People like to talk about "one medicine" a lot. It refers to the concept that we’re all animals, and that human and veterinary medicine should be one big happy family of healthcare providers that maintain the health of the entire family, human and non-human. I get a bit jaded talking about one medicine because there’s a lot of talk but it’s hard to get a lot of action. One problem is that while some people in both human and veterinary medicine are strong supporters of the one medicine concept, it doesn’t always filter down to the ground level.
A study in the latest edition of the Journal of the American Veterinary Medical Association (Hill et al. 2012) presents some concerning but not surprising information about "Tennessee veterinarian and physician attitudes, knowledge and practices regarding zoonoses prevention among animal owners with HIV infection or AIDS."
The study consisted of a survey sent to 454 vets and 1737 physicians in Tennessee. Response was pretty poor (a common problem with surveys), with only 43% of vets and 15% of physicians completing it. You have to wonder why the physician rate was so low. One potential issue is that the topic is not even on the radar of most physicians so they didn’t bother to respond. If that’s the case, then the people who responded could be more interested than average, potentially biasing the results (meaning that the problems described below are actually underestimated).
Here are some highlights from the study:
73% of veterinarians, but only 50% of MDs, said that veterinarians should always or almost always be involved in advising clients with HIV/AIDS about zoonotic disease risks.
- Considering a large percentage of physicians don’t initiate the discussion and don’t get any additional education in zoonotic diseases (see below), I’m not sure what the other 50% of physicians think should be happening in terms of zoonotic disease counseling.
58% of veterinarians had zoonotic disease educational materials available in their clinics compared to only 3.5% of MDs.
- Not surprising at all. Actually, the fact that some MDs have info in their offices is a bit of a surprise.
Only 5% of MDs had any continuing education (CE) on zoonotic diseases in the past three years, compared to 29% of veterinarians.
- Pretty pathetic numbers all around. Veterinarians probably have easier access to this kind of CE since zoonotic disease topics are commonly presented at veterinary conferences, although attendance tends to be limited (as evidenced here). It would be nice to know why almost no MDs have had CE on zoonotic diseases. Is it lack of interest? Is it lack of availability? These are two completely different issues that can be addressed differently.
Almost 70% of veterinarians reported regularly talking to pet owners about the risk of zoonotic diseases in people with compromised immune systems.
- One problem here is knowing with whom to have the talk. Asking people their medical history isn’t (logically) part of the normal pet examination process, and while it’s good information to have, veterinarians aren’t going to cross that line and routinely ask those types of questions. That raises the question about how to initiate the discussion, and a crucial factor is having pet owners who are willing to bring up the subject. For that to happen, they need to realize that it’s relevant, that the veterinarian knows something about the topic and can help, and that all information will be treated confidentially. Therefore, client education is key.
51% of physicians said they never see zoonotic infections in HIV/AIDS patients, while 44% said they almost never see them.
- In part, that’s a testament to the effectiveness of highly active anti-retroviral therapy (HAART), which has had a tremendous impact on management of patients with HIV. However, it also may be an indication that MDs don’t recognize some infections as zoonotic. Certainly, a patient with Salmonella would (hopefully) result in some thought about zoonotic transmission, but there are a range of other pathogens where the zoonotic risks are less clear or less well known. When you consider that 71% of MDs never or almost never ask HIV/AIDS patients about pet ownership and animal contact, you can see how discussion and consideration of zoonoses might be poor.
Only 26% of veterinarians and 33% of MDs were able to correctly identify zoonotic pathogens of greatest concern to people with HIV/AIDS.
- Pretty concerning numbers (especially among MDs, who do the diagnosing).
100% of MDs never or rarely contacted vets about zoonoses, and 97% of veterinarians never or rarely contacted physicians.
- For all the talk about one medicine, this shows how far we have to go.
We need to do a better job of actually practicing one medicine. Veterinarians and MDs need to communicate. Both groups need to realize that they play a role in zoonotic disease prevention, and that the other group has an important role as well. Zoonotic diseases is a niche field in human and veterinary medicine but that doesn’t mean they should be ignored. While serious zoonotic diseases are uncommon, they occur, and the failure to actually practice one medicine means that some people are at higher risk than they should be, and infections that occur may not always be identified and managed optimally.
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