I thought I would take well to emergency work; I’m a night owl, and when animals crashed or bled in general practice I kept my cool and worked logically, but quickly, to discover the problem and fix it – or at least, attempt to.
I had recently left my post as clinical director, and picking up a few emergency locum shifts while I wondered what do to with the rest of my career seemed like it would suit me perfectly.
I wasn’t prepared for how hard the work would be…
The best a pet can get
I had worked open surgeries for a while in my early years, but had spent most of my career working with booked appointments. The shifts in the clinic I was locuming for were, basically, an all-night open surgery where every single appointment was a emergency.
The support staff and colleagues were amazing – inpatients received the best care I had ever seen anywhere, and the wards resembled a human hospital (in the best ways) – but this came with a price: it was very expensive to have a patient admitted for the night, and the emergency practice covered a wide area, covering practices with widely differing client bases.
Chocolate Labrador
Early in the evening I was presented with a young Labrador retriever that had done what any self-respecting young Labrador retriever would do when presented with a large chocolate cake – troughed the lot of it. The dog looked extremely pleased with itself, but the owners were less so – especially when I calculated their pet had easily ingested a toxic dose of theobromine.
They were even less happy when I gave them an estimate for the price of treatment – they couldn’t even afford the vomiting drug, and couldn’t begin to afford the price of hospitalisation, which was in the low four figures.
I was very experienced at working in practice and no stranger to difficult financial situations, but as a locum I had far less leeway than I was used to. I gave the owners some advice about how to try to get their dog to vomit at home, but as they left, the idea I had confirmed their dog had eaten potentially lethal poison, but was unable to do anything about it, didn’t feel like I was helping in the way I had imagined I would when I joined the profession.
.
Same difference
A few hours later, I admitted two cats, one after the other. Both of them were young males, otherwise healthy, but in acute distress – not to mention agony – with urinary tract obstruction.
Now, the practice I was working for had a contract with an animal charity that provided veterinary treatment for people who couldn’t afford it; they would treat charity clients, but they received roughly £6 per case for doing so. One of the cats I admitted was for a paying client – this cat received pre-sedation full haematology, biochemistry and blood gas analysis, and was sedated, catheterised, scanned, given IV fluids and followed up with frequent blood gas analysis, as well as regular checks on renal parameters throughout the night.
The second cat was a charity case. It received pain relief, its bladder was decompressed via a needle, and it was checked throughout the night to make sure its bladder wasn’t filling up again.
Incomparable costs
In the morning, both cats were fine. One had a mid four-figure bill, the other was free to the client and, despite the minimal treatment it had received, probably cost the practice more money to keep in than they earned from the charity.
Now, I’ve avoided writing this blog for a while because, honestly, I’m not sure what conclusions I could draw from that situation, other than it seemed a pretty stark example of… well, of something.
I was a locum at the practice, so didn’t get any follow-up on the patients and whether they re-obstructed. Also, the charity cat never had its renal function tested, so it may have progressed to renal failure from there (although, subjectively, it didn’t appear to have significant renal problems on clinical exam in the morning).
Two-tier service
I suppose this highlighted something that had been a slight concern to me for a while – the increasing appearance of a two-tier veterinary service; those that were insured, or could afford it, and those that weren’t and couldn’t. I’m not really sure how I feel about it, or how unjust it is, but it doesn’t… it doesn’t sit well with me, in a way I find hard to express.
I experience similar discomfort seeing thousands and thousands of pounds spent on a patient at highly specialist practices for orthopaedic conditions, when I have personally worked in practices where pets are suffering greatly for the want of ectoparasiticide treatment.
The amount of suffering that could be relieved overall for the same amount of money as treating that single orthopaedic condition seems somehow obscene, although, however I turn it in my head, I can’t see where any fault lies. Certainly, I have spent large amounts on my own pets in (sadly futile) attempts to help them when things were going badly, and I would do again.
Lesson learned
I tried to express these feelings to a colleague some time ago, who very wisely pointed out that the problems I was trying to solve behind the situations that were giving me discomfort were poverty and inequality, and suggested these were perhaps bigger problems than were within the capacity of a single practitioner to solve.
They were right, of course. Inequality is increasing everywhere, and it’s not the fault of owners (rich or poor) or charities, vet practices or their corporate owners. It’s simply how the world works. But perhaps there is a lesson to take, somehow, from the apparently identical clinical outcomes of two patients with vastly different treatments.
The standard of veterinary care is better than it has ever been, and patients and clients receive a higher quality service than ever before. Simultaneously, veterinary fees are increasing – apparently beyond the capacity of insurance companies to keep up with them. It’s not possible to receive the best quality care without paying for it.
Cut price care?
When your animal needs that care, it really needs it. But, truthfully, quite often, they don’t; unfortunately, it’s not possible to tell which patient needs everything and which will cope with the bare minimum until it’s already too late.
However, if we’re a little more pragmatic, and a little less paranoid, maybe we can afford to be just a little more careful with clients’ or insurance companies’ money. Maybe we can slow the increase of veterinary fees just a little and maybe do a little to reduce inequality in our own corner of the world.
I don’t know. I’m conflicted, confused, vaguely uncomfortable and probably wrong about the whole situation. Your thoughts would be appreciated!
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