Human Medicine Could Learn a Few Tricks From Veterinarians

Yesterday, as staff at two different Arizona veterinary practices in cities many miles apart patiently explained to me the options for treating my snake-bit dog and the likely menu of costs for doing so, it occurred to me that I've rarely been treated with so much respect for my decision-making abilities or my wallet in any medical office geared toward two-legged customers. The reason is simple: At the vet's office, I'm the ultimate decision-maker and the payer-of-all-bills. At my doctor's office, I've allowed myself to be pushed to a secondary position as a responsible party. And the difference shows.

With my dog, Max's, head swollen like a pumpkin, I was presented by his usual veterinarian in Sedona with a couple of treatment options and the likely total costs ahead of time — including the stiff tariff for antivenin. I went for the "save the fuzzy bastard's ass" option, and paid.

After antivenin and other treatment, Max needed to be watched and medicated, so typically indulgent dog owner that I am, off I drove to Flagstaff to a facility that offers 24-hour care. There, not only was I presented with an estimate of the likely low and high costs associated with his care, but the prices of common procedures and vaccines were posted on the wall in every room.

My wife, a pediatrician, doesn't post price lists. They're irrelevant, since very few of her patients pay their own bills. Even regular, predictable expenses are handled by insurance companies, or by government programs, or by convoluted combinations of the two. She loves kids and respects parents and discusses care with them. But many of the important decisions are made elsewhere. There's little point in going in-depth about possible medications with a Medicaid patient when you're going to end up playing whack-a-mole with the AHCCCS Formulary — the ever-morphing list of medicines that Arizona's implementation of Medicaid has decided to pay for this time around.

The idea of removing patients as responsible parties was to remove money from the decision-making process — to give us the illusion that care is free, and that treatment will be provided with no need for us to fret over the bills. It's not free of course. We've just bought the illusion, and transferred the cost-benefit analyses to somebody else. We still get some choices, but unless we're among the few who pay out of pocket, they've been winnowed and pre-approved ahead of time.

Actually, there is one place where people make real choices: The dentist. After a day of not discussing costs with her patients, my wife has been known to decide among a few tough alternatives at our dentist's office for treatment of her inherited slow-moving train wreck of a set of choppers. But, like veterinarians, dentists expect most of their patients to pay their own bills.

Yes, there are some costs that are beyond the means of many people, and there are resulting tradeoffs to be made. But if we want to get the same adult choices in a doctor's office as we do at an animal hospital, we have to take back more of the responsibility for, at least, the predictable costs of our own care.

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  • ||

    How the hell does a dog ever get bitten by a snake?

  • Ice Nine||

    Because they're not smart and fast like cats.

  • Pro Libertate||

    They're smarter than cats, which are rodent-dumb.

  • Ice Nine||

    I don't know what rodent-dumb means or has to do with this but I can tell you that cats are reptile-genius. When I lived in Panama my cat killed two or three Fer-de-Lances - an extremely bad-ass snake - per year. People's dogs got bit all the time. I rest my case.

  • Heroic Mulatto||

    Many people forget that cats are desert animals. Deep down in their collective genetic memory are the skills to take down vipers and asps.

  • JW||

    When I was a kid, we had a de-clawed cat that was going at it with a copperhead. She landed plenty of hits and luckily never was bitten.

    We killed the snake with a shovel.

  • Ice Nine||

    It was horrifying to watch them square off against a FDL but there was nothing you could do. If you tried to break it up you'd throw them off their game and get them bitten and probably get nailed yourself. All you could do was watch and yell at them - which of course they ignored.

  • ||

    Many people forget that cats are desert animals.

    Not true. Cats come from wildcats which range in all sorts of bioms....but yeah there are snakes everywhere as well.

    http://en.wikipedia.org/wiki/Wildcat

  • Heroic Mulatto||

    Errr....

    Genetic, morphological and archaeological evidence suggests that the housecat was domesticated from the African wildcat, probably 9-10,000 years ago in the Fertile Crescent region of the Near East, coincident with the rise of agriculture and the need to protect harvests from grain-eating rodents.

    But it's really hair-splitting when it comes down to it.

  • Generic Stranger||

    The Fertile Crescent area wasn't really a desert at the time - hence the name "Fertile Crescent". The encroachment of the Sahara and the damming of the Tigris and Euphrates has made the area a lot drier than it used to be.

  • Auric Demonocles||

    GLOBAL WARMING!

  • Pro Libertate||

    Smart has nothing to do with it.

  • John||

    Ice Nine,

    My late cat killed a copper head. She owned snakes. Too fast for them. She would let them strike and jump back until they were worn out and then she would grab them by the neck and that was it.

    Dogs in contrast lead with their noses. They stick their nose in there and get bit every time. Dogs, unless they have some wild wolf or something in them are dumb as posts when it comes to snakes.

  • ||

    Every dog I have ever seen that found a rattler either stayed the hell away or kept a sane distance from them and barked like mad.

