Whether you’re a veterinary surgeon or an human oncologist, you rarely have to handle the touchy topic of public health. General practitioners however––regardless of species––are constantly tasked with taking the long view when treating our patients:
How might our patients’ conditions potentially affect the health of others? Which prevention techniques and tests are in the best interest of the population at large? How might these affect our individual patient’s health/psyche/stress levels? Our client’s pocketbooks?
They’re all issues we have to weigh as risks/downsides against the potential public health benefits of our medical decisions. Consider...
- infectious disease testing,
- parasite examinations,
- vaccination,
- etc.
For veterinary GPs, the problem is even more prickly: It’s not enough to focus in on the details of our patients’ individual conditions and the risks to their conspecifics, we’re also charged with gatekeeping detail when it comes to issues surrounding the health and well being of humans. Consider...
- toxoplasmosis,
- rabies,
- Lyme disease,
- Hanta virus,
- leptospirosis,
- roundworms,
- hookworms,
- salmonella,
- campylobacter,
- giardiasis,
- aggression,
- anthrax,
- etc.
After last week’s rabies debate, I couldn’t help but let my mind wander to this topic. After all, few non-veterinarians understand how it is that we’re required, by oath, to treat human public health and individual patient care on an equal footing.
Too often, the public at large assumes that veterinarians enter this profession to remain among animals...because humans are annoying or difficult or disgusting...and, of course, because animals are innocent and wonderful. There’s something exalted about us that we would prefer to minister to the defenseless of the word, it’s largely assumed.
While this may be the case when we initially elect to pursue this profession, most veterinary students soon learn that most of veterinary medicine is about human-human interactions and lots of public health training. Whether we as veterinarians accept this mission or not, there’s no mistaking the fact that our schools fully disclosed this expectation from the very first moment our butts hit those chairs.
That’s why I’ve got to admit I was a bit put out by the first comment that followed my USA Today column on rabies.
“I love how the whole thing is about having people get their pets vaccinated against rabies...so they don't get it themselves. Get the animals the vaccine so their poor, poor owners won't get it? How about getting the vaccine so the animals don't get it? Some veterinari[a]n. A vet's only concern should be for the animal, if humans mean more than you should be a doctor instead.”
Hmmm...I never thought I’d be accused of being overly concerned about human health (or of not being a doctor, for that matter) but I get the point. (Ouch!) And isn’t it the same one so many of you have been making in your comments under last Thursday’s rabies post? I mean, why should any veterinarian force the rabies vaccine issue (or, indeed, any cross-species, health-based initiative) if our patients are truly the first priority?
I guess that’s because the truth is...they’re not. They share that distinction––evenly––with all of you. And striking that balance is a lot harder to manage than you might expect. Especially when our sympathies might reasonably be expected to lie with the patients immediately before us.
Unpopular though this position might be, sometimes I think veterinarians need to be seen for what we’re supposed to be: gatekeepers of the one human medical domain MDs can’t possibly command without firsthand knowledge of veterinary patient care.
And if that doesn’t appeal to those among you who would expect veterinarians to possess a blind devotion to animal well being, consider that you wouldn’t much like us if we took that position to sociopathic extremes. After all, we’re only human, too.
***
For today's DailyVet post over on PetMD, brush up on the mandatory spay/neuter debate.
Add Comment25 Comments
I think that many of us have said that we'd rather have veterinarians in charge of our medical care, as they do a much better job in dealing with patients than so many human doctors. Anyone who thinks, as that commenter does, that you should only care about animals, is deluded as to how animals get to the vet's office in the first place. Fido doesn't have a driver's license, and Kitty won't get into the car with him without someone opening the door. Of course vets must be concerned about how animals and their health issues interact with humans. The disconnect is when thoughtful education is dismissed as 'taking too much time' and unbending rudeness about client knowledge (wrong-headed or a different viewpoint) leads a vet to conflict with clients.
Human doctors have the same problem when they don't take into account client knowledge (wrong-headed or a different viewpoint) too, and dismiss whatever the client says.
KateH September 22nd, 2009 11:46:27 AM
most veterinary students soon learn that most of veterinary medicine is about human-human interactions
Aaaaaaand that's why I pulled my application to vet school. I guess I'm grateful that I discovered this fact before committing to vet school, even though at times I really, really wish I had the knowledge base.
