Why Does My Vet... Require an Exam before Dispensing Meds?
You know your pet well ... the shaking head, red smelly ears, and gross wax are sure signs of an ear infection. Or maybe the frequent trips outside, small squats, and red-colored pee accidents in the house tell you there's a UTI. Your dog has soft stools and diarrhea for the 30th time and you just need the meds that helped last time. So why does your vet insist on seeing your pet first?
Legality: Veterinary-Patient-Client Relationship (VCPR)
The exact clause varies by state, but in general, veterinarians need to perform a hands-on physical exam and get information from the owner of a patient in order to practice medicine, which entails diagnosis, treatment, and prescribing. For most states, it is stipulated that the physical examination of the animal has occurred within a year. Even if the pet has been seen within a year, a new physical exam may be necessary for a veterinarian to adequately manage or treat a disease, which is not just a legal responsibility pertaining to standards of care, but also an ethical responsibility. A veterinarian's medical license could be on the line for prescribing treatments if your pet isn't seen and evaluated first!
The VCPR rules for each state have been compiled by the American Veterinary Medical Association.
Medicine: Different Diseases Can Cause Similar Symptoms
While your pet may be experiencing the same, or very similar symptoms, it is possible that a completely different process is occurring. Ear infections can vary in type (bacteria, fungal, both, parasitic) and sometimes angry ears do not have an infection component at all (inflammation alone). They can also vary in location-- and a middle or inner ear infection is treated differently from an external / outer ear infection, but the symptoms you see at home may be similar. While changes in urinary habits and the appearance of urine can be due to a UTI, such changes can also happen with endocrine (hormone) disruptions, kidney dysfunction, and non-infectious diseases of the bladder. Diarrhea is one of the most non-specific symptoms of all-- and if it happens frequently, it warrants figuring out why!
Medicine: Recurrence Often Indicates Recheck
Even if the same exact problem is at hand... for all of the common conditions listed above (ear infections, urinary tract infections, diarrhea, etc), a recurrence of the problem often means that the pet needs rechecked to ensure that all causes of the problem are being addressed. Ear drops, oral antibiotics, or anti-diarrheal meds respectively can often reasonably resolve uncomplicated infections or GI upset. That means that if symptoms occur again after treatment is finished, repeating the same treatment is not always enough as a next step. A single ear infection may be a one-off occasional occurrence, but repeat infections can indicate an underlying environmental allergy, food allergy, or husbandry (grooming & management) problem. Some animals can have growths in the ear that allow persistent infections. If a dog or cat develops a second UTI in a short span of time, other complicating factors such as stones, bladder masses, immune system impairment, and anatomical abnormalities may need investigated. Diarrhea that does not resolve with treatment, or reoccurs frequently, may lead your vet to suggest additional testing for parasites or GI disorders.
Antibiotic Stewardship: Reducing Resistance
Antibiotic resistance is one of the greatest global threats that we face. The indiscriminate use of antibiotics can contribute to the creation of superbugs that do not respond to the antibiotics we have available, and these dangerous bacteria can spread to humans as well. Repeatedly prescribing the same course of antibiotics for ear or urinary infections can cause this, or rotating through antibiotics without testing to confirm the usage is appropriate.
If your veterinarian requests a recheck, they aren't trying to inconvenience you or withhold care from your pet. They're just trying to provide the most appropriate care they can! Across the nation, many veterinary clinics are overwhelmed with clients or understaffed-- or both. If a recheck could be reasonably avoided, your office's staff would want that to happen as much as you do. Accusations that veterinarians don't care about your pet or are just trying to milk more money out of a recheck are unreasonable yet very frequently occur. Show your veterinary team grace and help them help you.
If you have other topics you would like covered in this series, email info@alltradesdvm.com