Here’s a good way to start a blog: Victorian humour.
Man: I say, Doctor, how’s that old chap you’ve been treating?
Doctor: I fear he is beyond medical help.
Man: Oh no! Is he dying?
Doctor: No, he ran out of money.
Hey, I never said it was a topical blog…
Uncomfortable bedfellows
In my past few posts, I’ve talked about a few different types of stress in general practice – emotional, mistakes and surgery – to try to understand why we have an issue with mental health in our profession. In this blog, I’d like to talk about another form of stress, which – in the UK at least – is largely unique to our profession.
I think most of us became veterinary surgeons because we wanted to help – our thoughts on how this may work might have been naive and muddled (they certainly were in my case), but I’m fairly sure the majority of us didn’t become vets to make money.
Unfortunately, veterinary practices are businesses; it may have become more egregious in our era of corporates, but it was always the case. The fundamental problem, however, is the business they are in is medicine – and, as the 100-or-so-year-old joke above demonstrates rather better than I can, business and medicine are not comfortable bedfellows.
Shake your money maker
Medical problems, by their very nature, cause suffering and distress – not only for the afflicted animals, but also for their owners. When you add in the fact medical problems are also extremely inconvenient for owners (ruined furniture and clothes, upset children, cleaning bills, unexpected time off work) then you’re already dealing with worried and upset people before you’ve got to the point of mentioning a price tag is attached to the remedy.
However much we hate the idea, our help – if not our compassion – is conditional on the owners giving us money.
I personally struggled with this throughout my career and, given the number of people I’ve spoken to that say: “Oh, I’m terrible at charging for things”, I suspect I’m not the only one – no wonder corporates now offer financial incentives for the amount of money vets earn.
Mastering the art of compromise
Although I think many of us come to accept that, as highly trained professionals, our time and skills are valuable and worth paying for, it still never sits easily with a lot of us.
When confronted with an animal in distress, our first instinct is to use our skills to help, rather than to quantify exactly how much that help is going to cost so the owner can decide whether they want us to help.
If they decide they don’t, we either have to watch the owner leave with a distressed pet, or (and this is much more common) come up with a remedy that is less likely to work, or will have other side effects, but will cost less.
These are decisions we make every day – in almost every consult, we find ourselves compromising care for cost.
One initially appealing way to escape the compromise is to find work with a charity, where the owner doesn’t pay for treatment at all. However, my experience is money is even tighter for charities than it is for most owners.
The harsh reality is, far from avoiding the problem, many vets who work for animal charities are faced with the most extreme and toughest of these medical compromises.
Money worries
I’ve touched on these issues a number of times before – mainly talking about corporate bonuses colliding with general practice – and how I feel about them (spoiler: not great). But here, I want to highlight the stress this disconnect between finances and therapy causes to practitioners.
Some of the most difficult, heart-rending moments of my career have been caused by the distress I felt in not being able to help patients because their owner was unwilling or unable to pay for their treatment, or from the worry caused by quietly doing work for free, or at dramatically reduced cost, to try to help regardless.
I vividly remember the miserable 30 minutes I spent after telling the owner of a bulldog bitch in whelp that I couldn’t perform the required caesarean until she agreed to pay for the bill – she stormed out of the practice and left me thinking of the pain her pet was experiencing. The fact she returned half an hour later waving a credit card she had mysteriously “found” didn’t do much to take away the suffering her pet and I had experienced during that time.
Other ways to pay
Insurance helps, but it doesn’t solve the problem. I remember when I qualified (a little closer in time to the opening joke than I’d really like), an insured patient was a thing of wonder – incredible limits of money it seemed would never be reached.
Today, insurance is far more common, but costs have risen and policy limits have fallen; it seems you’re hitting the limits of the cover almost immediately, and you’re back to compromising again.
Every time a client requests his or her arthritic dog be euthanised because he or she doesn’t want it “messed around with” (quite often used as a euphemism for “I can’t or won’t pay for the medicines that will help this treatable condition”, in my experience); every time I produce a quote for treatment and watch a client’s face fall; every time I compromise on tests and drugs to try to keep costs down, my soul aches a little.
Over the years, it grinds you down. If you’re lucky, it makes you cynical and hard. If you’re not, you feel it just the same as you always did.
A life without compromise?
I know it’s the way things work, and I know the alternatives have their own problems, but, just for a moment, I’d like you to imagine how your day in practice (the one you just worked or are working right now) would have felt if you could just treat your patients without worrying about the cost.
Would it have been better? More importantly, would you have found it less stressful?
Our daily compromises are contributing to our mental health issues and, probably directly, to the profession’s issues with retention at the moment. I don’t have solutions, because I’m more of a complainer than an innovator, but if we at least acknowledge the problems, I think we’ll be on our way to fixing them.
Leave a Reply