Good medicine has gone to the dogs

November 8, 1999

That's right--veterinarians have it better.

Good medicine has gone to the dogs

Who's really happy in the healing professions? Accordingto this physician, it's "my daughter, the vet."

By David A. Cooley, MD

The author, a rheumatologist in Shawnee Mission, KS, shares a vacationmoment with his daughter, Anne Cooley Haecker, DVM. She practices smallanimal veterinary medicine in Brainerd, MN.

Overlooking a serene, sylvan Minnesota lake at dusk, I listen as my daughterAnne, a newly minted veterinarian, explains in bubbling rushes of excitementhow, earlier in the day, she diagnosed a case of Lyme disease in a youngLabrador. Thanks to my daughter's cross-country telephone consultation witha former professor at Kansas State, the lucky dog now has a reasonable expectationof getting well with antibiotics. The pet's owner was overjoyed, and nearlyovercome with gratitude.

What a satisfying moment in a young doctor's life, knowing she can reallymake a difference using her newly acquired knowledge and skills! I lookout on the lake and think back to earlier, more enthusiastic days when Ifelt the same excitement during nearly three decades of (human) rheumatologypractice.

But the present summons me back. Just that morning, I had sat with severalcolleagues from the American College of Rheumatology in the HCFA officein Baltimore, discussing Medicare rules, regulations, and financing. Wespent two intense hours reviewing newly developed, truly revolutionary,but expensive treatments for rheumatoid arthritis.

We also discussed abuses in the system, such as bloated payments forear wax removal, or excessive reimbursement for multiple trigger-point injectionsof tendons. And we talked about audits of medical records with their veryown trigger points—the documentation errors of physicians. The final chillingmoment came when the medical director for Medicare reminded us that he overseesa budget that spends an incredible $170,000 per minute to providehealth care for the seniors of this country.

How ironic: The government looks to doctors for answers, while we drownin a sea of bureaucracy and oversight. Even the most courageous physiciansare changing jobs, seeing counselors, angrily revising practice patterns,applauding some sort of Patients' Bill of Rights, and seething at HMOs thatshuffle our days and, Trotsky-like, strip our ancillary services, then stealour patients altogether.

Six years earlier, my wife and I had begun to discuss career optionswith our daughter. She was ready for a change after graduating from collegeand spending a year skiing in Vail, holding down several jobs to pay forthe necessities—food, housing, lift tickets. She had always thought distantlyabout veterinary school. But, mostly out of deference to her father, wehad paid a visit to the local medical school. Both of us knew her heartwasn't really in it.

So vet school it would be. She clearly sensed my relief that she wouldnot, at least for now, suffer the deadening loss of autonomy that my colleaguesare experiencing as they are slowly trampled by an MBA-driven desire toreduce medical care to algorithms, guidelines, and shareholder dividends.

A few years later, how gratifying it was to watch our daughter functionin her clean, new office. She proudly showed me an X-ray, taken in-house,of a dog with an enlarged liver and spleen. I thought he had gallstones,but she patiently explained to me that those were just rocks the dog hadeaten, and anyway the gallbladder was on the other side. She also showedme a blood count (it, too, performed on-site), pointing to a type of anemiain which cells are rapidly destroyed. Based on this finding, treatment wasswiftly initiated.

How unlike my own office, where many patients needing X-rays are directedacross town to an imaging center where I may get a written report in a fewdays or be forced to listen to the rushed, garbled dictation of an unknownradiologist. This despite the fact that I have the most up-to-date equipmentand X-ray technologists in my own office. Lab work must often go to distantsites; our own extensive lab cannot always be used despite proficiency testing,instant patient access, and immediate, reliable results.

Interestingly, the two reference labs we are often forced to use havedefrauded the Medicare system so often that with one more violation, thepeople who run them will go to jail for performing tests not ordered bya physician and falsely billing insurance companies.

Can our daughter give good care to her patients without this bureaucraticintrusiveness? It seems to me she can and does. Bills are kept reasonableand treatment straightforward for a variety of reasons—no insurance, fewerstaff to shuffle papers, less oppressive and more humane attitudes towardeuthanasia, and relative ease of pet replacement.

Does she enjoy what she does? You can see it in her eyes—she loves everyminute! Are patients grateful? Every poll conducted puts the family vetright up there with the pastor, college teacher, and swim coach.

Would she do it again? In a heartbeat!

Does she remind me of myself? Sure—but that was a long time ago.



David Cooley. Good medicine has gone to the dogs.

Medical Economics

1999;21:281.