Thursday, April 16, 2015

Why Bother

This one is gonna jump around a bit, from here to there and then back again. Hopefully by the end I will have made some version of a point. If you don't get there, at the end, and don't get it, please try not to blame me. Ya see, I'm trying to make some sense of this myself and I'm not sure I can. So if I cannot 'splain this cogently to you, imagine the fun I am having churning it into sense for me.

I was introduced to a sick, demented, and fortunately tiny subset of humanity when a veterinarian I knew through the interweb was driven to suicide a short while ago. Dr. Koshi tried to rescue a cat from the demented efforts of a cat rescuer. Saving a cat from folks who think they are saviors. This is what ya call a no win situation. Dr. Koshi put the cat's welfare first, while the cat rescuers put their own selfish needs foremost. The crazies won when Dr. Koshi killed herself, and they celebrated long and hard, in their lonely homes and on the web.

One of the loudest haters on the web was a woman who had watched as her 20 year old cat died of kidney failure 20 years earlier. This woman never forgave the doctor who had tried to prolong the life of the doomed cat, and failed. Rational people, and those of us who know a few things, realize that the only 20 year old cats that don't die from kidney failure will be the 21 year old cats who die from kidney failure. The sun comes up in the east, always has, and likely always will.

This poor woman, bless her heart, thought more could have been done for her cat, and to this day, twenty years later, she has waged a one woman war against the profession of veterinary medicine for the slight visited upon her when her beloved cat died. This is her right, and the internet is her weapon, and the world goes on without even bothering to mock her futility. But as each day grows old, this woman seeks out any opportunity to rage against veterinarians who she thinks don't do enough to help animals. She is rather obsessed with this crusade. Death to veterinarians who don't do enough to help animals. She celebrated on her bit of the web when Dr. Koshi died. And daily she does all she can do to harm veterinarians that she decides have not done enough to help animals.

Please, remember this part.

Some time ago, a young man talked the National Geographic TV people into a reality show featuring his father, a quirky, aged, and arguably self-dedicated veterinarian who operates a mixed animal practice in Michigan. Folks love veterinarians, or at least they used to. The show has been entertaining at times, and the TV folks have made a fortune off it. This alone makes them happy. This is a win-win for everyone, right? The ratings are huge. Dr. Pol is the next James Herriot. We should all celebrate.

Well, not quite.

Ya see....on film, the incredible Dr. Pol has committed egregious malpractice, time and again, and some of us, the veterinarians dedicated to doing things right for the animals and their people, have objected to this. We've seen animals suffer at the hands of this man. We've seen him cut corners for no reason other than the fact that he doesn't care to do things correctly. We've seen his arrogance when charged with the abuse of his oath to reduce animal suffering. We've watched him cash the checks from his victimized clients and the TV folks, and walk away smiling.

So we have tried to stop this television program. We are proud of our profession. We are proud of the progress we have made over decades of time in the quality and effectiveness of the care we can provide your animals. We strive over our entire careers to improve this care. And we do this for the animals, and for you folks, and sometimes in spite of you folks. Thus, we want to stop that one doctor, because he mocks the progress we have made, and he attempts to elevate himself by denigrating the good that we as a profession have done for the animals and their people.

What? What you mean, in spite of “you folks”.

Yeah, spite of you folks.

We stirred up a hornets nest when we asked National Geographic to stop popularizing a fraud posing as a Doctor of Veterinary Medicine. We did this because we are proud of our profession and the care we provide, and because this one TV program is harming animals by undoing decades of progress in the care of animals.

“It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so.”

Mark Twain

When some dedicated veterinarians asked the National Geographic people to discontinue this show, because this TV show harms animals in the long run, of course nothing happened. The money is far more important to the TV people than any harm they might cause.

So some veterinarians filed complaints with the regulatory folks in Michigan, suggesting that they should enforce their own regulations against malpractice in the practice of Veterinary Medicine. Dr Pol clearly demonstrated a need for sanctions on numerous occasions while he was being filmed. God only knows what he did when not watched.

The regulatory people have acted twice now, finding clear evidence of substandard practice, malpractice on the part of the TV star doctor. The man has been shown to be a hazard to the animals put in his care, and a fraud as he sells his services to a gullible public.

Some celebration might be in order here, but instead, a throng of Dr Pol supporters have surfaced to oppose any constraints on this show and this practice. Anyone interested in the welfare of the animals, and also aware of reality, would want the Dr Pol show to go away. But, this is when it's what you know that just ain't so gets in the way of this.