    I have seen a rattler strike at a dog as well...and that rattler had no chance of ever biting it...dogs are pretty damn fast.

    My guess is Tuccille's dog was either sick, old or dumb.

  • Pip||

    It's possible that the dog's top hat slipped over his eyes momentarily. Or maybe the dog's monocle was really dirty. That would explain why the dog didn't beat the snake with his cane.

  • jdtuccille||

    Arizona is knee-deep in rattlesnakes. And many dogs like to go sticking their noses in interesting-looking bushes.

  • The Hammer||

    Who doesn't?

  • ||

    Nice.

  • ||

    My dog ran right up to the first rattler he saw (southern NM). It was a medium adolescent rattler sunning itself in the middle of the trail in the morning and I think my doggy decided he was going to make friends. Fortunately, it preferred to rattle and look intimidating rather than bite, and I managed to call him back and we veered around. Pretty close call though.

  • ||

    Was the snake coiled up?

    They can't strike if they are all spread out.

  • Pip||

    They can't strike if they are all spread out.

    Unlike members of the SEIU.

    http://www.google.com/imgres?u.....117ty=105

  • ||

    Yeah, coiled up in the classic pose when I came upon them. And the dog was practically licking the snakes face. I thought he was a goner.

  • Broseph of Invention||

    When I lived in South Africa my buddy's rottweiler ran up to a rinkhals (spitting cobra) to play with it. Fortunately the snake was pretty spooked and not cornered. I can't imagine the yelping had he got venom in his eyes.

  • Contrarian P||

    I do envy vets and dentists for that. They can actually tell their patients how much things cost and the patients can make educated decisions about what would work for them. I think we're way too far gone down the road of socialized medicine for that to ever happen on a large scale for physicians, though. People do occasionally ask me how much stuff costs and I have to tell them in all honesty that it varies so much from insurer to government to HMO that I have no way of knowing for sure. It's frustrating.

  • Pro Libertate||

    You know, why not offshore and offer diagnosis remotely?

  • Contrarian P||

    Because it's pretty hard to diagnose without being able to touch a person. It is possible in some cases, as in routine clinic visits for high blood pressure and the like, but in my line of work (emergency medicine), it probably wouldn't be a good idea.

  • R C Dean||

    Plus, it illegal unless you have a license where the patient is located.

  • galiana||

    This is why, whenever I get an infection, I read the relevant section of "Where There is No Doctor" and buy the requisite veterinary medicines for myself. As long as you do the research, it's better, faster, and cheaper to bypass the medical monopoly.

  • The Hammer||

    Hmm...I'm sure the DEA has somebody working on that.

  • galiana||

    Damn. You mean I've blown my cover?

  • RBS||

    "Oh, I'll take a vet over an M.D. any day. They gotta be able to cure a lizard, a chicken, a pig, a frog..."

  • Walter||

    Here is my doctor: http://www.southparkdoctor.com/ She doesn't have staff and doesn't mess with insurance. If you want services, you pay for them. Prices are posted. If you have insurance, congratulations. She'll be happy to print or email you an itemized receipt so you can file a claim. She also makes house calls! I hope to see more of this with more folks using high deductible plans.

  • The Hammer||

    Anon-bot?

  • Walter||

    Not a bot, not even a cyborg, yet, unfortunately. And that really is my doctor.

  • ||

    Walter, I am not going to send non-bussiness bullshit email to use up her time, so perhaps you could tell her I said Kudos and we need more like her. If she is thinking of moving, suggest central Louisiana.

  • galiana||

    Ironically enough, the only other doctor I've ever seen who still does housecalls is a guy who treated me when I lived in Moscow. It's pretty sad when you get a better standard of care in an ex-Commie hellhole like that than you get in NYC.

  • Pro Libertate||

    Sedona? How New Agey.

  • Almanian's Evil Twin||

    I read that as "New Aggie".

    Which is funnier to me...

  • Brandybuck||

    There are parts of Sedona that are very new agey, but get out of "Psychic Row" mainstreet, and it's just another Arizona desert town.

  • Pro Libertate||

    I've only been there once. Sure, I learned to levitate, but, other than that, it's a big scam.

  • R C Dean||

    My dogs, who view the better part of West Texas as their birthright, have gotten vaccinated for rattlesnake bites.

    I strongly suggest it for anyone who lives in snake country.

  • Pro Libertate||

    What about pythons? What then?

  • Almanian's Evil Twin||

    Duh - python vaccination

    *stares at ProL like he's an eejit*

  • Pro Libertate||

    Will an alligator vaccine work on pythons?

  • Almanian's Evil Twin||

    Now you're outside of my expertise.

    TONY! Little help!

  • ||

    Sadly, no. It doesnt work on alligators either.

    I had a beagle disappear a couple of years ago. A large alligator began hanging out in the bayou at the back of my property at the same time as the dog disappeared. Apparently the only thing alligators love more than duck is dog.

