The pain control conundrum makes its mark in one vet's painful case
The use of pain control medication in pets seems like a no-brainer to most of us—especially when it comes to seriously excruciating orthopedic surgeries. One US vet, however, maintains that it’s his prerogative to dispense with such niceties. Unfortunately for him, taking this stance in his practice brought on a complaint against his license from the owners of one of his patients.
The owners contend their dog was in severe pain after bone surgery, and yet this vet implemented no analgesics in his standard surgical protocol. They allege that his tactics represent a failure to provide a reasonable standard of care, given that vets everywhere use pain medication routinely for less painful procedures.
The doc, for his part, maintains that pain relief was not necessary in this case. He also eschews pain meds for spays and other surgeries for which “city vets” routinely dose their patients. He contends that his veterinary license grants him the freedom to choose whether to administer pain meds or not.
The Board of Veterinary Medicine in his state respectfully disagreed—and yanked his license to prove their point. But he’s fighting back. He’s taking the Board to task for pulling his license when there are no uniformly established guidelines for pain relief in veterinary medicine.
OK so the guy’s right on that last score. Indeed, the profession has issued no edict on how pain relief is to be applied. Add that to the fact that pain protocols for pets have been widely used for a mere ten years and you can see why some old-timers (a designation for which he undoubtedly qualifies) are feeling somewhat put-upon by their younger colleagues.
Vet medicine has changed dramatically in the last couple of decades. I’ve addressed that point in zillions of posts. And here’s one area where the change is exacting its toll on older vets: rapid evolution in the use of new drugs and procedures requires the ability to react rapidly to their use. But it’s hard to bring someone who’s been practicing for almost sixty years into line with the youngsters in the face of this newly fast-paced profession.
His attorney (one of my Penn profs, incidentally), argues that without established pain protocols there’s no way for a vet to know how things need to be done. He argues that this doc is being unfairly scapegoated for his antiquated ways.
Respectfully, however, I beg to differ. After all, there’s no established protocol for spays or setting bones. Do it differently than most of your colleagues in the US and you can bet that if someone complains you’ll be taken to task. Medicine is like that. It’s all about “standards of care.” If you don’t keep up with modern standards, you’re leaving yourself open to serious scrutiny should something go wrong.
And pain control is no different. Just because the AVMA (American Veterinary Medical Association) doesn’t go out of its way to tell you how you should push drugs doesn’t mean you have the right to pick and choose whether to keep up with the veterinary Joneses on any given medical issue. It’s not your call. It’s a numbers game. And if you don’t know what the numbers are, that’s your fault. Ignorance is no excuse—especially when it comes to medicine.
Predictably, most of the specialists I know are on my side. They have a vested interest in making sure the standard of care keeps rising. Generalists, however, are more likely to be appalled that a Board can refuse you the right to practice over a seemingly arbitrary standard of care issue.
Interestingly, this is a defining case in vet medicine. Standards of care have been used very generally in the past to determine negligence in vet medicine (as in, did you secure an incision with suture material or not?). With this case, pain is emerging as an issue that may well mark the beginning of the end for vets who choose to practice their old ways.
To me, it makes sense that how we handle pain paints the line between old ways and new. It speaks to our willingness to acknowledge that animal welfare means more than just keeping pets alive after injury or illness. It admits that our role is larger now that we have more tools at our disposal, and underlines the fact that minimizing suffering, by whatever means necessary, is an integral part of that role.
No longer do we live in mid-twentieth century America where animals inhabit our world as pure luxury items or for our most basic utility. This is 2007, where pets are more than mere toys and industrial-scale animal agriculture is just starting to recognize that their profit margins might eventually succumb to similar attitudes. After all, would you want to drink milk from a cow whose owners didn’t see fit to block a nerve before carving out her foot abscess?
So you see, this issue has legs. That’s why I’m gratified to see it coming to a head, even if one otherwise competent vet has to pay the price for this welcome change.