5 things medicine can learn from veterinary care

Over the last few years I’ve had numerous encounters with vets and vet hospitals. Domino, the dog that we had since I was in medical school, was sadly very sick. He was a Jack Russell-Corgi cross, black and white, with the loveliest sweetest nature. He lived till almost 13-years-old, bringing an immense amount of joy to our whole family. Sadly, he passed away last summer. My parents felt a huge gap in their lives and quickly realized that they had to get another dog to replace the loss. Sure enough, soon a new puppy was running around the house. Deeno looks very similar to Domino, and we got him when he was about six-weeks-old. He’s great for my parents and keeps them entertained and exercising. Growing up, we had always had cats at home, but dogs are of course very different in terms of the time and devotion that they require (and also the devotion they give back).

Unfortunately, Deeno was involved in a car accident only a few months after we got him and was rushed to our vet hospital in Uxbridge, England. It seemed like he had suffered a major injury at first, but over the next several weeks with some TLC and regular checkups with our vet, he thankfully made a full recovery and was soon back to his perky self.

So in a short space of time we’ve had more than our fair share of encounters with veterinary care. I have to say that I’m embarrassed sometimes when I observe how veterinary medicine works compared to human medicine. Although my experiences have been on my trips back to England, from what I hear from people I’ve talked to in the United States, the same appears to be true here. Here are 5 of my observations:

1. All the vets I’ve met have a palpable sense of love and caring for animals. Although doctors are among the most dedicated professionals you could ever meet, I’ve found the sense of caring and compassion amongst vets to be at times overwhelming. They really like animals! True, animals are more innocent, and can’t answer back or argue with you — but it’s something to think about in our profession. The same goes for veterinary nurses, who are the unsung heroes of animal hospitals, quietly working in the background to nurse your pet.

2. Keeping their owners updated at all times. When Domino was unwell and had a major operation, we would receive regular phone calls updating us about his progress while he was in hospital. Rarely did we ever have to initiate that call ourselves. The nurses knew how concerned we were and would keep us updated. We would also know exactly what times he was receiving his medications and what times his scans and tests were.

3. Welcoming customer service environment. From the receptionist all the way through to the vet themselves, the whole experience was welcoming and friendly. Never once did we feel like an afterthought or that we weren’t listened to. Some lessons here for human health care?

4. Specialist coordination. Again, when Domino was unwell, our own vet would have to coordinate with the other specialists that he was also seeing. At every visit, he was fully up to date with the latest developments. All of the records and images were either faxed over or emailed to him. He also had easy access to talk directly with the other specialists involved in his care. How many times in human health care do we encounter scenarios involving mixed messages and different doctors not being on the same page?

5. Time spent with each patient. Perhaps the most striking aspect of veterinary care is the time that the vets spent with us and our dog. We never felt rushed or pressured as the vet explained everything to us, went over any scans, or talked us through treatment options. This despite having dozens of pets of all shapes and sizes lined up in the waiting room.

These are just five of my own observations. Perhaps we were lucky having access to such excellent veterinary care, but nevertheless some of the contrasts hit close to home. The other side of the argument is that vets operate in a free market environment that is very different from medicine, and don’t have a lot of the headaches that doctors do — such as medico-legal risk, insurance bureaucracy (although we do have insurance for our dog), and political pressure to reach certain benchmarks.

Vets could counter this by saying that their profession is harder in many ways, because similar to being a pediatrician, emotions are high as owners know that their pets can’t talk for themselves. Vets also care for dozens of different animals with very different anatomies. Without getting into a debate about which profession is harder, veterinary medicine almost certainly has something to teach hospitals and doctors. I couldn’t help thinking how lucky my dog was to be in the hands of such great care when he needed help.

Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being.  He blogs at his self-titled site, Suneel Dhand.

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  • Dr. Drake Ramoray

    Do vets use government mandated EMR systems, have to submit prior authorizations, have their reimbursement cut by CMS facilitating the need to see more patients, how’s med mal in veterinary medicine? Does your vet have to submit PQRS data. I think there a lot of things we can learn from vet medicine, just like their are a lot of things vet medicine can learn not to do from us.

    This post actually points out quite vividly how healthcare could be provided via direct pay, although it is only mentioned in passing at the end of the article.

    • Lisa

      Some random thoughts:

      Vets make less money than MDs, say my friends who are vets.

      Vets may not have to submit prior authorizations to insurance companies, but they do have to discuss cost issues with pet owners, who for the most part do not carry insurance for their pets.

      Also, veterinary medicine allows euthanasia. I always say we are kinder to our pets than our elders.

      • Dr. Drake Ramoray

        My direct pay plan suggests I will make quite a bit less money than my current income. Costs will be posted and known ahead of time. They will be lower than what people are charged at the hospital (often times even after insurance settles the bill) I’m happy to make that trade to not have to deal with insurance paperwork and spend more time with patients.

        • Lisa

          Some advocats of direct pay practices indicate that such practices will enable doctors to maintain or even increase their income.

          I suspect your plan is more realistic. And it is a trade off – the possiblity of lower income versus a lower stress practice.

        • Lisa

          I wasn’t bringing up euthansia in relation to your practice, but in relation to medicine as a whole.

          • Dr. Drake Ramoray

            Understood. Like all analogies vet vs MD isn’t perfect

    • Jewel Markess

      According to google, the average vet salary is about 70K a year, much less than what doctors make.

      As Lisa said – vets need to discuss costs upfront and then if people cannot afford something figure out alternatives. Given that vets do care for pets yet can’t afford to treat for free, I’d imagine dealing with people who can’t pay for treatable conditions must cause a lot of stress.

      Additionally, most human patients don’t try to bite or scratch them.

