Thursday, June 09, 2016

"Well Patient" Visits Can Be Dangerous for Your Dog

False positives and full-court presses to turn every bruise and bump into a major surgical event are very real threats to the health of your dog.

The greatest scam in medicine is curing a patient of a disease he or she does not have.

In the Phillipines, this is called "Psychic Surgery," but in the U.S. it often falls into the folder of "preventive care," where "well patient" visits to the doctor generate a vast revenue stream for health care professionals but do little or nothing to improve patient health.

In fact, going to a doctor when nothing is wrong can actually be dangerous.

As a recent story on National Public Radio (NPR) notes:

[35-year old Emanuel Vega is one of more than 44 million Americans who is taking part in a medical ritual — visiting the doctor for an annual physical exam. But there's little evidence that these visits actually do any good for healthy adults....

"I would argue that we should move forward with the elimination of the annual physical," says Dr. Ateev Mehrotra, a primary care physician and professor of health policy at Harvard Medical School.

Patients should really only go to the doctor if something is wrong, Mehotra says, or if it's time to have an important preventive test like a colonoscopy. He realizes popular opinion is against this view.

"When I, as a doctor, say I do not advocate for the annual physical, I feel like I'm attacking moms and apple pie," Mehrotra says. "It seems so intuitive and straightforward, and [it's] something that's been part of medicine for such a long time."

But he says randomized trials going all the way back to the 1980s just don't support it.

The Society for General Internal Medicine even put annual physicals on a list of things doctors should avoid completely for healthy adults. One problem, Mehrotra says, is the cost. Each visit usually costs insurers just $150, but with so many people getting them, that adds up fast.

"We estimate that it's about $10 billion a year, which is more than we spend as a society on breast cancer care," Mehrotra says. "It's a lot of money."

Then there's the risk that a doctor will run a test and find a problem that's not actually there. It's called a false positive, and it can lead to a cascade of follow-up tests that can be expensive and could cause real harm. Dr. Michael Rothberg is another primary care physician and a health researcher at the Cleveland Clinic. He tries to avoid giving physicals.

What is true for people is even more true for dogs.  

Not only do well dogs not need to go to a vet for a "well dog" check up every year, but absent any indication of serious trouble, a false positive and a full-court press to turn ever bruise and bump into a major surgical event is a very real threat to the health of your dog.

If your dog has a simple bruised toe, it may result in a suggestion that it has cancer, and that the toe needs to come off.

A simple sprained muscle may get upcoded to a recommendation for cruciate surgery, or even amputation.

None of these are invented scenarios; they are the actual experience of an occasional reader of this blog.

The short story here is that vets are not less likely to upcode, bill-pad, and prescribe medically unnecessary treatments as human doctors -- they are more likely to do so, because there are few legal consequences for unethical behavior and, to put it simply, vets are much sloppier than their human counterparts, and also much less experienced when it comes to diagnosing serious problems.

Consider a simple x-ray for a hip or a toe.  Your vet will take the x-ray and read it too. There will not be a separate x-ray technician -- it's all a one-stop-shop and the vet taking the x-ray, and reading the results, has every reason to do more x-rays and recommend aggressive surgery.

Of course, vets and doctors are always quick to push back against any results-oriented study of medicine which might impact their bottom line.

In the NPR article, we hear the classic line that we so often get from vets:

"What if Mr. Vega had had a lump or bump that wasn't right?" Caruso says. "What if when he had his shirt off Mr. Vega said, 'Oh yeah, I forgot to mention this spot on my chest,' and it ended up being a melanoma we discovered early?"

Right.  Invent a scenario to justify the billing. Classic.  And. of course, every bump or spot is a melanoma, right?  Sorry, but that's simply not true.  What's being sold here is fear and surgery, not common sense and results-oriented medicine.

Here's the thing:  Most canine limps are caused by the same thing as most human limps – a pulled or strained muscle that will self-correct with rest and time.

As for lumps, most are sebaceous cysts or non-malignant lipomas -- a type of flat fatty tumor that does no harm and can be removed at leisure, or not at all.

Will a vet tell you that?  Why would they when "you can never be too careful" is a quick and easy way to add $1,000 to $5,000 to their bottom line?

And trust me when I say that the bottom line is their bottom line.  The only bottom line at far too many vets.

Almost everything a vet does these days is about getting you to come back so they can bill you more.

The condolence card they send you when your pet dies? Business maker.

The notice to renew your vaccines every year, (and never mind if that is bad medicine)? Business maker.

The add ons tacked on to your "prospective bill" even before the doctor has seenn you? Business  maker and a test to see what they can get away with.

The tests for every parasite and disease under the sun in a healthy dog?  Business maker.

The x-rays for a dog with a slight limp it has had for all of one day?  Business maker.

The rimadyl for the limp? Business maker.

And finally there is the next appointment, scheduled before you have even left the last one.

As "Partners for Healthy Pets" -- an organization devoted to teaching veterinarians how to up-code gullible customers -- notes on their web site:

Research shows that practices that book their patients’ next visits before they leave the office see more patients, more often. These practices schedule the next appointment for all patients before they leave regardless of the reason—from preventive health exam to medical recheck. Forward booking is ‘best practice’ for your practice, because seeing more of your patients results in more pets receiving high quality care.

So be sure to book their next appointment before they head out the door. Check out the tools below for ways to align your entire practice team around a shared preventive medicine philosophy and message.

Right. "Tools to align your entire practice team around a shared preventive medicine philosophy and message."

In other words: How to rip off your customers while concern-trolling for dollars.

Notice the complete absence, on this web site and at your veterinarian's office, of any mention of avoiding the inbred genetic wrecks at the AKC, or the dogs bred for defect, such a English and French Bulldogs, Pekingese, Pugs, and Cavaliers.  Notice the lack of statistics on mortality by breed, cancer incidence by breed, and veterinary care costs by breed.

Preventive medicine?

The only time a veterinarian is concerned about that is if he or she can bill for it!


5string said...

When I got my TRT Ratty spayed last year my vet made me buy an "annual" booster vac or they wouldn't perform the surgery.

I told them she had the shots at home and even brought the vial stickers.

And I get monthly emails from some vet email marketing company that slaps my dogs' names in the ad and my local vet's name.

So yes this crap goes on even at my rural county vet too.

geonni banner said...

There's another aspect to this scenario. Consumer responsibility.

I have been very careful in choosing my vets. They are not all alike. My vet, and the two previous to that one have never pushed for teeth-cleaning, annual shots, tests, etc. He knows that I get my pet's shots at low-cost mobile clinic's, and that I vaccinate every three years rather than annually. He makes no fuss or dire predictions.

This is partly because I do my homework, partly because I am rational about my dog's and cat's health.

It also helps that I can speak to my vet in his own language. I used to be a vet tech. Perhaps he feels that I will not be easily bullied into buying stuff I don't need.

People need to be pro-active in the health care of their pets and themselves. Learn about your body and your pet's and you will be less apt to ask questions that reveal your ignorance, or ask none at all, which marks you as a "mark."

Most people seem to take a "Whatever you think is best, you're the doctor attitude." Most don't want to know the details. This sort is lazy, foolish and they shoot themselves (and their pets in the foot."

Vets are in the business to make money, just like mechanics and plumbers. Pay attention and keep 'em honest.

PBurns said...

Well said!

I say much the same thing here >>

You have to read, go in with an ability to push back and say no... and BE WILLING TO CHANGE VETS.