In 1967 I was given a bound volume of the monthly journal “Animal World” which was the publication of the Society for the Prevention of Cruelty to Animals before it was granted royal Patronage by Queen Victoria in 1840. The book contained the monthly publications of 1837. The back page was devoted to advertisements for worming powders, wound dressings, and various tonic pills, potions and tinctures. At the top of the page was an advert placed by Mr Harrison of Harrow Road, North London, a veterinary surgeon offering his services at five shillings (25p) for a consultation as well as visits at five shillings per mile or part thereof.
Over one hundred and thirty years later, our veterinary practice in Woking, Surrey, was charging 7/6d (37½p) for a consultation. How times have changed. Modern pet animal practices beyond London now charge between £20 and £30 for an initial consultation. It grieves me to say that, after40 years in the veterinary profession and being retired for more than 19 years, I am increasingly ashamed of my past profession in which I took so much pride.
This feeling of shame is not simply the result of the exorbitant fees being charged on entering the consulting room. It is far more the quality of general veterinary practice commonly found in Britain today.
The vets of today have not been taught to take a history of the case, use their hands, eyes, nose and simple intelligence. Most cases apparently require a range of laboratory diagnostic tests such as blood analysis, ultrasound investigation, X-rays, ECG and possibly an MRI before being referred to a ‘specialist’ practice for further investigation. These have the effect of increasing the cost of a visit to the vets to exponential levels.
A simple example may explain the problem in practical terms.
By the late 90s I was taking a less active role in the practice, maintaining the paperwork and working part time as a consulting vet. One morning when I arrived to take a morning surgery, I was walking through the hospital area when I noticed a lively Springer spaniel in one of the kennels.
“What’s the Springer in for, Vicky?” I asked my theatre nurse.
“Tests,” she replied.
“The lot. Andrew has brought it in for everything — full blood workup, biochemistry, ECG, ultrasound and X-rays.”
Andrew was our latest assistant, three years qualified, who had the potential to be a good vet, but he was still at the learning stage. Not being too happy with this shotgun approach, I decided to discuss it with him after morning surgery. He was just finishing up his notes of the morning session when I joined him in the consulting room.
“I see you have got that Springer in for tests,” I said. “What’s wrong with it?”
“I don’t know so I brought it in for testing.”
“What are the symptoms?”
“Well, the owner said he was not well.”
“Was it eating? Had it been sick? Any cough? Has it got a temperature? Were its tonsils enlarged?”
All these questions were answered in a quiet, apologetic voice with the words “Don’t know.”
Not only had he failed to get a history, he had failed to carry out any of the simplest examinations preferring to let the laboratory do the work for him. It wasn’t his fault, he had not been taught properly. Many recent veterinary graduates have become scientifically lazy and seem happy to leave the process of diagnosis to the laboratory technicians.
He had never learnt the adage that “laboratory tests do not make a diagnosis; they are there to confirm or deny a diagnosis.” We may be entering the age of robotic surgery but we were still a long way from robotic diagnosis.
Don’t get me wrong. I have the highest admiration for some of the surgical skills demonstrated by very talented veterinary surgeons on the television but I occasionally question the justification of such miracles of the surgical art. Are they in the best interest of the patient? Not the client, the patient.
A case in point was brought home to me a four years ago after we had moved down to a Somerset village to be closer to grandchildren. Word got about that I was a retired vet and a few local people asked me for occasional advice. On most occasions my recommendations would be to take the patient to the nearest vet. On others I was able to offer simple first aid home treatment without the need for costly professional intervention. However, one afternoon I got a phone call from a member of the community to say an old age pensioner was in a distressed state about some advice she had received from her vet.
The 80-year-old widow had taken her 14-year-old Labrador, Goldie, to a local vet for her annual booster vaccination. (This in itself is unnecessary as dogs of such an age rarely require boosters.) Goldie suffers osteoarthritis in both elbows, right knee and both hips. Nevertheless, she can potter down the lane with her owner, she eats well, and she is happy. Despite this, the vet strongly recommended to her owner she should spend over £6000 on bilateral hip replacements.
This dog was the widow’s ‘baby’. She would do anything for her and was in tears while seriously contemplating taking out a second mortgage to pay for the surgery. The word got around the village and someone asked me to visit Goldie and discuss the proposed surgery with her owner. It took me over an hour to explain that, at Goldie’s age, it would probably take at least nine months to recover from the surgery during which time she would be in considerable discomfort if not outright pain. Even if she recovered, she would still have the arthritic elbows and knee.
I am happy to say that Goldie was not subjected to the surgery and was one of the few patients that died quietly in her sleep two years later rather that needing the ultimate kindness of euthanasia.
There are perfectly valid reasons for the relentless increase in veterinary fees. The cost of living itself continues to rise. The market for veterinary drugs and appliances is far smaller than its medical counterpart while large variation in the size of veterinary patients creates increased costs. Most adult humans fall into a limited size range while replacement hip prostheses for the veterinary profession must cater for both an Irish Wolfhound and a Chihuahua. Similarly a couple of different sizes and concentrations of a medication will cover most human needs but there needs to be a much wider range of penicillin medication to treat a small kitten and an adult bull mastiff.
Veterinary patients are demanding. They may see an elaborate surgical procedure performed on the television and demand that their pet receive similar treatment. Have you noticed that these televised veterinary programs rarely, if ever, mention the cost? It is left to the general practitioner to convey the bad news and then suffers a tongue-lashing for being a “typically greedy vet.”
Cancer therapy is a case in point. In 1994 our year had its 30th anniversary reunion at the vet school. I can remember the pride with which the clinical director, showed off the new oncology suite which offered almost every conceivable form of cancer therapy. He related the case of one 10-year-old greyhound which had suffered an aggressive osteosarcoma (bone cancer) of the lower jaw. Having removed the lower half of the jaw, they treated the animal with intense radiotherapy and concurrent chemotherapy at a cost exceeding £9000. With its tongue hanging out of the side of its mouth, the dog could only lap liquid food clumsily following the surgery.
I remember asking him how long the dog had lived following the original surgery. The answer was “over nine months”. This reply rather horrified me when I thought of the pain and suffering inflicted on that animal in the name of “healing” science. Quite an animated discussion followed for the next half hour during which he mentioned another couple who routinely transported their pet rabbit once a week for ten weeks from Scotland for aggressive radiotherapy at a cost of £500 a session.
I gave up at that point and while he and I differed in our opinions it did not jeopardise our friendship. Since that time, costs and therefore fees have increased at such an alarming rate that even the upper ranges of pet insurance policies often fall significantly short in providing cover for veterinary attention — treatment that, in the past, they would have covered in full.
Not all veterinary treatment needs to ‘break the bank’ as I try to explain in Part II.