Remember that old fast-food commercial bemoaning the lack of meat in its competitors’ burgers? “Where’s the beef?” it asked, thereby implying the obvious: “You’ve been cheated.”
Same goes for how it is that many humans treat their own healthcare. If they’re sick enough to go see the doc, they somehow take offense when the professional does not acknowledge their suffering with some sort of token therapy. In most cases, it would seem, that memento of their illness takes the form of a simple slip of paper, a temporary stand-in for that bottle of pills or container of elixir.
It’s almost Pavlovian. Enter your physician’s office or an ER facility with sickness in tow and you know you’ll be leaving with a white slip of paper sporting a blossom of chicken scrawl. After all, you’ve been trained over a lifetime of such occurrences to salivate for drugs when a certain disinfectant quality assails your nostrils.
I don’t blame you. It happens to me, too. After an episode of acute gastric distress a couple of years ago, I found myself doubled up in pain at a local ER. After about four hours and an ultrasound, it miraculously disappeared. But that didn’t keep the doc from asking whether I might need a script of famotidine for the long haul, as if I couldn’t buy Pepcid AC over the counter like anyone else. Yet, confused by the whiteness of my surroundings as I clearly was, I had to think about it twice before declining the offer.
But is it merely a learned behavior? Or do some of us really need evidence of the severity of our suffering in the form of a script? Maybe it’s something else: A human compulsion to believe in miracles. Hope in a bottle. Who knows?
Whatever the case, the reality is that veterinary medicine is not immune to such human behaviors. The classic case for this is that of the sniffly cat:
A sneezing, mildly feverish cat arrives at the hospital. A diagnosis of a viral upper respiratory infection is rendered, tentatively at least. The recommendation includes segregation from other cats, fluid therapy and other simple modes of supportive care––NOT antibiotics as most of my clients seem to assume is in order.
Now, sure, if they’ve got huge green gobs of goobers and evidence of lower respiratory involvement (or if they’re diabetic, FIV-positive or otherwise immunocompromised) you can be sure that antibiotics will be on the menu. But that’s not necessary––at all––for the bulk of these patients.
Still, my clients want something. It’s not enough to teach them how to support their cats through this kind of infection at home. Nope, most want to see a fluid-filled needle or a jar of pills...something tangible. Even my clientele who might otherwise be happy to decline an antibiotic in the face of an abscess wants something for their sufferers––even if its potential efficacy is a long shot. And I get that.
For that reason I’ve learned to recognize the many signs of “you-must-have-something-else-Doc” some of my clients tend to display. That’s when I offer to hospitalize with IV fluids or bring out the Vitamin B shot, the lysine powder and, depending on the cat’s symptoms, age and overall health profile, maybe I’ll concede to the antibiotics, too.
You might feel that docs who offer scripts or yield to client demands for therapeutics are merely “caving” to a misplaced human desire for drugs. I used to think so, too. In fact when I first graduated from vet school, I used to be one of those veterinarians who lectured her clients on the misuse of antibiotics and refused them on moral grounds.
Sure, I still do that, but far less avidly. Instead, I cajole and explain and work with what’s already in their heads––not against it. Hence, why I’m willing to “cave,” even when I know my patients don’t strictly require antibiotics. Over time, when clients learn that for some conditions drugs don’t help any faster than the non-drugs, they do come around.
I’ve come to learn that if I didn’t take this tack, I’d feel like the lone voice in the wilderness of allopathic medicine. And that’s not a useful place to be if that means you’ll alienate the average, willing-to-learn pet owner.
Still, I wonder: Is it modern medicine’s ability to modify human behavior to expect drugs that I’m up against? Is it just easier for docs to mollify than to teach? Or is it patient/client nature in general we need to address when we write our scripts? Maybe we do somehow feel cheated when we don't get the tangible recognition we feel our animals' suffering deserves.
Hmmm....
