The internet

More than just a series of tubes, the internet is a wealth of information on any subject you could possibly imagine and a few you couldn't. Unfortunately, the information available on the internet varies from being extremely beneficial to being downright harmful to the user. This is not going to be an attempt to discourage you from looking to the internet to answer your questions about your pet's health. I encourage you to look things up for yourself and educate yourself as much as possible about everything we could possibly talk about in an exam room when discussing your pet's health. I love the enthusiasm that people show when looking into what they should be feeding their dog or cat, or which vaccines they may or may not need or the best way to manage a diabetic cat. It's only when someone comes to me with misleading information that goes against the available evidence we have that I start to worry that all of that enthusiasm and time have been wasted.

My goal in writing this is to give you some advice on the best way to be sure that you are receiving valuable information from the internet. I am going to break it down into three basic categories and then have some other ideas at the end. I'll even throw in a few recommendations for good sources of information.

The most important part of any good internet search is to consider the source. While bias may or may not have an effect on the information being presented it definitely affects the presentation of the information. This blog is a wonderful example of that. I am a human being and have my own biases and perspectives, the information I present here by itself is objective and well founded on evidence but I present it through the mind of a veterinarian who puts a lot of emphasis on science, reason and logic. I would not recommend that you cite any one of my blogs in a research paper on any subject but one of my blogs might very well make a good starting point. The same is true of any other piece of information on the internet. While all information should be viewed with a healthy dose of skepticism, there are three basic tenants to look for when looking for bias. Anyone trying to sell you something is either financially tied to the information, emotionally tied or both. This will skew objectivity. Someone presenting a very strong ideologically position on a subject is emotionally tied to their subject and it is extremely hard to be objective when explaining your core beliefs. Anyone who argues that their information must be correct because an expert, doctor, scientist or astronaut told them so is also suspect for bias. We are trained to trust authority but authority by itself is not expertise and expertise in a particular subject does not give you pull over any other subject. No matter how much internet reading I do, I will never be an astronomer, meteorologist or auto-mechanic. Doesn't work like that. Looking for these sources of bias when examining a source is a good start. It isn't fool proof but that's where our skepticism about everything protects us.

Anyone providing scientific information has to also provide scientific references. I am providing opinion, my work is not meant to replace proper scientific inquiry, it is meant to pique you curiosity and get you looking for information. If you like I can typically within a few minutes find you a decent scientific reference for any piece of information I have shared with you. I can also provide references who will assert that this is the truth! Scientific references come from scientific journals. Magazines, newspapers, books and blogs do not count as they are not peer reviewed. The peer review process, while not perfect, is the best way to remove bias from the presentation of information. The reason it works so well is multi-factorial. First it is an anonymous practice, neither the submitter of a proposed scientific journal nor the initial reviewers know who each other are. Maybe they could figure it out as these tend to be small fields and people know what they are working on but by and large it is anonymous. Further more, these people all compete for the same grant money every year, that's how research is funded. No one receives any money for publishing a scientific article, not a single dollar, but you are more likely to receive funding for your next project if your current project reults in multiple publications. All of the people reading your submission are probably going to be applying for the exact same grants as you. They are going to try to find flaws in your work, if they do it will come back to you with notes and you must revise your work. If they fail to find flaws in your work, you win. It is a contest and that is why they call it the "arena of ideas." So you are looking for actual science when looking for scientific evidence to support a claim or someone's ideas.

Finally you have to look at the writer. The writer of a page giving medical advice about pets, technical advice on repairing automobiles or ballistics support for your sub-orbital space craft should have the appropriate training to do so. I personally always become skeptical when an author lists themselves as Dr. So and So. The exception to that of course being Dr. Suess. I would list myself as Heath McNutt DVM, if I listed myself as Dr. Heath McNutt I could certainly get away with giving out human medical advice or even physics lessons until someone with a little more knowledge than me realized I had no idea what I was talking about. By then, I might very well have a loyal following who don't care if I am discredited and still find meaning in my fraudulent works. I would feel good about myself "making a difference" in people's lives and they would feel like they were a part of something special and outside the mainstream. Except it would all be predicated on a lie. That is how quackery happens. So anyone writing to you from a grounded area of expertise should have no problem listing their educational background, beyond just DVM or PhD or any other degree. They should list the school they attended, the approximate time they were there and the degree conferred on them when they left. If they have advanced training they will typically list that as well. You want to look for training information when evaluating an author.

It is extremely important that you remember that when it comes to veterinary medicine, you do not have access to the same information that I do. For one, I belong to groups that give me access to literally hundreds if not thousands of other veterinarians many of whom are leaders in their specific fields. I have social circles that include veterinarians and allows me to use not only all the brains I have but all of the brains I have access to when researching a question. (Winston Churchill quote was not accidental) I also have the unique training of being a veterinarian, I know what I'm looking for before I am looking for it. For example, I am not going to search about why a dog's ear is swollen, hot to the touch and fluid filled. I will look for the most current treatment methods for dealing with aural hematomas. The difference in the quality of information between those two searches would be remarkable. I suppose that is a nicer way of saying, all of the internet research in the world won't make you a veterinarian anymore than it makes me and my wife pediatricians.