    • HJ

      My dog developed a lump. It was six months before we got it evaluated during an appointment for shots. We knew if it was cancer, we wouldn’t treat him. This is how my care would be with direct pay.

      • Dr. Drake Ramoray

        Im not suggesting direct pay oncology, nor do I think it a direct pay system at this point is feasible for a national system. My plan is a direct pay thyroid only practice. The medications uses are relatively inexpensive (generic levothyroxine is $4. Methimazole is $30-40 a month. have seen insurance bills to patients for 2-3x what my office gets paid now (this is the patient’s responsibility after insurance). $200 vs. $554 after facility fees. I get paid $4-500 for nuc med treatments. $1200-$1400 at the hospital.

        If someone needs surgery they are gonna have to go somewhere else anyway even under our current system. The acadamic centers that I use frequently for surgery often have indigent care programs. I don’t plan to solve the national health crisis, I plan to provide the best service for my patients for specific conditions of which I am one of only about 6000 docs practicing in the Endo specialty. Sure, I will make less money, but I will provide more personalized care and get to watch my children grow up.

        I have seen insurance bills to patients for 2-3x what my office gets paid now (this is the patient’s responsibility after insurance). $200 vs. $554 after facility fees. I get paid $3-400 for nuc med studies. $1200-$1400 at the hospital (again facility fees). I get paid $47 for a DXA. At the hospital almost $200.

        I didn’t sign up to be a physiican to be an algorithm following billing scribe for the hospital and grovel at the feet of insurance companies to get reimbursed.

        • HJ

          So the scenario isn’t what it would be like with direct care?

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    I’m pretty sure we are moving towards the veterinary model of care in human medicine. Only it’s not the pampered pet veterinary medicine in the suburbs. It’s the agricultural veterinary model.

  • DeceasedMD

    I agree with this article. I had a dog that survived three cancers who lived well beyond what he would have without treatment. And the vets involved at a top vet school in the country were very professional and caring. Their data is somewhat limited but it worked wonders for our dog. But wow was it ever expensive. I soon became jealous of the dog as I know no person would ever get that kind of attention here. But the buildings are a lot nicer for humans and they always have grand pianos in the lobby. And sadly, people are impressed with that.

  • John C. Key MD

    Ah yes, vets. A part of my life for 60 years. General practice and specialists. Before we wax poetic on them, it may be well to remember:

    1. They make a LOT of money. The line that docs are better paid ‘taint necessarily so.

    2, They use a LOT of steroids.

    3, They use a LOT of antibiotics

    4. They miss a lot of diagnoses.

    5. They can be great communicators; others, not so much.

    MD, DO, NP, PA, DC Some are wonderful, others not. Kind of like human physicians.

    As usual Dr Ramoray’s comments are cogent. Please don’t move to New Zealand.

  • ninguem

    Kramer would agree with you.

    http://www.youtube.com/watch?v=wXeV5cqb_3Y

  • guest

    Aaaaand, the number one thing that medicine can learn from veterinary care? Cash-only practices work better for the patients.

    Also, I don’t know about all vets being the paragons described above. We had to fire our current vet after one too many visit that involved blatant upselling of services: “You know, this GI ailment really could be cancer, you should do an ultrasound for $400 to rule it out. And you really should do the bloodwork under general anesthesia, it’s more humane for your cat and only $500 more…”

    • DeceasedMD

      There are definitely bad vets and costly. Many except at teaching hospitals are not terribly good at being astute diagnosticians as previously stated. And agree that like medicine many do take advantage in the way you are describing with worthless testing. But the hospital experience my dog had was way ahead of any human hospital at one of the top vet schools. No fancy equipment or buildings, just good care.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    Wow, great article! I have been saying the same thing for years! My wife shows & breeds Pugs and we have a lot of experience with vets. Sadly, I think some of the people commenting on this article missed the key point of your article. Yes, vets don’t have the same legal / insurance worries, but that is not the point. Your article focuses on key interpersonal and logistical elements such as loving care, friendly staff, care coordination and keeping patients updated. These characteristics should be part of every HUMAN practice. Also, our vets do an outstanding job of educating patients. I teach patient communication skills and some of my best tips I received from my vets! You rock!

  • itasara

    I spent the last two years taking care of the best dog I have ever had. At age 12 she was suddently unable to walk or stand using her back end. Vet suggested MRI, neuro specialist, and at over $2000 we declined. I nursed her, kept her going until she ran into a problem at age 14 this past May. It was not easy but she adapted as did we. I had two home health vets over a periode of several years which when we had 4 cats and the dog was a great convenience. It was expensive. I had to made decisions based on cost. I have two senior cats now. One has hyperthyroidism, kidney disease, high blood pressure the other has kidney disease and anemia and is not doing all that well. Some vets in town belong to an organization and I find those vets tend to charge about the same amount and go “by the book” when it comes to diagnosis and treatment. Other vets tend to be a little more independent in their pricing and how they approach different illness situations. Just this month with the two cats I have spent about $400 or When the dog was alive each visit if we did blood tests was another $300 and more if the vet saw the cats at the same time. This doesn’t count the expensive low kidney diet and medications, etc. I have stayed away from heroics. I learned that a prescription that is the same for pets and adults can be gotten at a much lesser costs by calling around. So far I had the best results at Walmart. However, some vets insist on dispensing the drugs themselves and can cost much more. So although vets may be a little less expensive than human care, the price is going up. I wonder how those with many pets and low incomes can possibly take care of their pets. I tried not to do heroics and a lot does depend on the cost. My daughter’s dog with its pica costs (us) $7000 to save its life! with two surgeries. She paid a little but we ended up with the bulk of it. There is a lot more politics and costs involved with humans. I find lately that money is at the root of everything and the patient is not the highest consideration especially when it comes to drugs and insurance companies. Medidine is changing and I don’t like what I see.

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