It has been a while since we last took at look at this topic sidetracked by the World Association of Laser Therapy international conference. As stated in the last post on this topic there are multiple reasons that the cost of treating pet illness has increased so dramatically. Perhaps the single most compelling reason lies in what is now referred to as teaching to “the gold standard” of medical care. Though this sounds ideal in providing the best medical care for your pet it is not without downside. There is not necessarily a single “gold standard” of treatment for each and every disease condition but simplistically it infers doing as much diagnostically as possible to confirm a diagnosis with nearly 100% certainty. In a perfect world this may be desirable yet frequently impractical.
Consider this example. A 7 year old male Labrador (neutered of course) presents to the hospital limping on one of the hind legs. Physical exam reveals pain when the knee is flexed, extended and manipulated in a way which can indicate ACL (CrCl) injury. Most of us are familiar with the rupture of an anterior (or cranial) cruciate ligament. It is a common injury for athletes and when totally torn would require surgery. We sedate the patient, take X Rays, and determine with 80% certainty that the CrCL is likely torn. At this point there are a few choices. We can reduce the pain associated with the injury and perhaps heal a partially torn ligament with rest and laser. This will only be effective if the ligament is partially torn. Another option is surgery to reconstruct the knee. The final option is to perform an MRI to gain nearly 100% certainty. In a perfect world we would all choose this option but it adds nearly $2000 to the price of the medical treatment. If one chooses to treat the knee with laser and evaluate the response after four or five sessions, the course of action may become more obvious with considerable less expense than an MRI. Similarly there are some dogs, with a partially torn ligament, that may heal reasonable well without any further intervention. Frequently, however, practices only discuss the “gold standard” which can place the price of CrCL injury, diagnosis, and repair at $5-8000, unaffordable for many clients.
As a medical practitioner we always want to be certain as possible before a major intervention. But in a world where expenditures on our pets are mostly out of pocket, practicality often prevails. A detail oriented and capable practitioner can often make diagnoses that, although may not be 100% certain, will offer the client with limited resources a reasonable course of action. Too often we have seen clients in our practice that are under the impression that euthanasia is the only answer since they couldn’t afford the “gold standard”. With exhaustive communication, careful assessment of clues, drawing from years of experience and deductive reasoning we can often bring about an affordable resolution. Now if we could only convince our human counterparts to use their brains as much as all of the available testing we might make some real progress in the health care arena.