PS: Thanks to Gina over at PetConnection for twisting in the light bulb on this particular topic. Yet another reason to keep up our regular marathon, cross-country telephone sessions. ;-)
Add Comment22 Comments
Is it that we are conditioned to expect a script...or is it that we see (or feel) suffering, and think there must be SOMEthing that can help? Would patients asking for meds be just as happy with something that helped to treat the symptoms as they would be with antibiotics? I know I'm always wary when the doc/vet mentions antibiotics, and tend to ask if the situation really calls for them.
But if there's *something* that can help--even a suggestion of particular OTC meds, with a dosage--I'd like to help. Certainly a lot of illnesses just need to run their course, and nothing will cure them prematurely. But if I'm miserable, or my pet is miserable, I'd really like to be able to lighten that up a little.
Galadriel July 22nd, 2009 09:41:14 AM
Hmmm... Interesting. I read this entry with curiosity, since I'm the complete opposite. I really have to be sold on a "need" for medication. I will balk and protest until I'm convinced. I don't even have aspirin in my home. I use drugs sparingly, and only when I believe them to be necessary. And I will fully admit that the only drugs that have entered my home in over 10 years have been for the animals...when I've believed the necessity/benefit of their use.
Marjorie July 22nd, 2009 09:45:40 AM
Having something tangible to leave the office with also validates the stress and worry we have over a sick pet. An at-home treatment plan might suggest that we're getting worked up over nothing. As in, if it can be managed so easily by a non-vet it must be nothing.
I suppose there are people that feel like they're not getting their money's worth if they're sent home with instructions for fluid care and segregation, although I'm not one of them.
Also, people want to feel like they're doing SOMETHING to help their pet. Segregating them isn't an action, like administering medication.
Smaki July 22nd, 2009 09:48:17 AM
To be fair, the lightbulb twist started with Dr. Paul Pion, of the Veterinary Information Network.
But yes, the marathon cross-country phone calls are marvy. :)
Gina Spadafori July 22nd, 2009 09:58:12 AM
After years of having little white slips shoved at me with little or no explanation or information, neither the critters nor I go to a doc (other than annuals) until we're half dead. At least then the white paper is usually warranted. Still, I want that information and still usually can't get it. At annual vet visits, I usually have a list of questions that have come up, want to know what I could have handled better. I've even had docs try to shove those little white slips at me then and, when I indicate I want information instead, I usually end up leaving without either.
Hmmm, my email says you posted this at 1:10 this afternoon. How odd.
PJBoosinger July 22nd, 2009 10:35:13 AM
Yes! I would rather have a veterinarian tell me about home health care/support when possible, rather than give prescription drugs.
Also to suggest changes where needed in diet/supplementation/exercise, etc., to improve my dog's life.
Thank you for your newsletter!
Debra Hawley July 22nd, 2009 10:37:51 AM
Another Case in Point: When Jerry first presented with a persistent limp, his first vet insisted it was "just arthritis" and prescribed various different pain killers over the course of about six weeks while the limp worsened each time we took Jerry of the latest drug. It was a compassionate tech who felt our concerns and stepped outside to recommend getting a second opinion from the nearest teaching hospital, UC Davis. Within another week, we had Jerry's front left leg and scapula removed due to osteosarcoma.
Thanks for twisting that bulb, and keeping the light on this topic!
tripawds.com July 22nd, 2009 11:03:33 AM
I think some of this is driven by client's desire to fix the problem in one visit. I have had experiences with one or two vets who were SO conservative that I had to bring the pet back over and over again, meaning that the pet continued to suffer, and I had to pay repeatedly. This left me a bit unhappy. I haven't had that problem in quite some time now, but I haven't forgotten. Still, when my Frenchie turned up with what appeared to be some staph lesions on his skin a few months ago, I didn't object when the vet wanted to use a topical treatment rather than oral antibiotics. I have become more conservative about giving my pets antibiotics, too.
Susan July 22nd, 2009 11:04:55 AM
tripawds: Boy, I hear you and can't help but feel Jerry's case is not unusual. My fears have commonly been confirmed too often, that diagnostics is lacking and the white script is an appeasement for the owner without getting to the bottom of an issue. On the flip side, owners often become crazed that a magic pill doesn't take care of an issue but do not want to expend further $$$ to search for a "cure".
