Another subject we covered in my Human Healthcare class was the Longevity Revolution. We all hear about the Baby Boomers getting older, but it is interesting to consider that our healthcare industry is aging, as well. And anytime you focus on longevity, you also have to look at the end of life. Choosing for animals is very different than choosing for people.
THE LONGEVITY REVOLUTION
OK, enough griping.
Now I’ll focus on some of the topics that I really liked this time and how I
see some of them in my veterinary practice. You know, sometimes my kids are
really impressed by how I seem to know everything (that ‘eyes in the back of my
head’ thing); at other times they roll their eyes because they can’t believe
how ignorant I am. I’m not ‘hip’ or ‘with it’, although I know those terms are
as dated as I am!
I really liked the
information about the aging population and the need for more general
practitioners. (I never really considered about the medical practitioners aging
as a group…hmmm.) I totally agree that there needs to be a move towards
family doctors. For many years the medical industry was gaining so much
specific knowledge and technical abilities, and it seemed like medicine became
very ‘targeted’ – if you had a joint problem, you went to a joint specialist,
etc. Of course, many people still technically had a primary physician, but
often it seemed that they did little but authorize the trip to the specialist.
For instance, I
never took my kids to pediatricians. My children are a part of a family unit
and need to be treated that way. They don’t live in a vacuum. And I think this
is the best example of how human medicine has gotten so off kilter. I’ve been
lucky enough to have found some really good family doctors who take the time to
do thorough histories. (Darned if they don’t leave just about the time I really
get them trained.) Doctors who take the time to listen and ask the right
questions are way ahead in treating the whole patient, not just throwing some
medicine at some symptoms.
In my practice a
good history is a must, especially since my patients can’t talk for themselves.
I think the biggest problem is that doctors have to get so many patients
through a day to make it profitable. Also, I think the culture of medicine
needs to get back to teaching the doctors about how important gathering
background information is. Or maybe just that it needs to be done. When you had
small practices in small areas, the doctors probably already knew most of the
family information about their patients because they were a part of the same
small community. That’s just not likely to happen today.
Another point that I
think was really well made this week was that lifespan does not equal
health-span. Whenever the legislature talks about raising the retirement age, I
consider it an interesting issue to tackle. When you look at the older people
you know, some people are ‘old’ at 65 and some are ‘young’ at 85. How do you
differentiate between those people who really need to slow down in their 60’s
(or even 40’s or 50’s), and those who are active and able into their 70’s and
80’s? I don’t see that there is a way to legislate this problem as it would
need to go person by person and case by case.
Hospice is one of my
favorite parts of the medical industry. My grandmother went into a hospice
house in Topeka after a massive stroke, and it was the best experience ever
(relatively speaking). Everyone I’ve ever talked to who have used hospice homes
have had good things to say about them. I don’t know as much about hospice done
at an individual’s home (I really haven’t heard of any in the last decade
personally), but I would imagine there is a move to get people into the hospice
facilities where there would be better access to staff, equipment, medications
To choose hospice is
to choose the right to die with dignity and comfort. But can the same be said
about euthanasia? As a veterinarian, I can say that euthanasia is one of the
most difficult things that I do. I hate the days when I transform from ‘Dr Glaum’
to ‘Dr Gloom.’ I appreciate being able to end the suffering and pain for the
pet of a family. Since I don’t like the ‘Dr Gloom’ I usually try to push the
animals and the families to put that decision off as long as we can maintain
the quality of life.
Once I have a
terminally ill patient, we have a ‘pet hospice program’ we use that helps the
patients stay comfortable and helps the families know when it is time for
euthanasia. This has been one of the best programs that we have instituted in
the past few years. We have a scoring sheet that looks at different topics
(like movement, hunger, pain) so that the pet owner can evaluate their pet, see
trends, and better communicate with us. If something is trending downwards, we
know that is an area to work on (like installing ramps, changing food types,
adjusting pain meds). Better quality of life (QOL) means that pet and parent
have more time together. And it relieves some of the worry and guilt that they
experience when that time does come.
One of the
non-scored topics I have to deal with though is the burden on the caregiver. I
know how important this is to people on the human side more than even the pet
industry. It is one thing to carry a 10# Poodle outside to go potty, but a very
different thing to move a 100# Labrador around. Sometimes the problem is the
clients can’t afford meds or have ‘people’ family commitments they need to
attend to. We, as veterinarians, have that luxury of being able to say,
“That’s OK, it’s time.” I have seen my parents caring for my
grandparents as they aged, and frankly, I’m scared that when it is time for me
to step into that role I may not be up to it. I hope I can find a way where it
is my responsibility, but not a burden. Time will tell.
The last thing I
wanted to note on euthanasia is what a burden it is to have the power over life
and death. It isn’t easy, at least for me. Perhaps that is because of my belief
that animals are all unique as God’s created creatures; I just don’t know. I do
feel honored to be allowed to be a part of the intimate time when the pet
owners say good-bye to their pets. I try not to cry at the moment, but often
the tears come on the way home. One especially bad period a few years ago, I
lost 12 pets in 9 days; it was a hot August and the little old guys just
couldn’t handle the heat stress on top of everything else. Anyway (probably TMI), I went into a
depression that lasted for months. The point is, euthanasia is really tough and
I don’t think the human medical industry needs to go to that difficult place. I
think that hospice can fill that need.