Doctor's Orders: following through with home treatments

Posted by Dr. Nina Mantione on Sep 12 2012

As I lay awake at night worrying about the health of my patients (yes, some veterinarians do this!), I often think about the factor that has the most profound influence on how someone’s pet will respond to therapy. It is not how expensive the treatment is or how cutting-edge (although certainly these things play a role), but rather it is something we call compliance.

Compliance is how well a pet parent follows the veterinarian’s instructions for treating their pet at home. Do you finish the entire course of antibiotics? Do you bathe your pet as often as I recommend (even as you curse me as you wrestle your 80-lb. dog into the tub)? Do you follow those very specific and often inconvenient dietary recommendations I gave you? If you answered yes, then you are compliant, and my favorite type of patient.

My job as your veterinarian is to give you the tools to help improve your pet’s health. Your job is to see that my instructions are carried out. Now before anyone starts feeling like I’m being bossy about this, let me just say that I completely understand how difficult it is to be 100% compliant with any treatment recommendation. Just last week I was a pulling out of my neighborhood when I realized that I had forgotten to give my cat his medication – that I had prescribed for him! (I did turn around and drive back to give it to him, but if I had been any farther away…)

I learned about compliance in my first year out of vet school from a wonderful man that I’ll call Mr. P., an older gentleman who came to see me with his little Cocker Spaniel, Jasmine. Jasmine had horrible skin disease and it had been awhile since she had been seen by a veterinarian. She was itchy and stinky, and most of the fur on her legs and belly was completely gone. She was suffering from allergic dermatitis and had secondary skin infections to complicate matters.

Up until that point I had not had any brilliant success with dogs like Jasmine. I had prescribed all of the correct medications and the (gulp) several-times-weekly baths with medicated shampoos, but I had yet to see one of these dogs respond as I had been taught they should. Sure, most of them improved, but almost none of them looked as good as I wanted them to. Often, my follow-up visits would reveal that medications were half given, or the baths had been discontinued, but I had not yet put two and two together – I hadn’t made the connection about compliance. Until I met Mr. P.

I gave Mr. P the customary armload of medications and shampoos necessary for a dog in Jasmine’s condition, and I had a lengthy discussion about how he was on the front lines of this battle and it was up to him now to make her better. I sent him on his way with a recheck appointment schedule for a month later.

A month later I walked into our scheduled appointment to see Mr. P. positively beaming, and on the exam table sat Jasmine. What had once been crusty, itchy, bald and oozing skin was now smooth and pink with a new growth of soft peach fuzz. She no longer had a yeasty infected smell about her and she looked almost normal. WOW! Mr. P. said, “I did everything you told me to, Doc. I bathed her every two days and gave her the medicine like you said to. You fixed her, Doc!” I looked at Mr. P. – I may have even hugged him if my memory serves me! “No,” I said, “you fixed her! I just gave you the tools you needed.”

From that day on, Jasmine never had horrific skin that she did the first day I saw her. Sure, she had recurrences of her itchiness all the time, but Mr. P. managed them like a pro, and I learned one of the most valuable lessons of my entire career: the lesson about compliance. To this day, I tell that story in my exam room to teach pet parents about the power of compliance and their profound role in the health of their pet.