Is your treatment on target?

Is your treatment on target?

Make sure you're taking aim before you implement therapeutic measures
Nov 01, 2010

Figure 1: Aimless dart throwing results in frustration. (IIlustrations by Lori Koehler, CVT, Minnesota Urolith Center)
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 2: Targeted dart throwing equals a good outcome.
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.

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.

Figure 3: The goals of treatment.
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.

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.