Scenes from St. Elsewhere Animal Clinic
Dr. Paul looks at two pills that had escaped and were rolling across the floor. He thinks to himself, "Those pills cost $1.30 apiece. No one will know if I just put them back into the bottle." So he does.
The entire staff except for Dr. Frank has left. He is an associate at St. Elsewhere and has now been out of school for three years. He has agreed to stay and wait for Mrs. Galloway in order to see "Franklin." Franklin had just started vomiting late this afternoon, and Mrs. Galloway is now frantic. After a brief visit she pays in cash. It is the end of April and Dr. Frank has recently sent a sizable check to the IRS. He decides to pocket the cash.
The Yellow Pages salesman asks one last time if the new ad looks OK. The new ad now contains information that St. Elsewhere Animal Clinic specializes in dermatology and feline medicine and surgery. Dr. Paul hesitates and then thinks, "I have a special interest in these areas of practice. Why not?"
Arlene, the receptionist/bookkeeper/office manager waits for everyone to leave. Today eight clients have paid in cash for over- the-counter medications. Arlene had entered these transactions as cash. She quickly removes the transactions from the computer and pockets the cash. The deposit balances perfectly. Arlene was at first guilty but has rationalized that Dr. Paul doesn't pay enough and/or appreciate her efforts. She, therefore, deserves this daily bonus.
It is busy, yet Sally has made three personal calls to her former "live-in" boyfriend's place of employment. Sally and her boyfriend are arguing over a house payment. After the call, Arlene confronts Sally. Sally lies and tells Arlene that her phone has been disconnected. Besides, in her own mind, she had worked late yesterday evening with Dr. Frank on a minor surgery that had come in right at closing.
The technician is busy in the next room so Dr. Paul decides to hurriedly mix the vaccines for another patient by himself. After drawing the rabies vaccine into a syringe he accidentally mixes a small amount of the rabies vaccine into the distemper vaccine instead of using the diluent. He caught himself and wonders what to do-his new distemper vaccine is expensive. He thinks about it a minute and decides that there will be no harm done. He vaccinates his patient with the cocktail.
Darla has worked at the clinic for three months and hasn't received a raise. She has six dogs and is glad she finally works for a vet. But even with a discount her dogs seem to be eating up her paycheck. Darla comes in to check on one of the patients this Sunday while the clinic is closed. As she leaves she sees the heartworm medication display and realizes she needs more. She removes enough for all her dogs (along with her best friend's Golden Retriever). Darla, at first guilty, finally convinces herself that she is justified in that she has been to the clinic many times to check on patients on "her time" and is underpaid "to boot".
Mrs. Harris' dog "Slobbers" has just died after a brief illness. She returns Slobbers' final medications and states that she would like the clinic to give the medications to some other dog that needs it. After all, Slobbers can't use them anymore. She wants no money back-just the assurance that some nice dog will benefit.
Later Dr. Paul hesitates a moment then pours the pills back into the bottles where the pills had originated. After all, Dr. Paul was sure that his associate had undercharged Mrs. Harris for Slobbers' last visits anyway.
The scenes presented above could go on and on. At this point you may be thinking that this article is about practice economics or criminal activity.
While there may be criminal and other acts described here that affect the economics of practice, these scenarios have a common root in a lack of business and social ethics.
We would like to think that these scenes are uncommon and mostly fiction, but everyone reading this article knows better. It would be helpful to look not at the symptoms, but at the underlying motives and rationalizations.
The scenarios above show individuals that feel justified for their activities. Justification is that little man on your left shoulder that out-shouts the little angel on your right shoulder. In a lot of cases, justification is that creeping delusion that life is unfair and you are at liberty to take steps to rectify the wrongs that others have imposed upon you.
Some individuals rationalize liberty in this way: "Other than acts that I know are against the law, the constitution provides me with liberty. I therefore can act in any way I see fit according my right to liberty as a free person." These people have overdosed on late night talk radio.
