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Thursday, March 22, 2012

Exam Vs. Vaccine?

I'm on a roll this week so let's kick the hornet's nest a little more.

Most of my discussions this week have centered around a need to change the business models of veterinary practice.  I've stated recently as well as many times in the past that the physical exam is actually the most important part of the veterinary visit.  But is it important enough to supersede the vaccines themselves?

As I've mentioned, there are many, many things that can be caught early on a routine physical exam.  A short list includes heart murmurs, tumors, cataracts, ear infections, periodontal disease, fleas, bladder stones and various endocrine disorders.  A good doctor is going to be able to find these problems or hints that lead to more diagonses by just a thorough exam.  No matter what the disease or disorder, it is always better to treat in the early stages than waiting until later.  So it's only beneficial to the patient if we are examining them regularly.   It has been common for me to notice a problem on the exam that the owner was never aware of (yes, including bladder stones).

Here's a little known concept about vaccinating animals.  It's often more important for population health than it is for individual health.  I have only seen three cases of canine distemper in my 15 year career (so far).  I have never seen a case of rabies.  Yet go back about 30 years and these diseases were much more common.  Though parvo is still common, it's not as rampant as it used to be.  All of this is because we have done such a good job of convincing people to vaccinate their pets and livestock.  The vaccinated ones not only are protected as individuals, they also slow or stop further spread of these infections.  Sometimes indivual pets may not be able to receive vaccines because of other illness or severe allergic reactions.  The chances of these pets contracting preventable diseases is low.  Now this isn't a license to stop vaccinating your pets.  You ARE protecting the individual, but realize that it's also to protect the population as a whole (human and animal).  And if we stop vaccinating we'll most certainly see a resurgence in these illnesses.

In my personal experience (no hard data here, folks) I believe that the average dog is more likely to develop a heart murmur than it is distemper.  And your typical cat is more likely to have cancer than feline leukemia.  I deal with problems I notice on physical exams more than I deal with infections preventable by vaccines.  Again, this is because overall we do such a good job of vaccinating.

Now some may say that people with low income may not be able to afford care for murmurs, dental disease, and so on.  But don't they have the right to know?  Isn't there a responsiblity we have to inform them of their pet's true health status and then let them make the decisions?  Shouldn't we tell them their options and not pre-judge based on a perceived income level?

So that brings up the question.  Which is most important to a pet's health?  An annual exam, or vaccinations?  I would argue that the exam is marginally more important than the vaccines because of the numerous health issues that we could detect and prevent.  To a population the vaccine is more important because of the contagious nature.  But to the individual the exam may actually be more important.

Again, please don't misunderstand me.  I am a huge advocate of preventative immunization in humans and pets, firmly believe that we have saved countless lives because of vaccines, and am completely aware that if we reduced vaccination we are going to see a return to the epidemics of now-rare diseases.  I am sincerely pro-vaccination and make sure that my pets and my family are immunized.  I also realize that often the only reason we get to examine the pet is because they came in for vaccines.  My point comes from my belief that we as a profession have historically seemed to emphasize vaccines over the exam.  For decades veterinarians have devalued the exam itself, and clients now have the wrong idea about the visit.  And this is a viewpoint that needs to change. 

Thankfully, I do see signs of such in the profession as consultants and new graduates are changing the way we think about ourselves and our patients.  I hope this trend continues, educating owners along the way about what they really need to do for life-long care of their pets.