Human Health Care Providers and Veterinarians Need to Communicate

It is not uncommon for patients to ask me whether an illness in a pet could be related to symptoms they are experiencing. For example, a patient suffering from allergies caused by mold in her house told me about her dog that was being treated by a veterinary allergist. Was it possible that human and dog were dealing with the same problem?
What are physicians or other health care providers supposed to do with such questions and information? Physicians receive no training in veterinary diseases and are not taught how to appropriately respond to these issues. Should a doctor ask more questions about the dog’s illness? Ask to speak to the veterinarian? Is this a useful line of inquiry or mere frivolous waste of time?
Over 60% of U.S. households include at least one pet (Hoff1999), and this proportion is increasing. Often the degree of medical care that the pets are receiving equals or exceeds the medical care happening for humans in the household. There is a basic rule that veterinarians are not allowed to treat human patients (but veterinarians tell me that their clients often ask for medical advice about zoonotic diseases and other conditions). Physicians, for their part, are not supposed to diagnose or treat animals (but tell that to the rural family doctor I met this week who is regularly asked to take care of goats and cows and dogs). At the same time, there are growing similarities between veterinary medicine and human medicine. (Rabinowitz and Conti 2010) Both disciplines use similar blood tests, urine test, and radiological studies to diagnose disease. Both use similar (but not always identical) medications to treat infections, diabetes, and even mental illness. And there can be value in seeing the numerous similarities between medical conditions that manifest in an animal and a human, as physicians such as Barbara Natterson have noted (see her zoobiquity website )
There are a number of specific reasons why physicians and veterinarians need to communicate and collaborate. Contact with pets or other animals can increase the risk of zoonotic (animal to human) disease transmission, especially for children and immunocompromised individuals (Pickering et al 2008, Kaplan et al 2009, NASPHV 2011), and veterinarians can contribute to effective prevention of such transmission. Veterinarians can also work with clients to reduce the risk of animal bites from pets. Beyond the risk of infections and injuries, people may share chronic health problems such as obesity with their companion animals, and be willing to engage in joint preventive behaviors such as exercise programs (Kushner et al 2006). The strength of the human-animal bond may affect psychosocial health, as well as access to medical care (for example; a patient unwilling to leave pets at home to go to the hospital). Drug-seeking patients may request pain medication and other controlled medications from veterinarians on the pretense that it is needed for their pets (LeBourgeois et al 2002).
In addition, illness in an animal may be a “sentinel event” indicating environmental risk for humans (see the Canary database for more information on this). An example would be allergies due to a common allergen in the environment, or a dog that is diagnosed with a tick-borne disease giving warning about risk to humans who walk  in the same suburban areas as the dog.
Despite all of these apparently obvious reasons for communication and collaboration between veterinarians and human health care providers, real life examples appear to be rare. The practice of medicine is increasingly evidence-based (as it should be), and the lack of published studies documenting the benefit of such encounters between professionals makes it hard to change current practice patterns. At the same time, there are also no studies showing a lack of benefit of such teamwork! In other words, these ideas, however obvious and promising, remain virtually untested.
What are needed are good pilot projects and studies to begin documenting proof of concept of collaboration between human and animal health professionals. These studies could test the acceptability and effectiveness of clinical protocols and materials such as templates for referrals between veterinarians and their human health counterparts. As information begins to flow between the disciplines, the evidence will be able to point future practice patterns in the correct direction. I (and many others) will welcome that day.

Hoff GL, Brawley J, Johnson K. Companion animal issues and the physician. South Med J. 1999; 92:651-9.

Kaplan JE, Benson C, Holmes KH, Brooks JT, Pau A, Masur H. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. MMWR Recomm Rep. 2009;58(RR-4):1-207.

Kushner RF, Blatner DJ, Jewell DE, Rudloff K. The PPET Study: people and pets exercising together. Obesity 2006;14:1762-70.

LeBourgeois HW 3rd, Foreman TA, Thompson JW Jr. Novel cases: malingering by animal proxy. J Am Acad Psychiatry Law. 2002;30:520-4.

National Association of State Public Health Veterinarians, Inc. (NASPHV); Centers for Disease Control and Prevention (CDC).Compendium of measures to prevent disease associated with animals in public settings, 2011: MMWR Recomm Rep. 2011 May 6;60(RR-04):1-24.

Pickering LK, Marano N, Bocchini JA, Angulo FJ. Exposure to nontraditional pets at home and to animals in public settings: risks to children. Pediatrics. 2008; 122:876-86.

Rabinowitz PM, Conti LA. Human Animal Medicine: Clinical Approaches to Zoonoses, Toxicants and other Shared Health Risks. Elsevier 2010; 432 pp.


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Abby Leders said...

The Veterinary Record surveyed recent veterinary graduates, and of the 82 of 105 respondents (78 per cent) stated that they had made a mistake; this resulted in a less than optimal or potentially adverse outcomes for a patient.

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