Thursday, October 27, 2011

A Tale of Two Clinics

This is the one you DON'T take your dog to.
This past summer, The New York Post ran this piece on Riverside Animal Clinic, at 187th Street and Fort Washington Avenue. A bulldog essentially barked himself to death while being boarded there. Being the New York Post, of course, they got Riverside Animal Clinic mixed up with the well-regarded Riverside Animal Hospital, which is down around 108th St.--much to the distress of Riverside Animal Hospital, which was bombarded with negative calls--believe it or not, the story about the poor bulldog even made it into the Daily Mail, a British tabloid.

And it just recently occurred to me that Riverside Animal Clinic is actually nowhere near Riverside Drive, which terminates well south and west of it. It's in Hudson Heights--Hudson Heights Animal Clinic would surely make a rather stylish distinctive name for a vet practice. So why is it called Riverside Animal Clinic? It finally dawned on me that the similarity in names might be deliberate, since Riverside Animal Hospital was well established as a reputable practice, long before Riverside Animal Clinic showed up. I wonder how many people have heard good things about the former, then confused it with the latter--sooner or later, it was going to work the other way around as well.

Anyway, the piece brought up some bad memories for me. It's been a long time since I set foot in Riverside Animal Clinic, though I pass its clean, well-lit, comfortable and oh-so-inviting storefront office all the time. I'd recently moved into the neighborhood with my dog Peggy, and was finding it hard to get her to the Bronx practice she'd been going to up to that time (New Yorkers without cars always have problems finding a good vet thanks to the idiotic banning of dogs much larger than a guinea pig from mass transit).

R.A.C. seemed to be a reputable-looking place, and it was nearby. I didn't inquire as to the practice's reputation. I didn't look at the available alternatives. I wasn't really hooked into the dog culture at that point. Peggy's dislike of other dogs made it hard to talk to other dog people about vets. Internet information resources weren't as well-developed. There was no Rocky Run back then either. I often wonder what kind of difference a dog run would have made to Peggy's notoriously touchy relationship with her own species.

Not long after she reached her 10th birthday, as fit and vital as she'd been at half that age, Peggy developed a growth on her gum, and I took her in to see Dr. Ramos at Riverside Animal Clinic. He diagnosed it as an epuli (this was after I had mentioned to him that I thought it might be an epuli, based on internet research). She had surgery to remove the growth. It was very expensive, but we didn't have any clear idea what it should cost, and it was Peggy. We'd have paid anything to keep her in the world a few more years, as long as she wasn't suffering.

She seemed to be okay for a few weeks--then the lump started growing back. Then she began to lose her energy, became increasingly (and very atypically) listless and apathetic. Then one day she collapsed, when I was at work--we rushed her to the Animal Medical Center's 24/7 ER in a livery cab. The staff lived up to that institution's sterling reputation, grabbing her out of our arms as we went up in the elevator, and trying their best to revive her (I've never seen this level of response at a human ER)--but she was probably gone before we got in the taxi. No, they didn't bill us. When they do bill you, you surely know you've been billed, but that is one veterinary facility where the term 'hospital' is no mere honorific.

As we stood there quietly weeping over her body, the young female doctor gently explained that an internal growth had burst a major blood vessel, causing her to bleed out internally. A growth Dr. Ramos never so much as suspected. In all fairness, a growth like this is hard to detect, by its very nature--but still--he'd just operated on her. A short while later, we got a generic condolence card from Riverside Animal Clinic in the mail--presumably the AMC informed them, because we never did. We threw the card away. No animal of ours will ever go there again.

Dr. Ramos' fault? Maybe not. Mine? Definitely. I didn't do my homework. I didn't shop around. I figured one vet was about as good as another. Peggy had been so indomitably mutt-healthy for most of her 10.5 years that I simply never needed a good vet. Until I did. At which point it was too late. I've never really forgiven myself. She might have died anyway--could have just been a genetic time bomb waiting to go off--but at least I'd know I took her to a good doctor. Peggy deserved better.

