About a month ago, one of my favorite colleagues got taken to task by a physician client. She was incensed by the fact that her little dog had had to wait three days to be surgically treated for his paralyzing disk injury.
She’d arrived with her Shih-tzu at his specialty hospital’s emergency room the Friday evening before Labor Day and consequently wasn’t eligible for surgery until Tuesday—after the holiday—due to the surgeons’ collective “laziness.” (I’m sure she didn’t say that but such was the implication.)
In fact, this physician-client had called all South Florida specialty hospitals and none would undertake this surgery on an emergency basis. For the record, only the University of Florida offered to perform the procedure right-quick--but she’d refused. On such a weekend, a mere resident would be taking on the case, not the experienced neurosurgeon she felt she’d rather handle her dog’s care.
Put yourself in her position. Making phone calls in rapid succession, scared out of your wits for your dog’s life, not understanding how the “veterinary system” works, and knowing that in any human hospital this procedure would have been accomplished ASAP by your choice of providers.
I would have been stressed to the hilt, too.
So my friend, he took her justifiable frustration in stride. In his explanation, he’d pointed out that there were accepted criteria for the canine emergency neurosurgeries such as her dog had required. Her dog had not met the emergency criteria (which is indeed far more lax than for humans). Because the dog could feel his extremities (even though he couldn’t use them), this procedure was not considered an immediate surgical emergency.
She countered with the “sooner is always better when it comes to nerves,” mantra. And he’d had no choice but to agree unreservedly. Of course sooner surgery is better—especially with a potentially crippling back injury like her dog’s.
Problem is, the criteria for pets is different because this kind of surgery requires specialized doctors, specialized technicians, specialized equipment and lots ad lots of cash to get them to all come in at the drop of a dime. They’re not all standing by their beepers waiting for the call that comes four nights a week. In fact, if those calls come only one night a month, it makes no sense to raise all your prices to cover the expense of on-call staff time.
Add to that the higher rates for reuniting an on-call high-tech staff on a holiday weekend and suddenly, a three-thousand dollar surgery turns into a ten-thousand dollar extravaganza. Most pet owners are not physicians with high enough incomes to handle that level of care.
That’s when she argued for a two-tier system. “If I can pay, why then can’t I buy it?” Because a two-tier system that only works for one pet once every three months is an extravagance. Unfortunately. And, after all, specialized vs. non-specialized medicine is already effectively a two-tier system. It gives the willing and capable owners among us a method of paying for better care if we can afford it.
The upshot is this: For all the advances in veterinary medicine, pet medicine continues to lag far behind human care. This is less obvious in a day-to-day setting and, ironically, surprisingly pronounced when it comes to accessing top-tier care. Sure, it’s impressive that this level of care is even available, but we still have a long way to go before its affordability (either through pet health insurance or some miracle in cost-containment) brings it in line with were human healthcare is today.
But as with most things in life that seem amazing from afar, I’ll offer some wise words of caution with respect to human-style veterinary care: Be careful what you wish for.
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I understand her reaction, but my worry is that as soon as something becomes available it seems the next step is that it becomes almost mandatory. I know that when my Moody (one-eyed Siamese) was so sick recently, I felt I couldn't afford $2000 for an MRI - but then I felt terribly guilty for trying to figure out how to ration my money. Balancing ordinary household expenses and unexpected and huge vet bills is a hard one to think through. At the very end when he became partially paralyzed, I panicked and was ready to drive him to the US to see a veterinary neurologist who was on call nights. My vet had to talk me away from that edge- the bill for that would have been absolutely horrendous, and it was obvious to everyone except me that Moo was not going to recover. However, those emotions kick in and chase away logic.
By the way, it would be interesting to read what you think about how to decide whether to spend the really big bucks on care for our pets. At the time Moo was so ill, I suddenly felt like maybe I shouldn't have pets since spending thousands is beyond my budget without a payment plan, and I've wondered if other owners feel that way.
Oops, sorry for rambling so far off-topic.
Cindy September 23rd, 2007 02:22:00 PM
One of my dogs slipped a disc a few years ago. I guess I'm lucky that it happened early in the week. She had surgery the day after she injured herself and was walking again four days later.
It's a strange situation to be in, and I'm not a doctor so I just went along with my vet's advice. The tricky thing is that vets can differ so much. The vet I was going to then suggested surgery after a day of monitoring my puppy. The vet I go to now is a bit more cautious. On the one hand, I'm glad that my dog is pretty much back to her old stuff. On the other hand, I changed vets because I just couldn't afford to spend several hundred bucks on tests and procedures every time I walked in the door. Especially after I'd spent $3k on the slipped disc.
Jen (SLC) September 23rd, 2007 11:35:00 PM
This is unfortunately is part of the reason for the high cost of human health care. Once an advanced technology becomes available, it soon becomes the standard of care. So now everybody who gets a bump on the head demands a CAT scan, and the cost rises to the managed-care companies who provide coverage for the insured pay the high costs to cover the testing done on the uninsured. Instant gratification has its price; specialty care is available 24/7, and the cost is astronomical----hence the sorry state of health care in the US. In many countries with national health programs such as the UK, the wait for elective surgery often is months; if patients want to have increased access, they can purchase their own policies to absorb the increast costs.
As veterinary science advances and the costs increase, people will increasingly have to make decisions regarding the cost of care and how much is too much.
Shellie September 24th, 2007 02:59:00 AM
Don't kid yourself - if you are injured on a holiday weekend, you'll want to wait until the next week for surgury if you can. Like vet hospitals, those on call over weekends are going to residents in most cases.
I witnessed a bike accident on the Saturday of Labor Day weekend. The injured persons foot was turned in at a 90 degree angle. He called me that night (I took his bike for him when the paramedics came and took him the ER) and said he was having surgury on Tuesday - because the orthopedic surgeon who specializes in that type of injury was off and the ER staff advised him not to have a rooky operate on him. His surgury involved three screws and he is now on his second cast so this was a bad injury. It was a pretty miserable weekend for him, but I think he made the right decision to wait.
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