And tripawds: I had a Scottie that did indeed go undiagnosed until death with "right front leg & scapula osteosarcoma".
But what I hear most often, among my pet friends-club-breeders, is the never ending urinary infections. IMO, the issue never resolves because of: wrong antibiotic, not correct dosage, or not long enough treatment. This surely does not help the antibiotic-resistant organisms dilemma either!
Then of course, you have the ludicrous situation: of no diagnosis and hopeless "treatment": Pocket's Story from NH
Barbara A. Albright/NH July 22nd, 2009 12:53:53 PM
I took my cat Bo to the vet twice for what seemed to be his slowing down - going more slowly up the stairs, not jumping as much. In this case, i knew there were supplements that could be given, and that I could give them just as easily on my own (and I even have a small supply of burpnex), but I wanted to make sure I wasn't missing something. Bo also had an episode like that when his IBD was bothering him. So, vet did a full exam, did x-rays both times and found signs of early arthritis in his knees. The first time we took him in, I was reminded of one very important fact for Bo - "No medications, supplements or food changes unless there is a necessity to do so". After slowly increasing his dose of unflavored Cosequin, three days after his last increase (Christmas of course), he landed up in the ER. So, we help off on arthritis treatment until May - this time using Adequan with success. I can also use the buprenex if I need to, but rarely do.
My cat Cougar developed a raspy voice two weeks ago. About 5 days later heard a few sneezes, and about 3 days after that the other two cats sneezed a few times. Only about one day of sneezing for all of them, but the raspy voice is still there. I'm tempted to pick up some l-lysine (I've never had the vet recommend it when Bo had viruses w/eye infections - just the eye ointment), but I haven't.
I've been through experiments on my own - fish oil, vitamin E, probiotics, enzymes. The vet did prescribe an eyzyme for Bo once, but the lactose in it made him vomit. But I figure the IBD cats have enough stuff they have to take when they are sick, I don't need to add things just to add them. Although they do get B12 injections even though they are normal!
Jenny July 22nd, 2009 04:16:15 PM
What a tightrope we sometimes walk over the vast sea of uncertainty in medicine. It all depends on what the cause COULD be as to whether we have the luxury to "Don't just do something, Stand there!". Another similar situation I see in cats: cystitis. Most young cats do not have bacterial infections and don't need antibiotics every time they pee blood and strain, most of it is stress induced or spontaneous and clears up on it's own. I do run a culture just to be sure and give antibiotics i it is positive. sometimes just canned food (any kind) to produce a dilute urine is enough.
Hobson July 22nd, 2009 04:24:19 PM
When I've interacted with a number (less than 30, more than 15) of doctors for my personal health needs, if they'd given me a script for pain relief and sent me away, I would have actually been much happier and felt that I had been less cheated than I did. At least it would have been something, instead of the "it's all in your head," "it's female issues, isn't it?," and my favorite, "you just don't like to do housework, do you?"
But of course, I'm referring to a pain issue, and in veterinary medicine, that's the thing that gets more drugs issued than it ever does in human medicine. And I certainly am not suggesting that drugs shouldn't be given easily for pets in pain (but they should be given with information about side effects, which doesn't happen much), just that 'people pain' deserves more concern than it gets. Especially when, up until a few years ago for a growing number of doctors, a mild sore throat could get at least one, if not more scripts, given over the phone!
But to get back to pet medicine: I don't want the vet to say "it's not that big of a deal" in those exact words, but saying something like, "a few doses of lysine certainly wouldn't hurt, in this case" and then just a few words about what lysine does and why it could help, and yeah, I'd be happy. If the supportive therapy at home is easy, I'm happier to try that than something complicated. Right now, I'm flushing a small bite on the muzzle of the one dog I've ever owned who I can't pill (he's not all right in the head, so trying to pill freaks him into a panic). This small treatment will leave a scar, but his looks aren't vital to his health, and my wallet could take this much better than a full-scale stitching and antibiotic regimen, which, technically, wasn't necessary.
