In most U.S. states, animals are classified as property. This condition feels profoundly uncomfortable to many people – I’ll admit it, even to me, dogged pragmatist that I am.

I suspect that the animals=property designation gives people the oogy-squirmies for one reason: In our heads, property means money and we don’t like linking money to love. The Beatles sang “Can’t Buy Me Love,” and one shouldn’t try to buy love, particularly on street corners. We love our animals, and yet somewhere deep at the bottom of that boundless heap of puppy kisses and pony rides is a price tag. That price tag has edges that lacerate our most vulnerable spots. We love animals for the joy and companionship that they bring, we want to give them the absolute best, but we know that our financial and emotional resources limit that giving.

I’ve been up close and personal with these price-tag injuries and have watched, unable to stop the bleeding guilt, as people weigh the balance of love and money. I had a client who chose to live homeless in a beat-up car packed with her few possessions so that she could devote her entire Social Security check to board her aged horse. I’ve cried with owners as I euthanized foals that might have survived with weeks of intensive care – at a cost that would have meant skipping mortgage and car payments.

I’ve felt the pain and the guilt firsthand, and I’ve had plenty of it thrown back on me.

“If you really cared about animals you would:

a) Give us a discount.
b) Treat my pet for free.
c) Tell me how to treat my pet at home.
d) Lay hands on my pet from miles away and magically turn him into a beautiful butterfly.”

Though it may sound like it, I’m not complaining. As much as words like that hurt, I’ve always kind of assumed it to be part of the job. When people are in pain, they need someplace to put that pain, and I’ve got broad shoulders. However, for the sake of everyone – veterinarian, owner, and animal, the money monster does need to come out of the emotional blackmail closet and face the light of day. Good decisions can’t and shouldn’t be made in the throes of guilt, embarrassment, or resentment. The latter three conditions occupy and activate a different chunk of the brain from the good decision nodule (also known as the neocortex or frontal lobe).

Remember when you were a kid and you couldn’t imagine that your teacher lived anywhere other than school or had a life outside of your classroom? Most of us probably pictured our teachers as holograms that shut off when the bell rang at 3:00. Sometimes for veterinarians, it feels as though we are medical holograms for our clients, existing only in our trucks or examination rooms, not real unless our hands are touching an animal. All veterinarians have stories about clients becoming enraged because we had the audacity to take a vacation, have a child, get married, or fall ill. I’ve been known to relay the following message from my bed to a client who was annoyed because I rescheduled due to illness: “Ask her if she wants me to throw up on her horse. Because it will happen.” Not tactful, but accurate.

Like everyone else, veterinarians have basic survival needs – shelter, food, companionship. At least two of those three require money. Like it or not, veterinary medicine is a business. We may love our work, but our work also pays our bills, feeds and clothes our families, satisfies the IRS, and allows us to build and sustain the business that provides care to our patients.

You may have taken your pet to the veterinarian and come away feeling as though the practitioner wasn’t sensitive to your financial concerns. Maybe you were right. Not having been there, I can’t say. But I can give you a bit of a view from the other side of the patient.

I was raised in a family where one did not discuss religion, sex, or money. Of course, as a rebellious writer, I’ve done all three, much to my mother’s dismay. So I have no problem getting personal here.

My little sister is a physician. I finished veterinary school 16 years ago. My sister just completed her residency last year. When she finishes her fellowship this year, she will likely earn two to three times my current salary – after going through much the same curriculum. And I can suture a patient while standing practically upside down! My husband has a bachelor’s degree in physiology. Our W-2 forms at the end of this year will show roughly the same earnings – some years I’ve earned a bit more than him, other years a whole lot less (and no, not from working part time). We live in a rental house, have one car - a 2005 minivan - and do most of our clothes shopping at Target. Some of this frugality was brought about by other priorities such as diverting a fair chunk of change toward our kids’ education, but by any modern standard, we aren’t living the resort life. In this, I probably fall somewhere in the middle of the veterinary spectrum. Most of us live reasonably comfortably, at least once we escape the teeth of student loans, but few of us are jetting around in the latest sports car or eating salads of tossed money for lunch. We work long hours; risk teeth, claws, horns, and hooves; spend most of our days on our feet; treat our patients at all hours and in all weathers; and generally do it not for the big bucks but for the love of the thing.

With that in mind, there are phrases and attitudes that are just about guaranteed to raise the blood pressure of most veterinarians. We know that the words aren’t meant to wound, but they do. Here are a few examples and reasons why these situations may provoke a reaction you weren’t looking for.

1) The aforementioned gem, “If you really loved animals you would treat Fluffy for free (or give me a discount, or tell me what to do over the phone so I don’t have to come in.)”

This one is emotional blackmail, pure and simple. I understand that there is often fear and pain driving the comment, but look at it from the standpoint of the person with the stethoscope. What am I supposed to do? If I treated every animal whose owner claimed financial duress for free, how would I stay in business? If I’m a practice owner, I can’t pay my employees, my landlord, my vendors or the IRS with that business model. If I’m an associate (a staff veterinarian), waiving fees is essentially stealing from my boss and is a short route to unemployment.

