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Sep 06
2014

Crazy Vet Rant Nothing To See Here Please Move Along

Posted by Dean Scott in Untagged 

Dean Scott

I didn't really have a concrete idea for this month's blog.  Don't get me wrong - I have plenty of ideas.  Some are vague one-line thoughts that need expanding on, others require more work than I have time for right now, and some I'll just have to be in a certain mood to get into them.  Humor is a fickle thing.  So, this month, please indulge me (as if this whole website weren't an ongoing, perpetual indulgement) as I'm just going to do a little stream of consciousness thing on thoughts I've had recently.

People are weird.  And I realize I'm a people too, therefore I must be weird in my own way (no need to post in the comments section, thank you).  However, I routinely seem out of sync with my fellow primates.  They seem like a different species, Homo clientensus, perhaps, or Homo ignoramus.  I had an owner recently who makes a very decent living and seems in the many ways society expects, to be educated and "normal".  He uses Palmolive for flea control and a "concoction" (his words) for cleaning ears that includes, in part, pink eye medication, athlete's foot powder, and salt water.  He also stated that the dog is an outdoor dog except in the winter (because, you know, here in Florida winter can be pretty brutal).  I told him that Palmolive just makes cleaner fleas.  He retorted with how it was a vet who told him to do it.  When I told him to not use that concoction in the ears, he replied rather arrogantly, "Well, it works."  Granted at the visit the ears looked fine, but he had already said that they are a recurrent problem and he has to treat monthly, which makes it seem, that, oh, I don't know, his concoction "doesn't work".  His next line of defense against a reasonable conversation was that it cost him $500 - $600 the one time he took the dog to a vet for an ear infection, which has to be an exaggeration, because he either had other things done as well as dealing with the ear problem or he's just pulling numbers out of a bodily orifice.

Three things I took away from this conversation.  One is that people aren't necessarily coming to us to get good and proper information.  It's not like I'm the neighbor giving unsolicited advice.  You brought your pet to me.  I'm going to do my job well and tell you what's best for them.  I'm sure human physicians get ignored by their patients as well.  Two, this encounter was a great example to show that ignorance crosses all educational and socioeconomic levels.  The last thing is that many of us got into this profession because we are most certainly attuned more to animals than people.  Yet we can't get to the animals except through people and only if they really allow us to.  And the more we deal with people, the more we like the animals.  It's quite a conundrum.

Let's talk about misdiagnosis.  This word gets thrown at us (or maybe just me, I don't know) and I don't think people know what it means.  If I tell you your dog has feline leukemia, yeah, that's a misdiagnosis.  If I tell you your dog has lymphoma and we treat for lymphoma and it really has ebola, that's a misdiagnosis (as well as a potentially bigger problem).  However, if I tell you that your dog might have neoplasia and actual testing reveals, instead, an immune-mediated disease then........not a misdiagnosis.  And besides, along with mentioning neoplasia, I also said it may be other things, such as an immune-mediated disease.  It doesn't help if a client has selective hearing.  If you run with your dog in the summer, in Florida, during the day, while it has an upper respiratory infection and its temperature reaches 106.7, yes, that's heat stroke.  Just because 3 or 4 days later it continues to cough because of the upper respiratory infection (which we're treating), doesn't mean your dog was misdiagnosed.  If your dog is fine on a visit from 9 months ago, but now has a heart-related condition, that is not a misdiagnosis.  That is because the problem wasn't there before, now it is.  If I had the ability to see the future, I'd charge more.  Lastly, if tests haven't come back yet and your pet's condition worsens while getting supportive treatment, that is not a misdiagnosis.  That is a "wedon'tyethavea"-diagnosis.  There's a difference.  If we didn't have to do testing to get a diagnosis, if I had the ability to just look at a pet, or do that "laying on of hands" thing, and tell exactly what something is every time, well, I'd charge more for that too.


Aug 07
2014

Client Communication and Translations

Posted by Dean Scott in Untagged 

Dean Scott

I had a conversation with a client recently that started me down the road thinking about communication.  She brought her dog in because he was “not eating and having diarrhea”.  With any inappetent pet, I always offer a little canned A/d in the room to test what the owner is seeing or perceiving.  Though it doesn’t assuage all of my concerns, I feel better if they at least eat the A/d.  This dog scarfed the A/d down without hesitation.  So I started asking the owner if they had enticed with other food items to get him to eat.  I was told “no”.  I thought this was odd (since most owners will go into some kind of frenzied Bob Fosse at the Golden Corral Buffet dance number if Pookums doesn't eat) and went on to ask if, when they put the dog food down, does he just walk away from it, does he sniff it or show any interest?  I was told “no”.   Another off-kilter answer which, with a follow-up question, I was told “the dog food isn‘t down” - this said with a rather incredulous expression.  Further questioning deteriorated and confused me and I will ease your pain now.  What the owner meant when she said that “he’s not eating” was that she had not offered him food.  Since he had diarrhea, she felt it best to take food away, which I told her was a good idea.  I don’t think she ever realized that if you tell a vet that a pet isn’t eating, we assume that to be a clinical problem, not a problem of access to food.  I have never had a client phrase something this way in twenty-one years.

I had a conversation with a client where I tried to find out if it was due for vaccines.  She replied she went to another clinic when it had some skin problem.  This really wasn’t an answer to the vaccine question, so I asked it again.  She said, “Yes, they do vaccines there.”  Which was an odd way to phrase an answer, I thought.  “Did they give vaccines to your dog while you were there?” I futilely tried again.  “They do vaccines there.”  Back and forth it went, until I went through an inch of non-chronological paperwork and discovered that, no, the dog was not up-to-date on vaccines and needed pretty much everything.  Apparently, she just wanted to let me know that if she had wanted to get vaccines at this other clinic, she could have done so, because they “do vaccines there”.

Our veterinary magazines love nothing better than to put the entire onus on our shoulders for proper communication, ignoring the fact that there is another person involved in any conversation.  If not the client's spouse, aunt, sister, child, etc. also.  The magazines insist that as long as we spend hours with a client, repeating things over and over again, using common words so as not to threaten or demean a person’s fragile psychology, and speak in a soft, NPR voice of mutual care and respect, we will be able to perfectly communicate all the time.  As Ira Glass would say, "Yeah, right."  Even when speaking the same language, as in the examples above, communication is specious at best.

Jul 03
2014

Future Veterinary News

Posted by Dean Scott in Untagged 

Dean Scott

Allergies of the future

An update on the most common food allergies in dogs, April, 2047: kangaroo, bison, ocean fish, pomegranate, blueberries, kelp, Yucca extract, and broccoli. Attempts have been made in the past to produce an all-inclusive non-allergenic diet for pets, which has simply changed what they are exposed to and therefore to what they become allergic. Veterinarians are now recommending owners with food allergic pets to try novel protein and carbohydrate sources such as beef, corn, chicken, wheat, and soy. New dog food manufacturers have already jumped on these latest trends, producing Blue Chicken brands, Solid Platinum, and Immunogood just to name a few. Their advertising lambasts Big Box companies for using such inferior meat sources as kangaroo, besides the inhumane slaughter of such a noble beast, and the obvious high allergen content of blueberries and broccoli.

Flee the fleas

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