Balancing needs and resources

One of the most difficult things I must do as a veterinarian is to make treatment recommendations to horse owners who face financial hardships.
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An unfortunate truth about veterinary medicine is that it is a business. While most veterinarians get into the profession with altruistic motivations---to help animals or to find ways to make them healthier---the reality is that those goals can’t be pursued without some sort of financial reward. It’s wonderful to help horses, but a person does have to eat.

A successful business makes money, and, in the case of equine medicine, the money comes from people who own horses. So, on one level, the more money the business makes, the more successful it is.

Still, a veterinary practice is quite different from, say, a car dealership or a real estate brokerage. In fact, a veterinarian has some significant advantages over many other sorts of business people. If you want to buy a car, it’s pretty easy to survey the market; you can compare prices at dealers all over town, shop among similar models, pick financing packages, and so forth. The buyer of a car is on nearly equal footing with the seller. It’s the same with buying houses, detergents, blue jeans and many other products.

Contrast that with a veterinary business, where the buyer---the horse owner---is at something of a disadvantage when it comes to evaluating the products and services offered by the seller ---the veterinarian. The horse owner doesn’t know nearly as much as the veterinarian and so must have faith that a diagnosis is accurate and the treatment options presented are valid and inclusive. Beyond that, the horse owner has to trust that the veterinarian is offering service at a fair price. But consumers of veterinary services have very little ability or inclination to comparison-shop. Sure, occasionally a client will seek a second opinion when an expensive treatment is recommended or a horse has a dire diagnosis or a complex problem. But for the most part, the client---veterinarian relationship is one of trust, both in terms of the veterinarian’s judgment and the fees charged.

None of these considerations are particularly acute when the buyer has deep pockets. While it’s never OK for a veterinarian to take advantage of someone, when a client has ample resources, it’s pretty easy to recommend any number of therapeutic and diagnostic options; the client will appreciate the effort to achieve a precise diagnosis in hopes that it will point to the most effective therapy possible. In those circumstances, everyone usually wins, or at least, no one really suffers.

Things get quite a bit stickier when a horse’s owner has significant financial limitations, as many people do. What to do in such situations usually divides veterinarians into two camps. The first says, “Owners know their finances, and it’s not up to the veterinarian to make decisions on how owners want to spend their money.” Members of the other group consider themselves stewards of the horse, but also the owner’s resources, and they believe that decisions need to be made with both in mind.

I’m quite sure that you could get into some heated discussions about which camp is “right.” If a veterinarian is in the first camp, and feels that a horse owner’s finances are really none of the veterinarian’s business, then there really aren’t any questions concerning horse needs and owner finances. The veterinarian offers options and the owner decides. It’s a clean way of thinking, actually.

I, however, fall firmly into the second camp. That is, I feel I need to take both the owner’s finances and the horse’s well-being into consideration. In my view, horses need owners. If you empty an owner’s bank account, he or she will find it difficult to continue to keep horses. That’s bad for owners and it’s bad for horses, too, because without owners, there would be fewer horses.

The question of the owner’s finances versus the horse’s needs is one that I think about a lot. Balancing the two interests is vital in my view, but it can be tricky.

For one thing, there’s not always such a thing as the “best” medicine or “optimum” care. In my view, the best thing for the horse is a good outcome, and doing more doesn’t necessarily mean that the horse will do better. For example, a horse with an injured tendon may benefit from a series of ultrasound examinations to diagnose the condition and monitor the healing process. But ultrasound imaging costs money, and horses recovered successfully from tendon injuries a long time before ultrasound was ever invented.

From the standpoint of academic curiosity, I’d love to know what’s going on at each stage of a tendon’s healing process, but in most cases serial imaging will not increase the likelihood of a successful outcome. So, depending on the owner’s financial situation, I may suggest that the owner not do a follow-up ultrasound exam and save his or her money. That means the horse recovers without any greater strain on the owner’s finances---in other words, the costs of a horse’s care do not jeopardize the owner’s financial situation or ability to keep the horse. That’s good for everyone.

I suppose I could just ask the owner, “How much can you afford?” and be done with it, but that doesn’t strike me as the right approach. For one thing, it puts the owner on the spot and might cause embarrassment. It also risks making it seem like my priority is the financial aspect of the situation rather than the horse’s well-being.

Ultimately, if I perceive that the treatment for a horse’s condition might be a real strain on the owner’s finances, I usually try to frame my suggestions in terms of likely outcomes and I do my best to estimate the costs up front. In cases where there is little realistic hope of a successful outcome, I try to be frank about it. I think it’s important that a horse owner is prepared for the financial implications of a treatment and has realistic expectations as far as what a procedure or medication can accomplish ---key elements in making an informed decision. And, from my point of view, making an informed decision is the most important consideration of all.

This article was originally published in EQUUS 485, February 2018

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