Thursday, January 8, 2009

no good deed...

last night a little wrinkled old man showed up at the clinic clutching a small (but fat) dog in his arms. the note from his regular vet said that the dog was anemic. how anemic? her PCV was 8. she had water for blood. all of the signs pointed toward immune-mediated hemolytic anemia, a disease i have discussed before. the typical cost of an IMHA diagnosis and treatment is $2000-2500. the patients require extensive testing, blood typing, crossmatching, and transfusions. even a "discount" IMHA (no testing, treat presumptively based on blood smear and some other cheap tests) is going to run $1000-1500.

this little man lives on a fixed income of $847 per month. he has no other money. he is little and would fit in my pocket. he reeks of friendly alcohol, cigarettes, and wears a fedora. he tells me that this little dog is his best friend in the world and tears up at the thought that she might die.

we spend a great deal of time discussing how dire her condition is. she requires a blood transfusion, which costs $250. she requires immunosuppressive drugs like prednisone and aziathioprine. she also needs aspirin and famotidine and doxycycline.

my soft-hearted technician volunteers to bring in her own dog and do a discounted transfusion for $100. while i hesitated (if we extend the discount to one - why not to all?), in the end - that is the course we pursued. the owner went to walgreens and spent $40 on the needed prescriptions (versus well over $100 at our clinic).

little dog gets her transfusion, as well as her medications and one night of ICU for the bargain of $500. after her transfusion, her PCV jumped from 8 to 22%. she perked up, her gums turned pink, and she ate a whole can of food with gusto.

i came to work tonight, and she was doing better. she had eaten all day, and she was pinker. unfortunately, with fluids - her PCV had dropped to around 13. that drop was likely due to her ongoing IMHA (it takes a minimum of 48 hours for the drugs to start working and sometimes longer) and the fact that she was receiving IV fluids.

we were out of money. she couldn't stay another night in the hospital without incurring a $210 charge the owner could not afford.

and so i sent her home.

but not before getting into a loud and extremely unprofessional (on the parts of all involved) argument with my senior clinician.

you see...our clinic gives away services all too often. we see these little old men and their best friends, or the young, engaged couple with no money and a puppy dying of parvo, or the financially strapped family with a hit by car dog, and they just don't have the finances to repair the beloved family pet. it breaks my heart. it breaks the heart of my intern-mates and senior doctors. we want to help. we really and truly do. and so we bend the charges here and there. knock off an hour of anesthesia for a surgery (a whopping $100). and an animal receives care and goes on to live another day.

the problem? there is no consistent standard. some people receive services much cheaper than others. and i'll be entirely honest - it has a lot to do with how the person treats my technicians, the front desk, and me. if they are respectful and understand the necessity of charging for the services we offer, i am much more likely to check the good samaritan box for drugs, slip them some subcutaneous fluids, or knock an ICU level 2 charge down to an ICU level 1.

but i've decided i'm finished with that. after the argument that ensued tonight, where i was accused of trying to make an example of a little old man, i decided that from now on, i charge for my services. if people can't afford to do what needs to be done, then i do what they can afford, and the rest is up to god or buddha or whoever.

after all, if i tried to run a veterinary business based on charity - i would quickly be bankrupt.

it may sound harsh, but tonight - in that position - i realized that it must be this way, else the system breaks down.



Barb said...

Wow how strange coming after your previous post. I was in the ER with my pet 3 times last year (~$7K -good thing for credit cards). I saw some elderly clients and I thought about them on their fixed incomes. What goes around comes around...

Superior Parrot said...

I understand completely. But I'm willing to bet good recession money that once in awhile you'll bend a little here and just a tad there. I suspect your conscience wouldn't let you do otherwise. ;-)

Life in vet school said...

I'm confused -- did your senior clinician think you should have helped the little old man more, or helped him less? Were you accused of comping too much, or not enough?

Sucky situation. Wouldn't it be nice to be a billionaire and be able to donate veterinary care for everyone who walks in your door and loves their pet and doesn't have enough money?