Lessons about health care from a sick kitten

My partner Bill and I have a soft spot for animals. It is one of the most important values I have learned from Bill.  Traveling to London from our farm we happened on a kitten sitting in the middle of the road. She was sick, blind, desperately thin, and only two or three weeks old – likely abandoned. We took her to the vet and she spent two very long and very difficult weeks in hospital. It was our first and very sharp experience with fee for service, self pay, uninsured medical services. These two weeks have reminded me of several poignant realities in health care.

Economic drivers hold huge sway in health care decisions

The kitten needed care; the care was very expensive. The treatments she needed were likely to be of benefit. Without those treatments she would die. We were not talking about unnecessary treatment and we were not interested in prolonging needless care and suffering. For us there was no question we would be her advocates and in fact, for her, the system funder. But what if we’d had to ask – as so many humans do – “is there enough funding to provide the care? Should we mortgage our house? Should we use our retirement savings?”. Decisions about a kitten are difficult enough; decisions about health care for people are much more difficult. In other health care systems, people face decisions about health care based on solely on personal ability to pay or whether that treatment is an insured service. That is a lousy way to contemplate a course of treatment or one treatment over another.  But we shouldn’t be smug in Canada. We don’t provide all of the care we should. We don’t think enough about cost enough as we struggle with providing health care in a system, that, because of design does not function as efficiently as it should. Thoughtless or non-justifiable spending in our system means someone is deprived of care. We should never think health care is “free”.

Prevention is less expensive than treatment

The kitten mostly contracted its multiple infections from its mother. Simply vaccinating the mother would have prevented the infections that required two weeks of difficult care. The same parallel exists in human medicine.  Preventing problems usually can be done at far less cost and with more assurance than treating problems after they develop.  Are we focused enough on preventative medicine? Do we as health care professionals focus too much on the glamourous and often high-tech treatment of illness, decrying the banal exercise of prevention? Are doctors too invested in treatment? Do we need to assign another profession to practice prevention if doctors are not interested – a group that will take it on as their raison d’être?

The frail and voiceless are the first to lose access to care

Some of you reading probably have responded – “but that was just a kitten – why bother? Why should we spend money on someone who is expendable? Why not just euthanize the kitten?” Many whys to be asked and the answers are not easy or simple, and I’m not sure I can clearly articulate our own motivations. However, in our own health care system, who speaks for and acts for the less visible, the less glamourous, the silent, the marginalized, and the less emotionally catchy? Fundraising is easier for those issues that jerk at heartstrings or we have had personal contact than those that are socially stigmatized. Are we making thoughtful, difficult decisions in an arena of loud voices where the emotionally charged issues, the sexy new technologies, the cause du jour, the politically-charged illnesses muscle their way to the foreground? Do we in the system have an ethical framework and operate within it to ensure those who cannot speak for themselves are spoken for? They, like the kitten, actually do rely on the kindness of strangers to ensure that their own very real needs are met. Mental health, elder care, palliative care – these are not issues, but people who rely on the ethical compass of society and the health care system to be heard.

When I started writing this blog I knew that I wouldn’t have answers – I write this to ask questions. The kitten made me think about health care in a different way, with a user’s set of eyes. Perhaps it was fate, not only for the kitten, but also for me.

And Maddie? She’s made a remarkable recovery. From a point where the look in the vet’s eyes said “get ready for the worst, it’s coming” to a happy, playful kitten with great sight in one eye. She doesn’t know anything about health care.  Lessons come from the most unexpected places.