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Saturday, July 9, 2011

Physician Vs. Vet

At the beginning of this past week I saw a dog for a health certificate prior to travel.  The client is moving from the US to Germany and is taking her dog with her.  She received her international health certificate  previously and just needed a more recent interstate one for flying within the US.  This was no big deal and we handled it quickly, examining the dog and issuing the certificate.  The dog was in good health so there were no issues.

Today the client calls, saying that the dog had discharge from its eyes and wondering if I had looked at the eyes.  It was a very busy day for me, so I relayed information through my staff who were talking to her on the phone. I remembered the case and said that I had indeed looked at the eyes (as I always do in my exams) and there was nothing wrong at the time.  My staff is trained that we don't issue medications without an exam, and explained this to the client.  She was not satisfied and told the receptionist "I'm a physician," which was probably supposed to open magic doors of compliance on our part.  I stood my ground and said that I still wouldn't issue medications without an exam since the problem hadn't existed a few days ago.  My office manager got on the phone and continued to explain to the client that we needed to see the pet first.  Then the question is brought to me "If you were going to prescribe something, what would it be?"  I could see right away that the client was trying to figure out what medicine she could give to her pet without being seen. Eye discharge could be the result of an infection, allergies, a corneal abrasion and several other things, all of which are treated differently.  So I couldn't give a specific medication without seeing the pet unless I was going to simply guess, and I'm not about do to something like that.  The client told my manager that she had too much to do as she was leaving the country tomorrow and couldn't take the time to bring her dog in to be seen.  She finally said "I'll just write a prescription for something" and hung up in a huff.

Sometimes the arrogance of human medical professionals astounds me.  I have never presumed to know more than my own doctor or pediatrician, and rely on their knowledge and advice.  I respect their training, position, and time.  Unfortunately I feel that some physicians and nurses feel that veterinarians aren't as smart or as well trained as they are, and see us as somehow not really doctors.  I have seen an attitude of superiority from many of these clients (though not all).  What really gets to me is that these clients should be the ones least likely to cause problems, as they should know better and understand.

For example, let's take this most recent client.  As a physician herself, what would have happened if I called her and said "I have an infection and I need you to give me some medicine.  Yes, I know you just saw me last week and I was healthy but you must have missed something and I have this problem now.  I'm a vet so I know you just need to prescribe me something."  Any responsible human doctor would say "no way" as quickly as I did.  Sending out medications for a problem that you haven't seen or diagnosed is poor quality medicine at best and potentially malpractice at worst.  Second, this client assumed that she will know as much about medical interactions with pets as she does about humans.  I can assure you that though many medicines are used between species, there are others that can be downright dangerous.  I always defer to my own doctor when it comes to human medications and don't presume to know the same things about humans as I do animals.  Thirdly, a human doctor is legally able to make diagnoses, perform treatments, and write prescriptions for only a single species:  Homo sapiens.  Though I doubt a pharmacy would really check, it is actually illegal for a human doctor to write a prescription for an animal.  Conversely I am able to write prescriptions for any animal except humans.  If I prescribed medications for myself or my family I would be breaking the law and could even loose my license.  A knowledgeable and responsible doctor would know this and wouldn't seek to circumvent the law.

Unfortunately there's not much we can do about situations like this.  Maybe some physicians, nurses, or other human professionals will see this and realize that vets are just as intelligent and highly trained as they are and give us the respect they expect be given to them.

9 comments:

  1. See "How the doctor almost killed her dog" on the New York Times website.

    This happens to me in my practice more frequently than I like to remember. Usually nurses are worse than physicians, but a bad physician is a nightmare client indeed. The arrogance - and failure to take responsibility for poor treatment decisions - is breathtaking.

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  2. That's ridiculous. I could see a non-health professional chancing their arm like that, but a physician who should know how this works? Pfft. I pity her animal if she's willing to throw human medication at it because she's short of time.

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  3. i've said before, because hand on heart I believe it to be true, vets, when they are good, are without a doubt the most wonderfully skilled, compassionate, knowledgeable professionals and would give any medic - general practitioner or specialist a run for their money because they are multi skilled they don't just focus on x part and earn their bucks on the humans suffering with X only or variation of something involving X. I regularly had animated discussions with research directors and medics in pharma on the topic of vets vs medical professionals for humans- no matter what the strength of their argument they would end up acknowledging that a vet has a larger skillset and knows more - quite simply because you guys do. When my goldie had a corneal ulcer I was fascinated at what had to be done for him - he had to have the surgery twice - when I visited my optician (bringing my goldie with me coz he often came along for the visit) - the optician asked what the vets had done and said that it would be the same for a human but acknowledged that as an optician he wouldn't be able to do the surgery himself and would have to send to a patient to a specialist who would do what the vet had done. he asked all about the meds my goldie was on and some of the drops were human ones - we had a great chat. Recently also I read an hilarious couple of books written by an Irish female vet - vet life is brilliant! and she spoke about her sister who is a medic and how they would often chat about their different careers and roles and the vet's sister would be amazed at the huge responsibility a vet has for animals in their care especially when time is not one one's side and you have to act quickly often in challenging situations to save a life - medics have teams of people they can "offload" a risky or complicated case to - or at least call on lots of hands and specialities to help. Vets get on with it.

    if I come back in another life - I want to be a vet - and one as skilled and compassionate as the fantastic men and women that care for my dog.

    just because humans are superior to animals and hence medics think they are above others because they deal with humans and make them well (when they can) does not make them better than a vet. A vet is much more skilled and knowledgeable - no two ways about it.

    Chris good for you not giving the medic an over the phone medical for the dog - you are quite right - it would not be in the animal's or your best interest.

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  4. Did you ever read my post about the ER doctor who was medicating his dog with prednisone and aspirin for arthritis? Dog came to me collapsed, pale gums, and melena. MD had no idea what had happened.

    And a few weeks ago, I had a DKA with a physician owner. He insisted that DKA is no big deal in people and instructed me to administer 1000cc SQ fluids, start insulin, and send his cat home - it would be fine. That was an argument I did not enjoy.

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  5. The attitude seems to be, how hard can veterinary medicine be? After all, veterinarians aren't as smart as physicians; if they were, why would they settle for such low salaries?

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  6. Maybe the attitude some human doctors have against animal doctors is because of how little value is placed on animals. If you don't value animals, you certainly won't value the doctor that is trained to treat them.

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  7. Sorry, there are jerks in every profession. As a physician, I am totally amazed that you guys have to know what we know about ??how many species??? We only have one. So by definition vet medicine is harder. And the science seems, hmmmn, less well funded at times, although it is hardly pure or purely applied in the human world of medicine either.

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  8. A human doctor told me once that vets are people that did not get into med-school. So arrogant and inconsiderate, even though there are only 28 Vet schools in the US.

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    1. Yeah, that's a pretty ridiculous comment, and shows how ignorant that doctor is. It is many times more difficult to get into veterinary school than it is to get into human medical school, so if anything it would be the other way around. I've also never seen any vet who "settled" for the profession....it's always a first choice. Human doctors have to know a whole lot about one species. Vets have to know equally as much about multiple species.

      I'd love to have a conversation with that doctor!

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