Where's the script? On freely given drugs in pet medicine
Remember that old fast-food commercial bemoaning the lack of meat in its competitors’ burgers? “Where’s the beef?” it asked, thereby implying the obvious: “You’ve been cheated.”
Same goes for how it is that many humans treat their own healthcare. If they’re sick enough to go see the doc, they somehow take offense when the professional does not acknowledge their suffering with some sort of token therapy. In most cases, it would seem, that memento of their illness takes the form of a simple slip of paper, a temporary stand-in for that bottle of pills or container of elixir.
It’s almost Pavlovian. Enter your physician’s office or an ER facility with sickness in tow and you know you’ll be leaving with a white slip of paper sporting a blossom of chicken scrawl. After all, you’ve been trained over a lifetime of such occurrences to salivate for drugs when a certain disinfectant quality assails your nostrils.
I don’t blame you. It happens to me, too. After an episode of acute gastric distress a couple of years ago, I found myself doubled up in pain at a local ER. After about four hours and an ultrasound, it miraculously disappeared. But that didn’t keep the doc from asking whether I might need a script of famotidine for the long haul, as if I couldn’t buy Pepcid AC over the counter like anyone else. Yet, confused by the whiteness of my surroundings as I clearly was, I had to think about it twice before declining the offer.
But is it merely a learned behavior? Or do some of us really need evidence of the severity of our suffering in the form of a script? Maybe it’s something else: A human compulsion to believe in miracles. Hope in a bottle. Who knows?
Whatever the case, the reality is that veterinary medicine is not immune to such human behaviors. The classic case for this is that of the sniffly cat:
A sneezing, mildly feverish cat arrives at the hospital. A diagnosis of a viral upper respiratory infection is rendered, tentatively at least. The recommendation includes segregation from other cats, fluid therapy and other simple modes of supportive care––NOT antibiotics as most of my clients seem to assume is in order.
Now, sure, if they’ve got huge green gobs of goobers and evidence of lower respiratory involvement (or if they’re diabetic, FIV-positive or otherwise immunocompromised) you can be sure that antibiotics will be on the menu. But that’s not necessary––at all––for the bulk of these patients.
Still, my clients want something. It’s not enough to teach them how to support their cats through this kind of infection at home. Nope, most want to see a fluid-filled needle or a jar of pills...something tangible. Even my clientele who might otherwise be happy to decline an antibiotic in the face of an abscess wants something for their sufferers––even if its potential efficacy is a long shot. And I get that.
For that reason I’ve learned to recognize the many signs of “you-must-have-something-else-Doc” some of my clients tend to display. That’s when I offer to hospitalize with IV fluids or bring out the Vitamin B shot, the lysine powder and, depending on the cat’s symptoms, age and overall health profile, maybe I’ll concede to the antibiotics, too.
You might feel that docs who offer scripts or yield to client demands for therapeutics are merely “caving” to a misplaced human desire for drugs. I used to think so, too. In fact when I first graduated from vet school, I used to be one of those veterinarians who lectured her clients on the misuse of antibiotics and refused them on moral grounds.
Sure, I still do that, but far less avidly. Instead, I cajole and explain and work with what’s already in their heads––not against it. Hence, why I’m willing to “cave,” even when I know my patients don’t strictly require antibiotics. Over time, when clients learn that for some conditions drugs don’t help any faster than the non-drugs, they do come around.
I’ve come to learn that if I didn’t take this tack, I’d feel like the lone voice in the wilderness of allopathic medicine. And that’s not a useful place to be if that means you’ll alienate the average, willing-to-learn pet owner.
Still, I wonder: Is it modern medicine’s ability to modify human behavior to expect drugs that I’m up against? Is it just easier for docs to mollify than to teach? Or is it patient/client nature in general we need to address when we write our scripts? Maybe we do somehow feel cheated when we don't get the tangible recognition we feel our animals' suffering deserves.
PS: Thanks to Gina over at PetConnection for twisting in the light bulb on this particular topic. Yet another reason to keep up our regular marathon, cross-country telephone sessions. ;-)