Your veterinarian probably isn’t as unsympathetic as you might think. We’ve all been slapped across the face with the “Ohmygod I can’t afford this” fish once or twice. However, attacking with guilt and manipulation is not the best way to win friends and influence people. Instead, be up front about your situation. State clearly your financial constraints and your hopes for your animal, and ask your veterinarian if there is any way that the two of you can work together to reach a point that will be in everyone’s best interests. Perhaps they have a payment program or can steer you to a credit agency. Maybe there is an interim treatment or a less-ideal but still functional level of care that could work until you can get the funds together. Maybe that isn’t the case. Maybe there really is no other option. But if you express your fears honestly instead of filtering them through hostility, there’s a much better likelihood of a healthy process for everyone.

2) This next one is more of a situation than a phrase. Let me put it bluntly. Veterinarians devote our careers to remaining current on the latest evidence-based ways to keep animals healthy. It hurts to watch clients spend hundreds of dollars on everything from herbal remedies to massage to Tarot card readings in pursuit of a cure only to be told that the veterinarian is “greedy and only wanting money” for suggesting blood work or X-rays. Did the massage therapist, supplement retailer, or Tarot card reader offer product or services for free? If the answer is no, how is that person any more altruistic than the veterinarian?

3) “But it was a free horse/dog/cat/giant anteater.” This one illustrates the uncomfortable intersection of animals and property in the human mind. An animal that earns its keep, either through athletic performance or the products of its body, does have an unarguable intrinsic value. However, most of our companion animals provide just that – companionship. Can someone explain to me how the companionship of a free animal is somehow less valuable than that of one that cost hundreds or thousands of dollars? The animal’s needs certainly aren’t any less. I used to tell prospective horse owners one thing: The purchase price of the horse, whether $50 or $50,000, is only a fraction of the amount the animal will cost over its lifetime. Sadly, as far as I know, there isn’t a grand charity fund that subsidizes lifetime care for “free” animals. They cease to be free once you take possession. Think of it this way: the money you saved on the purchase can go toward the vaccinations or the dental work.

4) There is a weird disconnect in most people’s minds when it comes to the medical aspects of animal ownership. I may take a public flogging for saying this, but I think veterinarians are partly to blame for this condition. In the past few decades, veterinary science and technology have grown apace with human medical sciences. We have techniques and equipment that would have sent James Herriot into a clinical sugar coma of pure ecstasy. Forget the wonders of X-ray. We now have digital X-ray that produces images that can be sent electronically to experts all over the world for consultation. Veterinary referrals of patients for MRI or CT scan are becoming almost nearly as common as for human patients. We have safer anesthetics and the means to monitor almost every physiologic parameter before and during anesthesia. Animals undergo chemotherapy, hormone therapy, and management of chronic diseases such as diabetes. Yet none of these medical advances comes without cost. Equipment, laboratory services, monitoring, even medications – they all have a price tag. For the record, these things aren’t cheap on the human side either, but many of us never see the true costs thanks to the wonders of medical insurance.

Pet product marketers, TV networks, and a host of talking-animal movies have trained us to view our companion animals as fuzzy family members who are cuter than that cousin with the hairy knuckles. The explosion of pet paraphernalia is proof that cats, not computers, are taking over the world. This phenomenon has produced an interesting side effect: when your son and dog can have matching T-shirts, or you can buy bejeweled fly-masks for your horse, it is hard not to demand the same quality of medical care for these animals that you would for your spouse, child, or second cousin. But while people seem willing to whip out the credit card at the first glimpse of a rhinestone collar or Burberry Pomeranian tote-bag (when did small dogs lose the ability to walk?), the same people may panic at the notion of spending the same amount on vaccinations, pursuing the elusive cause of the ear infection or dental work on the same dog. Ask yourself, which does your dog really want: the pink sweater vest or the ability to chew his dinner? (Hint: he’s voting for the one that won’t get him stuffed in a trash can by his buddies at the dog park.)

Veterinarians have largely been willing, if unwitting, co-conspirators in the animal quest for world domination. We like to use our clinical knowledge and skills. We like being able to diagnose conditions earlier and to treat them more thoroughly. It is far more satisfying to have solid medical evidence on one’s side than to rely on a handful of guesses and throwing bones to read the auguries. And yes, the shiny toys and added income are cool, too.

However, everything has a cost. Shiny, platinum-level, House-style veterinary care is seductive and important in its own way, but when discussions move to cost-estimates, the glow fades pretty quickly. It is here, in the shadows of bank balances and account books, that the real discussions take place, where they need to take place. In the reality of numbers, it is important for everyone – owner, veterinarian, and animal – that we discuss not only what can be done but also what should be done and what must be done.