A few years later, we'd mourned enough to let another dog into our lives, and Max introduced us to scores of local dogs and their people. And we began to hear one horror story after another about Riverside Animal Clinic. It has by far the worst reputation of any veterinary establishment in North Manhattan. And yet it apparently continues to flourish--because there are still so many dog people who aren't plugged into the social network of dog runs and offleash hours, and of course cat people don't even have the option of that kind of network, except maybe online. The office is efficiently run, attractively decorated, with an unusually roomy waiting room, and is in an enviable location, surrounded by upscale restaurants and stores. Presentation often trumps professionalism, and that isn't just true of veterinarians. Many great vets have shabby unimpressive offices--because they're spending the limited funds they have on better care, not interior design and nice real estate. I'm sure that as I type this, somebody is enthusiastically recommending Riverside Animal Clinic to a friend with a sick pet. One born every minute, you know.

Mind you, people also complain a lot about vets--even the best ones. There's often a lot to complain about, but I've had my quibbles with the nature of some complaints, which have more to do with the owner's pride than the animal's health--"I had to wait forever to be seen, the doctor wasn't nice to me, the office is dingy, the receptionist is clueless", etc. We forget how much it costs to run an office, how difficult it is to retain a first-rate medical receptionist/secretary/office manager/billing clerk--jobs that are typically done by multiple people in a typical human medical practice--without passing the cost of employing and insuring this paragon on to one's clients. So typically (unless it's an upscale neighborhood), either the office is run in a manner that you'd never accept from your dentist or chiropractor--or the bills make you gasp in horror. And it's not always either/or, is it? I'm not saying that a badly run office means the doctor is great, but a well-run nicely decorated office doesn't prove anything except that they're spending a lot of money on things other than patient care. They're doing that for your benefit, not your pet's. Because you're the one with the credit card. You're the one they're selling to.

Most pet owners have medical insurance of some kind for themselves and their human family members--otherwise they probably couldn't afford a dog, and certainly not vet bills. As a result of this, we tend to forget how much healthcare actually costs--until we take our doggie to the doctor, and hey let's be grateful to our animals for reminding us that if we ever let healthcare be totally privatized we are totally screwed. Pet insurance is, shall we say, a work in progress at this time--I've just taken the plunge myself--the Union Plus Gold Plan (for union members, and I happen to be one)--we'll see how that goes.

Vets do frequently order unnecessary tests, but so do human doctors. Nearly everything wrong with veterinary medicine is also wrong with human medicine--two branches of the same knotty tree. Difference is, you have to pay for 100% of the tests run on your pet, necessary or not (the other difference is that most vets are GP's AND surgeons--specialization is much less advanced, which is simultaneously a good and a bad thing, in my opinion). Many practices are in neighborhoods where income levels vary greatly--in fact, name me a New York City neighborhood where they don't. To help that elderly woman on a fixed income with an ailing Yorkie who is the sole remaining joy in her life, they may sometimes charge on a sliding scale--which is great if you're on the low end of that scale, but the money has to come from somewhere, or the practice closes, and the Yorkie dies.

A vet has to pay for equipment, supplies, office support, vet techs, assistants to watch and care for the animals--and good help is never easy to find, or to keep. Medical labs charge a lot for their testing services, plus there's rent, maintenance, taxes, and of course there would be very few competent vets still in practice if you couldn't make a decent living for yourself and your family (including pets) as well. Our vet bills are big, but not nearly as big as the vet's own bills. Which makes it all the more irritating that so many bad vets are out there, right now, charging ridiculously inflated rates for dangerously poor treatment. With a lot fewer professional and governmental watchdogs (so to speak) keeping tabs on them. Making it that much harder for the good vets to stay afloat.

Big animal hospitals, whether run by a charitable foundation like the AMC, or a consortium of high-powered doctors like NYC Veterinary Specialists (now in the process of changing its name to Blue Pearl Veterinary Partners for some reason), are certainly an option--but your animal will never get the same level of personal day-to-day care from them that he will from a good neighborhood vet. And since you probably won't ever live within walking distance of those big fancy hospitals, if you don't own a car, and your pet is much bigger than a guinea pig, you will pay a fortune in cab fares, because of the mass transit idiocy that says you can't bring a well-behaved friendly dog on a leash onto the subway--and yes, I know I said that already, and I'll say it again--IDIOCY.

