I wanted to take a moment to address some of the most difficult decisions an emergency clinician faces, every single shift he/she works. How do we provide the best, yet most cost-efficient care we can to patients for whom we have just met? How do we instantly imbue trust into the strangers who bring them to us seeking help? In human emergency medicine, a battery of tests are often performed in an effort to reach a diagnosis quickly (x-rays, full blood work, and possible advanced imaging such as a CT scan). Any idea how much those tests cost? Well into the thousands, if not tens of thousands, in a human emergency hospital.
Veterinarians clearly do not have that luxury. I would say that at least 80% of the patients we see in an emergency setting have gastrointestinal signs (vomiting, diarrhea, refusal to eat, abdominal pain), and each and every time I have to decide just on the basis of my physical exam whether to treat their signs alone or perform additional tests to be sure this “one out of ten case” doesn’t have just an upset stomach, but a life-threatening condition. Sometimes I’m right in encouraging owners to pursue additional tests or hospitalization, and yes, sometimes I’m wrong. Maybe some particular patient would have gotten better if I’d just treated the signs and the owners took them home. But I’ll tell you, what keeps us up at night isn’t questioning the times we did run a test, but the times we didn’t, and because we didn’t, we sent a critical patient home and did not provide the care that may have shortened a hospital stay or saved a life.
When I opened this hospital, I made a point of ensuring that owners didn’t feel like “money comes first” here. (I have been told some veterinary emergency hospitals require a credit card upon entry to their facility before they even see the doctor!) Yet if we don’t get paid, we can’t stay open to help the next patient that walks in the door. It is a difficult balance, and one that I doubt we will ever be able to circumvent. But I want you to know we try, and we think about it, every time.