Expectations and reality Print E-mail
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Wednesday, 17 June 2020 14:42
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Dr Liesel van der Merwe is a small animal medicine specialist. Send her your questions: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Dr Liesel van der Merwe

Every day I see evidence of misunderstandings. Being a lecturer, I often need to explain concepts to students and often realise that I don’t always do what I say.

When a vet talks to a client we often forget that the level of knowledge is not the same as ours, so our ‘simple’ instructions or explanations are incomplete or often misunderstood. My instructions to students are that if their mother couldn’t understand the discharge form, their client probably won’t.

Fancy jargon sounds good, but simple language with clear set goals and expectations are the key to a successful client-vet relationship.

Clients need to understand prognosis, cost of treatment and what the outcome will be to help them make decisions both on an emotional and financial level.

Many conditions are cured with treatment, such as simple tick bite fever in a dog, an abscess in a cat. Some conditions may possibly have some residual deficits; your pet will be better, but not 100%. You need to decide if you can live with the less than perfect pet. Certain orthopaedic surgeries fall under this category.

Then you get conditions where the aim is to control and reduce symptoms, but there is no hope of curing the pet. This is common with dogs that have severe skin allergies, bad ears, leaking heart valves and congestive heart failure and seizures from epilepsy as examples. They will always have the disease. Medications and treatments will help to reduce the episodes or severity. Flare-ups will occur.

Treatment and management is lifelong. Depending on response to therapy, the quality of life can range from good to poor.

Finally you get what we call palliative treatment – just suppressing or controlling the symptoms to maintain reasonable quality of life for a short period. This often occurs in patients with cancer. A full course of chemotherapy and surgery may have a greater chance of full remission, but often due to age, disinclination to put your pet through the trauma or financial constraints, we elect to go for a milder treatment course which will not cure the condition but control it for a while.

It is important to understand these aspects to your pet’s treatment. Many times vets are busy or think you understand the implications of different options and decisions are made with incomplete information. Then you as client are unhappy with the outcome, even when that was the most likely outcome expected from your decision. This can cause dissatisfaction with the vet’s efforts, yet it’s all down to poor communication.

Don’t be afraid to ask detailed specifics. Often I find I only think of questions I want to ask later, when I am less stressed or upset. Make an appointment and go in the following day to ask all you questions. Take your Dr Google printouts.

As long as both the vet and client understand what the outcome of a treatment option is, compliance is improved and disappointment is reduced.

I frequently see second opinions where the client says the first vet didn’t fix the problem. When I get the full history and do a clinical examination, the problem turns out to be a chronic condition which cannot be fixed. Here the issue was a lack of communication, not treatment. The client is unaware that treatment is lifelong and finishes a ‘course’ of medication, never returning for check-ups and repeat medications and scripts. The vet believes that the chronicity was implicit in the diagnosis. 

Follow-up visits are necessary, not just as an income generator. Vets need to check on how patients respond to a certain combination of medications. Sometimes we add or take meds away, change doses. Sometimes blood tests are needed to check for side effects of medications. 

As a client you shouldn’t be stopping and starting your dog’s chronic meds as you see fit. So many clients skip doses of epilepsy meds, change them to once a day instead of twice a day or run out for a week or so before they bring the dog in for blood tests, and then wonder why the dog has a seizure.

Then we get to the trust issue. If you don’t trust your vet then you need to change your vet. Sometimes it is a personality issue. Sometimes the vet is trying to please you and may be out of their professional comfort zone. Sometimes the vet is out of their depth as the case becomes more complicated. If the vet doesn’t say, “I want to refer”, but you feel uncomfortable, then ask: “Don’t you think we should refer to a specialist?”

A vet is much more than just a GP: We are dentists, surgeons, pharmacists, endocrinologists, oncologists and dog psychologists. We cannot be master of every aspect of veterinary science. We all have areas in which we are weaker than others. Let’s all be honest with each other. When vets feel out of their depth they should refer. If you feel nervous then discuss the options of referral. If financial constraints prohibit referral to a specialist, then you are on a journey with your vet where you know the limitations.

Communication, cooperation and understanding why your vet wants you to do certain things – that is the key. Listen to what they are saying. If you aren’t sure, ask again.

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