Because the veterinary industry is a cash-pay healthcare industry (insurance/government assistance are by and large not players like our human equivalent), the economy plays an enormous role in our ability to follow what is known as “best practice.” In short, people can not pay for services they can not afford, thereby limiting the practitioner’s ability to provide the best possible treatment. Both the owner and the veterinarian want the best for the pets, but the owner’s financial capabilities dictate the extent of the treatment.
As veterinarians, we are trained always to offer the best to clients. Propose what you know to be the best practice, then let the client determine what she/he can do. For me, it is a covenant rule never to assume what a client can afford or is willing to do. Full stop. That has always served my clients and me well. The best treatment plan may not ultimately prevail in the end, but every client is at least offered the best plan and allowed to choose what is right for them. That is not to say bad medicine is an option. There is still a standard of care to uphold—ethically, morally, and legally.
For a veterinarian, this can feel like a virtual tightrope balancing the pet’s needs with the client’s needs with your own need to practice a standard of care. This dynamic can also be a source of frustration for both parties. Veterinarians want to deliver the best care but feel frustrated if we are limited in doing that. Pet owners want to provide FOR the best care but feel a great deal of frustration and guilt over not being able to when personal resources are limited. Left unchecked, it is a vicious cycle—one never more prevalent than in the recession of 2008.
During the recession, I worked at a three-doctor practice located in one of the country’s hardest-hit regions. Home foreclosures and unemployment were at an all-time high. It was unusual NOT to know someone affected in one way or another, and everyone felt it.
One afternoon I saw an ADR, or “ain’t doing right” case. The patient was a large female mixed-breed dog around 12 years of age. I will call her Millie for the purpose of this story. Millie had been vomiting for days and was not acting herself. She came in with her mom, a middle-aged woman that lived with her adult son. They were both present during the exam.
As it turned out, Millie had been seen by another doctor in the practice the previous day. The doctor suspected something called a pyometra, which is an infection of the uterus. We see this condition frequently in older dogs that are intact (not spayed), and it is even more prevalent in older intact dogs with a history of breeding. It is one of the reasons veterinarians recommend spaying dogs. My colleague had given Millie’s owner a lecture about spaying her pet and how it could have prevented this condition, then gave her an estimate for a very costly surgery. The owner asked if there were any other options and was informed, “probably not.” Then she was sent home with some medication.
When Millie presented the following day, she had stopped eating, and her owner was at the end of her rope. She explained Millie’s history and what occurred the previous day. Then she proceeded to tell me that she and her son had both lost their jobs that year, forcing her to sell her house and move into a tiny one-bedroom apartment. She further explained that her son had to sell his car, so they shared hers during the day when they hit the streets to pass out job applications. I sat and listened to the story that initially sounded like several of the stories I’d heard that year.
The woman explained that Millie had been with her through thick and thin- depression, job loss, divorce, you name it. I was prepared for her to ask for a discount when she stopped to take a breath. She looked me dead in the eye and said, “I am going to sell my car. I don’t know how much I can get for it, but I should have at least half of the estimated amount, hopefully more. What are our options?” I quickly added the numbers in my head and quoted a figure totaling less than the previous quote, but still not small potatoes. I made sure to stress that this was cutting WAY back, and it wasn’t optimal, but it was still standard of care and would get the job done…barring no complications.
At this point, part of me was getting nervous because I feared the second I said I could do the procedure without the added measures, Murphy’s Law would kick me in the face— that something would inevitably go wrong. I mentally ran over the list several times before the woman said, “Can you please start the surgery, and I will be back with the money as soon as I can—two hours tops?? I just don’t want to wait, and something happen to her. I know she only has a year or two more [with us] at best, but Millie has been there for me, so I owe everything I have to her.” I couldn’t say no.
Millie’s owner signed all the forms, said her goodbyes, and off she went. There were rumblings about the possibility that she wouldn’t return, but I had the surgery to focus on at that point. Luckily, the surgery went off without a hitch, and Millie recovered well. Millie’s owner returned to the staff’s surprise, but not with the estimated amount I had quoted her. She had the full amount quoted from the previous day. Never underestimate what people are willing to do for their pets and never ever ever pass judgement on what they can’t afford. Any one of us could end up in her shoes, but not every one of us would do what Millie’s owner did for her in the end. I kept up my end of the agreement and told her to keep the extra money for Millie’s future care.
We scheduled a follow-up visit for the next day after reviewing Millie’s pain medication and antibiotics, plus any restrictions and miscellaneous instructions. The staff checked them out and helped them outside. There wasn’t a dry eye in the place.
I was late leaving to go home, so I grabbed my things and hopped in the car. I hadn’t made it a block down the street when I saw all three of them on the sidewalk. They were pushing Millie in a shopping cart. I don’t know how, but I had completely forgotten they had no car now.
I pulled over to ask if I could drive them home. Millie’s owner insisted that Millie loves riding in the cart and that they lived around the block. With all they had been through, they still managed to see the upside. They were just happy to have been able to provide for Millie, and Millie was just happy to be with them. I tried to insist, but they were adamant in their stance too, so I smiled and said, “Talk to you tomorrow” because I had no words. In all honesty, I still have no words.