Going For The Throat: Random Acts of Kindness–A Human Medicine Dodo Bird?
For the first time since starting writing for Dear Thyroid, I struggled a bit for a topic for today’s article. To start, I felt like there was no way I could top last week. The response to Six Word Thygraphs was overwhelming (thank you, everyone, a winner to be announced soon)–it would be like following Elvis at a karaoke bar. Secondly, I’m elbow deep in two different books about how doctors and patients relate to each other, but neither is what I would call a gripping read, subject matter notwithstanding. Lastly, well, one word: Olympics.
So I decided to “go with what I know” and talk about myself. And philanthropy.
I am a veterinarian. I briefly debated becoming a “real” doctor (we love when people say that, by the way), but then decided something about touching strangers in such a personal way was not for me. In the past couple of weeks, I have been reminded why I love what I do. A few Sundays back, a man came in carrying a dog that had been hit by a car. He was the owner, technically, but not emotionally–he had just “adopted” this pet from someone who found him, and upon getting home and out of the car, the dog spooked, bolted, and was hit. The young dog was beautiful–thick soft coat, amazingly muscled, and adorable face–we instantly fell in love. He was clearly in shock, and his left front leg dangled a la Joe Theisman. We got right to work–catheter and fluids to support his cardiovascular system, morphine for his pain, and radiographs to assess the leg damage and check for internal injuries. Within 20 minutes he was stable and comfortable, with a splinted significant fracture of his radius and ulna, but no other serious injury. He was lucky. The owner didn’t quite see it that way. A dog he’d owned for less than an hour had now cost him $600 before he’d even gotten him in the house. When I discussed the options and costs for repair of the fractured leg, it was clear that while he felt badly for the dog, he was not willing or able to pay the cost for such repairs. I can’t and don’t blame the man–they had no bond–the dog was just a dog, not a pet. He opted for euthanasia.
This is where the magic happens. As a policy, we do not take in surrendered pets. We’d love to, but you cannot image the numbers of animals we would have routinely relinquished to us. When I walked back into treatment with the news, one of the technicians stepped up–no way would he allow it, he would take responsibility for the dog. Unsure if he could even keep this pet, or if the dog would be compatible with his current dog and cat, he decided at the very least he’d pay for the fracture to be repaired and find the dog a suitable home. The owner agreed to pay the current bill and sign him over. After our new charge was placed in a comfy cage, it was time for my fingers to do the walking. I called a veterinary orthopedic surgeon friend who has a mobile surgical practice with the story and she immediately offered to perform a surgical repair in the next couple of days for half price. I agreed to come in on my day off to act as anesthesiologist to defray that cost. This was no simple repair, and reducing the fracture and implanting the plate and screws clearly takes significant time as well. As a bonus, while the dog was under I removed a broken incisor tooth and the orthopedist neutered him for free.
The technician named him “Caso” Italian for accident or random, and took him home the next day to start his long recuperation. The story, however, does not stop there. Two weeks into his recovery, he popped the latch on the front door and let himself out, re-fracturing the leg and completely disrupting the implant’s lower attachments. I happened to be working that night as well when the technician came in and dejectedly carried Caso to the radiology room for confirmation and assessment of the degree of damage. After sedating Caso, I reduced the fracture to the best of my ability and placed another splint. Even with all the discounts and help we had all given this staff member, his bill was not small, and now he was back at square one. Despite this, there was no doubt of his intentions to do whatever needed to be done.
The orthopedist came back the next day and fixed the fracture a second time, this time, totally free.
I’m not trying to make myself out to be some kind of hero. I’m not. In my field, stories like this are pretty much the norm. My boss, the clinic owner, gives each of the doctors she employs a “charity accountÃ¢â‚¬ each year to be used at our discretion. Additionally, we log returned items that cannot be resold into a “rescue stockÃ¢â‚¬ for needy pets. I have no idea how many hours of our (vets and associated staff) time are donated along the way.
In human medicine, there is charity too. Programs like Doctors Without Borders and Operation Smile help thousands of people who would otherwise not have access or financial means for care, and many doctors (from all over the world) have flown to Haiti to aid in that recent disaster. But I have no knowledge of doctors just deciding that the right thing to do is to run a certain expensive test for free, or arrange for a half price surgery for a needy patient. Why?, When I searched the internet for information, I saw stories of doctors treating medicaid/medicare patients when they suspected they would not be reimbursed, which to me is not quite the same thing. A study out of Atlanta from 2003 demonstrated that 25% of female physicians participated in pro bono work in their communities or practice.1 I assume some of this is volunteering time at free clinics. But I ran across this gem accounting for the bulk of physician charity:
“Researchers said the services that are going un-reimbursed are not unusual or luxury services, but are basic elements of good patient care and include such things as talking with adult children, managing pain over the telephone, calling pharmacies, coordinating home care services like physical therapy and visiting nurses, and ordering equipment like canes and wheelchairs…
So this is what the medical community calls giving free services to needy clients?, Talking with patient families?, Calling pharmacies and physical therapists?, As stated by the researchers in the quote, THESE ARE BASIC ELEMENTS OF GOOD PATIENT CARE (and things I do everyday and have never considered “billableÃ¢â‚¬)!
Am I alone in thinking this does not constitute true generosity?
I don’t mean to insinuate that human doctors have no sympathy or regard for their patients or human kind in general–I think just the opposite. But I wonder why the culture or structure of human medicine is so fully different from veterinary medicine (and dentistry and law as well, which both encourage or even mandate pro bono work) that small–and large–acts of assistance or philanthropy are not more routinely practiced?
1. Pro Bono Work and Nonmedical Volunteerism Among U.S. Women Physicians
Erica Frank, M.D. M.P.H. Jason Breyan, M.A. Lisa K. Elon, M.S. M.P.H.09/26/2003
Tags: conveying symptoms, endocrinologist issues, improving patient doctor relationships, patient responsibility, Robyn Davis Hahn Health Care Writer, speaking with doctors, thyroid health, thyroid patient issues