Thursday, June 23, 2016

How to Help Vet Clients Understand the Downside of Refusing Drugs

By Marty Becker, DVM
Veterinary Practice News

"Understanding your client's reservations about giving their pets medication can better help you explain the benefits.


The fast-talking guy on the human prescription drug ads probably had to train for years to develop the lung capacity to get out all the warnings on the latest and greatest medication for what ails us. From nail fungus to cancer, from rashes to TB, there's no apparent end to the dire consequences of modern drugs.

Is it any wonder our clients can be so afraid of drug side effects that they don't want to accept our medication recommendations?

How many of us have heard any of the following:

  • I don't want my pet to be "out of it."
  • All she does is sleep when she's on that.
  • I read the drug can cause kidney failure.
  • Can it make them blind?
  • What if they get addicted?
  • I don't want him to be on medication for the rest of his life.
  • Is there something natural I can use instead?
  • Is there a diet I can feed for that?
  • If she feels too good, she won't lie still.

However frustrating those oft-heard beliefs can be to a veterinarian who's just trying to help, let's not forget our clients' fears have some basis. Many drugs do have the potential to cause dangerous side effects or drug interactions, and simply pointing out they're a necessary evil isn't going to relieve the pet owner's extreme guilt if her pet develops one of them.

Climbing Mount Everest
Of course, the real-world choice isn't to not give the drug and the pet is OK versus to give the drug and the pet is harmed. Most pets are not harmed by their properly prescribed medications, and declining appropriate drugs may mean the pet will suffer or even die.

That's usually pretty clear to clients when the drug is an antibiotic or other medication related to short-term treatment of a distinct physical problem, like a bladder infection. But in the case of drugs for pain and anxiety in particular, there can be barriers the height of Mount Everest to overcome.

My approach used to be to try to convince clients that the benefits outweighed the risks, but to be honest, if their minds were made up, I never got very far with that one. As the old saying goes, "He who is convinced against his will is of the same opinion still." And there's something about the concept of "risk" that's so much more compelling than "benefit."

So now I do something different: I agree with them. I tell them they're absolutely right to be worried about side effects. After all, I say, who would want their pet's immune system to be suppressed? Sleep disrupted? Mental capacity diminished? Healing time lengthened?

I really get into it: increased blood pressure, heart rate and respiration; development of intractable reactiveness to stimuli such as loud noises; confusion; inappetence; nausea; diarrhea; dizziness; frequent urination; lengthy hospitalization; even the spread of post-surgical cancer.

Who would want that for their beloved pet?

Turn It Around
Just when they decide "Hallelujah, I've finally found a veterinarian who understands," I gently tell them those are not the side effects of the drug I want to prescribe but of the pet's untreated pain or anxiety left to fester.

If the pet has a painful condition, I ask them to think about the last time they had a really bad headache or a sprained ankle. Did they sleep well? Were their thoughts clear, energy levels high, outlook on life positive? Did they get lots of exercise and feel like socializing with friends and family, or was getting out of bed about the pinnacle of their achievement for the day?

How would they like to feel that nagging, constant, debilitating pain all day, every day? How well do they think they'd do fighting off a cold or other infection when in that state?

If the pet is suffering from anxiety, I ask the owner to think about a time when he was anxious about something. Imagine, I suggest, you're about to be audited by the IRS. How would you like to feel that way all the time, every day, without an end in sight?

What do you think the effect of untreated pain or anxiety would be on your body? Is that stress good for your heart? How about disease resistance? Social life? Job performance? Eating habits?

A Different Perspective
Of course, I don't hammer at them. My job isn't to overwhelm them but to change how they see the problem in the first place. I need them to fully explore both sides of the equation instead of just the one with the black box warning (literal or metaphorical).

Some clients are surprised to have the issue of the side effects of non-medication raised to them that way. I like it when I surprise my clients; it gives me a chance to provide an inoculation against Dr. Google and Dr. Facebook by sharing some of what I've learned in my 36-plus years as a veterinarian.

I explain that both pain and stress hep animals (and people) respond appropriately to things that can harm them. A zebra feels anxiety, fear or stress when a lion is in the distance, and the feeling prompts him to run before he turns into dinner. It's the same as when humans feel pain when we touch something hot enough to burn, which gets us to move our hand before our skin is damaged.

Those sensations of pain and anxiety, I tell them, are considered adaptive. That is, they help the animal even while they're causing temporary suffering. The threat goes away, and so does the negative sensation.

But when the pain or anxiety go on too long and become chronic, they start to rewire the whole process. Our pets' mind and nervous systems become primed to feel pain or anxiety easily, and things that wouldn't have bothered them before, like loud noises or a little stiffness on a cold morning, now cause elevated, even intolerable, pain and anxiety.

The sensations have become maladaptive.

Face the Facts
Pets in the grip of maladaptive pain and anxiety have poor quality of life. Their enjoyment of things like walks and new experiences is diminished or even eradicated. Activities that were once mildly stressful, such as going to the veterinarian, become unbearable, which triggers yet another cycle of escalation as it becomes more and more difficult to provide the very medical care that might relieve the symptoms.

And then there's sleep. Just as humans can't function at their best without restful sleep, animals suffer physical harm when pain or anxiety interfere with their ability to conk out for the required amount of time for their species. They're on the edge of wakefulness all the time, kept there by pain and stress they can't do anything about.

But we can do something about it. We can help our clients understand the real equation they have to solve: Are the possible side effects of this course of treatment for their pets worse than the side effects of leaving the condition untreated?

I won't say this works with every client. Some of them are stubborn, and others are immune to logic. But most people are simply worried that their pet will be injured in some way, and they don't understand that anxiety and paint don't just hurt, they harm.

That immobile, terrified cat on your exam table may not be a zebra on the Savannah. That once-frenetic Lab who can barely stagger outside to potty may not be at risk of imminent death. But their minds and central nervous systems don't know that. And as long as there's something we can do about it, we owe it to our patients to try to get our clients to let us."

Click here for the original article.


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