Posts Tagged ‘treatment options’

Reasonable Expectations V: Discussion of All Options Regardless of Cost

October 24, 2010

This is the fifth part of an ongoing series describing how people are developing new expectations when it comes to veterinary care for their pets. Parts one through four can be found at http://www.speakingforspot.com/blog.

Veterinarians wear many different hats when they are in the exam room. It’s a given they provide medical care for their patients. But did you realize that, for their clients they often assume the role of social worker, calendar planner, grief counselor, and even mediator when there are conflicting opinions between family members (mostly spouses)? Why on earth some veterinarians wish to also become financial planners for their clients is beyond me! These are vets who pick and choose which medical and surgical options to discuss based on what they think their clients can afford.

I don’t work this way- I believe in presenting every option that is reasonable for my patient and then letting my client determine what they can and cannot afford. This means that my client will hear all the same options whether he or she arrives at my hospital driving a Mercedes Benz sports car or a jalopy. The American Animal Hospital Association agrees with my modus operandi- they conducted a study documenting that ninety percent of people want their vets to present every option regardless of cost. Please hear what this is saying: it is perfectly reasonable for you to expect discussion of all options for your precious family member regardless of cost!

Let’s consider the example of a torn cruciate ligament. The knee joint contains cruciate ligaments that are responsible for keeping the upper leg bone (femur) in alignment with the lower leg bone (tibia). Cruciate ligament tears commonly occur in large breed dogs and there are several options for treating this injury. The least expensive option is rest and anti-inflammatory medications, the cost of which might be a few hundred dollars over the course of a several months. This nonsurgical least expensive approach restores mobility and use of the leg, but predictably results in arthritis within the knee and chronic lameness. The most expensive option is one of two highly specialized surgical techniques (referred to as TPLO and TTA) performed by board certified veterinary surgical specialists. Such surgery is the very best bet for restoring complete lifelong soundness to the knee. Depending on where the dog lives (everything is more expensive in California!) the cost for this surgery is $3,000-$4,000. Tack on post-operative rehabilitation therapy (on an underwater treadmill) and add another $500-$1,000 to your bill. The “in between options” include various surgical procedures that many general practitioners perform. While they are less expensive ($1,000 to $2,000) such surgery is less likely to result in an arthritis-free knee. Treatment of cruciate ligament disease is a clear example of, “You get what you pay for.”

Now there are a number of factors to consider when determining the best treatment option for a torn cruciate ligament. Perhaps the dog is ancient and debilitated and the risk for general anesthesia and surgery is too great. Perhaps there are other medical issues that are likely to be life ending soon- in this situation it would be irresponsible to choose surgery. There are many factors to consider, and finances may be one of them. But how would you feel if discussion of medical therapy for your dog’s cruciate ligament tear was purposefully withheld because your vet assumed you could afford surgery? Likewise, what if there was no discussion of referral to a surgical specialist because your vet felt it would be too much of a financial stretch for you? Do you want your veterinarian to be your financial planner or would you prefer to hear about all the options, then decide for yourself? Let me know how you feel about this. By the way, it might be wise to let your own veterinarian know as well!

Now here’s wishing you and your four-legged family members abundant good health.  

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of  Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association 2009 Animal Welfare and Humane Ethics Award
Recipient, 2009 Dog Writers Association of America Award for Best Blog
Recipient, 2009 Eukanuba Canine Health Award
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Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller. 

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