When I say I'm a veterinary oncologist, I am usually met with a bemused, slightly incredulous reaction. I'm often asked, "Do people really treat their pets for cancer?" As a matter of fact, they do. Not only do I administer radiation and chemotherapy to cats and dogs (not to mention the occasional ferret and hedgehog) on a daily basis, but I work in one of the most sophisticated veterinary hospitals in the country, with a neurosurgeon, a dermatologist, an ophthalmologist, and a host of other specialists. Pet owners routinely rack up $10,000 bills to save the life of an animal that they consider a beloved member of the family.
This may seem extreme, but it's not even close to what many Americans do for their (human) relatives. A breathtaking $66.8 billion each year—almost a third of all Medicare dollars—is spent treating patients in the last two years of their lives. Too often, expensive procedures are tried simply so medical providers can cover themselves against potential lawsuits from bereaved family members who want to make sure everything possible was done. The fact that insurance generally covers all of this makes it more likely that doctors and patients pile on excessive and nonessential tests and procedures.
About 90 percent of my animal patients are geriatric—and, as odd as this sounds, the veterinary world may hold lessons for the broader health-care system. While pet insurance exists, only roughly 3 percent of owners carry it; even then, clients pay a substantial portion of costs themselves. That means they usually want to know the rationale behind each test. I explain what I think is going on, what I want to look for, and which tests I need to perform to find it. I rank the diagnostics from most to least essential and lay out approximate costs. My clients then choose what they want done, with an understanding of the relative importance, risk, and cost of each option. This step-by-step approach may seem time-consuming, but it dramatically reduces the number of expensive, unnecessary tests. And the process is more gratifying.
When facing the death of a loved one—human or animal—the real challenge is coming to grips with the reality of the situation. Since my approach draws me closer to families, it's easier to suggest that the best course of treatment may be relieving pain rather than fighting a disease. Owners are less likely to fear that you're giving up on their beloved pet if they trust you. When I'm asked about performing tests, and I know the results won't change the outcome, I say so. If your golden retriever's cancer is too far advanced for surgery, getting a biopsy may be a pricey—and superfluous—exercise.
No family wants to subject its already sick pet to uncomfortable tests or dump thousands of dollars into dead-end diagnostics. So why do we do that to our grandparents? Clearly the stakes are different: we're talking about the people who brought us into the world. Vets, also, are not saddled with the threat of career-ending malpractice lawsuits. While most pets are treated like children, legally animals are property—I can't be sued for more than their face value. We're also not buried under paperwork, which accounts for our ability to spend more time with clients.
I'm not advocating that people and their families be allowed to dictate their care entirely. But there is something to be said for inviting them deeper into the process. In some ways, veterinary practice today is not that different from the practice of human medicine before insurance companies dictated policy and the threat of lawsuits guided decisions. Which might explain why the question I'm asked with the second-most frequency is "Do you think I could be treated in this hospital?"