Doctor Debate: Wellness testing-more important than ever!
I've proudly promoted wellness testing because what is the cost of not testing?
Be sure to read the other side of this debate, Doctor Debate:Wellness testing--Good medicine or not? by Dr. David Robbins.
Agree with Dr. Metzger? Agree with Dr. Robbins? Or do you have a completely different take? Click here to let everyone know what you think.
Clients deserve professional, honest, and ethical recommendations, and I always ask the same question when contemplating a protocol in my practice. What would I do if the patient was my own pet? My answer for wellness screening and preanesthetic testing for my own pets is a resounding yes!
Dr. Fred L. Metzger Jr.
THE COST OF NOT TESTING
I've proudly promoted wellness testing because what is the cost of not testing? What is the cost of missing curable diseases and letting our patients suffer? Many veterinarians think we're performing preanesthetic and wellness testing only to detect occult diseases. However, establishing baseline values when patients are healthy is a paramount reason for testing.
THE VALUE OF BASELINE
It's true that not all animals' normal values will fall within the reference range. But that's the most important point of wellness testing—establishing baseline values so the clinician does not overinterpret results and perform unnecessary tests and procedures. The best reference interval or range for an individual patient is determined when that patient is healthy. Consequently, wellness testing is critical.
THE ADVANTAGE OF SERIAL TESTS
Serial data collection and evaluation provide a highly objective and sensitive indicator of developing disease before obvious clinical signs or physical examination abnormalities are observed. The key to the power of this evaluation is that the data are collected year after year during wellness checks and must be examined serially.
Figure 1 represents yearly serum creatinine concentration measurements in a cat. Not until year 15 is there a clear increase out of the reference interval for creatinine. However, as early as year 8, the trend toward increasing creatinine concentrations is observed. This type of trend should prompt further investigation to more critically evaluate the kidney (e.g. graphically examine urine concentrating ability, perform renal imaging, obtain a urine protein:creatinine ratio measurement). Unless graphed, early changes might be missed. The earlier we identify developing disease, the better chance we have to either reverse, stop, or slow down the progression of disease.
Serial creatinine measurements
THE MERIT OF BETTER PATIENT CARE
And for those who think that veterinarians just do this to increase their bottom line, I contend that the first reason ethical veterinarians do wellness testing is better patient care. It is true we can profit—and in the current climate of increasing internet pharmacy pressure, I think testing is the only way to remain profitable—but we should have been testing all along. In my opinion, vaccinating a senior dog or cat every year and not discussing wellness testing is unprofessional and unethical.
My own pets receive wellness testing at least yearly, and I certainly would never anesthetize my pets without preanesthetic testing. Don't our clients and patients deserve the same?
Fred L. Metzger Jr., DVM, DABVP
Metzger Animal Hospital
1044 Benner Pike
State College, PA 16801