I'd say you are doing a bang-up job of educating folks about public health, be it human or other animal health. =)
Julie in OH September 22nd, 2009 12:57:28 PM
i'd say that veterinarians are much more conscious than physicians of public health issues and the relationships between different species and the environment. take this common example: what do most ob/gyn's say to their newly-pregnant patients as soon as they find out there's a cat in the house?? i've even had pregnant women come to me saying that their physician ordered them to get rid of the cat altogether. it's an absurd point of view that ignores the fact the humans share this planet and their lives with animals.
Dennis Leon, DVM September 22nd, 2009 05:28:50 PM
I appreciated this insight very much, Patty. A good friend turned me on to your blog, and I'm grateful he did so. I was also grateful to link to your recent reflection on the AVMA's response to the Pew Commission on my blog. Sincerely - Ben DeVries, Not One Sparrow (a Christian voice for animals)
Ben DeVries September 22nd, 2009 08:39:23 PM
Very good post Dr. Khuly. It goes straight to the point where the owner's concern for the pet and the vet's duty to both pet and owner/society tend to diverge, whether it should or not.
Skeptivet
Bartimaeus September 22nd, 2009 09:45:23 PM
I guess it is a difficult balancing act. On the one hand, vets seem to be encouraging over vaccination, science and facts be hanged until there's overwhelming proof and the risk to society from over vaccination be hanged too (shoot, that didn't even make anyone's radar last week). Scare tactics for this are just fine. When others use scare tactics to promote early spay/neuter, that raises at least some qualms but not too many since vets are still encouraging spay/neuter before maturity when, after that and before reproduction would apparently be the optimal situation for the animal. And the human/public health since the animal being in better health results in less risk to the humans.
There was a time when I would have prefered to see a vet over a human doc for me. Now that I'm understanding that vet's have even less respect for their client's wishes than human docs, I'm rethinking that. The balancing act may be difficult but the level of arrogance is just incredible.
PJBoosinger September 22nd, 2009 09:57:51 PM
PJB - sometimes your comments are interesting and I repect your right to voice opinions. However, your continued painting of all vets with the same negative broad brush is becoming tiresome and reduces the credibility of comments
Vets have a tough juggling act and can never please everyone, but my experience has been most really try hard to meet the client and animals specific needs, within reason.
DI September 23rd, 2009 11:59:41 AM
PJB is right, as always.
My dog and I are always arguing at the vet. I wanted her spayed, she protested, guess who won?
My dog is slim, very fit. Guess, what, she wants more! Guess who the vet sides with???
Now that PJB mentions it, the vet ALWAYS sides with me!! Very disconcerting.
Erich Riesenberg September 24th, 2009 11:50:50 AM
Thank you for the great blog posting. As a current MPH student and hopeful for Veterinary School next year, I was extremely happy to see you stress the importance of having a public health-type mind in veterinary medicine. Vets should not feel obligated to have the publics' best interest in mind, but, as stated, it is part of the oath they take, and therefore it should be a goal. Though pleasing both the owner and the pet may be a challenge, it is a challenge worth taking.
With the recent emerging zoonotic diseases such as West Nile, Avian flu, and swine flu, the general public should feel priviledged and somewhat relieved that vet students and practitioners have had a great deal of public health training. The profession has certainly realized the need for this, as animals and humans occupy the same environment and come into contact with one another, most of the time as pets, but sometimes through unknown vectors and hosts.
No vet should be chastized for using their public health training and making sure the human who takes care of the current pet patient is safe. After all, I would imagine that people who feel safe around animals and are aware of any health risks would be more understanding, diligent, and effective pet owners. Vets that are more thoroughly educated can pass their experience and concern for the well-being of the owners on to them, and thus create a better environment for both owners and pets.
I think there are many other forms of health practitioners who could stand to take a step back and consider public health ideas, methods, and responsibilities as they treat patients, be it a vet, a nurse, a pharmacist, or an MD.
Public health is a very real part of veterinary medicine, and owners should learn to embrace the profession's desire to treat animals AND protect and enhance the human public's overall health and environment.
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