Here is some good advice about overdiagnosis and overtreatment–with a beat!! 🙂
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Perhaps someday we’ll be seeing these as public service announcements rather than the numerous new drug commercials! (not that I’m against new research and new effective drugs, but like needing more cowbell, more public service announcements wouldn’t be a bad thing) 🙂
I’m a little worried that dogs and cats that don’t get the “annual exam” will not get care at all until it is too late. How do we hit that balance?
I don’t have a simple answer to that concern. The same thing was said about annual vaccination, and giving that up doesn’t seem to have impacted most practices financially or reduced visits. And in human medicine, it seems likely that regular visits and physical exams don’t contribute much to long-term health outcomes. But of course people can report symptoms, often at an earlier stage of disease than physical exam findings will be detectable, whereas our patients can’t, so annual checkups might be more useful to our patients.
Unfortunately, since we do almost nothing to track health outcomes in our patients, within practices or as a profession, there isn’t much empirical data to say whether dogs and cats that have annual exams have health benefits compared to those that do not. This leaves everybody acting mostly on their personal intuition about the issue, or on fear of revenue loss.
The AVMA puts out statistics suggesting that a lot of pet owners don’t seek regular care now, including well exams. I’m not sure how we could change that, but I do think we have to be honest with the public about the evidence, or lack of evidence, about whether doing so really makes a difference in their pets’ health. I think the AVMA push for more well care lacks a sound basis in evidence, and it is hard not to see it as driven as much by concern over revenue as over pet health. I think it puts the profession at risk of losing public trust if these kinds of initiatives come across as being about protecting our income. I think we would do better in the long run, for the profession and for the public, if we put more effort into studying which preventative healthcare interventions really have a significant impact on long-term health and which don’t so that we can aggressively promote those that we have good evidence really work. It may be that annual exams really do reduce morbidity and mortality, but it is our responsibility to demonstrate that before we advocate for it.
I personally think annual visits probably are a good idea because, even though I often do not detect treatable disease, my clients frequently have concerns or questions or misconceptions about some aspect of their pets’ health, and the visit provides me with an opportunity for education. I think this has value for my clients and patients. However, I can’t say that I have any empirical evidence to support my intuition that annual exams are a good idea, so when I recommend annual visits I have to disclose that it is merely my opinion, not an established empirical fact, that they are worthwhile. As long as we do that, I don’t think it is wrong to recommend them.
The second phase of the Bayer study (below) found a major divide between pet owners and veterinarians when it came to ensuring pets remain healthy. Nearly all veterinarians “believe” that pets require at least one veterinary well-visit annually, but two-thirds of them also believe pet owners don’t value these exams.
As a client I tend to use my pets’ annual checkups to point out or ask about little issues that don’t seem worth a dedicated vet visit; also to follow up on previously treated or chronic conditions, to get my vet’s opinion on weight, to check any lumps, or get general advice (e.g. tips on weight loss or something like that). It’s usually not a great time to cover these kinds of topics during a “problem” visit. Or my pet may be generally healthy and not have a problem visit during which I could bring up these other things. This year I’m mainly taking my dog in because he really needs a dental and I know my vet requires an exam & pre-anesthetic bloodwork first.
I guess from the comments here it will be a few more years before there is a video of dogs up on their back legs dancing to anti annual check up music that I can show clients.
In my opinion and experience, blood tests and annual visits are a complete waste of time. Go when your dog has symptoms or they need to get vaccinated. Both my dogs had normal blood tests just one month before being diagnosed with cancer. One of them stopped eating and was vomiting constantly yet his blood test came back fine. He then had another blood test 3 weeks later indicating serious problems. He died days later. My other dog probably won’t make it through the weekend. He had a perfect blood test at the end of September before dental surgery. The surgery was mid-October. Two weeks later, his appetite decreased and he had blood in his feces. Repeat blood test indicated high WBC and anemia. He got an ultrasound that indicated tumors on his spleen and liver. Another lesson – don’t get dental surgery for an old dog. I did because he had bone loss. I thought his decrease in appetite was from tooth issues. Now I know it was more likely the cancer. The surgery just put him though hell for nothing (and cost me $1,600) because he is now dying. I was really hesitant on the dental because of his age but didn’t suspect cancer. Maybe for an older dog, an ultrasound or x-ray and blood tests are a good idea before surgery. Otherwise, forget it. If I could have back all the money I wasted on stupid tests, acupuncture, and chiropractic, I could take a nice vacation. Never again.
>>>> annual visits are a complete waste of time.
Here is a video of a dancing dog that is happy he did not need to go in for “annuals”