With the throng of rabid Dr Pol supporters speaking out, a variety of opinions have surfaced. All these folks think they know for sure, and sadly don't. Allow me to compress them into an easily digested few.

“Dr Pol cares”

“Dr Pol doesn't use all those fancy tests.”

“Dr Pol is cheap.”

Let me translate, for convenience.

“Dr Pol cares”.

This means that Dr Pol is cheap. Those doctors who want to do things correctly cost more money. Dr Pol doesn't care about doing things right, and he cuts valuable corners to the detriment of the animals. Dr Pol is cheap.

“Dr Pol doesn't use all those fancy tests.”

This means that Dr Pol refuses to use the best methods to help peoples' animals, but instead does something far less. Dr Pol is cheap.

“Dr Pol is cheap.”

Well, never mind.

Just for jollies. That woman who has pilloried veterinarians for the last 20 years because one veterinarian didn't do enough for her cat in her demented mind. Didn't do enough....Death to those who don't do enough to help an animal. The woman who celebrated when a veterinarian killed herself.

This woman has come out in defense of the substandard care offered by Dr Pol. Because he is cheap.

Now, try to work with me here for a moment. I want you to wrack you brains, think long and hard, and then answer these questions.

Can you think of any time when you see someone doing a job, performing a trade, or practicing at a profession where people consistently and persistently beg, argue, demand, cajole, and order to get that person to do a poor job rather than a good job?

Do you, as a functioning human, beg the chef of a restaurant to do a horrid abortion of a medium rare steak? Do you ask the mechanic who wrenches on your Harley to please to a terrible job? Do you ask the surgeon who will attempt to save your baby daughter to please cut a few corners because you don't really want the surgery done right? How about the guys who will paint your house, your plumber, the airline pilot taking you to O'Hara, your kids' teachers, those politicians in Washington ( Oh never mind that one. Forget Dr Pol here), the dude at Starbucks making up your morning coffee, a damn cab driver.

Please do a shitty job, but please do it cheap.

I don't know for sure, but I'm pretty sure I'm right here.

The only time all those people are gonna demand that you do a shitty job, but please do it cheap, are the folks we veterinarians are pledged to help.

And you wonder why I write such things in the dark of night, trying to figure why I bother to go to work every day. In spite of you people.


  1. I am with you right up to the paragraph that starts with "do you, as a functioning human... "

    I do believe you can do a job "right" and do it cheap.. but the thing is you can not know that until the job is over and everything is said and done.

    There is a tendency in medicine - mostly human but you see it in veterinary care as well - to go not only above and beyond but three more steps after that. You end up walking away from a trip to the dr with a $1,000 bill for something that will heal up with out any medical intervention at all. The only problem is you often can not know that unless you either wait or you spend the $1000. the only problem with waiting is it could mean the pet would suffer.

    There is more than one way to do something 'right' but there is only one way to do something thorough. I personally, more times than not, do not want to take the risk that 'cheap' is good enough..

    1. This attitude from my clients, many of whom I liked very much and considered to be friends, is a major reason I left practice. Trying to do the best I could, from a quality and cost-effectiveness standpoint, finally broke me.

      As you say, too bad it's frequently impossible to tell whether a patient will improve without spending the money. "Three more steps after that" for something "that will heal up without any medical intervention at all". Eventually, I got tired of hearing this sentiment, expressed many times by clients who often had no idea what they were saying was hurtful and offensive. Surely, if I was smarter, worked harder and cared more, clients wouldn't say such things to me.

      I'm sorry I spent years' worth of sleepless nights worrying whether I'd done the right thing. Once in a while, though I've since moved out of state, someone pages me with an emergency. I direct them to the expensive, full-service emergency service in my region. That's when these former "clients" tell me how wonderful I was. I know they're lying. My clients who appreciated what I tried to do for them knew I left practice years ago. What are these people saying when they attempt to stroke my ego? They're saying I was better than the really cheap guys who frequently don't answer their pages, and cheaper than the reliable emergency services available in my region now that I'm gone. It's a monopoly. What did people expect?

      Now, I go to work, do my job, come home and turn off my phone. I'm done with practice, but it's not done with me, obviously. It's been years, and I'm still angry.

