One of our clients recently called and asked for a refill of an NSAID (non-steroidal anti-inflammatory drug). Not an uncommon request, many dogs (and people) are on one of the multitude of NSAIDs on the market for some type of pain or inflammation (usually arthritis). And the dog is a 15yr old Shih Tzu, so I'd fathom a guess that he probably has some arthritis and could benefit from it. Thing is, we've never prescribed anything to Fluff for arthritis . Oh he did get an NSAID from us once, but only a short course of something for post-op pain after a tumor excision....3 years ago. Regardless, the owner hadn't brought Fluff in for a full physical exam since that surgery was performed in 2008. Sure, the occasional "check ears", but nothing comprehensive and certainly nothing related to arthritis.
When I called the owner, I inquired if there was a reason for the sudden need for pain medicine.
"No, just the usual old age stiffness. In fact, just the other day he somehow got wedged behind the couch. He was limping pretty bad afterwards, his arthritis was really acting up from being stuck there for so long."
It's surprising how many acutely painful dogs are self-diagnosed by their owners with arthritis, or better yet hip dysplasia.
I politely explained that, although Fluff is fifteen and I have no doubt he would benefit from an NSAID, he really needed to be examined before we could dispense anything. And besides, we've never actually prescribed anything to him for arthritis before, so I definitely can't "refill" anything.
Wow, you'd think I'd just asked her to solve our current debt crisis. The extreme shock! How could I possibly ask such a long-time client to bring in her dog for something as benign as arthritis medicine?? "Do you know how difficult it is for me to come all the way down there?"
Interestingly, the owner is a family practitioner. But that's not the best part. She admitted on the phone to being completely against routine physical exams, thinks they're a terrible waste of time. She actually dissuades her patients from coming in unless they're sick. I didn't catch all of her reasoning, something about the cost of medical care, unnecessary tests being performed, too much doctors' time being wasted on healthy patients and not sick ones, blah, blah, blah. I guess the idea of preventative medicine is completely lost on her.
In the end I won out, she finally agreed to an appointment. Not because she agreed with me that Fluff needed an exam. Nope. She scheduled something because "finding a new vet was too much work, and they'd require a 'first visit' exam anyway, so why not just go to the place that has all of Fluff's records... what an incredible inconvenience you're causing!!". I think she was upset with me.
Turns out Fluff had a deep laceration on the medial (inside) aspect of one of his thighs that had become badly infected causing a significant amount of painful cellulitis surrounding the area. He wasn't limping from arthritis, he was limping because her owner (a medical doctor who disagrees with routine exams) had completely and utterly failed him. I admittedly expect a little more from my clients that are medical professionals, but this thing was huge. It's a sad and scary thing when a human physician misses something so blazingly obvious. Actually she didn't miss it, she just didn't care enough to look (which is even more sad and scary). I wouldn't allow her to examine my philodendron.
I hated seeing Fluff painful and sick, but it's a great thing knowing that he'll be fine all because you held your ground. Oh, and telling the owner told you so was icing on the cake.