Owner Compliance: Whose Problem Is It?
By Myrna Milani, BS, DVM
(originally published in Veterinary Forum: May, 2001)
Whenever an animal fails to respond to a treatment we believe will resolve its problem, blaming the failure on a lack of owner compliance seems like the most logical explanation. On the other hand, when you ask owners why their pets didn't recover from a particular problem, they'll often blame the veterinarian, or rather the treatment the veterinarian prescribed. This naturally upsets the veterinarian if that person believes he or she chose the best treatment for the animal's problem based on the latest scientific knowledge.
This particular breakdown in client-practitioner communication occurs because we and our clients often don't share the same view of the situation from the beginning. Our training programs us to diagnose and treat problems whereas owners typically see their animals as complete individuals as well as intimate parts of their lives. When the pet falls ill, it can upset the entire family; an illness in a prized cow can represent a farmer's economic hopes for the future. Because of this, it comes as no surprise that their and our definitions of what comprises the "right" treatment might differ, too.
As old adage about nutrition states that nothing's nutritional if the animal won't eat it. Similarly, even the most scientifically sound treatment won't work if the animal's behavior, its relationship with the owner, or the owner's lifestyle negate the animal getting that treatment as directed. When Dr. Corel dispenses eye drops for the squeamish Ms. Thumbs to put into her squirmy, aptly named Mr. Claw's feline eyes three times a day, you don't need to win a Nobel Prize in Veterinary Medicine to realize that compliance might pose a problem.
Or consider Mr. Basso's reaction when Dr. Corel dispenses an expensive psychotropic drug and a sheet of instructions for the necessary concurrent behavioral modification program for Ms. Basso's destructive poodle: "You gotta be kidding! All that for a dog?" Regardless now determined Mr. Basso's wife might feel about following Dr. Corel's recommendations to the letter, if her pet's health hinges on a consistent response from all those in the household, only the most naive practitioner would count on Mr. Basso to deliver the same. In addition to all the negative effects we see from the inconsistent treatment of behavioral problems, we see all those associated with antibiotic resistance when medical problems fall prey to this same owner orientation.
However, sometimes animals belonging to even the most devoted owners succumb to all the negative effects of inconsistent treatment because owner lifestyle negates consistency. For many working owners, giving any treatment every eight hours simply won't happen except maybe on weekends. Monday through Friday, Suzie Barlett and her two kids depart at 7:00 a.m. and don't return until 5:30 p.m, so Fritter gets one pill before they leave and one when they get home. By the time Suzie prepares dinner, get the kids to bed, the laundry done, and school lunches packed for the next day, it's 9:30 and she dozes off in her chair. Sometimes she remembers to give Fritter that third pill, but sometimes she forgets.
As a result of this owner's hardly unique lifestyle, her pet rarely gets his medication every eight hours and may only get it twice a day. If Fritter's problem resolves, it seems unlikely the treatment can claim the credit. If his condition worsens, putting the animal on the same treatment for a longer period won't solve the problem. On the other hand, this approach could lead Fritter to become resistant to that particular medication. Granted, treatments that only require twice or once daily administration fare better, but variations in owner lifestyle can sabotage even these.
To ensure owner compliance, we need to acknowledge that any successful treatment addresses the four distinct parts or every veterinary problem:
- The animal's physiological needs.
- The animal's behavior.
- The relationship between any care-givers and the animal.
- The care-giver's lifestyle.
"Yeah, right," snorts Dr. Corel. "As if I don't have enough to worry about already!"
Admittedly, because an awareness of the role these factors play doesn't constitute a routine part of veterinary education, gaining this may seem like just one more worry to add to the growing list of scientific and technological concerns demanding our attention. On the other hand, all the knowledge and expertise developed to formulate the best possible treatment may come to nothing if we don't take these other considerations into account. Even more troubling, our failure to do so may actually undermine the animal's health, its behavior, and its relationship with its owner rather than enhance these.
One simple way to address these issues involves asking clients the question, "Does this seem like something you (and your family) can do?" after describing the proposed treatment. This provides the client with the opportunity to mention that they're not quite sure how to pill a cat, or that they fear Skipper might bite, or that they work out of town 2 days a week and a neighbor's child looks after the animal those days. At that point, the creative clinician might either opt for a different treatment or suggest daycare during which a veterinary technician treats the animal. Whatever the choice, the veterinarian's concern puts the owner firmly in the treatment loop and helps ensure their commitment to the process.
We count on our clients, not only to pay the bills but also to implement our recommendations in a timely and consistent manner that will guarantee the health and well-being of their animals. Without their full cooperation in the process, prescribing any treatment becomes little more than a gamble. However, once we become sensitive to the animal's behavior, how the animal relates to the owners, and the relevant peculiarities of the owner's lifestyle that might affect the selection and implementation of any treatment, treatment becomes an art as well as a science. Granted, gaining this insight might require more effort initially. On the other hand, the benefits it pays in client compliance and animal well-being make it more than worth the effort.