Tuesday, March 29, 2011

We Provide Genuine Care and Compassion (While Deliberately Running Up Your Bill?)

This is going to be kind of a Part 2 for anyone who read my post last month on overvaccination in companion animals. I want to point out that I write these sorts of posts not to indiscriminately criticize my own profession. On the contrary, I think highly of my occupation and therefore believe it should conduct itself to be above the occupation of highway robbery.

Please, allow me to illustrate.

Recently, a relative of mine who lives in another state contacted me to ask whether her dog's vet visit seemed "odd" to me. She had taken her 6 year old (Katrina rescue!) dog in for a routine physical exam and vaccines, and left shortly thereafter with an $800+ bill. Naturally my first thought was, "Was there a medical problem detected? A disease diagnosis? A mass biopsied? Radiographs? A minor surgery?" Nope, apparently the dog had a minor ear infection, and was otherwise perfectly normal. Based on my own experiences, I didn't believe this bill was possible for a practically uneventful check-up, until my relative sent me the itemized invoice.

Here are just a few of the things that I indeed found "odd":

1.) $38 for a coronavirus vaccine. Two additional, separate charges of $28 and $26 were listed for parvovirus and DHLP, respectively. The fact that a combination vaccine containing all of these can be purchased from the distributor for approximately $5 cost to the vet is not even the oddest thing (although $5 to $92 is quite the mark-up in my opinion). The oddest thing is that coronavirus is known to cause illness only in puppies under 6 weeks of age, and even then only mild signs, i.e. there is no medical reason to give this vaccine to an adult dog. Even if it was given as part of a DHLPPC combo shot, why would one charge a separate fee for it, let alone one that is higher than that for the "functional" vaccine components?

2.) $89 for subcutaneous fluids. (Again, quite the mark-up considering even an entire liter only costs about $3 to the veterinarian). And now you're of course asking, why fluids??? Because her dog had been "taken to the back" for its vaccines, she wasn't even aware these fluids had been given until the dog returned. When she asked why they'd been given, a veterinary staffer told her it was to "dilute out" the effects of having so many vaccines at once. I cannot speculate (and have yet to find another vet who can speculate) as to how this bizarre protocol could be medically feasible. Please contact me if you have an idea!

3.) $38 for each ear when they did the ear cytology. The dog was then prescribed both oral and topical medications for the minor ear infection. Based on the recurring motif of superfluity, I have a feeling the topical alone would have sufficed...

4.) The 6 year old dog with no clinical signs then had full bloodwork performed. Perhaps they're going to do another senior screen next year when she turns 7?

5.) Special prescription diet. Even though there were no other clinical or bloodwork abnormalities, she was told the dog needed this because cholesterol was mildly elevated on bloodwork. It is normal that cholesterol can be elevated in a dog's blood for up to 10 hours post-prandial and dogs are not at risk for the cardiac problems/atherosclerosis strongly associated with high cholesterol in people. In the absence of other bloodwork or clinical abnormalities, high cholesterol in dogs is not considered a concerning or relevant finding.

Clients should know that, unlike human doctors, many veterinarians are paid based on their production. A veterinarian interviewing for a job at an animal hospital might be asked, "What is your average invoice at your current job?" Actually, this was directly asked of me in an interview. And although that particular veterinary business was sure to ask about invoices and the like, throughout their whole extensive interview process, they never once asked for character references or references from a previous job. Go figure. What is your average invoice? I would have been less put off by some over-the-top, pretentious quiz of useless knowledge, like "How many glycosylation sites are present on a molecule of Antithrombin III?" (The answer is 4, by the way.)

The following questions should help bring to light the difference between medicine and business:
Do you go to a human physician for vaccines every year of your life? Do people who vomit a couple times or have a bout of diarrhea head to the hospital and have mutliple diagnostic tests performed to determine the exact specific cause? Do apparently healthy children have bloodwork performed on them every year? Do you take a regular prophylactic for diseases that are not endemic to your geographic area?

The moral of the story (how annoying is it that I always have a moral?) is that more expensive vet care does not necessarily mean better care. In fact, some of the "extras" may instead put your pet at greater risk. My advice is this: if you ever feel suspicious that a veterinary hospital is exposing your animal to unnecessary vaccines, medications or stressors for the sake of "production" or because it's part of a hospital routine, I would encourage you to ask them for an in-depth medical justification, as it pertains to your animal.  "We're doing this to prevent____" shouldn't cut it.

If a veterinarian ever becomes defensive in the face of such questions, just ask them how many glycosylation sites are present on a molecule of Antithrombin III. They'll probably wonder if you're someone with medical discernment ability...and your bill might go down regardless!

Remember...productive veterinary business, despite all its bravado for being thorough and leaving no stone unturned, is not interchangeable with good veterinary medicine. Make sure you're paying for time with an honest, intelligent, compassionate professional and not paying predominantly for the hospital's fancy lobby skylights or a state-of-the-art treatment room, where your animal might be manhandled while you wait in the exam room. Believe me, it happens.

A wish for your tomorrow.

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