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Saturday, December 20, 2008

The Doctor Is Right?

One of the biggest problems that a veterinarian (and really any doctor) faces is with compliance. There have been several studies published recently that show that our clients don't follow our recommendations anywhere nearly as much as we think they do. This is an incredibly frustrating problem, as we don't make recommendations lightly, and always with the goal of helping the patient. Refusing the doctor's instructions can lead to persistent problems or failure to improve.

I had been in practice for about a year when I saw a kitty with an eye problem. It had some drainage and was squinting one eye. An exam and stain quickly revealed that the eye had a moderately sized but superficial ulcer. These can happen from scratches or something else abrading the cornea, and most of the time respond well to therapy. We prescribe antibiotic drops or ointment, and the problem usually gets better quickly. However, because this doesn't always happen, we do follow-up visits. When I saw the kitty the following week, the ulcer hadn't gone away. The owner was using the medications appropriately, and it wasn't any worse, so we gave it another week to heal.

The next week she brought the kitty back, and it was still the same. I started asking more questions, and learned that the cat was rubbing it's eye frequently. Thinking this might be causing the problem to persist, I recommended an e-collar. For those not familiar with the terminology, this is one of those lampshade collars pets wear for certain injuries. The do a great job of keeping the pet from getting to its face, or from licking its body. Unfortunately, pets hate these things, and usually try to get them off. It also makes eating and drinking difficult. It's a difficult treatment aid, but one that this cat really needed.

A week went by, and the cat came in for its recheck. The ulcer was still the same size. I asked the owner if she had been using the e-collar, and she admitted that she kept it off him most of the time. He just hated having it on, and she hated seeing him act that way. I strongly emphasized that he really needed this, since he was still rubbing the injured eye. She said that she would use it this time, though I was beginning to loose hope.

The week after that (for those keeping score, we're in our 4th week of treating something that usually resolves in 1), the cat came to us to be boarded. The corneal ulcer hadn't improved at all, and I knew the owner hadn't been keeping the e-collar on enough. Since he was going to spend three days with us, I knew we could give him some relief. Over the weekend, the e-collar was on continuously. However, when I checked with the kennel worker on Monday, he had apparently gotten the directions confused and had been putting the medicine in the kitty's other eye! With a bit of frustration, I repeated the stain to see how bad the ulcer was. To my surprise, the ulcer had almost completely healed! In three days, the problem had just about gone away, even without medication. All because we kept the e-collar on at all times. If the owner had done that to begin with, the cat would have been saved weeks of pain and hassle.

Doctors make therapeutic recommendations because it's what they feel is best to help their patient get better. If you don't follow their instructions, don't be surprised if the problem doesn't go away.