Lessons from the veterinary clinic

The patient

The world of human health care could learn a thing or two from veterinary medicine.

I’ve been a veterinary client for many years and can’t help noticing the many areas in which veterinary medicine is such an effective model.

There are the small things: For instance, I’ve never had to wonder when my cat’s vaccinations are due because a reminder postcard arrives in the mail every single year. It’s rarely difficult to get an appointment or to have the veterinarian return a phone call, and test results are reported promptly, often on the same day. Even the parking at veterinary clinics is usually easy – a real convenience when you’re trying to juggle a cat in a carrier or a dog on a leash.

In the bigger picture, veterinary medicine seems better at managing costs, perhaps because pet owners are footing most of the bill themselves. Dr. Patty Khuly, a Florida veterinarian who blogs at Dolittler, gave her perspective on the cost curve in a recent post:

… When vets and clients know how much everything costs, and when everyone’s a stakeholder in the cost conservation game, smarter decisions get made.

Add to this the fact that 17% of our hospitals’ costs don’t need to go to the billing department for arcane code translation and chronic insurance carrier disputes and you’ve got a recipe for an automatically slimmer, less wasteful system.

Nor does the veterinary insurance market operate the same way as health insurance for humans, Dr. Khuly points out:

I’ll also agree that giving consumers a choice in their election of insurance carriers and plans makes a big difference to the viability of the system. Unlike our human system, for which individuals are effectively forced into one company’s plan by their employers, pet health insurance offers multiple carriers with multiple plans any owner can choose based on its merits and their personal level of risk aversion.

There’s none of the cost-shifting that takes place in the human health care world. There’s also a higher degree of transparency about prices, making it easier for clients to shop and compare and to know how much they’re likely to pay, whether it’s for routine vaccination or a complicated surgery .

To be sure, the veterinary world has seen much of the same run-up in technology and specialized services as in human health care (but without the medical arms race that has left some communities with a cardiac catheterization lab on practically every corner). You can get CT, MRI or ultrasound imaging for your pet. There’s oncology for pets, orthopedic surgery for pets and physical therapy for pets. Some veterinary clinics even have adopted electronic health records with an online portal, as Josh Seidman of the Information Therapy Center describes in a blog post about his dog, Molly, and the canine-centered care she receives.

None of this is necessarily a bad thing. It means we now have options for treating diseases and injuries that previously would have been considered untreatable. The only limitations, in fact, are the size of the owner’s bank account and his or her perception of the risks vs. the benefits.

While the money Americans spend on veterinary care is growing at the same rate as our spending on our own health, it doesn’t match the cost of the human health care system, a blogger with the American Enterprise Institute points out:

… We spend hundreds of times more on ourselves than on our pets. The main reason for this is obvious: We value our own lives and those of our families more than we do our pets or other animals. At the same time, however, veterinary care is one of the few areas of health where we are directly confronted with difficult decisions regarding the costs and benefits of additional treatments.

I don’t think we’d want to apply such stark values to our own health care decision-making. After all, pets and people are not the same thing. But we’re often unaware of how much our health care costs, nor do we always make the connection between spending and outcomes- and perhaps we should.

I recently had the chance to see this whole system at work, up close and personal. My cat wasn’t feeling well so we made an appointment at our local veterinary clinic, the equivalent of my cat’s medical home for all her primary care needs. An ultrasound exam was recommended, which meant we’d need a referral to a larger facility.

I researched the options online and chose Metropolitan Veterinary Referral Services in Eden Prairie. I’m very glad I did. It’s a practice that specializes in internal medicine for dogs and cats, with advanced services such as oncology, cardiology, gastroenterology, surgery, and diagnostic imaging and evaluations. They have an intensive care unit staffed 24 hours a day; they also provide around-the-clock emergency care. It sounds high-tech and indeed it was high-tech, yet the place had the atmosphere of a neighborhood clinic. The care was patient- and family-centered, two hallmarks of quality in the world of people care.

When my cat’s ultrasound exam indicated we needed to do a biopsy, I promptly received an itemized estimate of what the whole package was likely to cost:

(The final bill, by the way, fell almost exactly in the middle of this estimate. Try getting cost information this accurate and straightforward from a medical clinic or hospital.) It was a real exercise in the true cost of care and the need to weigh that cost against the likely benefit to the patient.

These are some of the practical lessons to be learned from the veterinary clinic. Other lessons are harder to categorize.

How do we make health care decisions, especially when our decisions are on behalf of someone else? Are we able to separate our emotions from the patient’s best interests? Do we react in knee-jerk fashion or do we try to gather information and see the big picture?

What is the value of kindness and compassion? Providers can’t bill for it, and technically speaking, it has nothing to do with outcomes – yet it matters, especially when the patient is very sick or the prognosis is uncertain.

What do we want for the end of life? Do we want to exhaust all the options in search of a cure or do we believe it’s more important to focus on quality of life? Thinking about it ahead of time, before there’s a crisis, can give us a better chance of clarifying what’s important to us and making good decisions.

Finally, here’s the last lesson: Sometimes the story doesn’t turn out the way we want it to. Some diseases can’t be stopped, no matter how much money or how much treatment we throw at them. When that happens, we have to recognize it and let the patient go, knowing that life is something that’s only borrowed and one day we have to give it back.

Photos by Anne Polta

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