You may have heard the phrase “defensive medicine” used during the recent health care debate in the United States. Defensive medicine describes the situation where a doctor makes a decision regarding a patient’s care not simply based on what is best for that patient but also taking into consideration a perceived need to cover his or her white-coated backside in case things don’t go well.
Defensive medicine is not limited to the human health care system. Veterinarians often fall into this mindset as well. Consider the following scenario:
A previously healthy, well-taken-care-of, adult dog is brought into the clinic with a relatively mild case of diarrhea. The vet performs a physical exam and nothing remarkable is uncovered. The dog is not dehydrated, his abdomen feels normal, he doesn’t have a fever and he appears to be bright and feeling like himself. The veterinarian will probably want to examine a sample of feces under the microscope to look for parasites or abnormal bacteria. If everything looks good under the microscope, the vet is left with a decision to make.
Option A: The conservative approach
Many dogs with these symptoms have a simple case of gastroenteritis, often because they ate something that they shouldn’t have. Treating them with a bland diet and a medication to help clear up the diarrhea is a perfectly reasonable approach, even though a definitive diagnosis has not been reached.
Option B: The CYA approach
Granted, gastroenteritis is a strong possibility, but a long list of other diseases, some of which can be very serious, cannot be ruled out without more diagnostic testing. Blood work, a urinalysis, abdominal x-rays and other laboratory tests should be run to gather as much information as possible from the outset.
Frankly, both options have their pros and cons and neither is ultimately right or wrong. The secret to navigating these types of situations is COMMUNICATION.
In a perfect world, veterinarians in these types of situations should describe all the options available to owners, including their risks, benefits and costs, and the owners can then make educated decisions as to what the right choices are for them under their own unique circumstances. This is exactly what many veterinarians do, but alas we do not live in a perfect world. Some vets get into the habit of routinely offering only “Option B.” Should something go wrong, which is a possibility no matter which option you go with, it is always easier to defend oneself by saying “I did everything I could think of” than “in my judgment, more testing was not necessary.”
So, if you are in a situation where you think that your vet is only giving you “Option B,” speak up. Most doctors are perfectly willing to approach a problem in a different way as long as it doesn’t compromise your dog’s comfort and chances of recovering. The trade-off is that you, your dog’s guardian, have to take responsibility for the decisions that you make. If you choose “Option A” and your dog’s condition doesn’t improve, it is time to go back to the vet and move on to “Option B.”
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Jennifer Coates, DVM graduated with honors from the Virginia-Maryland Regional College of Veterinary Medicine in 1999. In the years since, she has practiced veterinary medicine in Virginia, Wyoming, and Colorado. She is the author of several books about veterinary medicine and animal care, including the Dictionary of Veterinary Terms: Vet-speak Deciphered for the Non-veterinarian. Jennifer also writes short stories that focus on the strength and importance of the human-animal bond and freelance articles relating to a variety of animal care and veterinary topics. Dr. Coates lives in Fort Collins, Colorado with her husband, daughter, and pets.
