Money & Clients: Can We Give Gold Standard Care in a Recession?

The job description of a veterinarian should include financial advisor and salesperson in addition to medical professional. It is rare for an appointment to conclude without some sort of financial discussion occurring first. Whether I am giving an estimate for a dental cleaning, going over the ideal treatment plan for a sick animal, or discussing the cost of routine blood analysis, I am constantly trying to help clients make important financial decisions. With the recent downturn of the economy and the rising number of people who have lost their jobs, the quality of medicine that I can practice is (unfortunately) often dictated by the economic status of my clients.

My initial approach to practicing medicine was the same as I was taught in vet school. Recommend the gold standard for care, both preventative care and treatment of an illness, give an estimate for that care, and wait for the client’s response. Approximately 75% of the time the client can’t afford the treatment plan, with maxed out credit cards and denial of healthcare financing, especially in the case of a seriously ill animal that needs hospitalization. At that point, the conversation can become quite lengthy as I try to reorganize the treatment plan, choosing testing that I think will give us the most “bang for the buck” and/or trying to decide on an empirical treatment approach. While this kind of compromise may not be the ideal medical care for the animal, if the alternative is no treatment or even euthanasia, it is the least I can do to try to meet the realities of the client’s personal situation as well as providing care for their animal. This is where the real art of medicine comes into play.

A dilemma often presents itself when a critically ill patient comes in whose prognosis would most likely be the best if transferred to a 24-hour care facility for monitoring and treatment. The problem for most clients in our area is that both the expense and lack of payment plans at these facilities make it cost prohibitive for them to have their animals treated there. Depending on the illness, the cost for 24 to 48 hours of care at one of these facilities is $3,000-$5,000. Even when the client understands the value of that care and appreciates that it optimizes the chances of a favorable outcome, if they don’t have the financial resources it becomes a moot point.

I struggle with situations like this on a weekly, if not daily, basis. What do you do? Do you recommend euthanasia for the most critically ill patients? Do you offer hospitalization at your own facility, stressing to the client that there is no staffing overnight and that the prognosis may be poor? Do you try to have staff check on the animal several times in the middle of the night?

Every situation has a different set of circumstances surrounding it and decisions are made on an individual basis. I have on occasion even taken patients home with me, as I live 40 minutes away from the hospital and cannot go back to check on them in the middle of the night. Is this the right thing to do or is it at all advisable? When you try to weigh ethical concerns against practical ones, it becomes difficult to say what’s right. All I know is that for some patients I feel like I have to give them a fighting chance and the best way that I can do that, short of transferring them, is to monitor them at my house overnight. This way I can make sure the fluids are running appropriately, treatments are being done, and I can respond to any changes in their condition. In the end, even if the case does not have a good outcome, I can at least sleep at night knowing that we’ve done everything possible within the constraints of the situation. I may become more calloused as I am in practice longer and make it entirely the client’s problem if they can’t afford a treatment plan or transfer, but for now I have to be able to live with the decisions that I make. After all, I did enter this profession to help people help their animals.

In the last year I have brought home 6 animals, with mixed outcomes. The one consistent result is that the clients are eternally grateful, even if the animal ended up dying in my bedroom overnight; it is a comfort to the client that their beloved pet was not alone in a cage at the hospital during its final moments. I hope that I have the judgment to carefully choose which cases I bring home so that I don’t emotionally burn myself out or burden my husband. I am fortunate to have a husband that supports me 100% and takes pride in occasionally being able to help me care for a really sick patient. With motherhood fast approaching, the end to my in-house ICU may be nearing. We will just take it one day and one case at a time.

Have you ever brought an animal home? How do you balance your ethical concerns (doing what’s best for the pet) against practical matters (running the risk of a lawsuit or taking “family time” away from your kids/partner to tend to a sick animal)?