These cases can be difficult and often require considerable time and attention-both during an examination and in conversations with clients. Here are some tips to get a better diagnosis and outcome.
Dermatology cases can be frustrating—there’s no quick and easy fix, they can require painstaking compliance on the client’s part, and a cure is often rare. But as difficult as these cases can be for veterinarians, they’re equally hard on the pet owners, which is why excellent communication and a thorough approach to obtaining a diagnosis is key.
Dr. Ian Spiegel, DACVD, a board-certified dermatologist who practices in veterinary specialty centers in New Jersey and Pennsylvania, stresses the importance of gathering the most information possible by asking clients open-ended questions about:
> The type and duration of clinical signs
> Whether they occur year-round or seasonally
> Whether other pets or people in the house are affected
> Whether the pet has been responsive to treatment.
Dr. Spiegel takes an equally comprehensive approach to the physical examination, paying special attention to troublesome spots, such as the ears, feet and axillary and inguinal areas. Collecting samples for cytology is critical throughout the exam process as well, as is considering the pattern and type of certain clinical signs, which may point to an underlying metabolic or endocrine disease and require a more extensive work-up.
Dr. Andy Rollo, a Veterinary Economics Editorial Advisory Board member and an associate at Madison Veterinary Hospital in Madison Heights, Mich., follows those important steps when making a diagnosis as well and recognizes the importance of not having tunnel vision when seeing an itchy pet—not to mention communicating openly with the owners. “There are so many possible differentials—parasites, atopy, food allergies,” he says. “It’s important to discuss the differences in signs with the owners and really enlist their help to get to a diagnosis.”
Also important, says Dr. Spiegel, is not rushing through a dermatology case exam. “It’s hard to do a work-up quickly,” he says. “Block the extra time with these cases—and charge more for your time.”
To give clients a better understanding of what to expect during a dermatology examination, get the handout at dvm360.com/DermExam.