    I fenced my remaining dogs in and encouraged the alligator to relocate.

  • Pro Libertate||

    Yes, dogs and alligators don't mix.

  • RBS||

    True, there are a lot of three legged dogs running around the golf courses down here.

  • ||

    Unless it's a gator dog.

    (Note: I remember someone else posting about gator dogs in another thread. So sad I couldn't find the greyhound-esque dog in a gator outfit again.)

  • R C Dean||

    encouraged the alligator to relocate

    I'm hoping the encouragement was offered at 1500 fps, and the relocation was to your shoerack.

  • ||

    "....we have to take back more of the responsibility for, at least, the predictable costs of our own care."

    Tucille, that is truly hilarious.

  • Almanian's Evil Twin||

    Living in Michigan, we have rattlesnakes, but no one's every seen one. The dogs DO like the garter snakes, and turtles, and frogs, and chipmunks, and...

    I'm glad they haven't gotten into skunk or anything that could harm them back, the little bastards. It is hard to say no when they need the treatment....we haven't yet.

  • Ice Nine||

    When they bumble on to a porcupine, you - and they - will wish they had been bit by a snake instead. And that first time doesn't cure them of the porcupine attraction, either. Doh.

  • ||

    And that first time doesn't cure them of the porcupine attraction

    Yeah this is the weirdest thing ever.

    Dogs will often keep going until the porcupine is dead.

    And they will do it again with another porcupine a few months later.

    I think in nature, like say with American wolves, the lesson is learned by dying.

  • ||

    "And that first time doesn't cure them..."

    Really? No porcupines around here, I know nothing about them...except to give them a wide berth.

    It seems odd that dogs wouldnt learn from that first encounter.

  • ||

    except to give them a wide berth.

    You really don't need to. They can't shoot their needles, and they never would bum rush you.

    When they see you they will just wander off.

    Less dangerous then a Raccoon.

  • ||

    Cool. If the opportunity arises I will certainly let them wander off unmolested.

  • Pip||

    Proverbs 26:11
    As a dog returns to its vomit, so fools repeat their folly

  • Almanian's Evil Twin||

    "New Aggie". That's still making me snicker.

    I'm so happy I'm easily amused...

  • ||

    How do dogs get bitten by snakes? They bark at it or chase it until it coils up defensively, then lunge at it repeatedly until the big surprise. I have never known a dog to be bitten twice.

    I have three dogs who have been bitten by moccasins, I live on a bayou. Moccasin poison is not often fatal, so I just made them comfortable, watched for infection, and let them recover on their own. I was bitten by a moccasin once and received the exact same treatment from Dr. Suthenboy.

    Vaccinating for rattlesnakes here is pointless. Around here we have eastern diamondbacks that get up to 9 feet long. The last time we cut timber, the cutters claimed to have killed 14 of them over a 40 acre patch, ranging from 4 to 8 feet long. A bite from one of those is certainly going to be fatal, vaccine or no vaccine.

  • Pro Libertate||

    I thought rattlesnake bites weren't usually fatal.

  • ||

    The southern hill country used to have a few fatalities every year from them. I cruised some timber in Ms that had one of the fat bastards hiding under every bush. I pity the guys that had to cut that.

    Of course, these days most of the cutting is done by guys sitting in the cabs of large machines so bites are rare. The days of stomping around in the chiggers and snakes with a chainsaw are nearly gone.

  • ||

    Fuck chiggers.

  • Heroic Mulatto||

    Woah, woah wo....

    Never mind.

  • Pro Libertate||

    He probably meant "fuck Spanish moss", not literally chiggers. That's possible, though inadvisable. Because of the chiggers.

  • ||

    Those fuckers are going to find a way to your groin area anyways, so why not?

  • R C Dean||

    So racist.

    Back in the day, we had to call them "chigroes". Now, I understand its "chigrican-Americans".

  • The Hammer||

    That's a few fatalities out of probably a few thousand bites.

  • Brandybuck||

    It's the young snakes that are the most dangerous. A baby rattler will kill you, a full grown eight foot rattler has enough experience not to shoot his full wad into a logger. Poison is used to kill prey, and anything bigger than a jackrabbit is not prey.

  • R C Dean||

    The vaccine just cranks up their resistance to the venom. Gives them much better odds.

    The Dean dogs are scary quick, but dumb as rocks. The vaccine is cheap insurance. If one of them got killed by a snake, Mrs. Dean would rent a D-9 to level and pave the entire neighborhood. And have you seen what they charge for those?

  • Pip||

    I echo J.D.'s experience. My vet goes over treatment options prices for everything my dog needs. It just makes sense.

  • Citizen Nothing||

    I actually love going for my dental checkups. Warm neck wrap, television or music I choose, good coffee, friendly hygienist. It's like a day spa for your teeth.

  • ||

    But a cop could take care of the problem for free!

  • johnl||

    Vets are such better doctors than doctors. It's hard to see how any dog owner could be in favor of socialized medicine.

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