If there’s one class of client that gives us pause more than any other it’s the human physician (and his or her spouse/partner). This may sound profoundly unfair (and is certainly not a hard and fast rule) yet many vets agree they are among the most difficult group of clients to handle.
While I was in vet school, our professors drilled us on issues we should specifically explore should our animal patients have an on-the-side, at-home clinician making medical decisions for their pets in our stead. It was, even then, a well-recognized phenomenon.
Human doctors, feeling themselves capable of (at least) being able to treat simple diarrhea, limping, or basic infections, have a reputation for giving inappropriate drugs or administering human-oriented treatments based on off-the-mark diagnoses. Most of the time these actions are benign or merely wasteful (of time and medication) but on more than one occasion (in my personal experience) led directly to an animal’s death.
Tragic Anecdote #1: A cat’s lethargy led the physician-owner to assume his cat had a fever. Baby Tylenol twice daily for three days led to an irreversible blood disorder. She died less than 24 hours after her owner brought her in for her fever of unknown origin (her temperature was actually less than 96).
Tragic Anecdote #2: An ill-informed physician gave Advil for several days before realizing that, though his dog’s limp was better, neither her diarrhea nor her appetite had improved. His wife then called the hospital to see what could be done for the diarrhea. We advised her to bring the dog in for examination immediately (five days is a long time to have diarrhea). She demurred. (After all it’s just a little loose stool. I think I’ll give her the bland diet you always suggest.)
After the dog collapsed on a short walk, the physician finally brought her in—DOA. After he blamed us for making her diarrhea worse (because his wife had given Pepto-Bismol—not our suggestion) he demanded a post-mortem. It wasn’t too hard to conclude she had died of blood loss subsequent to a gastric perforation (her Advil-induced ulcer had finally eaten through the entire wall of her stomach, blood vessels and all). To the physician’s chagrin, his wife confessed to the at-home medication on the spot.
Anecdote #3: This one’s not so tragic but it led to the firing of a client. A client complains she shouldn’t have to pay for my veterinary services since those things I showed her in the X-ray of her dog’s bladder can’t possibly be stones. (How do you figure?) Her boyfriend is a radiologist and he informed her that we had to be mistaken (and that she should refuse to pay her bill) because bladder stones are not visible on X-rays. (We called them bladder stones in vet school. Dump him now, sweetie. He’s a loser!)
Remember the maxim: A little knowledge is a dangerous thing. So beware. Dogs are not cats. And neither is human—though sometimes it might appear otherwise.
On the other side, veterinarians seem far less likely to diagnose and treat themselves. To be sure, some of us do (I`ve heard stories that would curl your toes). But I believe vets have a greater appreciation for the Byzantine nature of interspecies differences. What constitutes a powerhouse drug for a cat might just as easily kill a dog. This is what we are taught from day one: never assume that any species shares a physiological trait with another.
Beyond the treatment and diagnosis thing, doctors (vets included) can be pains in the backside in almost any environment. Some of us display a deep sense of entitlement for having achieved a degree, status and title others haven’t. But lets agree on one thing: we should stick to the species we were assigned when we received our licenses—unless we’re willing to go back to school and slog it out all over again.
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On the one hand, I nodded sagely throughout this marvellous little piece. And then it struck me that, as a former veterinary journalist, A) I am a similarly nightmarish client for a veterinarian and B) over the years I suspect I have become an equally dreadful medical patient.
For example, I will admit to having used the GIDEON tool to try and diagnose not only myelf, but also friends and my brother. (In my defence GIDEON and I have sometimes been right...)
So, food for thought. But not just for veterinarians and doctors. And as a journalist, let me also add, a pleasure to read as well.
All the best
Helena Jensen
http://animalpharmpublishersnotes.blogspot.com
Helena Louring Jensen October 26th, 2006 09:28:00 AM
The Merck Manual does for vets what GIDEON does for human physicians. It's helpful when we need a brain jog. It had better not be our sole source or we're in serious trouble. Of course we're all guilty of this kind of behavior (looking up things we think we or our pets might have). IMHO, it's a good thing to do as it might hep keep your vet and your physician on their toes. ;)
Dr. Patty Khuly October 26th, 2006 09:52:00 AM
On the strength of that, next time I visit either one, I shall be referring them to your blog! 8-)
I'm still very fond of my aging hardcopy Merck Manual, but I gather that they now have an online version. Is it interactive in the way that GIDEON is or not?
