As a veterinarian who shares a neighborhood with a major medical hospital complex, I have had plenty of experience with MD clients. While most are perfectly lovely, they do tend to treat our services with a tad less deference than the average client.
Moreover, I won’t deny many seem to share a certain brand of hubristic disregard for our education relative to their own. But it’s no big deal, right? As I like to tell the beleaguered front desk, “It’s all good as long as they pay their bills and refrain from verbally abusing us along the way.”
Still, it can be frustrating to work with some physicians. Presumption, superiority, and run-of-the-mill disinformation tends to color the relationship in too many cases. Overdoses and polypharmacy issues are problematic, for sure, but basic noncompliance is shockingly commonplace among my MD clients.
Having said all this (rather blithely, I will concede), some of my best clients are also physicians. They ask better questions and, when in touch with reality with respect to differentiating between what they know and do not know, are the best to partner with. This kind of physician not only understands the value of a strong collegial relationship, but empathizes with our struggle.
Enter the physician veterinarians encounter elsewhere in the natural course of our working lives. There aren’t many ways in which the two professions have the opportunity to interact in clinical practice but, when we do, it’s typically unpleasant. Take this most recent scenario as a for-instance:
Client gets bitten by her own dog, an 11-year-old puggle who had gotten into it with her sister’s Corgi-mix. While trying to break up the fight, she received exactly one puncture wound, courtesy of this fat and allergic, but otherwise healthy, docile, strictly-indoor dog.
This little mush-ball had been vaccinated for rabies exactly four times throughout the course of his life (all documented). Unfortunately, he’d missed his latest round of boosters. They had been deferred as a result of two separate allergic dermatitis episodes, and our client simply hadn’t gotten around to making a new appointment.
After being scolded by the ER doc for harboring an aggressive, unvaccinated animal in her home (she volunteered the information when asked whether her dog was fully vaccinated), she had to sign an AMA for refusing post-exposure vaccines.
What’s more, her regular physician agreed and felt very strongly that she receive the post-exposure vaccine protocol. Predictably, he also insisted she re-home the dog. And that’s where the veterinarian comes in, right?
While we are trained to always defer to physicians with respect to our clients’ own healthcare, we are not required to keep our mouths shut when our clients ask our opinion on an issue of specific veterinary relevance. In this case, she had asked about her dog’s risk of contracting rabies and whether he should really be re-homed as a result of his aggression. In lieu of a lengthy conversation, I emailed her a few links to some rabies and behavior resources on Dr. Google.
As reward for my efforts, I received a nasty call from her physician. Not only did I get chastised for interfering in his doctor-patient relationship, he also accused me of practicing human medicine without a license. (On what planet does providing someone with a list of websites resemble medical practice?) Once again, no good deed goes unpunished.
Not the first time
This isn’t my first uncomfortable run-in with an MD after offering a client general veterinary information that happened to conflict with their physician’s advice. While it’s typically related to common pet-related zoonoses (ringworm, rabies, scabies, roundworms, etc.), pet behavior concerns have also arisen (as in bite-wound cases, cat scratches, play biting).
While these issues are surely in our wheelhouse, some physicians don’t seem to understand why veterinarians would dare contradict them. Many consider animal welfare and pet health as tangential topics easily dismissed in favor of human health concerns and simply don’t understand why a veterinarian would deign to weigh in on such issues.
Take toxoplasmosis, for example: I don’t know if this happens a lot elsewhere, but here in Miami where a lot of doctors are schooled overseas, clients are often informed sharing a household (much less a bed) with cats is extremely perilous to the fetus. Expectant mothers are often counseled to leave cats outdoors for the duration of their pregnancy. One local obstetrician went so far as to tell a client keeping a cat indoors is like “begging for a miscarriage.”
Years ago, after my first terrible encounter with an offended physician (over toxo, of course), I pledged to be more careful around any topic that might attract physician wrath. Who needs the aggravation? Yet, I found it absolutely necessary to do so on more than one occasion, typically in cases where re-homing, euthanasia, and restricting indoor access were recommended.
So now, to ensure I get as little flak as possible and never find myself in a situation that imperils my license, I stick to a few informal rules. Here’s my short list:
1) Never contradict your client’s physician unless A) your client specifically asks if their doctor’s opinion is correct in a situation where a patient’s health is at risk, or B) it’s a life-or-death issue for your patient. In this latter case, I believe you can, and should, volunteer any information, whether or not the client asks for your opinion. After all, if you’re willing to paint crosshairs over your license, the stakes have got to be high enough.
2) Be sure to keep anything in writing to the barest minimum, all couched in general terms that could never be construed as specific medical advice.
3) Consider not saying or writing anything at all, instead forwarding a short list of links for the client to carefully consider and interpret on their own.
4) Always explain to your client it’s not your goal to contradict their physician, only to offer additional information that might clarify their decision.
5) In more extreme cases where it is impossible not to contradict the physician, let your client know their physician might not take kindly to being challenged by a veterinarian. If your clients are prepared for the possibility of blowback they tend to tread more lightly.
In general, knowing when to keep your mouth shut is the best advice I can offer. In situations where you’re not sure whether you need to say something potentially uncomfortable, try asking yourself three questions:
1) Does it need to be said?
2) Does it need to be said by me?
3) Does it need to be said by me right now?
The way I see it, if I can honestly say yes to all three, why muzzle myself? I can put up with the annoying things that often come with having a client base rich in MDs because I can also reap its rewards. However, I’ll not put up with it when my patient’s health and welfare is at stake. Not this time.
Patty Khuly, VMD, MBA, owns a small animal practice in Miami and is a passionate blogger at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.