Going to Vet School for Sanity's Sake

This may be my last article for Immediate Care Business. Between you and me, I am seriously thinking about going to vet school. Honestly, although I love my dog Scout, I am not what you would call the Dr. Doolittle of the animal kingdom. I am approaching this career change simply on the basis of the “ROS” (return on sanity).

What started me on this path and what was ultimately the genesis of the decision, which I arrived at after months of ... ahem, sole searching ...stems from two life changing events. The first is this exchange from a Seinfeld episode:

Doctor, is the squirrel going to live?

There’s been massive trauma, we could try to save him but it would be costly, difficult and we’d have to send away for some special really tiny instruments.

Well, uh, are there any other options?

We could put him to sleep; it is by the pound so it will cost about 80 cents.

Truth be told, I have always wanted to use really tiny instruments and since I am not a neurosurgeon, this may be my only chance.

The other event that pushed me to consider quitting the caring-for-Homo-sapiens team was an exchange I had with a patient who presented to an urgent care center. He complained of fever, a productive cough, was ill-appearing, wheezing, dehydrated and tachycardic. He had an elevated white count and BUN, an infiltrate on his chest X-ray, and an O2 saturation of 93 percent. He received IV fluids, IV antibiotics and a SVN. He finally was discharged home, much improved on oral antibiotics, cough medicine, an inhaler and a short course of prednisone. He did not have insurance and initially refused the discount program. His bill was $268. He was saved an emergency department visit and the resultant bill which would have been north of $1,000, not to mention the hours of waiting in one of our over-crowded emergency departments.

Bluntly, he was not happy. On discharge, he complained loudly and vehemently about how ridiculously high the bill was. Although he thought the care he received was great and very timely, he believed the bill for the services rendered was nothing short of highway robbery.

Compare that encounter and bill to having your family pet treated by a veterinarian. Have you ever taken the family pet to a veterinarian? I have — speaking of highway robbery — and it was an iguana, for goodness sake! So they lose their tail, it grows back; at least I think it does. I am always amazed by what vets charge (particularly at “emergency vet centers”). No one, at least when I am at the vet, ever complains about their bill. They may swallow hard once or twice or give sort of a loud sigh when they are handed the bill, but I have never heard anyone voice so much as a question about their bill. Apparently, no expense is too much for man’s best friend. Man, on the other hand, well, not so much.

I have a couple of theories about the dichotomy between human care and animal care. The first is that, at least in the United States, healthcare is an entitlement, no matter what sort of horrible things you do to your own body. Case in point; I know of a current medical malpractice case based upon the following set of facts: A man was driving 80 miles per hour through a residential area; he was unrestrained, talking on his cell phone and smoking meth while evading the police. He rolled his car and suffered a C5 and C6 unstable fracture. He was flown to a trauma center which specializes in neuro trauma. At the time of his arrival, he was responding only to gravity. He was taken emergently to the OR for C-spine stabilization. Although he worked for a company which offered insurance, he declined coverage. His total hospital bill was more than $450,000. He is currently suing the neurosurgeon, the hospital and the city where he rolled his car (he is arguing that the streets are unsafe). He clearly believes his care should be paid for by society without regard to his own contribution for his current circumstances. This is not an isolated case. I have heard person after person complain about paying co-pays up front, or having to settle up on very old past due accounts prior to being treated. Clearly, McDonald’s would not continue to serve a Big Mac to someone who somehow had not paid for their previous ones.

The second theory is that many people ascribe to the “it won’t happen to me" theory of life. These individuals believe that they will never have to pay the piper, that no matter what they do or don’t do, their health won’t catch up with them. The members of this group are easy to pick out. They are the ones who drive without seatbelts, overeat, smoke, use illicit drugs, run red lights, and drink to excess. When I see these people in the emergency department after the piper has paid them a visit, they are typically incredulous: “I cannot believe my bad luck! Why would this happen to me? I realize that I am overweight, sedentary and smoke but come on, why did I have a heart attack?” Or, as George on Seinfeld said after being confronted by his boss about having sex with the cleaning lady on his desk, “Was that wrong? I’ve got to plead ignorance on this one, I mean if somebody would have told me that this sort of behavior is frowned upon.”

At the end of the day it comes down to a simple equation: Do I want to care for a group of mammals whose owners never complain about their bill, who, save for chasing cars, typically don’t contribute to their own demise or ill health, whose bite is worse then their bark and who show gratitude by licking you? Or, do I want to continue to care for the mammals who are frequent contributors to their own state of ill health and who often complain about “their lot in life,” bark about their bill, and who, thank God, have never licked me in gratitude? I suppose if I put it that way, I will stick with the non-lickers.

John Shufeldt, MD, MBA, JD, founded NextCare Urgent Care, the largest privately held urgent care system in the U.S., in 1993. He is a physician, medical entrepreneur, attorney, educator, and author, and is a fellow of the American Board of Emergency Medicine, the College of Legal Medicine, and the American College of Emergency Physicians.

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