From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.cardiology,alt.health.policy.drug-approval,alt.activism,
	talk.politics.medicine,sci.med
Subject: Re: Doctor-bashing
Date: 11 Mar 1999 06:11:15 GMT

In <7bvopn$1a14$1@node2.nodak.edu> bellings@badlands.NoDak.edu (Brent A
Ellingson) writes:

>George Conklin (henryj@nina.pagesz.net) wrote:
>:    A doggie hysterectomy, which is just as complicated as a
>: human one, costs $110 in these parts and the vet has a lower
>: mortality rate than a Duke surgeon.
>
>First, doggies are usually healthy when they have hysterectomies,
>people are not.  Second, vets often use spays and nueters as a loss
>leader, and to some degree as a public service..


   Correct.  And they take special care with spays and neuters, since
if you lose even one animal that way, it's a major problem for your
reputation.  People just don't expect this, any more than they expect
to lose a 16 year-old girl to an uncomplicated appendectomy or
rhinoplasty (nose job).  Hysterectomies get done on 40 year-old anemic
women.  If you had to spay 8 year old anemic dogs, I guarantee you that
you'd have some trouble,  A unit of dog blood goes for about $200
bucks.

   "So," you may say-- "what does it matter that vets are `extra
careful'?  Couldn't human doctors just do the same?"   No.  By extra
careful, I mean minimum anaesthesia, which is just enough to do the
job.  Dogs and cats don't tell whether or not they remember the
operation, and they don't sue if they do.  If we could do that with
humans, we could do all kinds of lighter anaesthesia.  Quite often dogs
and cats aren't even intubated for surgury, and they get away with that
only because the plane of anaesthesia is not deep enough to have much
chance of stopping respiration.  So for animals it's more like what
your dentist does than what your surgeon does.  People just wouldn't
put up with that for abdominal surgery.

   You need to know that although vets do use sterile technique these
days, they don't have the same standards of sterile technique as a
hospital does (one-use instruments, all steam or gas sterilization, an
infection control and culture committee to monitor nosocomial infection
rates and microbe counts on surfaces, etc, etc), and they get away with
it because a young cat or dog (or for that matter, rat-- which is even
tougher) has tremendous vitality, and is not nearly so likely to die of
abdominal sepsis as a human if you get an extra couple of bugs in
there.  It wasn't that many years ago that NO sterile technique was
used in cat and dog abdominal surgery, the same instruments were used
on all animals though the day and just thown in a little cleaner
between-- and mortality was still very low.  Dogs and cats are just
plain more resistant to this kind of thing.

   And finally, you need to remember that a lot of the cost of surgery
on humans is liability insurance, government regulation of hospitals
with attendent paperwork, and cost shifting from indigent patients who
can't pay anything, or patients getting really complex things like
transplants which are really too expensive for most to be able to
absorb the cost entirely.  All problems a vet either doesn't have, or
has in quantity so much smaller that it makes a big difference.

                                        Steve Harris, M.D.

P.S.  Let me add that I've done a lot of surgery on dogs myself, so I'm
speaking here from primary experience.  If they survive my poor skills
as an internist, (which they almost invariably do-- our deaths are not
from the surgery)-- they're pretty tough.  I've seen a lot of
veterinary surgeons work, also, and even some consulting ones. I have
great respect for them.   A good vet really has to know a lot of
different stuff, as I've said here before.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,sci.med.cardiology,alt.activism,talk.politics.medicine
Subject: Re: Resident Training Costs and Subsidies (was: The Patients' Bill of  
	Rights (was Backlash against HMOs: a declaration of war)
Date: 23 Apr 1999 13:31:32 GMT

In <7fo0jt$deb$1@nina.pagesz.net> henryj@nina.pagesz.net (George
Conklin) writes:
>
>In article <7fnltt$fq6$2@fir.prod.itd.earthlink.net>,
>Ryan C. Maves <rcmaves@earthlink.net> wrote:
>>In article <7fn8kl$5sh$1@nina.pagesz.net>, henryj@nina.pagesz.net
>>says...
>>
>>>   Pay for the physician was set by politics not functional
>>>value to society.  Vets have higher educational admission
>>>standards and earn less than half as much for the same work.
>>>That is what human medicine would pay without the political
>>>input.
>>
>>
>>I'm not sure that makes sense. If by "politics" you mean "the
>>market", then sure. Vets do work hard and still make less than MDs,
>>but I suspect that people, as much as they love their pets and rely
>>on their farm animals, probably value their own health more than an
>>animals. Greater demand, hence greater cost.
>
>  The demand is self-induced by the physicans and their
>regulation of the patient.  A doggie hysterectomy at $110
>our a human one at $20,000 does not reflect anything other
>than the politics of the situation.  My vet says he has
>better results than human doctors do...lower death rates.


   Your vet opperates on teenaged healthy animals with minimal
anaesthesia (long as they don't move-- they don't sue if they remember
the operation).  Ask to see his anaesthesia machine sometime, and his
ET tubes.  "My what?"  He'll say.  He doesn't need them.  Nor do his
patients sue him if they get urinary incontinence after the procedure.
It would be so nice if a human doctor could just say: "Mrs. Smith, I'd
like you to try going on all fours for awhile.  See if you still lose
urine when you bark.  I mean, cough."

   Also, your vet does not have to opperate under the same stringent
standards as lab researchers do, or hospitals do.  That means some
government inspector doesn't come out and make him replace his ceiling
tile because it's the wrong material, or harrass him because he's used
a medication vial which expired last month.  If he wants to reuse
plastic disposables by puting them in cidex, he can do it.  If he wants
to do the same with his needles, he can do that.  The labs he uses
don't work with human blood, and they don't have to be as careful, so
their charges are less.  If he wants to use steel suture which leaves a
big scar for that hysterectomy, his German Shepherds are not going to
complain that they didn't get the bikini incision.  And so on.  I hope
you're begining to get the idea.  It would be possible to continue this
for pages, and it all adds up.  Because juries don't award damages for
pets in the same range as for spouses, his malpractice costs are way
down.  Even the state license costs him less, because the state spends
more time scrutinizing doctors, and wants money to do it.  Etc.