Stuck with a Big Vet Bill?

If you're a regular to my blog, then you are no newbie to the concept of cyberbullying of veterinarians. I had posted recently on how the idea of posting on a Google Review or other online review is considered Freedom of Speech.

But my question is, where is the line drawn between Freedom of Speech and Defamation of Character?

In fact, there are actually restrictions around the concept of Freedom of Speech, such as the Criminal Code and Human Rights violation such as hate speech.

You're allowed to state facts, you're allowed to state your experiences, but slandering an entire population of veterinarians without justification is defamation. Do people think we are doormats? So after defending ourselves against the human cardiologist who knows nothing about how the veterinary profession runs, here, the New York Times is asking for people who have been "Stuck With a Big Vet Bill" to go ahead and tell them all about it.

Click Bait Title

So, here we are yet again... having to defend ourselves against the statement of "Well, if you really loved animals, you would do this for free."

Need I say more about Dr. Shirley Koshi who un-alived herself ten years ago due to online attacks??

Do I need to remind everyone that suicide rates for veterinarians are the highest of any profession?

So let's take a look at the "survey"

If they do go ahead and publish the names of veterinarians, or veterinary clinics, let's make sure we also talk to those clinics and veterinarians to see what services those clients declined. Were those clients long term clients of that veterinary clinic? Were those clients bringing in their pets for wellness examinations to see if we can catch any early signs of disease? Early diagnosis, early treatment, better prognosis.

Only 4% of dogs, 1% of cats have pet insurance in the U.S. (I'm not sure what the stats are in Canada, but likely similar). The best time to get insurance is when your dog or cat is a puppy or kitten. When they are healthy. There are plenty of reviews for pet insurance companies. They will not cover pre-existing conditions. So if you plan to switch insurance companies, make sure you read that fine-print!

Like I said earlier, you better be asking those veterinarians for their side of the story.

It's interesting that the New York Times survey grouped $0 to $999 in one category. Does that infer that if it is less than $1000 it means that it's not extraordinary? Meanwhile, Dr. Levine was complaining about his less than $1000 veterinary bill. Maybe there should be a question about socioeconomic status of the individual paying for the bill.

They then ask for contact information and location of the person.

When we are collecting information for research in veterinary medicine the survey study should include information on the signalment of the individual. This is the species, breed, age, sex and spay/neuter status. This important information is not included in the survey.

It is also important to note what the presenting complaint was for that veterinary visit. This could be Wellness visit, or perhaps they are coming in for Vomiting and Diarrhea, or maybe a subtle Change in Behaviour, they could be limping or having other Mobility issues, or maybe they were having Seizures. Each presenting complaint goes on to a problem list.

When we see the pet, we need to gather more information on the history of the clinical signs the pet owner is seeing. One of the first questions we may ask is what is the duration of the clinical signs prior to taking them to the vet? So Luna isn't feeling well? She's been vomiting for the past 24 hours? How many times has she vomited? What is the contents of the vomit? Are there any other clinical signs? Did she stop eating? What about diarrhea? Did she get into any toxins, garbage, medications including CBD? Is she the type to chew and swallow toys or any non-food items like socks or underwear? What is her regular diet? Does she also get bones or chews? What does her environment look like? Does she go on leash walks, off leash, to dog parks? And so on...

If they have come to an emergency clinic, we're also going to ask them who their primary care veterinarian is and whether they are up-to-date with their vaccinations. Most don't really know the exact date of their previous veterinary visit. Some will say "They have always been healthy" and they have a 13-year-old dog that hasn't seen a veterinarian since they were spayed or neutered. So, now the presenting complaint of Vomiting and Diarrhea is expanding to a problem list of:

• Vomiting

• Diarrhea

• Inappetence

• Lethargy

• Fever or not

• Abdominal pain or not

• Dehydration and its severity

• Periodontal disease grades I through IV

• Obesity or maybe cachexia

• Maybe a heart murmur

• Skin lumps that have or have not changed in years

• Saliva staining on their paws which tells us they have been excessively licking

• Lenticular sclerosis or early cataracts

• Thickening around the stifle joints and maybe some crepitus

Phew! Where do we even start? This senior pet who has not seen a vet in 12 years has a lot of problems!

So, instead, let's say our patient was a young and otherwise healthy dog prior to coming in. It's also afebrile (no fever) and was bouncing around, showing no abdominal pain and not markedly dehydrated, a small bout of dietary indiscretion may be nothing to worry about. But that same happy, bouncy dog could take a turn for the worse if it ingested a piece of a toy.

So, we offer blood work and radiographs (x-rays). Nothing is found on blood work and the x-rays appear unremarkable, but the client now has peace-of-mind that symptomatic treatment is not contraindicated as we have ruled out a intestinal obstruction that would have required surgery.

But, let's say that client didn't have pet insurance and they just had to pay for their own medical bills. We have to tell clients, what I would like to do is blood work and an x-ray, but the likelihood of a foreign body obstruction is low, based on the history that you told me and based on my physical examination. BUT if they have additional vomiting, lethargy, inappetence, any abdominal pain or are not improving, you should bring them back for diagnostics.

Then, there is the young, previously healthy dog that has been vomiting for 3 to 4 days, lethargic, not keeping any food down and now is recumbent. These are the ones that turned out to have eaten a toy 6 days ago but the clients didn't notice that a piece was missing. Symptomatic care would be doing that pet a disservice, but now it's our fault and we are blamed for not saving their animal. While this story is a compilation of stories that we experience as veterinarians, I bet you every seasoned general practice veterinarian is nodding their heads in solidarity.

We want to help. We need to know the answers. It keeps us up at night not being able to solve these problems. It affects our personal relationships between us and our family and friends, partners and children, that we come home distraught that this young, previously healthy animal had to pass. You know who we blame? Ourselves.

I've taken blows from clients in the past, and likely in the future. I tell myself that this is an emotional time for them. I am their verbal punching bag, and this is not due to my negligence or inadequacy as a doctor. They must go through their grieving process.

But you know what I do not want to stand for? The Media and folks on Social Media berating my veterinary colleagues. Saying that veterinary medicine is a scam, when human medical doctors are making about twice the salary of animal medical doctors, with the cardiologists taking home three times the amount of veterinarians.

So, just as Dr. Forbes says, The Times is missing a lot of information from their survey and we look forward to the journalist showing an unbiased view of veterinary care because we do not need any more of your public discourse. We have enough to deal with without them pouring fuel on the fire.