Vets - are their bills too large?

[Dalua]

Why should people be forced to have insurance?

They shouldn't, in my opinion.

However, my fear is that increasing rates of uptake of insurance will so skew the owners' expectations with respect to the extent and high-techery of intervention and treatment (which of course, have to be paid for) and vets' expectations with respect to remuneration, that most folk will not feel able to do without insurance, and worse still, no vet will feel able to offer basic, more lower-tech management without feeling either that he's risking being sued or selling himself, or his patient, short.

This concern is based on observation over the years of how medicine and surgery (and psychiatry, perhaps) seem to be practiced in the insurance-funded sector, compared with the NHS, so might be a complete irrelevance!

 

[SimpleSimon]

My concern with the "put money aside just in case" approach is what happens when your young dog has a problem and your savings won't cover it? At least with insurance you're covered up to the amount on your policy, not the amount you've paid so far.

 

[willie_gunn]

My concern with the "put money aside just in case" approach is what happens when your young dog has a problem and your savings won't cover it? At least with insurance you're covered up to the amount on your policy, not the amount you've paid so far.

So what are the alternatives? Means test every pet owner? Make insurance compulsory??

Unless you're willing to sign up to the above, you are going to have to accept that making the choice is down to the individual's value judgement.

willie_gunn

 

[SimpleSimon]

So what are the alternatives? Means test every pet owner? Make insurance compulsory??

Unless you're willing to sign up to the above, you are going to have to accept that making the choice is down to the individual's value judgement.

willie_gunn

You misunderstand me. All I mean to say is that, for me, based upon my own circumstances insurance is the only way. If something were to happen to my pup, I'd very quickly be priced out of vet care, and if I were to pay money in to a tin/savings account I'd feel uneasy knowing that I couldn't cover the cost of, say, an accident which occured when the pup was 6 months old. If it works for others, that's fine.

 

[Dalua]

...but the first question a vet asks is whether you have insurance and then prices it accordingly doing a lot of unnecessarily tests normally!!

If the indication for a test or intervention were to become less clinical and more related to whether it was on the insurance company's tariff, that would be as wicked a perversion of veterinary practice as it is in medical practice.

...vets being too reliant on electronic gizmos and not the old fashioned vets skills with hands, ears and eyes.

Another parallel with medical practice, perhaps? Not necessarily entirely caused by more-prevalent insurance, but certainly not helped by it.

 

[Apache]

most folk will not feel able to do without insurance, and worse still, no vet will feel able to offer basic, more lower-tech management without feeling either that he's risking being sued or selling himself, or his patient, short.

The simple fact is that by offering anything other than the best treatment we are doing the dog a disservice. Now the real grey area comes on where one can legitimately cut corners. This is a situation vets are forced into every day. Is it fair on the animal?

I would like to clarify that I am not of the school of thought that just because we CAN do something means we SHOULD. There are some palliative surgeries, some treatments (particularly cancer treatments) that are on dodgy ethical grounds in my opinion.

This is where it gets really messy who's to decide between what's best for the dog and what's not ethical?

My reason for suggesting compulsory insurance is due to the sheer numbers of animals we see daily where owners cannot afford the care their pet needs. I'm not suggesting kidney transplants and the application of bionic limbs, but relatively simple dental work, blood profiles, mass removals, ongoing treatment for painful conditions etc etc etc. It doesn't matter if you are a 17 year old schoolboy or a 60 year old billionaire - if you drive on the road then you need insurance.

I would suggest that the dogs currently insured are of higher than average risk. The majority are pedigree and many of them high risk. We'd always recommend insuring a pet when brought for puppy vaccs, but some breeds I would recommend insurance much more strongly. The price to the customer reflects the risk and if a huge number more dogs entered the pool and didn't claim the price would stay down for all. It would remove any barrier of taking the dog to the vet when sick. It would massively promote animal welfare.

 

[2130martin]

IMHO vets bills are not cheap but you get what you pay for and my local vet will not spend your money if its a lost cause he is very straight!!!..............now that is more than i can say for one or two stalking guides i have employed!!!!!!

 

[Dalua]

The simple fact is that by offering anything other than the best treatment we are doing the dog a disservice.

The thing is, you are not being employed by the dog. It might be that you are actually doing the owner a disservice by suggesting things that he can't afford, and making him feel that he really ought to pay for somehow. Probably, I guess, you ought to set before the owner the options and the prognosis and costs associated with them and then let him decide without undue pressure.

