Access-to-care conversations continue

Access-to-care issues may be the most substantial animal welfare crisis affecting pets in the U.S., said Dr. Zarah Hedge during the Aug. 22 session “Access to Veterinary Care: What Do We Know and Where Are We Going?” at the AVMA Virtual Convention 2020.

Dr. Hedge is the chief medical officer and the vice president of shelter medicine at the San Diego Humane Society.

Challenges around access to care impact many areas of a community, but there are ways to discuss incremental amounts of care and financial challenges with clients.

“We didn’t go to veterinary school because we wanted to go into practice and turn people away or have to euthanize animals for treatable conditions,” Dr. Hedge said. “This takes a huge emotional toll on the veterinary profession. These ethical decisions really take a toll on us. Wouldn’t it be great to create pathways for these animals so they don’t have to be euthanized and they don’t have to be relinquished?”

During the session, Dr. Hedge focused on what the profession can do to break down potential barriers to care.

Affordability is the largest barrier to care within the U.S., according to the 2018 “Access to Veterinary Care” report from the Program for Pet Health Equity out of the University of Tennessee.

As previously reported by JAVMA News, the COVID-19 pandemic will likely increase access-to-care issues as many people face financial challenges related to job loss (see JAVMA, July 1, 2020).

“We are faced with the reality that this is likely going to become an even bigger problem,” Dr. Hedge said. “We can’t avoid this issue anymore. We have to take meaningful steps to make changes. This is the human reality that we live in.

“Factors that have created this issue are not really the fault of the veterinary profession, but this is our issue to deal with, and, in reality, we are not doing what needs to be done to address this. Ultimately, it is taking a toll not just on these pets and families and communities, but it takes a toll on us as a profession as well.”

Talking about money

But how should veterinarians discuss finances with their clients? Dr. Kate Boatright, a small animal veterinarian in Pennsylvania, spoke during another Aug. 22 session at the virtual convention, “Tales from the Trenches: Working Within Client Financial Limitations,” about how to incorporate and discuss the spectrum of care with clients.

Dr. Boatright said the first step is defining the standard of care.

“We should shift our perspective a little. Instead of thinking of the standard of care as a set baseline, a nonnegotiable, let’s think about care as a spectrum,” she said.

Dr. Boatright said when she gives clients an estimate and they can’t afford it, she tinkers with it by reducing diagnostic testing and prioritizing patient comfort. She suggests asking questions such as “Are you treating the presenting complaint?” and “Are you comfortable with the options as a doctor?”

Dr. Boatright suggests the following tips when working with incremental care:

• Evaluate the patient with a physical examination, and obtain a full history from the client.
• Decide if testing is necessary by asking questions such as “What information will I gain from the test, and will it change how I treat?”
• Always offer the client the ideal care plan, and then discuss the spectrum of care if finances are a concern.
• Educate a client on what they are giving up by doing incremental care.
• Express empathy for and understanding of the client’s limitations without judgment.
• Be transparent about costs and possible outcomes, but talk about care first and money second.
• Ask questions up front such as “What is your budget today?” and “What are your goals for today’s visit?”