Friday, March 22, 2013

Grifting: The New Veterinary Stock in Trade

Have you noticed that your veterinarian spends more time looking at you than at your dog or cat?

What's going on there? 

Well, one thing that is going on is that your veterinarian is being encouraged to become a grifter -- someone who is supposed to get inside your perimeter wire so they can then lift your wallet.

A grifter is simply someone who is playing a confidence game. There are variations on the theme -- long cons, short cons, affinity cons -- but all of them have one thing in common; they prey on human weakness.

Veterinary grifters are not practicing fee-for-service medicine so much as they are sizing up their customers -- the suckers -- so they can figure out exactly how many worthless services they can sack them with, how deep a dependency model they can push, and how steep a bill can be presented.

Think I am kidding?  Ah, well you probably do not read the veterinary economics literature.  The good news is that I do.

Over at the Canadian Veterinary Journal, for example, Amanda Reinoisch writes about the "human-animal bond" (HAB in the lingo of the modern veterinary grifter).  You have heard folks talk about it, perhaps.  Do you know what it means, and why veterinarians talk about it so much?

A trend has recently been identified in the United States that indicates people are willing to spend more money on their pet’s health. When queried as to what was most important when choosing a companion animal veterinarian, price was not ranked first, but rather, reputation and a caring and empathetic attitude were among the most important factors. In this recent study, individuals who spent money on their pet’s health were more likely to be married, have a higher than average income, live in a rural area, and indicate their race was “white”.

This study also demonstrated that there is a large and growing portion of the population who own companion animals, as evidenced by the purchase of products such as animal feed, but are not consuming a proportionate increase in the use of veterinary services. The authors hypothesized that this differential growth between pet ownership and consumption of veterinary services may be due to increasing cultural differences in the changing population of the United States. The authors concluded that a large portion of the companion animal market has yet to be tapped....

... It has been almost a decade since the landmark reports of the KPMG  and the Brakke investigations into the economic state of the veterinary profession in the USA. These reports both identify the HAB as a potential component of companion animal practice management.

So what part does the HAB play in the evolving economic and social reality of pet ownership and care? The history of the HAB in academic veterinary medicine has recently been reviewed. An additional and parallel concept of “bond-centered” practice (BCP) has also emerged in the practice of veterinary medicine and in the education of veterinary students.

Some authors have suggested that the HAB is a conceptual construct. The literature would better support a working theory that the HAB is a legitimate field of sociological and psychological investigation, and the BCP is an applied business theory. The BCP business model suggests that veterinary practices can provide a better service (and be more profitable) if they de-emphasize the goal of dealing with the health of the companion animal and spend more time attending to the emotional needs of the companion animal’s owner. If taken to the extreme where the client’s perception is the reality then patient health outcomes could become disassociated from practice success.

Dr. Bernard Rollin argues that in order for a veterinarian to make a successful living they must be “liked” by their clients. A veterinarian must be able to convince the client to commit to treatment regimes. It is likely that to foster this level of trust in a veterinary-client-patient relationship the veterinarian and the client need to be like-minded. No one doubts the emotional challenge of some individuals dealing with companion animal loss, and that empathy is appropriate in veterinary practice (recognition of the HAB). However, ethical reflection may illuminate concerns related to making “grief” a profit center for your business (institutionalization and application of the BCP business model). However, it is possible to have a very satisfied, strongly bonded client with a very unhealthy management style for their pet such as the lovingly overfed, obese dog. Supplementing the rather instrumental economic model; the articulated driving philosophy of BCP is well-developed, holistic, and includes a reverence for animal life.

Companion animal veterinarians are not the only (self-funded) profession to develop BCP-like services in support of the human-animal bond. Psychologists and lawyers are beginning to benefit from providing services in response to people’s emotional attachments to their pets. It has been suggested that psychologists work with veterinarians to educate them about the grieving process.The implementation and management of a “bond-centered practice” has also been promoted to the profession through professional continuing education meetings and the American Association of Human-Animal Bond Veterinarians.


Grifters also have conventions and schools -- places where you learn the art of the dangle, the pigeon drop, and the lonely widow. So, no surprise to learn that there are trade associations that teach veterinarians how to grift using the psychological manipulation of their clients.

The core tool that veterinary grifters use is the same tool that "pure positive" dog trainers use -- the dog owner's inflated sense of self, and the fear of being judged by someone who claims expertise.

"You're not listening to those old, outdated, abusive, non-scientific dog trainers are you?"

"You want what is the very best and most modern medicine for Tricky-Woo, don't you?"

"You don't want any risk, right?"

"I mean, our pets are like family, right?  I just don't understand people who are willing to pay $3,000 a year for car repair, but who will not do the same for their cat or dog."

