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Friday, August 24, 2012

Who Do You Believe? Part 2: Vet vs. ?

Yesterday I talked about the medical aspect of Laura's post and today I want to talk about the rest of it.  Here's a repeat of her email to me.

I recently rescued a 9 year old chihuahua. He only has 2 bottom fang teeth remaining and they are rotten and loose. He has been to several vets with varying opinions of treatment. I was told to leave the teeth because the jaw will completely breakdown without the teeth there to anchor the jaw. I was told by another vet that if I leave the teeth they will make the jaw infected. The rescue group I adopted the dog from says leave the teeth in because the jaw will break if the teeth are pulled. I'm not sure if this is a question futon website but I would really like some feedback, option and/or experiences with this type of situation.

People come to a vet because they want help and advice for their pets.  You might be surprised how many times they DON'T believe us.  Breeders, groomers, pet store employees, shelter workers, and just about anyone who works with animals will have an opinion.  But you have to look at the education, background, and training of the people you listen to.  

A veterinarian has many years of intense, comprehensive training in anatomy, physiology, pharmacology, parasitology, infectious disease, and surgery.  In order to keep our license we are required to do continuing education training every year, keeping up to date on the latest developments in the field.  Most vets read several professional journals every month.  We see things every day that most people won't see in a year, or even in their lifetime.

So please tell me how all of that pales in comparison to someone who's main qualification is having bred dogs for a few decades.

Yes, it's a fact that many people will believe their dog's breeder over the vet.  Or in Laura's case possibly the shelter worker.  I've seen people ignore a vet's advice because the clerk in the pet store told them something different.  In many of these cases there is no arrogance or ill-intent on the part of the person giving the advice.  They are saying what they honestly believe.  But I've also seen many people (and breeders are a high percentage of this) who honestly believe that they know better than a doctor.  They try to convince you that the vet is full of crap and is only trying to make money, yet they have no training or education whatsoever in immunology, medicine, or anything else.  They may have read something on a web site or forum from like-minded people and don't actually have any real evidence.

So please, when you have conflicting opinions look not only at the motivation of the person giving advice, but their background and experience as well.  In 9 out of 10 cases the vet is going to be the one with the more solid facts.

Now all of this becomes more difficult when you have vets who differ in opinion, as Laura had happen.  I've often said that if you put five vets in a room and ask about a specific topic you'll get at least six different opinions.  There is rarely a 100% consensus in medicine.  Our opinions are going to be based on where we received our training, which lectures we've attended after graduating, which articles we have read, and so on.  It's sometimes difficult even for us to make sense of what we should do and recommend when specialists differ on a diagnosis or treatment. This can be confusing to clients and I've been in the position of giving different advice than the last vet they saw.  This is never intentional on my part and I'm very careful to never disparage my colleagues to a client.  Rather it's simply a difference of opinion.  I even have differences with my associate doctor!  Thankfully they are minor and we otherwise have similar practice philosophies.

So what does a client do?  If you're uncertain, ask for details and reasons.  I've always felt that if I'm going to have an opinion I should be able to justify it.  I don't like hearing "because" as an answer to my questions, and I don't like giving it as an answer.  Have your doctor explain in as much detail as you can understand and need, and if they can't give adequate answers you should consider getting another opinion.  In the end, though, you'll have to make up your own mind.  I feel that a vet's job is not to make a decision for you, but to give you the information so that you can make your own decision.

Laura, I hope some of this may have helped your situation!


4 comments:

  1. I was about to email my own question about owner-vet relationships, but your last couple of sentences rather closely answered it for me. Thanks! I really enjoy your willingness to answer general questions in a public environment.

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  2. What a thorough answer to her question. I applaud you for eloquently explaining the dilemma of being in the medical field. Fortunately or unfortunately, pets are not cars and so the answer is not always so black-and-white. (though the pet may be! Hehe). Although we learn knowledge of what diseases do and what causes them in vet school, it's hard to always know the best course of treatment for that particular pet (especially when owners decline diagnostics ;-P). Thanks for a great blog! -Katie

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  3. Having seen a variety of vets - well - the vets at the vet school, I pretty much just believe whatever they say. Although if I am curious about an issue, they usually come up with a study to show me. Vets in general practice, I might not believe so automatically. Yes, there is continuing ed, but if you want an easy way, there are very basic internet "courses" that fill that requirement without learning much of anything. Just like everyone, vets vary, some are smarter, better, and more up to date than others.
    And some good, knowledgeable, breeders might have some extra knowledge about disease that their breed is prone to. No vet (or any other person) can know everything.
    That said - there is a lot of nonsense from breeders too, and I agree, the odds are generally much in favor of the vet's knowledge. You have an excellent point though - the vet should be able to back up what they say. But an educated owner or breeder can be a help to a vet, not necessarily a liability.
    I do 100% sympathize with the vets having to deal with many breeders though.
    TAM

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  4. My Vet is always my go to person for info. If she does not know the answer she tells me and she will research the answer. I totally respect that because no one can know everything and being a general practice vet they cannot know all the ins and outs of every disease. The important thing is knowing where to go to get the info. My Vet is also very willing to read any info I bring in to her. But she also knows that what I bring in is going to be well researched and will be Veterinary Peer reviewed. But I also know that not all Vets are like this. Some resent being questioned and I know it can all be in "how" you ask or present your info. I am fairly well versed in Addison's disease and belong to a "dreaded" online support group. The things we hear about that comes directly from Vets on Addison's management can be concerning. We regularly see repeat ACTH tests recommended to monitor the prednisone dose on dogs with Primary Addison's, not Iatrogenic Addison's which do require followup ACTH tests. Prednisone doses cannot be monitored that way or with any blood test for that matter. So here is a question for you, how would you approach a Vet who wanted to do a test like the ACTH as a followup test on a properly diagnosed Addison's dog?

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