Practice Dilemma: The impatient owner

Managing skin disease is always a long-haul, and – as yet – there’s no “magic bullet”. However, this can be difficult to explain to an owner, so let’s take a look at an example.

Coming into your consultation room is “Lucky” (always an unfortunate name) Jones, a 3 year old Golden Retriever. One of your colleagues made a clinical diagnosis of  atopic dermatitis a week ago, initiated an “emergency” short-acting steroid injection to damp down the clinical signs while Mr Jones thought about the options. Well, Mr Jones has now brought her back in to talk about treatment options in the longer term. He would like a repeat steroid shot – because “the last one fixed her up just right”. He’s also reluctant to go and buy “that fishy oily stuff” that the previous vet recommended, because “it’s just some alternative money making scam” and he wants “just one real medicine” to “fix” Lucky.

Quickly reading back over the notes, you note that your colleague [doubtless inspired by Sarah Warren’s webinars!] had indeed recommended that Lucky start on YuDerm. She had, however, also noted the “need to discuss longer term options [note the plural!] with the owner”.

So, where do we go from here with the irascible Mr Jones?

Sadly, this isn’t an uncommon situation. Modern veterinary medicine has been very effective in developing a curative treatment for a wide range of acute – and some chronic – conditions. However, atopy is not one of those conditions. Effective treatment requires multimodal management, over a long time course. And often, the “optimal” balance of treatment will change over time. Mr Jones will have been expecting a straightforward solution to treating his dog’s problem, not a lifelong, sometimes expensive, management plan that the treatment of atopic dermatitis so often demands.

This has also been compounded by the fact that the initial steroids seem to have dramatically helped. This is of course a good thing… but does not offer a long term solution to managing Lucky’s condition.

As all vets are aware, the key to addressing Mr Jones’ concerns is to manage his expectations by discussing the complexities of atopic dermatitis. It’s often best to present this as a discussion with the client, rather than a top-down “educating them” conversation. But atopy is one of those incredibly complex conditions where there is still a great deal not known, and explaining that can be helpful. Generally, once people realise that a condition is complex, they seem to be more open to the option of using multiple different medications to manage it – and of course, that’s the case with atopic dermatitis, as we looked at last time [link to “Spring into Skin: Supporting Your Clients”].

Added to that difficulty is the fact that there are indeed a lot of products on the market offering miracle cures for a range of ills. YuDerm (and, in fact, all the Lintbells range) are based on solid biological, clinical and nutritional science – but you can’t blame Mr Jones for being skeptical. It may be that he’s seeing the cost building up and up, but doesn’t see why he should value this “oily stuff”.

Explaining how essential fatty acid supplements can benefit dogs by helping to reinforce the skin barrier [link to “Practice Dilemma: The Itchy Dog”] will hopefully convince Mr Jones of the importance of using YuDERM as part of Lucky’s long-term plan. And if it’s the money he’s concerned about, we are pleased to say that we now offer a loyalty card – as well as a money back guarantee!

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As always, this comes down to good communication. Mr Jones isn’t (necessarily) a bad client – but he rightly has high expectations, and is disappointed and concerned that, in this case, we cannot give “Lucky” a single jab and make the problem go away. However, by reassuring him that the condition is manageable, – it’s just more complicated – there’s every reason to be optimistic that you’ll get Mr Jones onside. And that’s what the vet-client-patient relationship, of course, is all about.

References and further reading:

Bond R, Lloyd DH. (1992) A double-blind comparison of olive oil and a combination of evening primrose oil and fish oil in the management of canine atopy. Vet Rec. 1992 Dec 12;131(24):558-60. PMID: 1481346.

Gortel K. (2018). An embarrassment of riches: An update on the symptomatic treatment of canine atopic dermatitis. The Canadian veterinary journal = La revue veterinaire canadienne, 59(9), 1013–1016.

Paterson, S (2019) Foundation therapy in canine atopic dermatitis, Companion Animal 24:7, 347-352

Saevik BK, Bergvall K, Holm BR, Saijonmaa-Koulumies LE, Hedhammar Å, Larsen S and Kristensen F (2004), A randomized, controlled study to evaluate the steroid sparing effect of essential fatty acid supplementation in the treatment of canine atopic dermatitis. Veterinary Dermatology, 15: 137-145.