While some patients with advanced conditions do require referral to veterinary specialists, many cases, especially dogs with canine hyperadrenocorticism, are well within the case management capabilities of general practitioners.
Dr. Roark practices at Cleveland Park Animal Hospital in Greenville, S.C. He is a popular veterinary conference speaker and a regular contributor to several veterinary publications and websites. He can be found on Twitter @DrAndyRoark and Facebook (Facebook.com/DrAndyRoark).
Dr. Andy Roark
Ironically, one of the biggest weaknesses veterinarians have is directly tied to a key reason many of us enter this profession. It's a trait that is also one of our greatest common strengths. Veterinarians derive great pleasure from addressing a problem and fixing it. We may even feel a strong need to solve problems immediately. Few things are more gratifying than "fixing" an ill or injured patient. Making an immediate difference for a patient, and for the people who love that animal, is energizing.
While this compulsion often drives veterinarians, it may also hold us back. Patients with Cushing's syndrome and other conditions that require long-term care and ongoing communication with pet owners often do not have an immediate emotional pay-off. In fact, it can be weeks before the earliest positive results are realized. These cases are marathons rather than sprints to glory. The extended and involved nature of these types of conditions can be daunting, and many practitioners feel a subtle, yet persistent desire to refer these patients away.
While some patients with advanced conditions do require referral to veterinary specialists, many cases, especially dogs with canine hyperadrenocorticism, are well within the case management capabilities of general practitioners. They simply require commitment from both the doctor and the client.
A 2007 review of treatment adherence in human psychiatric patients highlighted four predictors of treatment concordance problems associated with clinician factors: poor doctor-patient relationship, poor explanation/communication, poor empathy, and inadequate follow-up.1 By avoiding similar pitfalls in veterinary practice, we can improve patient care and successfully manage more of our canine patients with Cushing's syndrome and other chronic diseases.
Strengthen the doctor-client relationship
Weak doctor-client relationships can lead to client mistrust and low perceptions of value in the services received. A demonstrated long-term commitment to the resolution of a chronic disease such as Cushing's syndrome may be the single strongest medical tool that a veterinarian can employ. Trusted doctor-client relationships can take time to build, and ideally exist before a patient faces a diagnosis of a chronic disease. However, these relationships often must be forged as treatment progresses.
Explain and communicate
Unlike treatments for many acute illnesses, where therapy is performed in the veterinary clinic or for a short time at home, treatments for chronic diseases require client persistence. Pet owners must provide significant ongoing time and financial commitments and discipline in treatment plan adherence. Nothing will make these sacrifices seem unreasonable to clients faster than a veterinarian's poor explanation and communication and a lack of quick results. (See boxed text, "Effective client communication is key.")
Effective client communication is key
If pet owners don't understand why a treatment is being recommended, they are likely to ignore the recommendation or abandon it over time. If they have unrealistic expectations for how quickly or completely clinical signs will be controlled, they may feel disillusioned. We must invest and reinvest our time in educating the client and maintaining reasonable expectations for treatment outcomes.
When clients express frustration, it is easy to sympathize, but that's not enough. To help patients and pet owners over the long term, we must go beyond sympathy and stay actively involved in the situation. We need to put ourselves in the pet owner's shoes — to show true empathy, rather than just sympathy — so that we may share in their emotions and show that we're taking action that improves their experience and the quality of life of their pet.
Avoid common relationship and communication pitfalls
For example, it's easy to sympathize with a pet owner whose spouse is skeptical or unsupportive of the pet's treatment plan. So to maximize treatment effectiveness, move beyond the role of "sympathetic ear" and help devise solutions. Offer a group consultation so you may review the disease process and the medical rationale behind the treatment to enlist support from previously uninvolved family members. Alternatively, give the pet owner educational materials to share. Regardless of what path you choose, getting involved and sharing the pet owner's experience helps increase the probability of long-term success.
Follow up thoroughly
Veterinarians often tend to consider the appointment "over" as soon as we finish writing up the medical record. This approach is ineffective. Many chronic disease processes, such as Cushing's syndrome, are not cured by your recommended treatment; however, they can be well managed. These patients will need to be treated the rest of their lives. We need to monitor the case to ensure that treatment plans are adjusted as needed and before clients lose faith in the medical management process. Success, in the eyes of the owner and for the patient, requires regular patient evaluation as well as an assessment of client satisfaction. Follow-up phone calls and recheck appointments are essential components of the management plan. As the preceding two Canine Cushing's Case Files articles described, a practice's entire veterinary team has a role to play in client communication and education.
In our busy practices, it is easy to fall into a "fix-it-quick" mentality and slip into these practitioner pitfalls. Dedication to working through these challenges (with the support of resources like the Veterinary Technical Service team at Dechra Veterinary Products) allows us to experience the many rewards that come from building stronger relationships with our clients, managing chronic diseases successfully, and giving suffering patients a new lease on life.
1. Mitchell AJ, Selmes T. Why don't patients take their medicine? Reasons and solutions in psychiatry. Adv Psych Treat 2007; 13:336-346. doi: 10.1192/apt.bp.106.003194. Available at: http://apt.rcpsych.org/content/13/5/336.full
Go to the Dechra Veterinary Products CE Learning Center at www.dechrace.com and choose one of the online CE modules to learn the latest on managing feline hyperthyroidism and canine hyperadrenocorticism. Plus earn free CE!
• Diagnosing and treating canine hyperadrenocorticism
Presented by Audrey K. Cook, BVM&S, MRCVS, DACVIM, DECVIM, and David s. Bruyette, DVM, DACVIM
• Cushing's disease: Inside and out
Rhonda Schulman DVM, DACVIM, and John Angus, DVM, DACVD
• Diagnosing and treating feline hyperthyroidism
Presented by Andrew J. Rosenfeld, DVM, DABVP
Then get your whole team on the same page, by visiting the Team Meeting in A Box section at www.dechrace.com
• Stop getting burned by ear infections
How you handle otitis externa and ear infections can make or break client bonds—and dogs' well-being. Use this Team meeting in a Box to create a team approach to help pet owners and heal patients.
• Coping with Cushing's syndrome
Pets with Cushing's syndrome suffer from a chronic illness that will be managed throughout the pet's life, not cured. This Team Meeting in A Box will help you deliver a successful team-wide approach.
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