Sunday, July 31, 2005

Better Care for Animals than Humans?

The below comes in from daughter Eleanor who teaches philosophy at the University of the Pacific in Stockton, California.

She has asked me on occasion to explain the vast difference between animal health care and human health care and so far I haven’t come up with anything very convincing. Perhaps someone who reads this can help.

George is Eleanor’s ex-husband. Auggie is her cat.

“If I ever get seriously ill, I don't want to go to Stanford or any of the big (or little) hospitals, I want to get taken to U.C. Davis Vet hospital. I really think it would be informative if someone would study the differences in animal and human medical care. My animals get VASTLY better care than I do, and it costs pennies on the human health care dollar. Why? The science, surely, is no better. The instruments are the same. Ok, surgery on cats and dogs is easier because they have better immune systems than we do so don't need as much in the way of sterile environment. But surgery is the least of it.

I know I have told you the story of George's laceration and stitches (six inch gash, down to fascia, twenty or more stitches, nine hours in the ER waiting room, four more in a treatment room, bill totaling more than fifteen hundred dollars that took eight months to settle - even though we had perfectly adequate insurance and all the information was given twice at the emergency room.) vs. Barney (the horse)'s two inch gash, which from injury to treatment took 45 minutes, the doc came to us, brought the prescription, took payment and gave him treats and cost $120 which got paid right then. Oh and the Doc Lindstrom talked to me and was much more informative than the ER doc.

Auggie's experience at Davis convinces me that I am going to re-register as a non-specific primate. I am comparing it to George's experience at Stanford Hospital when he had the really bad migraine, or the urinary tract blockage, or the colonoscopy. First, the med students at Davis are much, much better. More respectful, better listeners, ask better questions, and are genuinely interested in your understanding what is going on. Second the Docs are also better in the same ways - and at Davis they seem less stressed, they seem to be able to take the time necessary to diagnose, treat and advise. Third - the treatment is just as high tech and based on cutting edge science.

Fourth, Davis vet hospital is WAY less expensive. Try getting in and out of Stanford medical center (and seeing someone with letters after their name) for less than $800. I'll bet no one has ever done it in this century. Oh, and the Davis doc has called me every day (except Sunday) since we were there to check on Auggie. My local vet calls every three days or so. Who was that guy at Stanford? We never heard from him again. We never heard from our GP either - and that was a small town operation and we were friendly with the doc. At Davis we did a biopsy and got test results within the hour. Try THAT at Stanford. When we asked a question the med student couldn't answer - she WENT AND GOT HER TEXTBOOK and a medical dictionary and helped us look up the info. I'm pretty sure no first year resident has ever done that. All in all the Veterinary medicine people are just more human, at the same time that they are more efficient.

What makes the difference? Surely the quality of person who goes into Vet medicine can't be that much better. I suspect that the root of the difference is cultural. Vet residents aren't chronically sleep deprived for years. They aren't socialized to view the patients as "the enemy." They learn to do all the basic stuff themselves, and aren't ever encouraged to think that they are "gods" or that they are above any of the routine tasks of medical care (drawing blood, looking at fecal samples, giving shots.) I suspect the hospitals are better managed too, maybe because the people are just more easy-going - having had enough sleep and normal egos. The Davis folks are also very conscious about being "slow" compared to their local counterparts ("Sorry it is taking so long (after an hour and a half) we have to do everything just right according to the protocols. And it takes some time to get everything set up and all the people in place"). I think they don't make very many mistakes.

Of course veterinary medicine is fee for service, and a lot of animals don't get the care we would expect to provide for people. But even "low end" vets WOULD do (and do well) more sophisticated treatment on a routine basis if their clients could or would pay for it. Maybe very little in the way of malpractice litigation has something to do with it - although I doubt it – horse people sue over stuff at the drop of a hat, and horse vets are still quite reasonable, and the Davis equine facility is just like the rest of the hospital. I can't help but suspect that the lack of insurance infrastructure decreases costs a whole heck of a lot though. And since the fact of the matter is that poor people DO get less and worse medical care than rich people, maybe we should stop pretending that everyone gets the same, establish an acceptable/affordable universal minimum and just resign ourselves to the fact that some people can afford to have more done for them when they are sick.

It would be great if someone would do a study to compare U.C.
Davis with some people-teaching hospital. Maybe they could compare that to hospice operations as another comparable operation (much more human...maybe due to the absence of doctors?) Who knows, we might learn something.

I'll tell you one thing, if I could count on getting care as good as Auggie's, the prospect of getting cancer, or some other horrible disease, wouldn't be nearly as scary. Remind me again, what is the purpose of human medicine? Everybody I've encountered seems pretty clear on the purpose of veterinary medicine. Maybe that's the difference.”

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