Posted by M. W. Myers, D.V.M. on October 15, 2001 at 23:42:24:
In Reply to: Re: Crossing the line...what's ethical? posted by Ray Miller on October 15, 2001 at 22:08:27:
: : Although I am only a farrier's wife, I am posting here (hope no one minds - just didn't feel that it belonged on the owners board) in hopes of getting some thoughts on this subject. It is something that we discuss often. Here is the senerio:
: : Laminitic horse, vet suggests Cushings (without lab work to verify), owner most likely will not pay for lab work. We know from experience that there is a chance that this animal is not Cushinoid, but may possibly be suffering from a thyroid problem, insulin resistance, or other problem that is more successfully treated with magnesium and chromium supplementation rather than drugs.
: : The problem is that my husband feels (and rightly so) that he is over-stepping the bounds of farrier science if he suggests that there might be an alternative treatment. He also fears that if something goes wrong he may be sued. I agree with this, however, I also feel that it is his duty as a farrier to suggest alternatives to enhance the horse's well being (as long as it is directly related to the feet) and that nutrition is included in that realm. He feels that it is a vet's job to enlighten the owner about treatment for metabolic disorders. However, I feel that it is wrong for him not to talk to the owner about possible alternatives if it means that the horse could suffer further, or if it is suffering further becuase the vet is not knowledgable of the subject.
: : I am sure that you all encounter things like this in your work. What would you do? Dr. Myers, any thoughts from a vet's point of view?
: : Thanks in advance.
: : Sue
: I always suggest what I might be thinking. But I make sure they understand that it is a suggestion and they should follow up with a local equine vet.
: Just like to day. I did a write up for both the owner and the vet. On it it stated my tretment for the founder horse, follow up treatment, bedding and stall rest. On the letter i put my other suggestion. Gave a copy to both.
: Some times two pair of eyes are better then one pair.
: I very seldom have a problem doing it this way. I like to do it in writing with both haveing a copy. Then there is no mistake of what I mean.
: Just my thinking.
: Ray Miller
I can empathize with your dilemma. You are not only dealing in a gray area of ethics, but a very real area of egoes. There are, unfortunately, a great many "equine veterinarians" with very minimal experience in lameness, especially laminitis, and apparently "too busy" or just plain unwilling to keep up to speed on a variety of equine problems.
I would recommend you suggest to the owner that he question his veterinarian about tests and alternatives for this problem. Make sure this owner gets to this site and goes through all of the information available on laminitis. This will "dilute" your direct input on the situation.
I have learned that you should never assume an owner will not or cannot pay for optimal treatment for their animal. You should tell them what the best treatment is and then let them decide what is too expensive. You will be surprised how many will go for the best treatment.
M. W. Myers, D.V.M.