The concerned pet owner—let’s call her Reagan—had a 15-pound, 6-year-old female poodle named Sassy. I almost always ask the genesis of a pet’s name, and Sassy was short for Sassafras, which happened to be this gourmet cook’s favorite spice. Reagan unlocked her iPad and showed me lots of photos of Sassy and Reagan, a few of which were risqué: Reagan, in her wedding lingerie, holding Sassy, who was in a pet wedding dress. Seems she had Sassy before she had a husband and he literally married both of them. (By the way, she never showed me any pictures of him.) She said Sassy had always had skin problems, but mainly during times of high pollen loads, and the scratching, chewing and licking had gotten worse as Sassy aged. Reagan said her veterinarian had recommended using oatmeal-based shampoo, fish oil as a supplement—no brands were mentioned for either—and Claritin. Sassy improved a little, but despite weekly baths, daily fish oil and Claritin, she continued to suffer. No, No, No As any of you would do, I dug deeper. Did the veterinarian run tests such as a skin scraping, culture and sensitivity, or blood tests? No. Allergy tests? No. Did the vet talk about bedding, external parasites, house and yard chemicals? No. Use antibiotics or other prescription medications for infection or pruritus? No. Recommend seeing a specialist? No. The veterinarian did recommend a professional dental, nail trims and vaccinations, including oral kennel cough every six months. “She just said we see allergies in light-colored dogs like yours all the time,” said Reagan, “and by using the same drug you use—Claritin—we can save you some money.” Maybe so, but those recommendations didn’t go beyond temporary relief, or save the dog from unnecessary misery. They did, however, cheapen the perception of veterinary medicine. Pardon the pun, but Bad Dog Doc, you caused the rest of your colleagues pain and misery. The hospital in this story is located in a community where my wife, Teresa, and I often vacation. I not only often drive by the hospital, but I have had Teresa visit clandestinely. (I didn’t want to risk being recognized.) On the proverbial 1-to-10 scale, this practice’s curb appeal, interior design, staff friendliness and professionalism rate a 9.5. From the practice’s ZIP code, the size and newness of the practice, and the make and models of the vehicles in the parking lot, I could tell this was a practice catering to the upper crust. Reagan’s wedding ring sported a diamond that could plug a volcanic cone. The spare change in her high-end Mercedes sports car—I watched from my spot on the dining room patio as a valet brought it to the entrance circle—could have paid most vet bills. Reagan didn’t need cheaper pills, and Sassy shouldn’t have received them. Underestimating the Pet Owner Let’s get specific. While I didn’t interview the veterinarian for this article, I spoke with Reagan a couple of times. I found her to be a very intelligent, informed and experienced pet owner. From childhood she’d gone with her family’s pets to the vet, and as an adult she had been to a specialty hospital for another dog’s eye problem and to Colorado State University’s Animal Cancer Center for the same dog. Reagan had the knowledge, desire and budget to seek the highest quality veterinary medicine available. This veterinarian, by recommending Claritin and not recommending the best FDA-approved veterinary pharmaceutical to stop itching in dogs, and by not making specific shampoo and supplement recommendations, damaged all stakeholders—the pet, pet owner, practitioner, practice and profession—not just short term, but long term. Setting aside why the veterinarian didn’t run additional diagnostic tests for recurrent skin problems, let’s focus on the product side. As you know, Claritin is a popular over-the-counter human allergy product that is widely advertised, heavily promoted in Sunday fliers and online, prominently featured in store displays and typically discounted during allergy season. Claritin and Zyrtec are the General Motors and Ford of the allergy drugs. Rather than look at where you can get Claritin, it would be easier to list where it can’t be found. Claritin is in every grocery store, drugstore, big-box store, convenience store, airport and online outlet. Whether you buy a pack of two at the airport newsstand or a box of 200 at Costco, this product seems about as high tech as aspirin in consumers’ eyes. Veterinary Solutions Reagan didn’t need to save money. Sassy needed something that helped and provided relief. The veterinary practice provided both a disservice and a low perceived value, cheapening the profession. Looking to remedy the problems, both real and perceived, I talked with Reagan about the veterinary drug Apoquel. I explained that I had a Lab/pit cross named Gracie who had suffered from chronic skin problems (cycle after cycle of antihistamines, steroids and antibiotics, or cyclosporine and antibiotics). After getting Apoquel, Gracie quit itching the same day, quit stinking three days later, and has never scratched, chewed, rubbed or licked her skin or paws another day in her life. I completely understand that sometimes you need to prescribe an OTC product for a pet owner who is either very price conscious or has limited resources. For example, if it comes down to a pet owner being able to afford a professional cleaning or a top-shelf veterinary-exclusive antibiotic, you might have to go with the cleaning to restore oral health and relieve pain and with a generic antibiotic from Walmart or Walgreens. The vast majority of the time, the pet owner can afford the very best quality of medicine for their pet if we believe enough in the product, state-of-the-art medicine and ourselves as pet health experts. To paraphrase an old Hallmark tagline, “Care enough to recommend the very best.” Human doctors, unless the patient expresses otherwise (wants generic) or if health insurance won’t cover it, prescribe the best pharmaceuticals and health care products available regardless of price. Not only does this typically offer the best chance of an effective treatment or cure, it keeps the human patient looking to the family doctor for health care solutions. The patient skips Drs. Bing or Google and aisle upon aisle or page upon page of OTC products (or worse, unproven holistic products and snake oil). How It Should Be Done If I’d seen Sassy as a veterinarian—regardless of what Reagan drove up in, how she dressed or how she carried herself—I would have followed my mantra of close to 40 years of practice in that “I always recommend the highest level of care, and only the pet owner can decrease that level of care.” I’d have been thorough in my examination, run appropriate diagnostic tests, not hesitated to ask another vet at the practice for a second opinion, got on VIN if stumped, prescribed the very best products, and referred to a specialist if my diagnosis and treatment plan weren’t working. When this one veterinarian looked to save this wealthy pet owner some money, everybody lost. The pet suffered unnecessarily. The pet owner was saddened by her dog’s continued misery and lost faith in the practice as a problem solver. The practice lost present and future income. The profession was tarnished. Missed opportunities to practice the best medicine can travel far outside the walls of the exam room. The pet owner’s friends, family members, co-workers and social media contacts also may try Claritin, or Pepto for vomiting, Imodium for diarrhea, borax powder and eucalyptus shampoos for fleas, and maybe a spray product to remove plaque and tartar and treat advanced periodontal disease. We should always respect our clients’ genuine financial limitations and work with them to get the pet the best possible care for a price they can afford. But to decline to start at best medicine and work your way down? There’s nothing good about that approach. Let’s stop selling our patients, and ourselves, short. Dr. Marty Becker writes every other month for Veterinary Practice News. He is a Sandpoint, Idaho, practitioner and founder of the Fear Free initiative. For more information about Fear Free or to register for certification, go to www.fearfreepets.com. Originally published in the February 2017 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!
