Veterinarians explore promoting wellness

Proponents say preventive medicine not just about vaccinations

March 23, 2011 (published)
By Edie Lau

Dr. Debbie Taranik changed a policy in her veterinary practice a few years ago that infuriated some clients and cost her profits. Despite the fallout, she stuck to the decision because she believes it’s good medicine.

Her clinic, Animal Care Hospital in the desert community of Apple Valley, Calif., requires that a physical exam be done annually on every pet brought in for vaccinations. In other words: no exam, no shots.

Because an exam adds to the cost of a visit, Taranik took a lot of flak.

“For the first year, we got a lot of yelling on the phone,” Taranik recalled. Clients would say, “How dare you?” They accused the veterinarian of being motivated by money. But the truth, Taranik said, was just the opposite. “I gave up the vaccine revenue,” she said. “It was a huge thing for me.”

Taranik is on the leading edge of a movement gaining credence in veterinary medicine. Historically pooh-poohed by many in the profession as a marketing gimmick, wellness increasingly is accepted as a legitimate focus in medicine. Moreover, it’s viewed in some quarters as one way of rescuing general veterinary practices from the brink of irrelevance.

A recent study by Brakke Consulting Inc., Bayer Animal Health and the National Commission on Veterinary Economic Issues found that misunderstanding among pet owners about the value of regular exams is one factor behind a national decline in veterinary visits, even as the population of dogs and cats in American households grows.

The study results helped give impetus to a national campaign being planned by the veterinary establishment to educate practitioners and pet owners alike about the value of wellness.

The campaign was born out of a discussion last August during an annual Pet Health Care Summit sponsored by Banfield Pet Hospital, according to Banfield officials.

Dr. Jeffrey Klausner, senior vice president and chief medical officer of Banfield, said talk centered on declining veterinary visits and factors behind it, including the fact that many modern vaccinations need be given only once every three years, and flea and tick products are increasingly available from outlets other than veterinary clinics.

“The challenge is, people have less of a reason to go to the veterinarian,” Klausner said. “Sometimes, you have to fight a bit to keep (visits to the veterinarian) relevant. ... Prevention is part of it.”

Major organizations in veterinary medicine — the American Veterinary Medical Association (AVMA), the American Animal Hospital Association (AAHA) and the American Association of Veterinary Medical Colleges (AAVMC) — along with some animal-health companies have a hand in the nascent campaign. What shape it will take has yet to be determined.

“At this stage it is an informal coalition of organizations, and a number of options are being considered to address the decline in veterinary visits that we know are essential to the health and long-term well-being of pets,” Dr. Ron DeHaven, CEO of the AVMA and the coalition’s point person, said by e-mail.

“When the exploration of options is complete and decisions have been made, all the details will be made available to the profession and to the media,” DeHaven said.

The traditional “treat disease” emphasis in veterinary medicine is rooted in veterinary education, which is similar to human medical training in that regard, said Dr. Marguerite Pappaioanou, executive director of AAVMC and formerly with the U.S. Centers for Disease Control and Prevention. “This curative approach reflects the focus of our health-care system in general, where prevention is often overlooked,” she said.

At the same time, the medical community is not without a good example to follow, said Dr. Mike Cavanaugh, executive director of AAHA. “I think the group that really has wellness-care down to a fine art are the dentists,” Cavanaugh said. “They’ve been able to educate the general public about the importance of twice-annual teeth cleaning and it has resonated with the average person as the right thing to do.”

And the folks who don’t follow that dictum? They’re most likely to be the hardest sells when it comes to routine checkups for their animal companions. A survey done as part of the Bayer-Brakke study found that pet owners who don’t value regular veterinary visits are less apt to visit their own health-care providers regularly, according to John Volk, a Brakke senior consultant who designed and managed the study.

“Lapsed pet owners or laggards clearly do not go to the dentist and physician as much as they should,” Volk said during a press briefing on the study results in January. “It’s not a one-to-one correlation but there is a relationship.”

To shift focus in medicine over the long haul, incorporating prevention and wellness into the curricula of veterinary schools will be essential, Pappaioanou said. Helping current practitioners give more attention to wellness, such as by providing opportunities for continuing education along with support tools and materials, is equally important, she said.

Such outreach likely will need to include a touch of persuasion. Historically, veterinarians and their staffs typically have viewed with skepticism the idea that healthy animals need to see the doctor.

“I remember going to a wellness thing years ago at Vegas and coming out thinking, ‘How ridiculous can you be?’ ” said Dr. Josephine Banyard, a practitioner in Chilliwack, B.C., recalling an experience at the annual Western Veterinary Conference in Las Vegas. “I just thought it seems like you’re trying to rip people off."

Veterinary staff often react in the same way. Heather Howell, a licensed veterinary technician and practice-management consultant based in South Lake Tahoe, Nev., said many hear the term “wellness” as code for “marketing.”

“A veterinarian will go off to a conference and bring this (idea of promoting wellness) back, and the support staff go, ‘Oh, they just want us to sell something,’ ” said Howell.

That goes against their nature, she said. “Most veterinary staff that I’ve come across are not good salesmen,” Howell said. “They don’t want to be salesmen. It doesn’t feel good to them and they resist it. ... It has to be presented as, ‘Here’s how it benefits you and your pet.’ ”

Howell became a champion of wellness after working with fellow consultant Dr. Thomas Catanzaro. Catanzaro, who goes by the handle “Dr. Tom Cat,” co-authored with Caroline Jevring a book published in 1999, Healthcare of the Well Pet.

