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Veterinarians and Physicians: Allies in Family Health

Tonya Sparks, DVM, MMicrobiol

Zoonoses & Public Health Concerns

|July 2012|Web-Exclusive

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According to the CDC, approximately 75% of recently emerging infectious diseases affecting humans are of animal origin (cdc.gov/ncezid).1 In that same line, 62% of US households own a pet; this is an increase of 6% from 25 years ago.2 A majority of pet owners (57%) sleep right next to their pets each night.3 With pet ownership rising and the role of the family pet becoming more integral, whose job is it to screen and educate human patients for potential zoonotic disease risks?

It is not breaking news that physicians are continuously time-crunched, allowing for limited face-time with patients. Though as veterinarians we do not typically have an abundance of time, we do share the burden of responsibility for protecting the public (and our clients). Preventing zoonotic disease transmission goes beyond ethical rationale and our sworn Veterinarian’s Oath; it makes sense financially to practice preventive medicine and protect from litigation.

For those unfamiliar with the hierarchy and continued subspecialization within human medicine, the family practitioner is the general veterinarian equivalent. Family physicians essentially see those who are most at-risk for infections; these practitioners are subsequently instrumental for disease prevention. They diagnose and monitor patients with potentially immune-compromising conditions, such as chronic obstructive pulmonary disease (COPD), asthma, chemotherapy-responsive disease and HIV infection. They also care for patients who are pregnant, alcoholic or diabetic, the elderly and infants. These doctors are first-line when it comes to surveillance (eg, ringworm, flea bites, recent public health outbreaks) and education of their patients about risks with referrals to appropriate specialists, if needed (Infectious Disease consult, anyone?).

Richard Lord, MD, MA, Immediate Past-President of the North Carolina Academy of Family Physicians and professor of family and community medicine at Wake Forest University, admits: “Yes, time is thin in primary care, but [zoonotic disease education] is definitely an importance. Nurses help screen social histories and with questions about pet ownership, especially if the presenting complaint is acute diarrhea and occasionally with cases of suspected bacterial resistance.”

However, there is still a lot of room for improvement.

Preventive medicine is an important aspect of family medicine and Dr. Lord foresees zoonotic infections becoming more prevalent as a result of the changing roles of pets. “When I was growing up, the dog stayed in the yard, but that’s no longer the case with many of my patients—we have different interactions now with our pets.”

This provides many opportunities for interface between family physicians and veterinarians. Though family practitioners know which patients are susceptible to infection, they may not know which patients have pets or how much preventive care they practice with their pets.

That’s where veterinarians step in.

Every person who walks into our office is a potential patient, and although many of us mention some common zoonotic risks if a pet is diagnosed (eg, cutaneous larval migrans, giardiasis, ringworm), we can always do better. The American Academy of Family Practitioners (familydoctor.org) has some generalized information about pet ownership that may be useful to refer owners or use as handouts. Dr. Lord also recommends that pet owners should be encouraged to inform healthcare providers if they: they have pets, and if the pet is ill with a potential zoonotic infection.

If we as veterinarians raise awareness and education of potential zoonotic transmission to pet owners, we will drive physicians to learn and ask more about these types of diseases. Dr. Lord states that “To get more people talking about this, it’s important to determine the prevalence of these zoonotic infections. We need recognition that these infections are on the rise and then convince family practitioners to ask and screen regarding pet ownership.”

The old idiom holds true: “If you don’t look for it, you won’t find it.”

This will hopefully lead to further collaboration between our professions. Professional organizations for “human health” are laid out much as they are in veterinary medicine, with most counties having local medical societies. Though not everyone is a member, periodic integration of local organizations may provide the best opportunity for impact, according to Dr. Lord. A joint dinner meeting on recent health outbreaks (eg, risk for Salmonella spp contamination in pet foods) is one example. There are medical societies at the state level that include all specialties and an academy association specific to individual medical specialties. Collaboration between a core group of individuals at the state level for each Veterinary Medical Association and the Academy of Family Physicians could offer further benefit.

As healthcare continues to evolve for both pets and humans, the challenges of implementing the One Health Initiative at the ground level can seem abstruse and daunting. The One Health Initiative is dedicated to improving the lives of all species—human and animal—through the integration of human medicine, veterinary medicine, and environmental science. This is not an esoteric cooperation of large-scale organizations (eg, WHO, AVMA, AMA, CDC, USDA) and its implementation on the local level is critical for its success.

As we integrate the One Health philosophy into our profession, we must remember: Reach out to our general practitioner colleagues—they are our allies when it comes to education and surveillance. Together we can provide improved healthcare to the whole family.

Tonya Sparks, DVM, MMicrobiol, is the Interactive Medical Editor for Clinician’s Brief and is a practicing veterinarian in Winston-Salem, NC.

References

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