The ASPCA or Humane Society hospitals will charge less, and the doctors will be competent (and constantly changing), but I hear some negative stories about them as well, and those hospitals are likewise tricky to get to for us North Manhattan dwellers. We need all the options we can get, and that includes the local practitioner. Who needs to make a living, in order to keep practicing.

But that's no excuse for not doing a good job. That's no excuse for killing somebody's dog, or cat, or ferret, or parrot. That's no excuse for being a quack. And the sad truth is that a lot of veterinarians are quacks. They may sometimes have a degree that isn't worth the paper it's printed on, but even if they have acceptable professional training, some still end up seeing all the dogs and cats and birds they treat as the same species--cash cow. If they went into veterinary medicine with any idealism or compassion at all, it's left them a long time ago, and now they're just in it for the money, and it's easier to make money when you cut corners.

There are millions of pets in New York City, and that means millions of people ready to part with hard-earned cash to keep their cherished companions alive and healthy--sheep waiting to be shorn. A capable honest veterinarian is a pearl beyond price, but a bad one is a living walking insult to all of us, and a threat to our furry friends. It's up to us to shut them down, by refusing to patronize them, and sharing information about them. But for us to do that, we need to learn the difference between a good vet and a bad one. We need to distinguish between a vet who is maybe a little gruff or brusque with us sometimes, or makes us wait a bit too long, or persuades us to pay for a test that may not have been 100% necessary--and a vet who KILLS OUR ANIMALS. Or simply isn't capable and canny enough to know how to treat them, same difference.

The internet may not be your best friend, but it can be a useful adviser--check online review sites like Yelp. Assume that at least some of the negative reviews are written out of pique at some perceived slight, and read between the lines--what are they complaining about? Reading online reviews of our various local vets, I noticed that only in the case of Riverside Animal Clinic were some people saying "They killed my pet." That doesn't prove they actually did, but it's not a good sign, clearly. Neither is somebody saying a vet practice diagnosed his pet with cancer, then it turned out there wasn't any cancer. As somebody says about Riverside Animal Clinic. For example.

Look for people saying that the vet is a good diagnostician, a good listener, takes his or her time examining the animal, doesn't over-vaccinate, over-test, over-treat--but is ready to advocate for a given test/medication/procedure--when it's truly needed. The vet is not there to agree with you--you are there to learn from him or her, even if sometimes you decide, as is your right, that he or she is wrong on a specific point (and that happens, even with the best vets, but odds are they'll be right more often than you).

Most of all, look for people saying "S(he) really cares about the animals." Dog owners usually have pretty good radar for that--we know when people really like our furballs, and when they're just shamming. And honestly, if you don't love animals, if being around them doesn't make you happy, you don't belong in this field. There are other ways to make a buck.

But again, and above all, ASK AROUND. Talk to other dog people, at the run, in the park, on the street. Doesn't matter how well you know them--this is one topic you will never have a hard time getting an opinion on. We will always be ready to listen, to sympathize, and to advise. Because we have all been there. And will be there again.

And for the love of Dog, don't board your pet at the vet--even a good vet--unless said pet needs constant medical attention. While all vets have to have boarding facilities for patients, I personally would mistrust any veterinary practice that runs a pet motel on the side. I mean, how many pediatricians offer 24/7 daycare for toddlers? I believe that would be zero. Kennels are frequently the source of disease outbreaks, and when you board a healthy dog at a veterinary clinic while you go on vacation, you're basically putting him in a kennel where most of the dogs are, by definition, unwell. There are better boarding options available, but that's another article.

So caveat emptor, for sure--but show some appreciation as well for the truly wonderful doctors out there, whose bills are surely not fun to peruse--but would you rather read your dog's obituary in the Times?? If dogs got obits in the Times, that is. That's yet another article.

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