This week: Dispensing drugs isn't as easy as it looks
Inevitably there are times where even the healthiest among us will need to take some sort of medication to remedy ailments.
As a veterinarian there is always a rational reason behind the choice of drugs we dispense to patients. The factors involved are surprisingly complicated. The core of the decision is of course primarily to affect the specific treatment of a disease, but it often isn't as clear-cut a decision as that.
For example: to treat an animal for an upper respiratory infection or more simply the flu, I am faced with myriad choices of drugs and without due consideration I can end up dispensing a massive cocktail of medication. The aim of treating the flu is to minimise the symptoms that make the animal feel ill, such as a runny nose or cough or a high temperature, to minimise the chances of getting a secondary bacterial infection.
The initial primary infection is often caused by some incurable virus or a combination of viruses. Another angle for treatment is to increase the animal's immunity by augmenting its body's natural defences.
Aside from these direct factors affecting the disease there is also the matter of professional ethics. I shouldn't be using a new generation broad-spectrum antibiotic for something as simple as a simple flu - these drugs should be reserved for specific, difficult cases that are resistant to simpler more primitive antibiotics.
By doing so, I am minimising the chances of antibiotic resistance and at the same time minimising the client's expense as new drugs usually cost more. But, as usual, the situation is not as simple. We doctors are faced with the conundrum of client satisfaction and medical ethics. There is a hidden pressure to use the new broad-spectrum drug because it is more likely to work the first time.
Because the animal was healed using the first treatment, the client thinks you are wonderful and is more likely to visit you again. As you can see, it is a major conflict of interest.
In training new veterinarians, I induct them to better medicine by promoting better client communication. In the example above I would use a basic antibiotic that is likely to minimise the chances of a secondary bacterial infection and inform the client that if it fails, bacterial culture and a resultant change in antibiotics may be necessary. Sure, I risk an unhappy client that didn't get the quick fix they wanted but I have used antibiotics in an ethical and responsible manner. I urge you the reader to be patient with your doctor.
My advice here is to ask your doctor or veterinarian what the diagnostic plan is if a diagnosis wasn't already presented to you, and then a treatment and prevention plan which includes what happens if things don't work out the way it was planned.
Most clients don't have a problem with drugs that minimise the symptoms, such as the antihistamine that will help dry up that runny nose and minimise coughing, or the anti-inflammatory drug that will bring down that temperature, so we medical practitioners rarely have difficulties making these decisions.
What about the drugs that augment the immune system? Does your dog really need the extra cost of that vitamin B or C or something as exotic as acupuncture? It has been proven time and again that these vitamins are essential for a healthy immune system but that doesn't mean that they are so lacking that supplementation is necessary. But these supplements are sure not to do any harm either. For this decision the answer is simply: it's optional.
The extra cost is not monumental but these drugs are not essential either. So I present them to the client as such and most clients take them anyway to optimise their chances.
As a veterinarian there are unique factors that influence my decision for dispensing some drugs over others. The form of the drug is important; it is much easier to give a tablet then it is to give a capsule. Some owners find liquid medication easier. Some drugs can be applied to the fur so the cat licks it off! Some drugs need to be given several times a day and these may not suit busy clients who cannot be at home most of the day.
The taste of the drugs is also an issue; it is impossible to explain to the cat that the bitter medicine is good for them. Client safety is also a factor. Sometimes it is just impossible to treat fractious animals that will injure you if you try, so you need alternatives.
So next time you visit the vet or doctor, ask them about the decision-making process that went into the selection of drugs. You will be wonderfully surprise how much thought went in to it.