Veterinary medical ethics
Will the real veterinary medical ethics please stand up?
"I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics." ~~2nd paragraph The Veterinarians Oath.
There seems to be some confusion as to what the term, "veterinary medical ethics" means. In fact, the term has taken on new meaning considering the recent emergence of the animal rights movement.
Younger veterinarians may view ethics simply as it relates to the protection of animals and a societal responsibility to the animals of this planet. An older veterinarian may think of moral issues related to the interaction of people. In fact, animal rights issues are only a tiny fraction of the ethical questions that face veterinarians on a daily basis (see sidebar).
Where to go
Where can we go to improve our ethical behaviors?
Veterinary schools have attempted to provide students with training in ethical issues concerning the profession.
Many of these courses now center on applied ethics and take the focus away from personal responsibility. They instead focus entirely on the social issues of applied ethics confronting our profession. Animal rights and animal welfare are obviously legitimate concerns for the profession and veterinarians need careful and practical instruction in this area. But veterinarians also need to confront the more pervasive and insidious problems rooted in the issues of personal responsibility.
Veterinary ethics was one of those courses at vet school that no one wanted to take and usually didn't. It can be common for veterinary students to brush aside the issues of ethics as "corny" or "old fashioned".
On the other hand, some students have found that the controversial issues of applied ethics to be their own special calling and crusade to hold others to narrow interpretation of their viewpoint. Indeed, some have obviously entered the profession for this very reason.
We also need to keep in mind that many teachers of veterinary ethics are non-veterinarians and often come from outside the schools of veterinary medicine. As some of these courses may only include instruction concerning applied (controversial) ethical concepts, our veterinary schools owe it to the profession to have oversight and input as to the content of these courses.
Without question this is a controversial subject.
Before I get a lot of hate mail I would like to point out that I was thrown out of a Tennessee Walking horse/racking horse competition for which I was serving as the show veterinarian because I disqualified a horse for obvious soring in violation of federal law. I watched from the grandstands with disgust as that horse went on to win the event.
Animal welfare issues are important for everyone. Veterinarians, with some exceptions, have always championed the welfare of their patients. Without discussing the issue further, we should be ever mindful of the extremes of this issue. Taken to the extreme, some animal rights proponents condemn the keeping of pets altogether. We should look soberly at the prospect of a profession with no patients and subsequently no veterinarians.
Into the looking glass
Staff and veterinarians alike need to look no further than their own mirrors to find ways to improve the ethical framework of veterinary medicine. Everyone in the veterinary workplace today needs to take a fresh look at ethical issues and how they affect our lives either in a positive or negative way.
Steps you can take now:
1. Talk about personal ethics at a veterinary staff meeting and provide your own scenarios. Talking can be great preventive medicine. At these meetings do not accuse others of unethical conduct. Remember that when you point your finger there are three fingers pointing back.
2. Learn to recognize ethical situations that come up and learn to overcome the rationalizations that are obviously coming from that little man on your left shoulder.
3. Recognize and discuss with staff members the controversial issues of applied ethics, making sure not to bind others to your own opinions.
4. Use a "golden rule" approach when dealing with other people and hold your staff up to an ideal of helping others before helping themselves.
5. If you recognize unethical conduct, talk to the person in private. They may not even understand their own conduct.
6. Publish and distribute an employee handbook that includes expectations regarding ethical conduct.
In the end, we cannot rely only on our schools and religious institutions to provide our veterinarians and staff members with proper training in ethical conduct.
It begins with the owner or owners of the veterinary hospital as well as veterinary school faculty and colleagues.
If our staff sees us treating our clients or patients badly, it will follow that the staff will feel that they may behave similarly. If our staff sees or suspects that we are cheating the system in some way or treating other staff members with condescension, they will follow suit. This ultimately results in a dysfunctional working environment. This will be true even in the presence of otherwise superior veterinary medical care.
As Pogo once said, "We have met the enemy and he is us."