Economic medicine: a practical approach to cost-challenged veterinary cases

Small animal practitioners are often faced with sick pets whose owners cannot afford all that their veterinarian wishes to do. Many younger practitioners find these situations to be particularly stressful and it is easy to see how disillusionment and/or an uncaring attitude may follow. It is important to equip ourselves with the skills to deal with these situations and when assembled this skill set might be referred to as “economic medicine”.

Economic medicine recognises that, for a variety of reasons, for a plethora of clients and for a range of their pets, the textbook solution simply costs too much. This problem affects the entire spectrum of veterinary practice from charity clinics where clients pay little or nothing, to tertiary referral centres, where owners may be insufficiently insured. The thresholds may be different but the problems and the fundamental principles underlying their solution are the same.

Doing more with less

Our determination should still be help the pet and the owners, providing they are prepared to play their part in the process. Dealing with the cost challenged case is not about more efficient debt collection or reducing charges. It is not quicker or less work in the consulting room (if anything it is more). It is not about doing things badly - but rather about doing more with less.

The challenge of economic medicine is met with good communication and a sound grasp of decision making in medicine. Each reduction in cost often comes with a cost of the increased risk of hazards to the patient. The hazards include death, missing significant diseases, prescribing medications that might worsen the condition, or confuse subsequent attempts at a diagnosis. The risks of these hazards occurring is often not scientifically quantified. As many owners are unaware of the risks and hazards of reducing costs, it is vital that clinicians get informed consent from owners before proceeding.

Assessing an owner’s ability to pay from the car that they drive, the address they use or the clothes that they wear is misguided and a veterinarian does not have the ethical right to control costs for a client without their informed consent. Therefore it is important to start any discussion with a client with an outline of the preferred diagnostic/therapeutic pathway assuming there were no cost limitations.

Consultation time should not be reduced

Sometimes symptomatic relief is best (e.g. acute vomiting not associated with systemic signs) but sometimes making a diagnosis is more cost-efficient (e.g. anaemia, polydipsia); sometimes trial therapy is more cost-efficient than making the specific diagnosis (e.g. acute fever without localising signs) but sometimes a balance of basic tests followed by a logical sequence of trial therapies is best (e.g. chronic diarrhoea).

Whole blood clotting times performed in glass serum or test tubes are a very cheap and often effective way of assessing coagulation without the need for more sophisticated tests such as measurement of the one stage prothrombin time. This would be a significant cost saving to the client but the possible short-comings of the test need to be acknowledged as well.

Some attempts at cost reduction are false economies, for example starting, but not completing, a diagnostic procedure is rarely a good way of saving clients’ money. Time spent in consultations getting a good history, performing thorough clinical examinations and discussing the case with a client is never wasted and this charge should not be reduced.

So if you are interested in learning and discussing more about this area of medicine then why not join us on the CPD course The approach to the cost-challenged case in Edinburgh on 11 April 2018. The course will use common medical problems to show how managing disease does not have to be hugely expensive to clients but can still be very worthwhile in terms of patient welfare and practice economics.