Now the real grey area comes on where one can legitimately cut corners. This is a situation vets are forced into every day. Is it fair on the animal?

I think this is where my complete lack of understanding of veterinary ethics will shine forth most clearly: I'd have thought that you would only be able to treat if the owner (or insurance company) agreed to pay. So it wouldn't really be you cutting any corners, but rather extrinsic financial constraints forcing a particular course of action, or lack of it.
The avoidance of unneccessary (whatever that means) or perhaps unendurable (again, debatable) suffering of the the animal would be at the forefront of your advice within the given financial constraints, I suppose: but if someone (or an insurance company) won't pay, what then?

...if a huge number more dogs entered the pool and didn't claim the price would stay down for all.

This might apply if the insurance companies were co-operatives or mutual societies, but in the real world?
This does sound a little like the arguments put forward when it was suggested in the '40s that the NHS would be a bottomless money-pit - that everyone would be healthier and healthier and go to the doctors less, so it would be cheaper in the long run. In fact, pretty much the opposite is true.

Just to try to sort out this 'if you drive on the road you need insurance' thing, we need to be clear that you are obliged to have insurance for the benefit of your fellow human-beings, and that, notwithstanding some of the sentiments expressed (no doubt with the best and most sincere intentions) on this thread, animals are animals.

 

[Apache]

animals are animals.

Yes they are, but their care is entrusted to us. They cannot make their own decisions. They cannot seek medical care of their own accord.

If you are financially unable to care for an animal properly don't get one. I've said somewhere on here owning any animal is a privilege, not a right. You owe it to the animal to take proper care of it.

 

[Dalua]

Yes they are, but their care is entrusted to us. They cannot make their own decisions. They cannot seek medical care of their own accord.

If you are financially unable to care for an animal properly don't get one. I've said somewhere on here owning any animal is a privilege, not a right. You owe it to the animal to take proper care of it.

I agree. However, I can't help but think that someone who makes a living from providing high-quality care for animals whose owners can afford it is perhaps not the person best-placed to make the ultimate judgement as to what 'proper' means in this case.

 

[Apache]

OK. Who do you suggest makes that decision?

RSPCA?

PETA?



I don't know whether you know this or not, but when admitted to the Royal College of Veterinary Surgeons we have to swear an oath:

" I PROMISE AND SOLEMNLY DECLARE that I will pursue the work of my profession with integrity and accept my responsibilities to the public, my clients, the profession and the Royal College of Veterinary Surgeons, and that, ABOVE ALL, my constant endeavour will be to ensure the health and welfare of animals committed to my care."

I would say vets were probably the best qualified people to make that call. I could be biased. I await your better suggestion.

 

[limulus]

Thank goodness for the PDSA I say.
One of my labs has a lymphoma on the her shoulder.
Vet 1: (knows the this dog isnt insured) Its not causing any mobility issues and she doesnt seem to be in any pain. Removing it would leave a fairly large pocket behind it potentially causing other complications.
Vet 2: (I lied, said she was insured) She really needs it removing asap....!

In all walks of life, professional or not, even with an hypocratic oath in place (The Royal Society of Chemistry using similar language) there are those that cant see past that most poisonousness material called money.

 

[Apache]

Limulus - I hope you mean lipoma and not lymphoma. One is a benign fatty lump and one is a nasty blood cancer. The dog will likely live a normal life with the former, and be dead soon with the latter!

This is where it gets tricky - I've been caught out before "keeping an eye" on lumps. Had one dog that felt like fatty lumps and they were significant malignancies. They grew and spread and caused the dogs death. Unless the dog very old I tend towards remove and send off to be sure it's nothing nasty. There is not a vet in the world who can tell if it's significant or not by giving it a squeeze!

 

[limulus]

Lipoma....the first vet excised a small amount from the lump using an hypodermic needle and then viewed it under a microscope....second vet didnt even do that.
She's an 11 (almost 12) year old otherwise seemingly healthy animal. Good coat, energetic, typical lab food whore, and still loves going out whether its just for a run after a ball or pigeoning etc (I retired her this winter from 'real' work...she cant see a full picking up day out now so my younger lab has taken over those duties).

 

[Apache]

Can't be bothered now, but we could open a whole can of worms looking at the representation of a fine needle aspirate of a mass when examined by a vet not a pathologist. The specialist pathologists love sitting on the fence.

Anyways, I digress.

