Your Veterinary Voice episode 9: Meet Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP
Downing describes her latest research on clinical bioethics and what it means for the veterinary professionand we nerd out, bigtime.
Dr. Downing poses with Kula, the sweetest golden you'll ever meet.Pain-prevention advocate Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP, has been a longtime friend, contributor to dvm360.com and CVC speaker (to packed rooms, no less!). So when she had a few minutes to breathe in between those high-volume sessions, we pounced on the opportunity to discuss the latest in her revolutionary approach to pain in pets.
Business Channel Director Brendan Howard is back chatting with Dr. Downing about her own serious physical pain and how that shaped her career, why veterinarians should give a second thought to clinical bioethics and how it could shape the profession for years to come.
Short on time? We'd suggest savoring this one-but here are some highlights.
At 5:40, Dr. Downing discusses how pain evolves in people and pets. She says veterinarians and team members need to be particularly attentive to pets in pain, especially senior pets whose conditions are evolving. Check out this tool from Downing's partner in practice (and in life), Sharon DeNayer:
> 7 steps to make your practice comfortable for older patients
> And this accompanying handout for your team.
At 8:00, we ask what the hang-ups are for veterinarians managing chronic pain in their patients. Downing's response: Vets are too sensitive to the idea that their clients are going to reject the idea of returning to the practice.
> Want to get a better handle on your recheck protocol (and prove once and for all whether your recheck reality is positive or negative)? Use this tool.
At 11:00, Downing talks about the critical need for the vet team to embrace forward-booking. There's a BIG REASON the dental industry has been able to move from intervention (when your teeth are falling out due to decay) to prevention (because the receptionist basically keeps you locked in until you book your next appointment).
> Don't fear forward booking. It's so easy. And you're not doing it. Here are super-simple steps to make it work for you.
At 13:00, TIP ALERT! Downing has a super-simple solution for forward booking that changed her business: The client care representatives book the next appointment before the client pays. This way the client isn't mentally "checked out" before the next appointment is on the books.
At 16:30, Downing mentions a quote by one of her mentors, Dr. Lloyd E. Davis, from 1983:
"[O]ne of the psychological curiosities of therapeutic decision-making is the withholding of analgesic drugs because the clinician is not absolutely certain that the animal is experiencing pain. Yet the same individual will administer antibiotics without documenting the presence of a bacterial infection. Pain and suffering constitute the only situation in which I believe that, if in doubt, one should go ahead and treat."1
No big deal, right? But Downing points out that the very first textbook on animal pain wasn't published until 1992. This, Downing says, proves the veterinary industry hasn't taken pain management quite as seriously as we would like to think we have.
Here's some suggested reading ...
> The 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats
> The 6 myths of palliative care (you'll see an appearance from Lloyd Davis in this article, too)
At 20:00, we discuss how clients fear suffering for their animals, but can't recognize pain at home. Here's where we give you the tools they need to do so!
Try these handouts ...
> Identifying pain: The enigmatic ways pets show and hide pain
> Team tool: Recognizing pain in pets
> Will my pet be in pain?
> 5 signs of dental pain in pets
At 22:00, the discussion turns to consciousness. Downing throws it back to Darwin, who first stated that the differences between humans and animals in mental and moral capacity are differences of degree, not of kind. Since animals do possess consciousness, and therefore they do suffer, it is the veterinary profession's medical obligation to focus on the physiology of pain and relieve that pain. The moral imperative, then, is to eradicate suffering.
At 28:10, Brendan breaks to let you all know that he is nerding out hardcore on Downing's thesis on why borrowing four principles of human clinical bioethics will enhance the lives of our veterinary patients. Here's where to read more.
In human healthcare, ethical decisions are made at the bedside. For veterinarians, that means ethical decisions are made at-you guessed it-the tableside. At 32:25, Downing discusses difficult decisions like when it's appropriate to withdraw cancer treatment when the patient is miserable.
> Here's a quick video where Downing discusses ethics in everyday practice.
> Here's Downing's latest contribution to dvm360.com-the acute pain management pyramid
1. Davis LE. Species differences in drug disposition as factors in alleviation of pain. In: Kitchell RL, Erickson HH, Carstens E, eds. Animal pain-perception and alleviation. Bethesda, Md: American Physiological Society, 1983:175.