Actually, have you come across Vetstream? That's not dissimilar in some respects but doesn't offer a decision tree format, which I always thought would be useful.
Helena
Helena Louring Jensen October 26th, 2006 01:39:00 PM
The online version of the Merck manual is not interactive like GIDEON. Vetstream, if it's the service I'm thinking of, is not widely respected. But I have not used it so I can't responsibly speak to its utility.
Dr. Patty Khuly October 26th, 2006 02:53:00 PM
Okay, so I'm confused. Tylenol, Advil are bad. I have given my dogs Pepto Bismal, Benedryl when having an allergic reaction & Immodium. I believe that it was as a result of a conversation with a vet (Maybe Chris?).... Am I right?
This is what I'd like to have, or maybe I shouldn't. A list of acceptable/unacceptable meds.
I could be crossing boundaries.
Janet (Cody and Gracie's mom) October 28th, 2006 01:20:00 PM
Janet: As a general rule, benadryl and Pepto are pretty innocuous. But if you think you need them you should still be talking to your vet. Of course Tylenol and Advil (and any other human NSAID except for the occasional dose of aspirin) should be strictly avoided. Keep in mind, doses are different in pets and it's always best to check first. Chris is a vet so of course you can count on his recommendation.
Dr. Patty Khuly October 29th, 2006 07:51:00 PM
Immodium can be dangerous/deadly for the collie breeds (collies, aussies, shelties, and more) that carry the MDR1 gene mutation. See http://www.vetmed.wsu.edu/depts-VCPL and http://www.busteralert.org for more info.
kabbage October 30th, 2006 08:49:00 AM
Those are probably the same physicians who can't tell the difference between a 60 lb child and an 180 lb elderly person. On the other hand, there is the veterinarian who tells the client that his 'dog bite' looks fine, and we know all about dog bites and vets! Or the vet who is looking for the dog gentamicin spray to treat his or her own skin infection on a desert island.
As a former 'health care whatever,' I think it works best if each professional 'hooks the other in' in a collegial manner. Discuss science - wow that looks like this in a human lung, but how is it different? Isn't this interesting that you can't use tylenol in cats, loperamide in mdr1 alleles, and by the way do you know how this was figured out...
One vet would say to me, "Hey do you want to look at this cataract, aspirate, whatever! Hey look at that! This is probably okay, this isn't." I love that vet, I go out of my way to visit him, and he tells me tales of continuing vet ed, etc.
Another vet seems to have an 'attitude' to a friend. I go in, I'm polite, the bill is getting paid, etc. "Wow, I was wondering what that is, I don't know, is it like human whatchamacallit," and "btw, I'm a whatever, I really don't know what you are supposed to call this joint, this 'ankle,' this artery," etc.
A vet and I interface and he says, "Why on earth did they do whatever when I was in the hospital, it makes no rational sense." I can say, "well, that is some crazy hospital protocol, but they do it for this reason, or because of these studies."
Granted, medical professionals of all types can be jerks. as above. OTOH, a lot of medical professionals can be 'cowboys,' it's inherent in ones who work well in limited situations, from an overflowing ER to the other medical professional can't get the line started...... to middle of the night and the vet that's trusted is not on call. Same for the large animal vet working in the field with something missing from his truck in a very important situation.
With a lot of medical professionals, the interface can increase respect on both sides. There are no hard and fast rules, but a collegial relationship goes a long way.
Also, the obsessive-compulsive type of medical professional (you know, the one who listens to your heart if you the vet ever go in for a physical, lol) will quickly get this: not in cats, oh the liver, wow, the antifreeze, how weird, better check on this before I give it to the dog. This type will actually remember what the vet says and often write it down in a little notebook, tell everyone they know, even people on the street walking their cats, and file it in their computer. Oh, and stick it on the fridge for any catsitters, too. :))
And vets, please don't deal with any non-toe or non-finger foot or hand fractures! :D
Red Golden August 13th, 2009 02:34:33 PM
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