Do Veterinarians Owe Owners Anything After A Pet’s Death?

Several years ago, an owner scheduled an appointment with me about a week after I’d euthanized their pet. It was an unusual request, seeing as though their pet was no longer alive and in need of my services. I urged the owner to call me or email me with any outstanding questions or concerns. It was explained that if they were to schedule a specific time to see me, not only would it take a spot away from another pet in need of treatment, but that I was required to charge them for the appointment spot, while it would not cost anything to talk on the phone or via email.

 

The owner elected to keep the appointment. We met and talked about their pet and its disease and how it had progressed over time. We didn’t spend a great deal of time together, but it was a significant moment for both of us. As per the policy of the hospital, and our prior discussion, an appointment fee was generated.

 

Several days later, I received a letter from the owner criticizing the fee on the grounds it was unethical for me to charge a visit after all they’d been through. An additional suggestion was made that I should provide follow-up appointments, free of charge, to owners who’d recently euthanized their pets as a means for them to obtain closure and to provide a forum where they could process their feelings and/or frustrations.

 

As I read the letter, a complex mixture of emotions rose within my mind. Empathy, sadness, resentment, and confusion – I felt it all. But my overriding sentiments regarding the words were, “Why had I not accurately prepared this owner for their pet’s death, leading to their compulsive need to talk with me afterwards?” and “Why should I be obligated to give my time for free when a human physician would never face this expectation?” I didn’t feel particularly good about my thoughts, but I’m being honest in my description.

 

Discussing end of life care is something I’m entrusted with nearly every time I enter a new appointment. Invariably owners want to know what to look for to indicate their pet has reached the end stage of their disease. It’s never easy to consider concepts such as death and dying, planning for end of life care, advanced directives, or euthanasia. But experience tells me it’s much better to talk about these topics before we’re in the midst of an emotionally charged situation.

 

In human medicine, dialogue centered on end of life care is frequently entrusted to social workers or hospice providers. Though well-trained in these difficult topics, it’s a patient’s doctor who is best equipped to do so. They possess the medical knowledge about the specifics of what actually occurs physiologically within the body during measures such as cardiopulmonary resuscitation, or in response to treatment of disease, and how to prepare owners for what lies ahead.

 

The results of a pilot study presented this year at the annual Quality of Care and Outcomes Research Scientific Sessions showed physicians were reluctant to discuss end of life issues with their patients because they perceived their patients or their families were not ready to discuss it, they were uncomfortable discussing it, they were afraid of destroying their patient’s sense of hope, or they didn’t have the time to engage in those conversations. The latter example tells us, if a doctor isn’t going to be paid for the time it takes to have an end of life discussion, it’s not going to happen. Period.

 

The good news is more and more private insurance companies now offer reimbursement to doctors for conversations related to advanced care planning. The American Medical Association (AMA), the country’s largest association of physicians and medical students, recently urged Medicare to follow suit, indicating doctors are not only committed to the cause, but recognize they are the ones best equipped for the job.

 

Unfortunately, insurance companies offer lower reimbursement rates to doctors for the time spent talking to people compared to performing medical procedures. If we’re simply sitting around talking, we can’t be ordering tests or administering drugs or performing surgeries, and, ultimately, we’re not making any money. Even when doctors try to do the right thing, it seems we manage to be penalized.

 

It is incredibly sad that innocent animals develop debilitating diseases.   I recognize how fortunate I am to work with owners who have the time and resources to treat their pets. And I understand the loss of a pet is an intensely painful process. None of this changes the fact that being a veterinary oncologist is my job and my source of income. I too, must earn a living, pay bills and loans, and support myself.

 

Was if wrong of me to charge for an end of life/closure discussion? Did this represent detraction from my reservoir of compassion? Worse yet, did it make me a bad doctor? My answer to each of those questions is a resounding, “No!”

 

Years later, I still think about that owner and their letter, and something deeper than being labeled good or bad, compassionate or unethical, or right or wrong continues to weigh on my mind. By gaining a sense of closure and peace for themselves, this owner ironically created a sense of uneasiness in my soul.

 

Sometimes the toughest cases for veterinarians have nothing at all to do with actual animals we are treating. Sometimes the price we pay for the stress can’t be quantitated in dollars or cents.