 

[limulus]

I guess what Im trying to say is given the two scenarios I'm of a mind, rightly or wrongly, to believe the presence, or not, of in sewer ants coloured the professionals judgement.

 

[Apache]

I think this falls within the variability of vets.

Your 3rd opinion, from me, is remove the lump as it could be something nasty, send the whole thing off and get a decent histology report back. That's the only way you'll know for sure.

Because I've had my fingers burnt in the past and been wrong. A small lipoma removal is a relatively quick and simple surgery. Incredibly rare for it to cause a problem, compare the alternative of a nasty lump getting bigger and spreading.

Couldn't care if you are insured or not.

 

[Dalua]

OK. Who do you suggest makes that decision?

RSPCA?

PETA?

I'd suggest that the law was a good place to start. As long as animal welfare laws are not broken by an animal's owner, I guess no-one has much to moan about.

I don't know whether you know this or not, but when admitted to the Royal College of Veterinary Surgeons we have to swear an oath:

" I PROMISE AND SOLEMNLY DECLARE that I will pursue the work of my profession with integrity and accept my responsibilities to the public, my clients, the profession and the Royal College of Veterinary Surgeons, and that, ABOVE ALL, my constant endeavour will be to ensure the health and welfare of animals committed to my care."

I didn't know that, but it doesn't surprise me.
I note, however (as I'm sure you did) that it doesn't specify that you exert yourself towards these worthy goals pro bono. To be fair, it doesn't mention charging for your services either, but assuming you and yours have to eat and keep warm, let us assume taking money for the service is implicitly permitted.

So, what happens if a man brings you a poorly dog, but you know he hasn't the rhino to fund what you consider to be the minimum work needed to ensure the health and welfare of his animal? I guess decline to have it commtted to your care - and quite rightly so.

What if an agricultural labourer, the father of three children, brought you his poorly dog. He is advised that the animal will live for a few months in pain and then die unless £500 is spent on treatment: treatment which is likely to give the dog several more healthy years of life. With thanks he pays your consultation fee and, taking the dog home uses his shotgun to do what might otherwise have cost another £100.
Have you, or he, done anything morally reprehensible? At the end, the animal didn't suffer unduly, and although he's spent his beer-money for the next two months on your fee, his children will still eat.
Should this man, who fed, trained and worked with his dog for many years while it was in good health really not have been permitted to have had it in the first place?

I would say vets were probably the best qualified people to make that call. I could be biased. I await your better suggestion.

As George Bernard Shaw wrote in 'The Veterinarian's Dilemma': All professions are conspiracies against the laity

My better suggestion (and it is only a suggestion) is that owners of animals should behave as a minimum to the standards of husbandry mandated in legislation. That, I suggest is basic 'proper', which it would be sensible to enhance with veterinary care, either preventative or treatment, if funds allow.

 

[Apache]

What if an agricultural labourer, the father of three children, brought you his poorly dog. He is advised that the animal will live for a few months in pain and then die unless £500 is spent on treatment: treatment which is likely to give the dog several more healthy years of life. With thanks he pays your consultation fee and, taking the dog home uses his shotgun to do what might otherwise have cost another £100.
Have you, or he, done anything morally reprehensible? At the end, the animal didn't suffer unduly, and although he's spent his beer-money for the next two months on your fee, his children will still eat.
Should this man, who fed, trained and worked with his dog for many years while it was in good health really not have been permitted to have had it in the first place?

I have absolutely no problem a farmer shooting his own dog if he wants to. I've defended the farmers right to do it to many vets who think it's not as 'nice' as an overdose of IV anaesthetic. Despite having a few guns at my disposal I wouldn't dream of shooting my own dog. Take from that what you will.

Thankfully I have never been put in such a situation, but I know of cases where vets have had to get permission from the professional body to break client confidentiality to report an owner to the police/RSPCA for cruelty. This is in cases of neglect where they will not consent to treatment or euthanasia.

I wouldn't be able to sleep at night if I was charging £100 for euthanasia. I deliberately keep the fee low so that is never a barrier to having the animal put to sleep, humanely. (I'm not saying shooting the dog is not humane, but it's not the lasting memory I want of my dog).

My better suggestion (and it is only a suggestion) is that owners of animals should behave as a minimum to the standards of husbandry mandated in legislation. That, I suggest is basic 'proper', which it would be sensible to enhance with veterinary care, either preventative or treatment, if funds allow.

