Doctors, pets and vets Part 2: We need to talk
Recently, I wrote a post about the need for vets and physicians to communicate more, and about concerns that zoonotic diseases get missed because vets deal with animals and physicians deal with people, but few people pay attention to the interface between them. A reader (my father, actually) wrote this comment.
“...is the opposite also true? If I take my sick cat to the local vet, will he advise me to see my physician if I begin to feel ill effects? Are vets trained to know that pets can transfer disease to their owners or in this an emerging part of vet. science?”
It’s a good question and one that doesn’t have a straightforward answer. Vets certainly do get educated regarding zoonoses. From what I understand from talking to colleagues in the human medical field, there is much more emphasis on zoonoses in the veterinary medical curriculum compared to the human medical curriculum. However, a lot of the focus is on foodborne and waterborne zoonoses, with much less information about companion animal (e.g. dog, cat, horse) zoonoses. Different vets have quite variable knowledge in this area, ranging from excellent to poor. It’s a huge field (I’m still learning more about it all the time), and vets and physicians alike have busy schedules and many other areas where they need to stay current as well, so it’s not unfathomable that zoonoses could get neglected.
So, to answer the question, if you take your sick cat to the vet, it’s unlikely he/she will initially ask about your health. However, if the vet suspects a zoonotic disease, hopefully he/she would tell you what it is and possibly what signs for which to watch out. Providing additional information would also be useful, which is why we're developing the information sheets that are available on our Resources page). At that point, the vet would typically (and reasonably) leave it up to you to determine whether you should see your physician and what should happen from there. In the grand scheme of things, it would be very useful for vets and physicians to have some form of dialogue or at least an understanding of each other's roles and a willingness to call each other when appropriate.
Both human and veterinary medicine have a long way to go to get to the "one medicine" concept that people like to talk about. I think we’re slowly moving in the right direction, but vets and physicians need to talk more to properly cover this important area of overlap between their professions.
Doctors, pets and vets
Over 50% of households in Canada and the US have pets, and the numbers are probably similar in many other countries. Pets are often considered part of the family socially but we need to consider them part of the family biologically as well. It's clear that diseases that be transmitted between people and pets - in both directions. Unfortunately, it's also clear that physicians and vets don't do a very good job talking to each other.
Pet contact (and animal contact, in general) should be part of the standard history obtained by any physician. In my perfect world, every medical record would include a permanent record of contact with pets or other animals. This information is potentially useful because certain diseases that are not a big issue for non-pet owners may need to be considered (or may be higher on the list of possibilities) in pet owners. Knowing about pet contacts up front could help speed up diagnosis and proper treatment.
For example:
I have a flock of rare breed sheep. The other day, I had to assist with a lambing. Contact with newborn lambs and fetal fluids is the main source of the organism Coxiella burnetti, which causes Q-fever. If I became infected, the illness would start off with vague signs like fever and malaise. If I went to a physician at that point, I'd probably be told to go home, rest and take anti-inflammatories as needed (the old "take two aspirin and call me in the morning" type thing). If the physician knew I had sheep, he/she might ask about the risk of exposure for Q-fever. Upon hearing that I had a high risk exposure a few days earlier, Q-fever would be considered right away and appropriate measures could be taken.
Also, as strange as it sounds, in my utopian world physicians would ask about pet health. Yes, it may seem strange if your doctor were to ask "So how are you doing today? And how's your dog been feeling lately?" - but it might be important. Illness in your pet may be associated with illness in you or other members of your household. Knowing that a pet is sick might give some indication of that (a) certain disease(s) are more likely in a person. Also, if the sick pet has been to a veterinarian for testing, those results might be useful to the physician. There's no guarantee that a pet and owner that are sick have the same thing, but a general principle of medicine is that a single cause is more likely than co-incidental independent problems.
For example:
Similar to the case of psittacosis in a pet store employee that I reported about recently, let's say that you own a bird and it's been sick for a week or so. It's weak and not eating well. You then come down with a fever and cough - something that's not uncommon. However, when your astute physician asks about the health of your pets, he/she gets concerned about the fact that your bird is sick. Your doctor contacts your bird's veterinarian, and it becomes clear that the bird could be infected with Chlamydophila psittaci, the cause of psittacosis in people. Your doctor therefore puts psittacosis on top of the list of potential problems, and instead of telling you to go home and rest, he/she takes some blood samples to try to diagnose it the infection and may even start treatment right away. Because your physician identified a higher risk situation with your sick bird, you get prompt treatment, you start to feel better in 24 hours and it's unlikely you'll have any major problems. (The mortality rate from psittacosis is < 1% in people that are treated properly. If the diagnosis is missed, the mortality rate increases to 20%, and you also run the risk of complications such as heart valve damage.)
