I had an interesting two visits to my family doctor recently. During the initial appointment, the wait was forty minutes and the visit lasted about forty seconds. That is not necessarily a problem. The doctor knows his stuff, and forty seconds was all it took him to make an educated guess about why my eyelids had swollen up like red balloons (making for a very embarrassing forty-minute wait among people with less obvious problems). Off I went, with a prescription for two medications and directions to come back in a week. In a week things were better, but not better enough. So, another forty-minute wait, another visit with the good doctor. This time I got five minutes of his time because he was training a new graduate. So, it was not what he'd initially thought; it was something else, and it would get better if I kept using the steroid cream. That was fair enough. Uncertainty is the foundation of medical decisions, and sometimes the only way to know if this is condition A is to see if it gets better with medicine B. None of this was a surprise or a disappointment to me. Here's what was: at the end of the appointment he said, "Sorry to have wasted your time." I was too surprised to ask what he meant. Did he mean he knew the wait was too long? Or that I should have ignored his instructions to come back and just kept using the cream, since things were getting better? Although I don't think any less of his medical expertise, I thought his remark was lame; maybe he was too tired and busy to express himself more clearly. One day I might shoehorn this into a short story.
The reason I found this curious is the contrast it provides with the veterinary standard of client care. In my line of work it would be unthinkable to make such a careless if innocent remark. We simply cannot afford a potential misunderstanding or offense. If a client has been waiting for forty minutes (as they sometimes do, because of emergencies and routine appointments turning out to be not so routine), they get an apology. No exam lasts less than ten minutes; twenty- to thirty-minute appointments are becoming the norm. Of course not all of this time is spent examining the pet; a large part of it is devoted to a conversation with the client - about medicine, and about money. Does money make all the difference between human and veterinary medical standards of customer care? Money makes an enormous difference, but not because it is absent in human medical care: it is present but for the most part invisible, while perception is everything. (Despite what many of my fellow Canadians think, medical care is not free, although our taxes pay for a very small part of it with the rest being heavily subsidized by Fort McMurray oil; but that's a story for a different day). Maybe veterinarians are trained to walk on eggshells because they work with a much more vulnerable type of patient, the kind that can't speak for itself - but then, so do pediatricians. So neither money nor the fragile status of our patients explains why MDs are free to practice medicine while DVMs must practice customer service that offers medicine as its commodity.
I think this is because veterinarians are on a crossroads of social, economic and emotional demands that make for an impossible situation. How else to explain why we constantly second-guess our medical decisions, beat ourselves up over the most trivial of things, why the rate of suicide among veterinarians is painfully high, and why, for all this, the public perceives us as heartless merchants who only care about money, or at best as glorified janitors whose purpose is to end the life of an animal at the owner's request?
Our profession evolved from caring for food animals and transportation/working animals (horses). For most of our history, our work was essential to society and its health, and our successes and mistakes were often a matter of life and death. From our history we have inherited a sense of the utmost importance of our work, and the self-imposed requirement to excel. Then came a sea change that resulted in veterinarians being service providers in a sentimentally important but largely non-essential sector. Caring for house pets is a very recent development in the evolution of veterinary medicine, but in first-world countries this is now the bulk of what veterinarians do. Here is the sad and sobering truth at the heart of the matter: with the exception of service animals, pets are a luxury and not a necessity. Companionship is a necessity; getting an animal to provide that companionship is a luxury, and while other humans may not be everyone's first choice of companions, the choice is there. And no matter how many times we call our pets babies and family members or how sincerely we feel about this, there is no guaranteed safety net for them in case of accidents or major illness. They are at the mercy of their owners' financial decisions and of their veterinarian's readiness and ability to give away services for free. For all the failings of the human medical care system, there is the fundamental understanding that a human life is precious and that no person will be allowed to die simply for lack of money. There is no such promise made to animals by society and the government. The nation (i.e. government, taxpayers, laws and regulations) does not regard pets as its children the way it does human children. Yet there is the expectation that animals be treated in the same way as humans when it comes to emergency situations.
Veterinarians carry the emotional burden of responsibility for other people's fur babies, and they are held morally accountable when owners cannot come up with the funds necessary to treat their pets. We strive to offer the very best medicine (which not everybody wants, and which is not always in the patient's best interests) and spend countless hours arguing among ourselves about the best way to do this or that procedure. We are incredibly skilled at blaming ourselves when something goes wrong, even when this something is not even remotely our fault. Despite knowing very well that this is no longer true, we behave as if the customer is always right. There is a huge disconnect between what we offer and believe is good for the pet, and what the owner wants for their pet (and this may have nothing to do with what they can afford). Is this because we are nerds with our heads in the clouds, while the owners often have no idea of how their pet's bodies work, and may not really want to know? (Again and again I realize how many people have no idea of how their own bodies work, and how many do not want to know.) Is this because veterinarians have somehow inspired the image of suckers who love animals and *should* save them at all costs to themselves? Or because in our society people do not always know the difference between entitlements and responsibilities? Is it also because pet ownership has come to be viewed as proof of a happy family and good moral character, and people often acquire pets not simply without due forethought but without even really, truly wanting them? These are not warm and fuzzy questions, but it's time to start asking them.