KateH July 22nd, 2009 04:32:56 PM
Barb, Make friends with a French national who travels home periodically and then do the research on which and how much to dose. It appears the customs agents can't read French or just don't want to argue with them. And you can bring back just about any antibiotic from the Dominican Republic where they're OTC and usually have a nice long shelf life.
PJBoosinger July 22nd, 2009 05:46:43 PM
KateH - I can relate on the people pain. After my regular doctor took x-rays on my hip several years ago, they felt the x-ray was of enough interest to send me to a specialist. Well, the first visit with the specialist was pretty much "So what - you have hip dysplasia. It's congenital. What are you doing here??" I felt stupid for going.
A couple years later my hip was bothering me again, and my regular doctor again sent me to the specialist who was like "wow - you have hip dysplasia. Some day you will likely need hip replacement surgery. Be sure to take your glucosamin". So, now I was impressed by this doctor. Except...
He wanted to see me again in two years. He took one look at the x-rays, didn't have the old ones to compare to, and again said "What are you doing here" as if I was wasting his time. And asked me to rate my pain on a stupid 1-10 scoring - well, I could walk so I can't very well be a 10 for pain. Told me he wanted to see me in 5 years and would send me a card - never received a card.
Anyway, so I gave up on the specialist. Took matters into my own hands researching an excercise program that seems to work. Asked my regular doctor for something besides mega ibuprofen when it was raally acting up - although I have only taken it twice so mostly just suffer. I guess since I'm only in my 40's (late 30s when I first visited the specialist) I'm not important.
Jenny July 22nd, 2009 06:06:46 PM
Oh, and meant to add on the bottom of that...But my own vet is more than happy to let me give buprenex to my very mildly arthritic cat when needed.
Jenny July 22nd, 2009 06:09:03 PM
Jenny: I could never get away with that. I know lots of docs (vet and human) who do––somehow––but my clients would never let me live down that kind of uselessness. Even if they never said anything (and most don't) I wouldn't have them for very long. That's one fact of fee-for-service care you can't deny. The free market means my clients are truly free to walk.
Dr. Patty Khuly July 22nd, 2009 06:13:06 PM
And you are so right - I wouldn't let my own vet get away with that! But no worries there - she is very good about it. The good news is it seems the more frequent excercise seems to be helping me so I only need ibuprofen before bed - sometimes on Saturday when I'm most active.
Jenny July 22nd, 2009 10:59:59 PM
Jenny, Have you tried taking an advocate with you to the doc? Most of us do a better job advocating for our pets than for ourselves, IMO. "stupid 1-10" pain scale. I couldn't agree more! But do some research on the short and long term effects of chronic pain. You might reconsider taking those rescue doses of pain meds after you see how harmful the pain can be to you. Those of us who live with chronic pain can develop an incredible tolerance but it's taking its toll.
PJBoosinger July 23rd, 2009 04:26:06 AM
Yes, Jenny, I agree with PJ. I was often in a ton of pain while working at the best job I ever had (or could have wanted), and while my work ethic was great (first 6 months, only 6 days off), I wasn't in a happy mood often and while the people I worked most closely with understood my grouchiness, others did not and that had a huge impact on why I lost that job. Even though, near the end, when I'd gotten the pain under control, one last personal thing (father's death out of state) and they got rid of me.
KateH July 23rd, 2009 10:07:06 AM
This is why I so much love probiotics. It fulfills the needs of the client, to somehow be intimately involved in the recovery of the animal, without continuing the overuse of antibiotics.
I'm just scared the FDA is going to crack down on enroflaxin again.
Jackson July 24th, 2009 08:01:24 AM
Jackson: Agreed. Supplements of all stripes fulfill the need to provide the kind of value our clients have grown to expect.
Dr. Patty Khuly July 25th, 2009 04:01:23 AM
IMO, just like with human medicine, I think big pharma has gotten their foot in the door. Pro-drug propaganda is everywhere, and it can be really hard to filter through it. Many people believe, among other things, that drugs bring a quick fix.
Is it really bad in veterinary medicine too
Jen M. August 20th, 2009 02:01:36 PM
Add Commment