"Sure it's expensive.  But you would get all these tests for yourself, or for your son or daughter, right?"

And so it goes.

The customers practically tee themselves up to be ripped off because so often their relationship with their cat or dog really is their primary emotional connection to any other living thing on the planet. No husband?  No kids?  Aged widow?  Perfect!

And so the table is set.

The veterinarian, or the pure-positive dog trainer, presents as someone who understands and who is a fellow member of the tribe of Deep Emotional Attachment to a pet.  Sure this person is really nothing more than a profiteer engaged in the psychological manipulation of his or her vulnerable mark.  Of course.  But you cannot fault them, can you?  Birds got to fly, grifters got to grift.

And so the selling pitch is all about working the emotional connection.  It's not about a discrete medical or training problem that can be fixed by straight-forward fee-for-service work. "That's not how we are thinking about pets these days" you may be told.You want to be modern right?  Well, of course you do!

And so, to demonstrate you care about your pet, and in order to win the approval of this fellow member of the Tribe of the Special Pet Relationship whose is your friend, you now need to shell out money without meter and to not ask too many questions about what you are getting for it.

"Yes, pets ARE expensive" you will be told if you hesitate for even a second.

"The good news is that we sell pet insurance which you can buy for your next dog or cat!"

And so it goes.

In the end it's not so very different from coffin sales grifters who tell you, right at the top of their pitch, that "of course you want what is best for Grandma Lucille."

Then, without missing a beat, they point you to a $10,000 dollar casket and a $10,000 dollar funeral service and, feeling guilty because you did not call Grandma Lucille very much that last year (or spend enough time walking and throwing the ball for your dog) you fold like a dish towel. The hook is in, and the grift is on.  You have been taken like the pigeon you always were.

If it's all been done well, you tell everyone that the only reason Tricky Woo is even alive today is because of that nice veterinarian who made you feel so good and noble about yourself as they quietly lifted your wallet, price-gouged you, and sold you a plate of medically unnecessary services.

And if Trick Woo died?

No problem. The modern veterinarian knows you will be getting another pet within a month or two, and so a nice condolence card will come in the mail expressing deep sympathy for your recent loss.

Don't worry, that card isn't free; they'll charge you an extra $200 for it when you come in for that first "well puppy checkup" with the new dog.   

"Oh, you got 12-week old Nestor from the pound? We must do a heartworm check and a Lyme test too just to make sure... in case.  You wouldn't want to risk anything, would you?"

And so it goes. 

Birds got to fly.  Grifters got to grift.


Meagan said...

I definitely have experienced this at my local emergency vet. My dog tore his inner thigh open and it was a huge gaping hole that wasn't going to heal on its own. So off to the vet we went. They presented us with a $700 estimate to have him put under, drained, stitched, etc. I told her he was just neutered 3 months ago and put under for that so I asked if there was any other option. Of course-Only AFTER I asked, there magically was a $200 option to staple his leg and do warm compresses at home. What a joke. They would have gladly taken my $700 had I not asked for another option with no concern for putting my dog under for no reason. This same vet does yearly teeth cleaning with anesthesia on a friends dog. Even my regular vet who knows I only go in for rabies shots and once after my cat had a stroke treats me differently than my friend who is in there all the time with her cats. He even kept her cat overnight and gave it an $80 anti-nausea shot when my friend thought her cat was dehydrated. A few hundred dollars later and nothing was actually wrong with the cat. I wish more people knew to question their vets. I have a customer at work who pays top dollar for some Science Diet crap made for 'dogs who eat fast'. It is a kibble that is the size of a cherry tomato. Right, the dog is going to chew that slower than regular sized kibble? ...or more likely choke on it if anything.

boct said...

Perhaps Reinisch is rather 'soft' in her criticism, maybe criticism is too strong in this case..but reading her paper she does seem to question the ethics of this new procession and to me it seemed she was using those citations as points of reference. She concludes with this..just to be fair:

'In conclusion, it is the role of the scientist to challenge an assumption when data are not consistent with theory. The recent AVMA report (11) should be read with a critical eye and with reflection on the progenitor reports (13,14). While it is important for the veterinary profession to be aware of the changing needs and desires of society, self-reflection is very important in determining if an ethical line is being crossed. This article does not negate the importance of the HAB — it questions the commercialization of it. It is possible that the emphasis on the HAB is causing the companion animal veterinarian profession to become available to rich, well-educated families only, rather than society as a whole. It is time for the profession to develop options for an alternate discourse and to critically examine these issues. Veterinarians work with and protect all animals and support appropriate individual and societal use of animals.'

PBurns said...

Agreed, the author of this piece knows there's a problem. Talking softly about it, but she's clear enough.