The wording of the Animal Welfare Act 2006:

4 Unnecessary suffering

(1) A person commits an offence if—

(a) an act of his, or a failure of his to act, causes an animal to suffer,

(b) he knew, or ought reasonably to have known, that the act, or failure to act, would have that effect or be likely to do so,

(c) the animal is a protected animal, and

(d) the suffering is unnecessary.

(2) A person commits an offence if—

(a) he is responsible for an animal,

(b) an act, or failure to act, of another person causes the animal to suffer,

(c) he permitted that to happen or failed to take such steps (whether by way of supervising the other person or otherwise) as were reasonable in all the circumstances to prevent that happening, and

(d) the suffering is unnecessary.

(3) The considerations to which it is relevant to have regard when determining for the purposes of this section whether suffering is unnecessary include—

(a) whether the suffering could reasonably have been avoided or reduced;

(b) whether the conduct which caused the suffering was in compliance with any relevant enactment or any relevant provisions of a licence or code of practice issued under an enactment;

(c) whether the conduct which caused the suffering was for a legitimate purpose, such as—

(i) the purpose of benefiting the animal, or

(ii) the purpose of protecting a person, property or another animal;

(d) whether the suffering was proportionate to the purpose of the conduct concerned;

(e) whether the conduct concerned was in all the circumstances that of a reasonably competent and humane person.

(4) Nothing in this section applies to the destruction of an animal in an appropriate and humane manner.
Animal Welfare Act 2006

A couple of common scenarios (I'd argue that an average small animal vet will come across more than one example per day):

1. Dog presented for routine vaccination. Full health check is carried out and the vet notices a fractured tooth. This is brought to the owners attention. The vet explains that the open pulp cavity will be painful for the dog and lead to ongoing infection. The vet offers to remove the tooth in house at a cost of £200 or refer the dog to a specialist for a root canal treatment and restoration of the tooth at an estimated £750. The owner declines all treatment and assures the vet "he's still eating his food". The animal never receives any treatment.

2. A dog is presented to the vet with an ulcerated mass the size of a large orange. That mass has not just appeared overnight, but the owners wife is complaining about the smell and so he's brought the dog in. You see on the computer that a colleague recommended the removal of the egg sized mass 18 months ago. The dog is now in pain and will require a much larger, invasive operation if they chose to go to surgery.

3. An owner gets a puppy course of vaccines completed, but then decides not to bother with boosters. Three years later the owner decides to breed his bitch. Due to the bitch not having booster vaccinations her puppies go down with parvo-virus and the entire litter die.

4. A 9 year old overweight Labrador is presented for vaccination before going into the kennels. The dog hobbles into the consulting room. Palpation of the joints reveals painful swelling over the elbows and pressure over the hips causes the dog to yelp in pain. The vet suggests some blood tests to check the kidneys are healthy before prescribing a course of anti-inflammatory painkillers. The vet explains the dog may need them for life. The owner declines the bloods, but will take the painkillers. A 21 day supply is prescribed with the instruction to come back after the holiday. The owners are not seen until the next booster. The dog hobbles into the room even more slowly having been on no painkillers for almost a year.

In each of the 4 examples animals have been caused to suffer, unnecessarily. The owners are in direct contravention of the AWA. Should each of these owners be prosecuted? It's interesting that the act doesn't give a magnitude of suffering, so each party is equally guilty.

These are real cases happening every single day in general vet practice. This is far from OK. The AWA is NOT working. There is a huge amount of suffering going on all over the place. Far too much ever to go to court. Everything is not fine.

What is fine is your example of a dog been given the option of treatment or euthanasia and the owner accepting euthanasia (by any humane means). I deliberately left the bottom point in the quote from the AWA.

 

[grumpyoldsod]

My reason for suggesting compulsory insurance is due to the sheer numbers of animals we see daily where owners cannot afford the care their pet needs. I'm not suggesting kidney transplants and the application of bionic limbs, but relatively simple dental work, blood profiles, mass removals, ongoing treatment for painful conditions etc etc etc. It doesn't matter if you are a 17 year old schoolboy or a 60 year old billionaire - if you drive on the road then you need insurance.

.

Yes all vehicle/road users are required to have insurance , That insurance only need to be third party to cover damages caused to others , it is their choice weather they feel the need
to insure their vehicle for repair costs ..

I have no problem paying for necessary vet fees but I do feel that some treatments are just prolonging the life of an animal that is of poor health and with no quality of life