Fine lines, fancy geometry and acceptable complications in vet medicine
In case you didn’t know it, "acceptable compication" is a technical term. That's becase some complications in medicine are counted among the “expected” variety. They have little to do with human error or poor quality healthcare. Statistically, they have been proven to have more to do with individual responses to treatments than with surgical technique, choice of medication, or specific procedures followed during hospitalization.
In vet medicine, the category of “acceptable complications” takes on a whole new meaning when you add to it the vagaries of pet behavior. Multiply this formula by its intersection with capricious human conduct and you get a whole new dimension of potential problems.
You may think this is a vet’s ultimate cop-out. “Wasn’t my fault. I was set upon by a vast right wing conspiracy of ‘acceptable complications.’”
A simple proof: Think about the common feline spay. Let’s say your vet does such a great job that your kitty feels her oats again as soon as she gets home. No moping because of a great pain relief protocol. No dull demeanor as a result of modern anesthetics’ short-acting effects and your vet’s competent, quick way with the knife.
So kitty takes on her toys and gorges on food and generally does the things that make you feel she’s 100%. Next thing you know, the E-collar’s off, the pouncing begins and the perfect little row of stitches unzips before your eyes—at 11 PM at night. Consequently, you spend $450 fixing a $250 spay.
In the morning you call your vet to explain the circumstances. Maybe you’ll feel a little guilty for letting kitty do her thing. Maybe you won’t—not everyone understands what “keep her quiet” really means. Sometimes you’ll even want your vet to pay the emergency bill.
Despite your ire, a “dehiscence” (incision unzippage) under these circumstances is considered an “acceptable complication.” Your dog takes the steps quickly on a recently fixed cruciate, tearing the TPLO plate off its hinges? Acceptable complication. All those common problems we see with suture material reactions and phantom pain after declawing? Acceptable complications. Sudden death under anesthesia? Many times, it’s a real live acceptable complication.
Yet all complications, even those of the “acceptable” variety, are generally viewed by us as our responsibility, in spite of the technalese differentiating these from complications where we clearly messed up. Which is to say that we feel guilty regardless of our technical blamelessness. We might not go so far as to pay your e-clinic bill but we will often fix ‘em up ourselves for the cost of drugs and supplies (that’s my policy, anyhow).
I’ve talked to lots of vets about this issue and it never fails to raise a few hackles. “I told them what could happen, I explained the risks and complications, then when it happened I still felt guilty and sucked up the price of the complication. I’m just a pushover.”
God knows human docs don’t take on the cost of these complications. When one of my girlfriend’s breast implant incisions formed a cheloid scar the bill was as big as the initial surgery itself. When another’s IUD somehow slipped its spot she’d had to pay for a whole new device (only one every five years according to her policy). And the MRSA infection you got in the hospital because someone else there had it? You guessed it: Add $30,000 to your bill for the extra week of care.
What is it about us vets that gives us cause to feel our responsibility s much more acutely? Or do we? Perhaps it’s those lengthy forms you have to sign before being hospitalized that helps draw some imaginary line. I don’t know the answer. This geometry gets way too complicated for me…