Google Maps and Moral Authority

At a recent conference held for the leadership of state veterinary medical associations, I had the opportunity to listen to the sobering economic statistics that veterinary medicine faces. These are not, by the way, altogether new or shocking (I’ve listened to them and read them well before the average new graduate entered the profession with the 2.7:1 debt to income ratio of the Class of 2014), and my profession always seems to endure. When care for the equine-based transportation infrastructure was supplanted by Fords and Chryslers a century ago, veterinarians began a focus on pets that now dominates the profession. So we contend today in practice with few patients named “Trigger” and more named “Toonces,” a paradigm shift of the first order, and, increasingly, with our medical expertise supplanted by the opinions of “Dr. Google.” It is a reminder that, whatever the intensity of the human-animal bond, much of our profession is supported exclusively by the discretionary income of others. We’re not unique among professions who consider the practice of their craft a fragile thing indeed. The palpable angst of the many physicians who blog in this site, those who face challenges in the human medical profession far more revolutionary than evolutionary, sometimes seem to blunt the big professional worries faced in my field.

But common to all of us is a sensed need to practice defensively. No one wants to offer low-hanging fruit to the trial lawyers, or to spend depressing amounts of time dealing with liability cases. We all document things assiduously. When the dust settles in a case, I may ultimately look like an idiot, but it sure better not be because of a failure to accurately chronicle what I was saying or thinking.

But now, according to a bright veterinarian who is a marketing guru and speaker (and, curiously, about whom I say all those things without sarcasm and with notable reverence), we have new fears. In a competitive marketplace for services, we need to stand out; we need to offer something that others do not. Any medical professional knows that already seems to be stamped on our DNA—we got to medical or dental or veterinary or whatever school because we were driven to be the best, to stand out, and we have the emotional scars and empty Prilosec bottles to prove it. It’s what makes us all, not just DVMs, think, as American Veterinary Medical Association (AVMA) Executive Vice President Ron Dehaven recently stated, that “ninety-nine percent of veterinarians think they communicate better than their peers.” We crave excellence in what we do, and how we communicate it, and have reasonable expectations that the work we do and the hours we sacrifice will make us just a bit different than our peers. We will offer that optimal “experience” that the gurus say we must.

So often the way we stand out has nothing to do with our medical or surgical competence, but has everything to do with how we are perceived in the public. Dr. Google, and his cousin, Professor Yelp, and what seem like a host of other sites can give us star ratings that appear whenever someone in the public just seeks our phone number online and is automatically shown a “Google Map” of our location, complete with our reviews. These can build up our professional egos, or crush our spirits. Chillingly, statistics say that 69 percent of the population would place as much stock in an online review of a medical professional as they would from the personal recommendation of a friend. We have become, as Tristam Englehardt, Jr., has commented, a society of “moral strangers.” The online opinions of a disgruntled former employee or the supportive golfing buddy of a doctor, neither of whom has to particularly identify as such, are granted the same authority for help in making significant and important and often difficult medical choices as a trusted friend. How awful.

I’ve written of the consequences of online bullying of a veterinary colleague before, bullying that seemed to have contributed to her suicide. Medical professionals have long had to worry about what happens if the outcome of a case is not optimal. Now they (we) must monitor the Internet as sentinels waiting for the poor rating from a client or patient we may have inadvertently offended, from any number of rating sites. I say this as someone whose practice has great online reviews; hooray for me. But popularity, and especially online popularity, is ephemeral. Does this change how we practice? Does it change how we share the truth or protect our staff or other patients from toxic people? Does it mean that standard medical ethics are replaced by the business model of “the customer is always right”? How do we even try to change the cultural authority of anonymous (or nearly so) online reviews? I don’t like how it may impact the way I now practice, but I must accept its presence and deal with its ramifications. For those who face remarkable burdens to practice ethically and honestly within their professions, it offers one more sobering burden to doing just that.

On Animal Welfare and Professional Consensus

The original reason I become involved with organized veterinary medicine, first the local association and then the state, was because I had become a solo practitioner in a start-up practice. This is a lonely business, where you can’t bounce ideas off colleagues within your own practice and where the struggles of being a veterinarian can only be recognized by others who live a similar professional life, people who you don’t see a lot as a solo doc.  Thus came an entry into the veterinary political process, the innocuous-sounding “Member-at-Large” position in the local association. I would seek out relationships with my colleagues, and work together to strengthen my profession. Since relatively few seek out such spots anymore, and with a modicum of competence in my role, an ascent was assured. On to the state association!