And now the good stuff. There are websites with information that I find more valuable and useful than others. When it comes to pet medical information Veterinary Partner is a wealth of information. The site is a little difficult to navigate but the search function works fairly well. Free Medical Journals is a site that gives you free access to several medical journals, it too is a little difficult to get used to but has a reasonable search function. My favorite site for finding new papers and information is the United States National Library of Medicine and the National Institutes of Health website PubMed.

Enjoy the web, be safe out there and please share what you find! You truly own the knowledge you seek out for yourself.

 

Pet Restraint

One of the toughest things I encounter on a daily basis is the realization of how much a lot of my patients really don't like me. In fact I often tell people looking to become veterinarians that if their major motivator is a love for animals, they should think about owning a boarding facility or being zookeepers. I say that because more often than not the animals we are dealing with want nothing to do with us in the exam room. Even my own cat will hiss and get his fur on end in one of our exam rooms and at home he's an absolute love.

Pet aren't in my office, however, for me to pet and love on them. They're there because I have a very specialized set of skills. A set of skills that allow me in less than half an hour to use my ears, hands, eyes and often nose to tell you whether or not your pet is healthy. Unfortunately, even for the most skilled veterinarian the examination part of that half hour requires the patient to be restrained. Restraint is often the most difficult part of the visit for pet owners to deal with. Many times they will try to comfort their pet during restraint or some owners will even try to do the restraining themselves. Over the next four short paragraphs I will try to explain why restraint is important and why you should step back and let us do what we're trained to do.

It's dangerous for you. Hospital and court documents are full of stories of well intentioned owners whose pet's would have never bit them otherwise who were injured while trying to comfort or restrain their pets and subsequently had to sue their veterinarian. Notice I said had to sue their vet. A single cat bite in an otherwise healthy person can lead to an infection that requires a hospital stay and intravenous antibiotics. it's not unusual for treatment like this to cost tens of thousands of dollars. If you have insurance, they will sue me. If you don't, you will have to sue me just to cover your medical bills. I understand that and wouldn't blame you but if I can prevent it simply by not having you hold your pet or touch it while it is being restrained, I will. the last thing I want is for you to get hurt and possibly seriously ill from something I could have prevented by being a little more assertive.

It's dangerous for your pet. You know your dog or cat better than anyone. I never forget that, in fact it's why I ask you to bring them in every year and not have someone else do it for you. To me, you are the most important source of information about how your pet is doing. What you might not know about your pet is how they are going to respond when I inject them with a vaccine or apply gentle pressure to that really painful loop of intestine I found on physical exam. I have seen owners "have to" hold their cats by one leg as they tried to jump off the exam table, needless to say that is not good for the cat and possibly not very good for the owner either. Th bottom line there is, you aren't trained in animal restraint, my staff is. Allowing them to do their jobs makes the exam go faster and allows it to be more thorough. Fortunately, I have never seen an injury to a pet during an exam but much like the paragraph above, if my telling you that I can't allow you to restrain your pet during my physical exam is what it takes to prevent an injury, that's what I'm going to do.

It's dangerous for me. I make a living with my hands. I need them to do my job. The number one place I'm going to be bitten by a pet is on the hand. If I get a bad enough bite or an infection from a bite that costs me the use of one of my hands, my career is over. You might know your pet inside and out but you don't know what I'm going to do next. My staff does. On any given day we will examine between fifteen and thirty pets together. Sometimes we are examining pets together in the early hours of the morning when no one is quite awake. For safety and to offer your pet the best care we have to get it right every time. To do that, we practice together. We don't practice until we get it right, we practice until we can't get it wrong. If I'm having someone I haven't worked and practiced with hold a pet during an exam, there are things that aren't are going to happen. The most important is that the pet is not going to get as thorough an exam as it deserves and there are certain things that I will not even attempt such as a full ocular exam, a complete oral exam and I may not look as thoroughly at the ears. I will probably not be doing a rectal exam and in some cases will have to even skip the temperature. That's not great medicine. Oddly enough, we don't have a charge built in for an exam limited by having the owner hold the pet. You're still going to pay for the full exam I would have performed if my staff was holding your pet. You just won't get that exam.

Finally, it is below the standard of care for a veterinarian to have you restrain your pet during a physical exam. In Setting the Bar Higher I talked about how there are not many actual defined standards fo care in veterinary medicine. This is actually one fairly universally defined standard. If something happens in an exam room and a pet or owner is injured while the owner is restraining the pet, that is my fault because allowing an owner to restrain the pet for examination or treatment is below the standard of care. I try to never practice below the standard of care, that is a commitment I have made to myself and to your pet and you. Often that is difficult and the standard of care is open to interpretation. When I have a set standard that I can adhere to, I will.

Many of the people who read this blog have been in situations where I might have let you hold your pet for something, I'm not perfect but maybe you'll be more understanding now when I ask you to give us a little more room to do our jobs better.