What would you think if you walked into an exam room and observed a veterinarian throwing darts around the room (Figure 1)?
Wouldn't you look for the target? What if you did not see a target? Would you ask the person where the target is? What would
you think if the person said, "The target is wherever the dart lands."? Would you have confidence in this person's cognitive
process? On the other hand, what would you think if the person identified a clearly defined target with several darts in the
bull's-eye (Figure 2)?
Figure 1: Aimless dart throwing results in frustration. (IIlustrations by Lori Koehler, CVT, Minnesota Urolith Center)
The goals of treatment we provide to our patients are analogous to a dart game. For ethical and moral reasons, we should have
a clearly defined therapeutic target. We should be able to describe exactly what treatment (if any) we are providing and the
rationale for it. Why? Because goal-setting fosters precision, and precision fosters high-quality patient care. Recall the
medical axiom, "No patient should be worse for having seen the doctor." Always keep in mind that there are some patients we
cannot help but there are none we cannot harm.
Figure 2: Targeted dart throwing equals a good outcome.
What are the possible goals of therapy?
Picture your treatment goals as concentric circles on a target (Figure 3), and then take aim where it is most appropriate.
Specific treatment, the bull's-eye of the target, is given to eliminate, destroy or modify the primary cause or causes of a disease process.
Examples include antibiotic therapy for bacterial infections, antidotes to counteract toxins, replacement hormone therapy
and surgical correction of anatomic anomalies.
Figure 3: The goals of treatment.
Supportive treatment consists of therapy that modifies or eliminates abnormalities that occur secondary to one or more primary diseases. Treatment
designed to correct abnormalities in fluid, electrolyte, acid-base, endocrine and nutrient balance caused by primary renal
failure is an example. Successful specific therapy is often dependent on successful supportive therapy.