    2. It's an old thread, but as a cat owner I do understand sometimes having to spend money for something that may resolve. It happened to me a couple times, but really I think it way my being scared and overreacting an taking my cat to a vet ER rather than anything any of the vets did. After hours care costs more, so do emergency visits. Facts of life.
      One time was when my previous cat had a vestibular disorder. I was scared - the cat was falling off every couple of steps, so instead of waiting for an appointment, I rushed her to the 24-hour care in the clinic I go too. I thought maybe she had eaten something. The ER vet thought that it's something in her brain, but said she'd need an MRI to find out, but he also suggested that I might want to take her instead to another hospital 40 minutes away that had a neurologist on stuff that may be able to diagnose her without an MRI. I did it, but that late in the evening the neurologist wasn't present, and the vet in the hospital said that I could leave the cat overnight with fluids on an off chance that it's something she ate even though she thought it was something in my cat's brain. I could've left and came in the morning, but I was scared, so I left her (for $2000) - my choice entirely, nobody twisted my arms. In the morning, the neurologist called me and told that based on the eye movement it was peripheral and not central, in her middle ears rather than brain, could be an infection or idiopathic and rather than go with an MRI, I could wait for a couple of weeks, try antibiotics in case it's bacterial and see rather than do an MRI. I decided to wait, and my cat felt better in a week. Again, if I hadn't overreacted, I'd save money, but it was my choice entirely.

      I never have an issue with cost, I want the best for my cats. Now, it might be easy for me to say since I have a high salary, paid off mortgage and ample savings. But I spent as much back 17 years ago for my previous cat's surgery, and back then it was a big expense. It's the matter of priorities. Back then I asked myself what was more important for me, my cat or my vacation.

      I am actually very angry at my vet right now, but this is a completely different subject. No harm, just the fact that she lied to me. A stupid lie, completely unnecessary, easily verifiable and even somewhat insulting. I am trying to decide if it's a reason to switch vets, but this is another subject entirely.

  2. Well said, Doc. I now avoid any and all reporting of these stories because I cannot get my head around the ignorance. I have to try to remember that most normal, sane people see these other people and know they are nuts. That's my only hope.

    Meanwhile our colleagues are getting the book thrown at them with thousands of dollars in fines, probation and suspensions for making mistakes honestly, because they wanted and needed to save money for their clients. Yeah for "not spending $1000 on all of those silly tests". Is it wrong of me to daydream about a day when the world wakes up to no more veterinarians and thinks, "what did we do to ourselves?"

  3. They'll all be sorry when there are no veterinarians available to manage the zombie apocalypse!

  4. Please go to work for me and my dogs. I appreciate you and what you do. I've said this before...maybe you are my vet. We've been through a lot and you got me through. I know you don't spend my money unnecessarily. My dogs and I need you.

  5. I try to do everything right, to the limits that our clinic offers, and if I think it could be done better elsewhere, or it needs more than our clinic can manage, I always offer referral to a specialty clinic or emergency center.

    My only solution has been to give the clients all their options and the potential outcomes...
    1: wait and watch: potential outcomes: gets better, or gets sicker and you're back here tomorrow, or it dies.
    2: supportive care for presumed problem: gets better, or gets sicker and you're back here tomorrow, or it dies.
    3: diagnostics and proper treatment for underlying cause
    4: referral for advanced diagnostics and treatment

    And the I document what they were offered and what they chose (especially if it's option 1).

    I don't watch Dr. Pol, and I imagine I wouldn't want to. But given that I sometimes deal with clients who tell me, word for word: "I don't care if her teeth rot out of her head. I'm not doing a dental on her. Never had to do one before, not going to start now."... I probably wouldn't be all that shocked at what people are willing to put up with for the convenience of cheap care.

  6. I think you have gotten your Internet bullies confused. Regret a vet is the one supporting doctor pol (the woman who was displeased with the care of her dog). To my knowledge, Veterinary Abuse Network (run by the woman whose 20 year old cat died) has never come out in support of Dr. Pol. Nonetheless, I agree with your points.

  7. As frustrating as this is, these people are not trying to be hurtful. They are just ignorant. My dad used to be one of them before I was old enough to teach him better. His childhood dogs never went to the vet and the people in the house rarely went to the doctor. He and my grandparents would absolutely had advocated for bad medicine because they didn't see it as such. Humans and animals are built to survive injury and illness and they can tough it through a lot of bad things, making it look to the uneducated like they are "fixed" by substandard care or even like nothing is really wrong at all. why pay all this money when it'll probably be fine? Fluffy can't climb stairs anymore. No biggie. Neither can I. Educating the public is a constant battle we must fight. I really wish the AVMA or some similar organization would take the fight to their living rooms rather than leaving us alone on the front lines battling on the rare occasions these owners deign to show up. If the ASPCA can bombard us with vidoes of sad puppies on every channel and Frontline can make itself a household word, why can't we market how important health care is to pets? It doesn't have to be cheesy or cheap but just encourage more awareness while our clients are on their couch relaxing and not on the defensive.