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A couple of weeks ago, a little surfing mishap led to an unexpected trip to my local hospital’s emergency department. Of course, as an emergency vet, how things operate in the human ECC world was of great interest, and I was also very curious about how the experience feels from the patient/client side of the process.
What I felt was pure gratitude. Everyone was so caring and professional that I just wanted to hug them and bring them coffee. (The desire to hug them may well have been magnified by the drugs, but the gratitude was real!) They were my heroes—pure and simple.
But how would those feelings have differed if I had to pay for it all?
Thanks to Australia’s medical system, the entire drama didn’t cost me a cent. Would I have been as impressed if, as the day progressed, someone had stopped in to discuss money with me: “We’d like to X-ray your spine—that’ll be $600. These cuts need sutures—$1500. Painkillers are extra…”?
I wouldn’t have been angry about it, and I’d still have been grateful for the way they cared for me, but it would have been a very stressful experience (for me, and also for the team trying to fix me). I would likely have skimped a bit on the treatments I agreed to. (I suspect I would have declined the sutures and just stapled myself at home.)
Seth Godin’s new business book—This Is Strategy—was my most recent read. A major theme in the book is that whatever endeavour you take on, whether it’s running a business or trying to start a revolution, you are operating within a system. The system has inputs, players, rules, checks and balances, and outcomes. The system exists to produce those outcomes—and “the system wants what the system wants.” Seth urges the potential change-maker to have a clear understanding of what system they are operating within, including being clear about the outcome the system seeks.
This, of course, made me think about the vet profession: what is the desired outcome of the system within which the average vet practice operates? ‘Healthy animals’ or ‘reduced suffering’ feels like the obvious answer, right?
But the more I think about it, the more I conclude that our system primarily seeks profit.
Good patient outcomes and happy clients are key inputs that make the system work, but they are not the ultimate output. (Feel free to disagree with me on this—I’m still not 100% sure!) So, when clients make that most galling of accusations—”all you care about is the money”—we get deeply offended because that’s probably not true of you, the individual delivering the care. But at the level of the system, they’re kind of right.
This is not a criticism, just a recognition of reality. For most of us, it’s the system we have to work within. But it’s a conundrum, because profit and happy clients are often indirectly in opposition.
In his book, Seth defines stress as wanting two opposing things at the same time: “I want to be fit and healthy, but I also want the cake.” For us, it’s “I want to provide excellent care and have happy clients, but I also want to be profitable.” No surprises, then, that there is so much stress in our system!
So what can we do about it? (If you’re expecting a neat answer from me—I’m sorry. This is one I want YOU to think about.)
The possible options I took away from the book are:
Not easy. Well-established systems are persistent. Certain nodes within the system benefit from things staying the same and will resist change. Not easy, but not impossible, and worth considering. (The publicly funded healthcare system that cared for me resulted from someone changing a system.) Is there a (sustainable) way to dissociate care from profit?
Seth says: “The system causes one kind of problem, but we promise to reduce another kind.” Maybe that’s exactly what our profession is for: people come to us with a problem, and solving that problem is more valuable than the pain of paying causes? (But not always, and not for everyone, right?) Maybe we don’t have to change anything, but merely get better at demonstrating how valuable solving Problem A is?
I was discussing this conundrum with my (vet) wife over dinner while my in-laws were visiting, and my mother-in-law, who was listening quietly, said: “Isn’t insurance the solution for this?” She might be onto something.
As Geoff Wilson said in his interview on the Vet Vault: “it’s a bloodsport—make sure you’re prepared, and love it for what it is.” Maybe this means training in communication, conflict resolution, and even clinical skills, to ensure you solve problems at a level that makes the pain of paying worth it?
Like I said—I don’t have the answers. Your homework is to reply with one solution for each of the three ways of acting on this. Or to disagree with me!
Hubert Hiemstra is the friendly voice behind The Vet Vault and Vet Vault Clinical Podcasts. With over two decades of veterinary experience across three continents, he's on a mission to help fellow vets find fulfillment in their careers. Through his podcasts and conversations with hundreds of veterinary professionals, Hugh empowers vets worldwide by filling in knowledge gaps and boosting clinical skills. When he's not in the clinic or podcasting, he loves hanging out with his wife and energetic boys, catching some waves, going for a run, or just soaking up nature.
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