The Dilemma: sometimes old is just fine

Editor's note: All names and businesses in this dilemma case are fictitious, but the scenario is based on real occurrences.

Clinton Animal Hospital is a community institution. For 40 years, if you owned a dog or cat, you could bet they were patients at the Clinton Animal Hospital. The veterinarians working at th clinic were truly a diverse group—3 recent graduates, 3 veteran practitioners, and 2 veterinarians—who had logged over 30 years at the clinic. In theory, this diverse group of practitioners should provide a mixture of experience, mentoring, and newer approaches to the practice of veterinary medicine. In practice, that was not always the case. The veterinarians often had some clashes when it came to newer approaches to treating pets vs tried and true long-time diagnostics and therapies.

In a recent staff meeting, the doctors aired their grievances concerning the varied treatment approaches to some common medical maladies. When a dog presented with otitis, the newer practitioners would examine the ears and, when indicated, do an ear swab cytology and, if necessary, a culture. Having seen thousands of patients with otitis, one of the senior practitioners approached things differently. His experience allowed him to examine the ear, observe the debris, and identify the odor as a classic yeast otitis. Both approaches to this common problem resulted in highly successful outcomes.

However, another treatment approach also ruffled some feathers. Oftentimes, dogs were presented with small papillomas, skin tags, and epithelial growths. The estimates and expectations developed by the younger staff included presurgical bloodwork, appropriate sedation or anesthesia, chest radiographs (if indicated by the history), and postoperative pain medications. If the growths were clearly papillomas, skin tags, or other obvious benign eruptions, one of the senior vets practiced a different approach. He opted for local lidocaine-based infiltration and a minimal excision wound with hemostasis provided by silver nitrate, cautery, or a couple of sutures.

Clients were often thrilled with this option—but administrators, not so much. This procedure approach was a lot less costly. These varying approaches by the doctors triggered a discussion with the professional staff led by the hospital director. Some staff clinicians felt these shortcut approaches did not meet the current standard-of-care guidelines. The clinicians that utilized these techniques disagreed. They felt that a licensed veterinarian had broad discretion in approaching medical and surgical issues if there was full disclosure of these approaches with the pet owners.

Ultimately, it was determined that every staff veterinarian had the right to use their judgment when treating patients if there was an informed discussion with the pet owner. On occasion, a client would ask about a varied approach to a pet care problem. For example, a client may ask why the previous doctor treated this issue differently. The response to such a question should be both honest and ethical. The explanation should mention that there are varied approaches to similar medical issues and that each doctor is acting in a medically sound fashion, with the best interest of the pet as a priority. Interesting enough, the staff meeting was not contentious. Rather, it was an opportunity for veterinarians to share and learn from one another. A combination of tried and true as well as things that are new is the formula for excellent veterinary medical care.

Rosenberg's response

I must admit I fall into the senior category in this dilemma. This is not a discussion about newer medical approaches vs older techniques and remedies. The approach to medical and surgical treatment of a pet patient should be a cooperative exercise between the pet owner and veterinarian. The age of a pet, the financial situation of an owner, and the comfort level of the veterinarian with a treatment procedure all go into a final treatment decision. I think we can all agree veterinary medicine is a combination of science and art. Clinical instinct and sound scientific principles are the formula for successful animal care. The artful component of veterinary medicine should be respected, as well as successful treatment plans by vintage veterinarians.