The American Veterinary Medical Association (AVMA) is a group that has struggled mightily to make statements of substance on a wide variety of issues that reflect a remarkably disparate group of veterinarians in a very diverse profession. It is, pardon the pun, herding cats.  Their job is not enviable, and they seek to hold us all together as a kumbaya group of animal medical professionals.  So the result of this has been a philosophical foray into the gradations of vanilla, with position statements that have the strength of a triple A battery.

The states are the laboratories of democracy in the political process, and incubators of thought in the taking of positions. In my state of Indiana, we are not blessed with or burdened by the same forces that make public policy in California or Vermont or Alabama. We are Hoosiers, people who live and work in a hotbed of practicality in the epicenter of common sense. And I am a member of the Animal Welfare Committee for the state association, the perfect place for an ethics dilettante like myself to engage the big issues. It was our task to arrive at a consensus statement about animal welfare that captured Hoosier values and I was excited about the chance to help shape things.

Yes, this is a bit “tongue-in-cheek.” I am actually quite pleased with the abilities to engage bioethical issues that my education has afforded, so I am not altogether a dilettante. My ability to address issues of animal rights and appropriate stewardship ethics has come from the expert teaching I received in my degree program. As I worked (on a fast deadline) to offer up an introductory statement that sought to secure the rights (or at least “interests”) of all human beings to be considered distinct from animals—a view under increasing attack from the Singers and Regans, the PETAs and the HSUSAs that are gaining traction, I consulted with Trinity faculty and others who helped crystallize my thoughts. Here is what I submitted to others on the committee, themselves bright and thoughtful veterinarians in small animal and swine and equine and regulatory medicine practice. It isn’t perfect (and actually was not even completely vetted by those who I wanted to have read it before the deadline), but here it is nonetheless:

“Human beings, in their essence as a species and in the degree of sophistication of their various capacities, should be considered to have rights, and maintain a significance of moral status and moral agency, that non-human animals cannot possess. However, humans have great power toward animals for compassion and harm alike, and therefore bear a unique responsibility for wise stewardship of animals, particularly for those animals that have been domesticated. This relates to how we care for the environment we share with wildlife, and to the husbandry of domestic animals used for food, clothing, and companionship.

Many issues of human welfare should be considered separately from animals, because they are different kinds of beings. But there are significant areas of overlap in the welfare of humans and animals that necessitate a focus on the latter, in knowledge that to be good stewards of animal welfare is also to provide benefits to human health and flourishing.

To the extent that animals may be considered sentient beings, there is variation between species. The level of mental, neurologic, emotional, and social sophistication ranges widely, and must be considered in how welfare can be optimized in a practical way and to an appropriate degree toward different species. These considerations should be based on the best science available, not on sweeping generalizations or sentimentality. They should also reflect the unique ability of human beings to process and comprehend the available data from biology, behavioral science, and other disciplines, and to make legitimate welfare determinations for animals.”

This began one of the most fascinating back-and-forth electronic conversations in which I have ever been privileged to find myself included. Comments ranged from “too long, too philosophical” to the conclusion that “humans have what they deem to be moral agency only because they happen to be the dominant species (at least vertebrate mammalian) on the planet presently.” Consensus is not so certain, even in the Midwest.

After much chatter, and upon review and acceptance from the full Board, this was the final result for the introductory statement:
 “Humans have a unique responsibility to be wise stewards of animals. This relates to how we care for the environment we share with wildlife and to the husbandry of domestic animals used for food, fiber and companionship. The best science available from the fields of biology, behavioral science and other disciplines should be used to make legitimate welfare determinations for animals.”

Yes, this is a significant paring-down of the prose I offered. But it’s also has some key items that I think are important. Among those, the fact that an introductory statement even survived is notable. The idea that humans have a stewardship role over animals is significant, and that we have the ability to determine animal welfare is not to be assumed in all philosophical contexts today.

I’ll share the rest of what points followed in our full statement soon. But there is a lot to be learned here. Achieving consensus from those who aren’t part of the philosophical (or theological) “home team” may mean some small, but hopefully substantive, victories. And, I dare say, putting out what may be contentious words in a pluralistic society may lead to review from others that may be made by scalpel or hatchet, but is (hopefully) worth the effort nonetheless.