Don’t Just Do Something, Stand There!

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In the world of human medicine it’s estimated that 80% of the maladies that prompt physician visits would completely resolve on their own with simple “benign neglect.”  In other words, time is all that is needed for a cure.  Does this mean that 80% of people are jumping the gun by scheduling a doctor visit?  Not at all, because the physician is the one trained to discriminate which 20 percent or so need more than “watchful waiting.”

I suspect that the percentages mentioned above may be comparable in the world of veterinary medicine.  Nonetheless, many vets are intent on prescribing, and many of their clients are intent on receiving unnecessary medication for situations in which watchful waiting would suffice.  There seems to be a desire to give an injection and/or send home some pills, perhaps to placate the prevailing perception that clients who leave empty-handed will feel under-served.

A classic example of this “gotta do something” philosophy is the dog or cat presented for a couple days’ worth of diarrhea.  The patient is completely normal otherwise, and a stool sample check is negative for parasites.  In this situation it would be absolutely appropriate to recommend a bland diet, some watchful waiting, and a follow-up phone call or email with a progress report in two to three days.  Instead, the client is often sent home with instruction to treat the diarrhea with prescribed medication(s), more often than not, an antibiotic.  Please know that cases of canine or feline diarrhea caused by bacterial infection (salmonella, campylobacter, clostridium) are rare at best!

Guess what the number one side effect of most antibiotics happens to be? Diarrhea! (Can you sense that I am cringing as I type this?)  Antibiotics are capable of disrupting normal bacterial populations within the intestinal tract which can then turn a simple case of self-resolving diarrhea into an ongoing nightmare.  Antibiotics are not unique.  Each and every drug a veterinarian can prescribe has the potential to cause adverse side effects.  Giving medication when watchful waiting is all that is necessary defies logic as well as the important, universal, medical mantra that states, “First do no harm.”

If my clients absolutely, positively can’t stand the thought of doing nothing, I keep them busy doing something that has zero potential to negatively impact my patient.  In the case of diarrhea, this can include preparing a homemade diet, keeping a written log of bowel movements, walking the dog six times daily to observe stool samples, or disinfecting the litter box twice daily.  Heck, I’ve even had clients who measure and weigh their pet’s bowel movements – their idea, not mine!

This blog post is my way of encouraging you to be okay with watchful waiting (aka, benign neglect) when this is what the situation calls for.  Understand the logic behind any medication your veterinarian prescribes, and avoid pressuring your vet to prescribe “something” for the sake of helping you feel more secure and comfortable.  Time is a wonderful cure-all for many maladies.

Have you or your pet ever had a medical issue that benefited from watchful waiting?

If you would like to respond publicly, please visit http://www.speakingforspot.com/blog/?p=4380.

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award

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