In an interview by e-mail, Catanzaro suggested that a focus in the veterinary profession on maintaining healthy pets is common sense. “It is the core of why we entered this profession and it is the basis of the companion-animal practice,” he said. “Sorry to say, the academics have not caught up, and veterinary schools are still centering on ‘fix and repair broken animals.’ ”

Veterinary professionals interviewed for this article uniformly said they did not remember learning about wellness or preventive medicine in school. Advocates for the approach came to it from different paths.

For example, Banyard, who once considered promoting wellness “the stupidest thing,” started thinking differently a few years ago when a good friend became chronically ill. She realized then that good health is something people often don’t appreciate unless and until they lose it — and recover it, if fortune allows.

She realized as well that people can take steps to maintain a state of wellness, whether for themselves or their animal companions. One of those steps is having regular thorough checkups to identify health conditions before they become severe. In pets, disease in its earliest stages usually isn’t obvious to untrained eyes, Banyard said.

“People, they assume that when an animal is wagging its tail and jumping around when they say, ‘Come on, Fido, let’s go for a walk,’ and he’s eating — they think Fido’s fine,” she said. “But how many vets see Fido, and on the thorough physical exam they diagnose ear problems, dental problems, skin problems and many other problems that the owner did not know about or thought were normal or ‘old age.’ People think they can look at an animal and tell, but actually they can’t.”

A few years ago, Banyard had her staff pull random files to examine the findings of yearly checkups. In a non-scientific sampling taken from May to August 2003, the staff at Little Mountain Veterinary Clinic found that only 22 percent of animals brought in for routine exams were found to be problem-free. The rest had dental disease (52 percent), eye problems (17 percent), ear problems (11 percent), skin problems (5 percent), parasites (3 percent) or something else. Some patients had multiple health issues.

Banyard posted the findings on her website to help demonstrate to clients the value of well-pet checkups. “Any (veterinary practice) can do this sort of analysis — it would be a fun thing for clinics to do and very helpful to their clients,” she suggested.

Banyard also shared her ideas about wellness with colleagues via a message board of the Veterinary Information Network, an online community for the profession.

At Animal Care Hospital in Southern California, where policy dictates that physical exams accompany vaccinations, the insistence that pets be seen regularly has proven invaluable in a few cases. “Three times last year I diagnosed lymphoma in patients (whose owners) only wanted to come in for a vaccine,” said Taranik, the clinic owner. In the few minutes it took the veterinarian to run her trained hands across the dogs, she was able to detect enlarged lymph nodes that the owners had not.

Klausner, the chief medical officer at Banfield, has a similar story. Klausner said he received a letter from a grateful client who related how, during a well-pet exam, her dog was found to have mild periodontal disease. When she brought her dog in for the recommended teeth-cleaning, the veterinarian discovered a small tumor that turned out to be osteogenic sarcoma. The dog was referred to a specialist, who removed the tumor and determined that the cancer had not metastasized.

“What could have happened if the dog had not come in for the wellness checkup is that it would have had no teeth-cleaning,” Klausner said. “The tumor would have grown. The owner probably would have noticed halitosis, which could have been months later. The likelihood of prolonging his life is better because (the cancer) was diagnosed early.”

Klausner credits Banfield’s “Optimum Wellness Plans” with making it easy for clients to bring their dogs and cats to the veterinarian often. Under the plans — which come in 10 different varieties, based on species, age and service options — clients pay a membership fee plus a fixed monthly fee for access to a variety of preventive-health-care services, including biannual checkups and unlimited office visits. (Depending on the plan and the animal’s condition, there may be extra charges for services rendered beyond the office visit itself.)

Klausner said the wellness packages, pioneered 16 years ago by Banfield founder Dr. Scott Campbell, are successful in bringing clients in more frequently. He said the average patient not on a wellness plan visits the pet hospital once a year; wellness patients visit four to six times a year. For Banfield, the largest owner of veterinary clinics in the country with 766 sites, that adds up to a lot of visits.

The company estimates that about 45 percent of its 2.95 million regular dog and cat patients are on a wellness plan.

While clients on wellness plans pay less for each covered service than if they were paying a la carte, Klausner said the wellness packages overall are a revenue-generator for the company. “I can’t give you a figure off the top of my head,” he said. “But (wellness clients) typically spend more on veterinary care than non-wellness clients.”

Whether making regular wellness visits actually extends pets’ lives is an open question. “I would love to show data that it makes a difference in pets' lives,” Klausner said. “But it’s confounding. There are so many factors in longevity.”

Banyard looks at the value of maintaining wellness differently. “As veterinarians, if we can help people keep their animals well, in the long run, the animals are happier. See, the difference between wellness and unwellness is not longevity,” she said. “It’s how much you enjoy life.”

If the role of the veterinarian in keeping pets happy seems nebulous — what pet enjoys visiting the veterinarian? — at least one North American veterinary-education program is trying to change that.

Ontario Veterinary College at the University of Guelph in Canada opened a “primary healthcare centre” last summer designed to teach students the ins and outs of working in a regular companion-animal clinic. Among the concepts being conveyed are “basic, fundamental things that are part of preventing disease: taking care of teeth, nutrition, preventing obesity, encouraging healthy forms of exercise for pets,” said Dr. Shane Bateman, director of the center. “These are things we know lead to higher quality of life.”

Tackling the role of veterinary medicine in maintaining pet wellness is no small undertaking, Bateman acknowledged. “It’s really about a massive re-education of the public about how veterinarians function and fit into their pets’ lives,” he said.

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