This week: the phobias surrounding medication Medication is probably the most important tool in the treatment of illnesses. Without them there is surprisingly little a medical practitioner can do. I am often asked if I do house calls and in most situations my initial response is to get the client to bring the animal to the clinic instead, as my arsenal of medication is too large to bring with me on a house call. Murphy's Law applies to us vets as well and the drug I need to use is the drug I didn't bring on the house call. Without all the modern pharmaceuticals on hand, all I could do in the treatment of many diseases would be primitive indeed. But there is an alarming increase in what is call medication phobia. During consultation it is difficult enough to arrive at a diagnosis and then respond by using an effective treatment. It is downright frustrating if I have to battle a client's unwillingness to use the medication as well. It happens quite often. I understand that there is a general wish of most clients to minimise medication as it can be costly and some drugs are not absolutely necessary. In some cases the client is very forthright and directly asks if it is OK not to take medication. As there is always a rational reason why a particular drug is prescribed, I am more than willing to explain the need and if any of the medication is optional. The client is an important part of the decision-making process and if they want conservative therapy then it is my job to explain the benefits and risks involved so they can make an informed decision. There are some clients who don't even ask why a drug is prescribed and simply refuse the drug at the reception desk and leave. To these clients my advice is to communicate more closely with the vet or doctor so a treatment regime can be suited to your idea of treatment next time. The third kind of client are those that refuse all drugs; they are extremely resistant to any medication and have an irrational fear of drugs. For veterinarians, the most common reason is the client is afraid of the potential side effects of the medication. Sometimes it's an extension of the client's own fear and that is what I am most worried about. I am often left wondering if the client is so afraid of medication, even for their pets, what about when they have to take medication themselves or members of their family? This fear is a type of anxiety and if it extends beyond the treatment of their pets then it certainly should be confronted. It is quite reasonable for people to be afraid of the side effect of medication. In fact, many clients ask what the side effects of a prescribed drug are before even asking what the drug is for. I like to think of medication as a balance of risks and benefits. Most people are able to see obvious risks, such as the risk of side effects, but are blind to the risk of not of taking the prescribed medication. As a trained professional I am able to predict the course of any illness and hence assess the risks of not treating such illnesses. So to help limit such anxieties I suggest clients ask more questions of their medical practitioners to fully understand their decision-making process. If your doctor or vet is insensitive to complaints about drug side effects then I suggest it is time to talk with your feet and change doctors. Once we have eliminated the unknown it should help alleviate irrational fears. I am not surprised at the increase in medication phobia; people in Hong Kong are constantly bombarded with misinformed advertising about 'natural' therapies and how 'unnatural' the conventional therapies are. There seems to be a constant search for market niches for alternative therapies as the conventional therapy market saturates. The problem is compounded with the ease with which bias and unfiltered information can be accessed, especially through the internet. I am not saying that finding out more information about what you are taking is bad, but it is hard to be objective and filter out marketing trash from what is real information. Remember that different people have different experiences with any one medication and what applies to others may not necessarily apply to you. And that is why medical professionals exist - we are trained as scientists to filter out the marketing and distil the facts. Communication is key to a better collaboration. If you find that going through all the risk management with your medical practitioner doesn't help with your anxieties, it may be prudent to seek a therapist that is not anti-medication and start on some cognitive-behavioural therapy.