Multiple veterinary sources offer handouts practitioners can share with their clients. Among these are those that provide how-to instructions for clients who desire to do basic procedures, such as injecting certain medications or administering subcutaneous fluids, at home.
When Dr. Bernard first began sharing such handouts with her clients, she considered this a win-win for her, her clients, and her patients.
“I practice in a low-income area where many people live paycheck to paycheck. But my clients do care about their animals and they do try to do the best they can,” she explains. “Providing them with the wherewithal to do simple treatments at home like injecting medications or giving SQ fluids to a cat with renal problems is more than a convenience in some of these cases. It enables those people to provide care for their animals that they wouldn’t be able to afford otherwise.”
Meanwhile her colleague, Dr. Dougherty who practices in a more affluent area, considers these handouts beneficial for a completely different reason.
“There are times when doing routine, repetitive treatments in-house stresses the animal or the client sufficiently that it decreases the efficacy of the treatment. I’ve had several cases where it became stressful enough that clients started missing appointments or tried to convince me their animals no longer needed treatment even though I knew the animals did,” the practitioner comments. “When I gave those clients the option of treating their animals at home themselves, they were thrilled.”
However, Drs. Bernard and Dougherty soon realized that providing this service had a downside as well as an upside one that could create communication dilemmas for them. For example, it quickly became apparent to both practitioners that some clients desiring the service were less competent than others. Although Dr. Bernard’s client, Mr. Erikson, wanted to treat his rambunctious golden retriever at home for financial and convenience reasons, the elderly client lacked the physical ability to restrain the animal properly. Add that the client’s arthritic hands and failing vision made administration of medications of any kind an “iffy” proposition at best, and Dr. Bernard initially found herself in a difficult position.
“I wanted to acknowledge my client’s legitimate concerns and fulfill his wishes. But there was no way I could support his performing a procedure that potentially could put him and his animal at risk,” she explains. “It took me a while to figure out how to tell Mr. Erickson this in a way that wouldn’t jeopardize our clinician-client relationship.”
To accomplish this, Dr. Bernard began by acknowledging the legitimacy of Mr. Erickson’s desire to medicate his dog at home. Then she explained her concerns about her client’s and his animal’s safety. However, she did not end the discussion there. She also provided Mr. Erikson with a viable alternative. She would help him solicit help to restrain the dog from willing and able friends, and have one of her technicians who lives near him stop in to medicate the dog daily for a reasonable fee. In such a way, the veterinarian provided the client with a compromise that addressed his needs as well as those of his animal.
Dr. Doherty’s communication challenge takes the form of what he calls “Give ‘em an inch and they’ll take a mile” clients.
“I fully support clients with terminally ill animals who want to make their animals’ last days as comfortable as possible. And I also accept that there are certain procedures many clients can do at home, such as change bandages or give injectable medical support of one kind or another to treat their animals with chronic problems,” he declares. “But it irks me when those same people expect me to dispense medications for a new or even recurrent problem in an animal I haven’t seen in ages. After one client tried to badger me into dispensing medication for a relative’s animal I’d never even seen, I decided I had to come up with a standard response to avoid saying something to these clients that I’d regret.”
After trying several different approaches, Dr. Doherty decided that the one that worked best for him was the simplest as well as most professional one. He told these people he could not do as they asked because it would be poor veterinary medicine and a disservice to them and their animals to do so.
“I know you think Sherwood is perfectly healthy except for his ears bothering him again, and I certainly hope that’s true” he tells Ms. Rasmussen. “But it’s been more than a year since I’ve seen him. And while it’s possible he has the same kind of infection he did the last time, he might not. If he doesn’t, it’s not just that the wrong medication might not work. It could make his infection worse and much more difficult and costly to treat.”
The third at-home treatment challenge is one practitioners in all areas increasingly may encounter: dispensing certain drugs or apparatus for home use in a household in which the potential for abuse is suspected or known to exist in one of its residents. Unlike clients such as Mr. Erikson and Ms. Rasmussen who fully intend to use any medications and apparatus from the veterinarian to treat an animal, substance abusers want any medication or equipment for their own use. This obviously can create problems for practitioners that have implications for their patients’ well-being.
In general, substance abusers who steal medications or needles prescribed for animals belonging to other family members or housemates are secretive about this. Some may feel embarrassed that their addiction causes them to behave in such a deceitful manner. Additionally, most abusers do not want to compromise what they perceive as a reliable source of medication or useful medical apparatus. But regardless of the abuser’s specific motivation, it may result in liquid medications intended for the animal being surreptitiously removed from vials and replaced with water, or tablets replaced with over-the-counter look-alikes. Sterile needles meant to inject medications or fluids to treat the animal may be taken and replaced with used ones.
When this occurs, practitioners may assume that clients are treating their animals with specific amounts of specific medications and administering these using sterile apparatus when this may not be the case. When their patients do not respond to their prescribed medications as anticipated, Drs. Barnard and Dougherty used to increase the dosage or switch to a different medication. If the animal displayed symptoms related to contamination of any administration apparatus, the veterinarians lost valuable time and sleep trying to determine the source of the problem as well as treating the animal for its negative results. They also felt obligated to replace the contaminated apparatus at no charge. When the same circumstances arose again, they became frustrated and angry.
Based on these unrewarding experiences, the practitioners once again developed a basic communication protocol to accompany their medical ones to ensure their patients safety and well-being. Instead of dispensing more or other controlled drugs and apparatus for home use when problems arise, they immediately hospitalize the animal to determine what is going on. If the animal responds as expected to the prescribed treatment properly administered in their facilities then they knew that, whatever the problem was, it was related to something going on in the home environment.
When they discharge such an animal to the owner’s care, the veterinarians’ remarks avoid blame or speculation in favor of focusing on the animal’s well-being.
“Because Chelsey didn’t respond to the medication when you gave it at home, I want to medicate her here daily or send a skilled technician to medicate her for you at home,” Dr. Bernard tells her client.
If the client protests about the added expense, she also notes that she could dispense a different, but unfortunately less effective nonnarcotic oral medication for home use if the client would prefer this.
“This isn’t a perfect solution, but we can only work with what we know for sure,” Dr. Doherty sums up these difficult situations. “No matter how suspicious we may be about the potential for human drug abuse, all we know is that at-home treatment with that drug or the way of administering it isn’t working in that client’s home and that’s jeopardizing the animal’s health. It’s our responsibility to do the best we can to help the animal within those limits, not to identify and out a substance abuser.”
Fortunately, touchy situations related to at-home controlled drug administration or injected treatments of any kind comprise the minority. But when they do occur, they can take up a disproportionate amount of practitioners’ time unless a standard protocol exists to address them. But although most practitioners routinely master protocols that strictly address the animal’s physical needs, they may assume that the words that will enable them to accomplish the sometimes delicate client communication skill associated with these will magically occur to them. Unfortunately, though, sometimes when they need her the most, the muse of quality client communication lets them down.
Footnotes
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