 

And sometimes this is why we so often work for free, even when we know we shouldn’t, because we hope it will somehow save us from the unyielding pressure of charging adequately for doing our jobs.

 

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5 thoughts on “Do Veterinarians Owe Owners Anything After A Pet’s Death?

  1. Whadzen Carrasquillo says:

    I was honestly stunned reading this post. You do deserve to be paid well for you knowledge and skills. You are highly trained and I’m sure amazing at what you do. But I feel the situation you are describing here is uncommon and you should have taken 10 minutes of your time to help this owner with closure at no charge. It’s no big deal. And it probably happens once in a blue moon. Veterinary Medicine is an art. I’m sorry to say you missed the point on this one. And I’m sure many day practice DVM’s (except corporate vet med) would agree with me. (i’ve been practicing very successfully for 20 yrs). And please stop comparing us to MD’s, that’s one of our many problems. We can still be financially successful through the art of veterinary medicine.

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    • Nancy Treadwell says:

      I am certain, it would not have taken 10minuets to address this owner’s needs…maybe on the phone, but not in person. Every day I face managing the needs of my patients, vs the needs of my clients, rDVMs and the needs of my schedule. Dr. Intile eloquently stated the practice and emotional issues most veterinarian’s face. I am surprised at the judgment you pass on this issue….

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  2. jen says:

    i would hope that most of the owner’s questions would have been answered before the euthanasia, and cant see what the difference between an email and a visit would make. furthermore, whatever your policy is, if it is explained to, and agreed to, by the owner prior, than they’ve got no leg to stand on.

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    • Nancy Treadwell says:

      It is common for owners to have questions afterwards, especially when the problem is complex or if the illness and death occurs quickly. I spend quite a bit of time with owners before a euthanasia decision is made, and still questions come at that time…I offer phone and email conversations at no charge (rightly or wrongly) but if a client comes in during appointment times, and they are properly informed of the costs – that is the right thing to do.

      There is no difference in our initial examination fees or recheck fees…

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  3. D says:

    For me the most interesting part of this post is not the title question (for the record, I think we do owe them some time after a pet’s death if they want it, particularly in a specialty/critical care setting. Plus, it can be done in a way that’s respectful to the owner’s bottom line and doesn’t ruin the vet’s bottom line).

    The interesting stuff in my opinion is further down where you talk about a more fundamental business/service question, which is, “What is worth more, our time communicating with clients, or the procedures we perform?” This discussion is enough for its whole own blog post.

    I think it’s a sad thing that we’ve locked ourselves into a system that values the latter above the former, and I think we have the choice to break out of it. Veterinarians specifically have more of a choice in this matter than physicians, because there are fewer layers in our money transactions with our clients.

    When we talk about disease/end-of-life/risk/etcetera with a client, we are using no less of our expertise than when we perform a physical exam and order a chest radiograph or a thyroid level. And while those things take time and labor and expense, our discussions in the exam room also take time and labor and expense, specifically the time you spent going to school and reading all those books. And yet we mark up our drugs and lab tests through the roof because they’re “practice builders” and whittle away our time in the exam room to increase volume, and tell those same clients that if they think of any more questions, they can call us back on the phone later. For free.

    It’s a system that perpetuates itself; ask any physician and I’m sure they’ll tell you all about it. And it leaks all the way back into education. How much time did we spend in vet school learning about client communication? Granted, it’s hard to fit that sort of stuff into a curriculum when you’re working hard to memorize all that MEDICINE, but it’s not like you don’t have to learn it later.

    I’d be interested to see what GPs think about this. I’m looking at this from a specialist’s point of view, which is admittedly different from a general practitioner’s. But GPs have to treat complicated cases, too, and even during annual wellness checks they have an opportunity to educate their clients, and that still involves time and communication.

    I think if we valued our client communication time more, we wouldn’t feel so upset about charging for it, and we would also be more inclined to project that value to our clients. Not in a way that would be a grab for money, but in a way that would be worth it to them. When I read the initial story from this post, I don’t see a person who felt like they were “owed” free time from the oncologist; I see a person who was failed by the system. The time with the oncologist is the only thing they see! They don’t see any of the ultrasounds or CBCs or chemo hoods, but yet that’s where we look to make the big bucks, and there’s a disconnect there.

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