Having graduated in May of 2016, I’ve been a practicing veterinarian for slightly over six months now. As such, I’ve become accustomed to managing appointments with my clients. However, I haven’t been to a human doctor in far too long. So last week I decided to go for an annual check-up at an M.D.’s office. I figured this would be the perfect time to compare and contrast a visit to a veterinarian vs. a human physician.
Upon entering the doctor’s office, the first people I dealt with were a nurse and a physical assistant (PA) student. The nurse took my temperature and blood pressure while asking some basic questions as to why I was at the office today (for me, it was an annual exam with questions about ringing in the ears, lower back pain, and some moles). The PA student (her first rotation!) soon took over the bulk of the visit and gave me flashbacks to my terrifying first rotation as a vet student at Michigan State. She asked me a thorough history about the reasons for my visit, my lifestyle, and my previous medical history.
This PA student also obtained a large amount of diagnostic information right off the bat. She drew blood for a complete blood count and chemistry, told me to get a urine sample, helped the nurse obtain an ECG, and oversaw pulmonary testing. She told me that this was all standard testing for a new client.
This series of tests is much more advanced than any I have seen a primary care veterinarian perform. While we certainly can measure blood pressure, obtain an ECG, and do blood/urine testing, we don’t do these for all clients. Blood pressure is a much less pertinent issue in veterinary medicine and is typically only done after heart or kidney disease has been diagnosed. ECGs are saved for prior to anesthesia or if there is concern for heart disease. Blood and urine testing is done more often, but is usually recommended once in younger age, once in middle age, and perhaps annually in the geriatric years. Of course, blood and urine testing would also be recommended for a wide variety of suspected illnesses.
After all these diagnostics were complete, the PA student began a short physical exam. She ausculted my heart and lungs, palpated my abdomen, and quickly looked in my eyes and ears the same was as a veterinarian would. She also quickly manipulated by back to check for pain. The only significant thing that she did not do that a veterinarian would is palpate the lymph nodes – the PA who later came in the room also neglected to do this.
After that brief physical exam, the student moved into my specific problems. I was impressed with the degree of basic auditory testing the PA student could perform compared to a veterinarian. While I’m sure there are at least couple veterinary audiologists out there, measuring animal hearing loss in a primary care setting amount to abruptly clapping your hands and seeing if the dog reacts. At my physical, the PA student whispered different phrases into each of my ears and asked me to repeat them. More impressively, they used a tuning fork to perform Rinne and Weber hearing testing in an attempt to localize where (if any) my hearing loss was.
After this hearing testing, the student left to present her case. The PA came back into the room with her several minutes later. He was professional but curt. After validating a few things about my history, he began a series of vigorous neurological and orthopedic tests in regards to my back pain. He checked my patellar reflexes, had me do a wide variety of range of motion exercises, and checked for any facial nerve deficits. Overall, I was very impressed with the amount of care that went in this orthopedic and neurologic exam.
At the end of the exam, I mentioned my concern about two moles (one on my nose and one on my arm). The PA did not even look at them, he simply mentioned that he can give me a referral to a dermatologist. He also gave me a referral to an audiologist and a slip to go get a radiograph at a hospital. He prescribed me a lidocaine patch for my back in the meantime and said we would do a recheck appointment in 2 weeks to discuss the bloodwork and radiograph of my back. One last thing happened on my way out. I mentioned that while teaching a vet assistant how to do an ear cytology, I took a swab of my own ear and examined it. I saw approximately 5 cocci (round bacteria) per high powered field on the microscope. I asked what the normal flora in a human ear was, and he said that he had no idea but that 5 was probably fine.
So, how did all of this compare to a visit to a primary care veterinarian? As far as history-taking goes, it was the exact same. The physical exam was very similar. While the PA did not look at my lymph nodes, he did a much more thorough auditory exam than I ever could.
Laboratory testing was done on a much more extensive routine scale. However, interpretation of these tests and the radiograph was much-delayed. In a veterinary clinic, routine bloodwork and radiographs are usually interpreted within 24 hours. For a more complex case I may send radiographs to a radiologist for review or call an internist about bloodwork. Even with those delays, we almost always get back to a patient within 48 – 72 hours.
Also in regards to bloodwork and radiographs, veterinarians often discuss these results over the phone. I always offer to discuss the results in person if the client desires, but if we were purely discussing lab results I would never charge for a second visit. (When I return to my PA in 2 weeks I will have to pay a copay).
In regards to a referral to specialists, I always offer transferring a patient if I feel it is in their best interest. But in regards to my mole, even if I did not any idea how to deal with a skin issue, I would still take a look at it and make note of it in the patient’s chart. I was very disheartened that a primary care physician wouldn’t at least take a quick glance to ensure it wasn’t secondarily infected. This goes along with not knowing the normal flora of a human ear canal. Veterinary general practitioners routinely deal with things that human practitioners always seem to refer (most skin issues, ear infections, reproductive issues, etc.)
So, who wins this brawl? As I would hope you’d expect me to answer, there is no winner. In general, I feel that primary care veterinarians are better versed to deal with a variety of issues. Taking insurance out of the picture, we are also vastly cheaper to visit than human physicians. We are also speedier in getting results back to our clients.
However, human doctors typically have more concentrated knowledge on the things they do focus on. This is due to their more-extensive training. (Whereas an internship and residency is optional for veterinarians, they are required in human physicians.) So while a primary care practitioner may not know how to diagnose or treat a mole, they are highly capable to treat the things they are comfortable with and diagnose/manage long-term diseases.
Although I do wish they would at least look at the moles.