Compliance with preventive veterinary care is down, and it's time for veterinarians and their teams to renew their commitment to advocating for the health and well-being of animals in their care.
Perhaps the best place to start is by taking a trip down memory lane to revisit the reasons you became a veterinary practitioner. Surveys conducted at a national symposium in 2011 and 2012 confirmed that veterinarians enter the profession for a variety of reasons. But principally, we do it for love of animals and the reward of supporting the relationship between animals and people.
Maybe it's also time to reexamine what it means to be an advocate in the true sense of the word: one who supports or promotes the interests of another; one who defends a cause. If the Veterinarian's Oath states that a veterinarian's responsibility toward animals is to protect health and prevent suffering, then by definition being a veterinarian means being an advocate for patients in your care. The team members who work in your practice must be committed to the same core principle.
Preventive healthcare has been shown to be far preferable to interventional treatment. It reduces the likelihood of disease and is far less costly in terms of time, inconvenience and money to the pet owner. All major pet healthcare guidelines stress the importance of preventive measures, yet, like human healthcare, veterinary medicine has become more focused on disease treatment than prevention. The result is that millions of pets are exposed to preventable diseases. This clearly indicates that the veterinarian's role as advocate isn't what it used to be, nor what it originally aspired to be.
The concept of core and noncore vaccines was introduced in veterinary medicine some 20 years ago. Core vaccines are those that have been deemed necessary for all dogs and cats. Unfortunately, the role of noncore vaccines has been less clear, and as a result they've come to be seen as optional and less important rather than "situationally" core.
What's more, most veterinarians are now opting to administer core vaccines on a triennial basis. Consequently, they've gotten out of the habit of advocating for annual noncore vaccines. Because noncore vaccines are now less familiar to pet owners, client education on the part of the veterinarian is that much more critical to remove the stigma of their being optional and unnecessary.
Perhaps veterinarians themselves have begun to see noncore vaccines as less important to preventing disease. However, annual risk assessments show that many if not all pets are at significant risk of exposure to the diseases these noncore vaccines protect against. In fact, the risk is often greater than that of being infected by so-called core diseases. Just think of feline retrovirus in cats or, in dogs, leptospirosis, respiratory disease and Lyme disease. The goal is to stop thinking of noncore vaccines as optional and develop protocols that recognize their specific role in achieving the goals of veterinarians and pet owners alike—namely, the health and well-being of pets.
It's impossible to even estimate how much animal suffering and zoonotic disease have been prevented since the introduction of effective broad-spectrum parasite control products. Without a doubt, year-round parasite prevention and control have done much to improve the state of pet and human health. These products are safe, effective and affordable.
Why then do internal and external parasites and the diseases they transmit continue to expand in spite of safe and effective prevention measures? If anything, the ranges and distributions of parasites have increased. The range of many ticks has expanded greatly, the prevalence of internal parasites is still high, and heartworm infection has gone from a regional disease to being reported in all states.
Why? Because, quite simply, these preventive medications are inconsistently or inappropriately prescribed and administered. These products need to be recognized and recommended as a first line of defense against parasite diseases that are frequently asymptomatic and yet have serious ramifications for both pets and people. Merely mentioning or even recommending a measure is simply not enough. Veterinarians must strongly advocate for parasite control and prevention, stressing the benefits of administration but also the potential ramifications of non-use.
If nothing else, veterinarians need to recognize the moral and potential legal ramifications of a lack of preventive care advocacy. When a cat gets heartworm disease and the client sends a complaint to the medical board stating that her veterinarian didn't recommend heartworm preventive or educate her on the risks of heartworm disease in cats, it's the practitioner's responsibility to show not only that the conversation did occur, but it took place annually. This requires more than a check box on a template—it includes thorough documentation of the conversation and the use of "declined" codes in the practice management software. Other protective processes include having clients sign waivers if they opt to decline certain vaccinations and parasite testing.
What happens to those reminders for preventive testing, vaccines and medications that a client either chooses not to pursue or the veterinarian decides not to recommend or administer? If they remain in "red" as overdue year after year, the client no longer receives reminders for these services from the practice on an annual basis. That often means the veterinarian doesn't have the opportunity to conduct a risk assessment every year. Updating reminders, regardless of whether a preventive care service or product has been previously pursued, is an important responsibility when acting as an advocate for the patients in your care.
When an industry issue goes "global," those who serve that industry respond and help implement a fix. Improving client communication skills by utilizing free tools such as those provided by the Partners for Healthy Pets initiative (see partnersforhealthypets.org) can take you from "powering through" preventive education to enjoying the conversation with clients.
Preventive care vaccine and prescription drug manufacturers and distributors are also taking huge steps to help practices. It's no longer just about product advertising and special promotions but about educating and assisting practices. Many companies offer programs that help practices track and improve compliance, train their support teams and educate clients more effectively.
We need to stop placing blame for poor compliance on our clients and take responsibility for our level of advocacy. In many cases, the weak link in the chain of preventive health isn't the pet owner but the pet healthcare provider who, for a number of reasons, fails to accept his role as an advocate. Take a minute and rate yourself on a scale of one to 10 with one being the worst and 10 being the best advocate for the health and longevity of your patients.
Now, make a firm commitment to upping your game by getting back to the reasons you became a veterinarian in the first place—reconnecting with your role as a trusted advisor and advocate. By reigniting this passion you'll experience the ultimate professional satisfaction by watching both your patients and practice thrive.
Dr. Michael Paul, @mikepauldvm on Twitter, is a nationally known speaker and columnist and the principal of Magpie Veterinary Consulting. He lives in Anguilla in the British West Indies. Jessica Goodman Lee is a practice management consultant with Brakke Consulting based in Dallas.