable time during puppy/kittenhood discussing the value of flea control and neutering.
Why do we ignore this problem?
My suspicions for why we ignore this problem include:
I've got news for you...re-read the answers to questions 1 and 2 above. This is our problem, and it's not going to get better by ignoring it.
Professional excuses After the session at WVC, numerous colleagues made the following comments regarding this controversial contention:
From my viewpoint, this is like telling someone it's going to hurt after you've ripped off the Elastikon bandage from his hairy skin. Your clients need to start saving for that PU surgery, ACL tear, or splenic tumor when the pet is young.
The solution I believe it's time for a new paradigm in which all general practitioners take greater responsibility for your clients' inabilities to cope with the ever-increasing costs of sick care for their pets.
No, you are not responsible for putting their money under a mattress or advising them on investments. Yes, many of them will ignore this valuable, and life-saving advice. So what? Many clients decline your annual dental prophies, yet I hope you don't stop offering them if you feel they are necessary.
Letting your clients know that insurance and credit plans exist, and that the cost of a major illness can run thousands of dollars, is your obligation as a responsible family doctor. Although my hospital carries credit and insurance brochures in the lobby, for most clients, the initial exposure to the veterinary medical system is through their visit to the general practitioner for vaccines.
Consider how your valuable time is spent with your patients in the first six months of their lives, and which subjects will have the greatest impact on their ultimate longevity and quality of life.
Besides the profound impact of behavioral/elimination problems leading to euthanasia decisions, I can't think of another matter that carries such a dramatic and daily impact on us, our patients and clients, that for now, we choose to ignore.
Until the day arrives when most of us take the time to discuss the costs of medical care with our clients, I will continue to feel saddened and responsible when the next pet owner in my exam room looks up at me through tears and states, "I had no idea it would ever cost this much to save my dog 's life".