Animal care

Question
I'm just wondering what the heck has happened to veterinary care over the years. I get that many people love their pets like they are their own children and will do anything and spend any amount of money to take care of them. I have two cats, and I love them. They are the best cats I've ever had, and I've had many over my life. These two came from the animal shelter. But I recognize they are animals. They are not human beings. Consequently, all I want is to get them their regular preventative shots. I don't want or need anyone to take extraordinary measures to extend their lives. If some illness befalls one of them, I'm not interested in having them treated like a human would be with all sorts of medications or procedures. For instance, about three years ago, our vet heard a murmur in one of them, and he recommended that I take the cat to a veterinary cardiologist in Syracuse, NY, to have tests run. I politely declined. Now, I'm with a different vet, and one of the cats has a cyst under his skin on the top of his neck. It's like a big marble. You can play with it and roll it around, and the cat doesn't care. The vet drained it once, and it was a bunch of brownish-clear fluid. Within about a week, it had filled back up. But since it filled back up, it has just remained the same size. The vet said he could remove the cyst, but before he does any surgery, he requires a blood test that is almost $300. No telling what it will cost to remove the cyst. Here's my question. Are there any vets out there who cater to people who respect and take care of their animals, but who are not interested in a bunch of human-like medical procedures? Why can't a vet simply drain this cyst, disinfect the area, make a small incision and remove the cyst capsule, put a stitch or two in there if needed, apply some antibiotic and hand the cat back to me? If there is some unforeseen complication, then I would deal with that in the same way -- do what is necessary to prevent the animal from suffering, but don't take any extraordinary (expensive) measures. Are there any veterinarians who will take that approach if asked? Is there a name for that kind of approach to treating animals versus the other kind of approach like taking my dang cat to a vet cardiologist? It just seems to me that if a veterinarian was to offer that approach and explain right up front or in some kind of advertising that that is the approach that or she takes towards animal care, he or she would have a full appointment book everyday. Thanks for whatever light you can shed on this issue.

Answer
I agree with your premise, but you must understand that by virtue of having a veterinary license, we are obligated to provide care that is not negligent.  Yes, it is easy to remove a cyst, but what if the cat is having other issues that prevent good healing?  What if it is a metastatic cancer and removing it will cause it to spread.  As professionals, we have to take things like that into consideration.  When there is a problem that happens and a client approaches the veterinary boards, it is our peers who judge us as to the correctness of our medical approach.  So there has to be some minimal standard of care.

I do see many of my colleagues that take that way overboard.  I practice with the KISS method.  Keep it simple, stupid.   More and more analysis is showing up in the veterinary literature to see if what we consider the standard of care is really necessary.  Two examples stand out.  One is presurgical blood testing.  If the animal is otherwise healthy and it is a routine procedure 1 or 2, (procedures and risks are graded on a 1-5 scale) there is probably no need for blood testing.  The other example is antibiotics after surgery.  In a minor routine non-infected  surgery of risk 1 or 2, there is probably no need for antibiotics after surgery if the surgery was performed in a sterile manner.

The other issue is that veterinarians spend lots of money maintaining a clinic. In my practice I have 4500 different items in inventory to maintain for the pleasure of my clients and their pets.  We want to have what we need when the need arises.  That is quite an investment.  We are small businesses.  So the charges you pay have to be enough to maintain a clinic, have the instruments and drugs available, and have a staff of people who run the office and provide a livable wage to the vet(s).  I can tell you that in my small practice, my profit margin after all is paid runs only in the 20-25% range before income taxes.  As a contrast, my brother is a human internist and his office expenses are 30% of his income because he does not have to maintain a whole hospital.

It is not as simple as you might think to just do procedures without regard to the whole picture.