The Veterinary Advice Phone Call
Since the advent of the telephone and the wider availability of veterinary services, both clients and veterinarians have been frustrated with informational calls about specific instances of medical concern.
Owner frustration is generated from not knowing why their description of the circumstances is so difficult to understand and a suspicion that the vet is only interested in the money derived from the farm visit or office call.
Veterinary frustration stems from an inability to appreciate that animal owners don’t fully understand the complexity of symptoms as an identifier of disease or the legal implications of providing advice based on incomplete information. Admittedly, this is not a big issue, especially to petMD readers who are generally more involved in their pet’s health, but I thought it worthy of discussion, and possibly instructive.
Example: The Constipated Pet
A frequent veterinary telephone inquiry is what type of enema should be given to a constipated pet. The owner has not witnessed a bowel movement in two days and has found no evidence of a bowel movement. They are absolutely sure that their pet is not feeling well because it is constipated and needs an enema.
This assumption is not without medical precedent. Anybody who has been hospitalized for more than two days knows that a nurse will soon appear with questions about bowel movements or an enema in-hand. This medical behavior is built into the system. Having not eaten in two days is not a medical excuse for no fecal output! I have actually become adept at lying and flushing the lack of evidence down the toilet (the nurses always ask patients to leave feces for the documentation of bowel movements). Pardon the hyperbole, but fecal preoccupation has a long medical, particularly nursing, history. With this historically in our medical experience, it is no wonder that a lack of bowel movements signals constipation to pet owners.
The truth is that constipation is not a common clinical veterinary problem. With the exception of the “manx syndrome” (the genetically short, misshapen tail of the manx-related cats that affects neuromuscular function of the colon) and pets with acquired functional problems to the lower bowel, constipation is uncommon. Accumulation of feces in the colon for other reasons is not the same as constipation. The leading cause of decreased or no fecal output in pets is the lack of food input. There are no feces because there is no bowel content. Despite good intentions the owner may be focusing on the wrong symptom for which they seek advice.
Another compounding factor is whether lack of evidence is proof of no fecal output. Owners of “constipated” animals that have access to large, heavily landscaped yards or extensive acreage are not presenting a compelling case for constipation.
The most important reason for decreased bowel movements during illness is the remarkable fail-safe system of the animal body. As the amount of body fluid decreases with dehydration, an intricate hormonal response activates to protect the heart and brain at all costs. Organ systems that are non-essential to survival like the skin and the intestines are the first to have their fluid volume decreased. This is why a veterinarian will often estimate the level of dehydration in an animal by pinching up skin on the neck and timing its recovery to flat. Without fluid the skin loses its elasticity. The same is true of the gut. Without adequate fluid, motility or movement stops and there is no progress of gut content toward the anus. These animals need fluids, not an enema. In fact, for a dehydrated animal, an enema could make dehydration worse and turn a serious case into a life-threatening critical case.
Not a Solitary Example
This constipation example is far from extensive in its discussion but I hope it points out the complexity of medicine. Every symptom in veterinary medicine requires this same extensive consideration of the circumstances and body response. Conveying this via traditional phone is difficult, especially without highly trained reception staff who have the communication skills to draw more extensive information from clients.
The role of smart phones and technology may eventually help “the advice-call” and improve veterinary care. So far it is in its infancy and potential legal liability issues are still germinal.
Dr. Ken Tudor