Practice owner tests boundaries, leaves veterinary technician queasy

Dr. Sam Kane was 64 years old and had been practicing veterinary medicine for almost 40 years. As the sole practitioner, he was always available to clients and used relief veterinarians only when he was ill. He was a kind, dignified man and beloved by his entire staff-five technicians, four receptionists and a bookkeeper. If they needed a loan, he helped. If they needed his counsel, he gladly offered it. In a nutshell, he was well-respected by staff and clients alike.

June Whitlock was a 43-year-old technician who had worked for Dr. Kane for six years. He was her boss, mentor and occasional father figure. Recently, June had been getting headaches at work. She thought they might be due to the new germicidal solution the team was using to clean the exam tables. June consulted Dr. Kane. He said he would go back to the old solution and recommended that she take some ibuprofen that was available in the hospital pharmacy. He kept the 600 mg size on hand and advised June that if her head was really bothering her, this strength would give her more relief.

Photo source: Getty ImagesA couple of weeks later, June received a minor cat bite. It's a common occurrence in many veterinary facilities, but Dr. Kane insisted she go to the emergency room for treatment. As he said, “Even simple cat bites can cause a lot of trouble.” June went to the ER, received treatment and was given a script for the antibiotic Augmentin.

She returned to work and described her treatment to Dr. Kane and her coworkers. Dr. Kane told her, “Between you and me, Augmentin is exactly the same drug as the Clavamox that we use for the pets. You didn't hear it from me, but Clavamox is much cheaper and will do the same thing as Augmentin.”

June appreciated the tip and followed Dr. Kane's veiled recommendation. The Clavamox cost her half the pharmacy price, and the strength prescribed was easily obtained by using two 375 mg tablets.

On the second day of using the Clavamox, June experienced an upset stomach. Her husband, in an attempt to assist her, noted the medication she was using and its veterinary-use label. He asked why she was taking “dog medicine.” She recounted her discussion with Dr. Kane-and it didn't go over well.

“He's not a doctor; he's a vet!” June's husband shouted. “Thanks to him, you have an upset stomach and God knows what else.”

He demanded that they see their family physician. The doctor advised June to stop taking the medication and said her symptoms would disappear. He also told her not to take any prescription medications not prepared by a physician or pharmacist.

June's husband called Dr. Kane to advocate for his wife. He said Dr. Kane's medication recommendation had been unprofessional and illegal. He also said Dr. Kane was lucky he didn't report him to the state veterinary board. Dr. Kane responded that he only meant to be helpful and never intended to endanger June's health.

After the incident, things weren't the same between Dr. Kane and June. Dr. Kane didn't feel he'd overstepped his bounds. All he'd done was try to help, and his gesture had resulted in a verbal attack and a threat. He maintained that Clavamox and Augmentin were the same drug and that recommending ibuprofen to a coworker was not a crime.

Do you agree with Dr. Kane, or was he out of line giving medical advice to his employee?

Rosenberg's response

Veterinarians spend endless hours using and dispensing drugs from their pharmacies. A large percentage of these medications are crossover human medications. Cephalexin, amoxicillin and diazepam are commonly used medications that are prescribed and dispensed daily by veterinarians.

Unfortunately, there's a tendency to become complacent when discussing minor ailments with veterinary coworkers. People are not pets, and a veterinarian must not offer medical advice to clients or coworkers in the execution of his or her clinic duties. The veterinarian is viewed as a member of the overall medical community, and as such has medical credibility beyond that of a layperson. This makes it even more important that the veterinarian not offer medical advice to people.

Dr. Kane was absolutely wrong. He advised his subordinate to take a prescription-level dose of ibuprofen and then encouraged the use of prescription veterinary medication for a person. Fortunately, the consequences were minimal. This is a cautionary tale for all practitioners who, although well-intentioned, often mimic Dr. Kane's behavior.

Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, N.J. He is a member of the New Jersey Board of Veterinary Medical Examiners. Although many of his scenarios in “The Dilemma” are based on real-life events, the veterinary practices, doctors and employees described are fictional.