Wellness vs. illness diagnostics: test now or later?

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Which came first, the chicken or the egg? Since the beginning of time, that classic philosophical question has been pondered.

And so it is with veterinary medicine that we ponder our version of this question: Which should come first, the illness or the diagnostics? Some argue that diagnostics come first, so that we can find problems earlier and thus provide more effective care. Others argue that illness comes first, because if we run diagnostics to screen all the time, there will be no resources left when we actually find a problem. Let's spend a little time and examine our veterinary chicken-and-egg dilemma.

Illness first

The "chicken first” camp argues that we should conserve our resources until we actually have a chicken in sight. Going on an egg hunt of endless diagnostics will simply exhaust our patience and attention to detail while draining our clients' financial resources and frustrating them with long strings of normal diagnostics. This fractures the bond between the veterinarian and the client, leaving everyone in a weakened state when it comes time fight an actual “chicken” (illness).

A further subset of the illness-first camp-hereafter referred to as the “rubber chicken cadre”-will also argue that the idea of wellness testing is simply a vast lab company conspiracy to wrench money from the pet-owning populace and veterinarians by recommending an endless series of tests that just result in more tests.

Diagnostics first

The “egg first” consortium feels that it is far better to find an illness before it hatches, as it's much better for our patients to fight disease in its infancy before it becomes a giant chicken monster. Waiting until a problem declares itself is like waiting for Godzilla to hatch and grow up before taking him on.

Regular wellness testing prevents this by detecting early signs of disease when they're more easily treatable. This gives patients the best quality of life possible and reinforces the human-animal and veterinarian-client bonds. Even normal test results are things to be celebrated, as they give us as veterinarians and our pet owners piece of mind knowing that all is well with their pet.

Illness-first veterinarians deride diagnostic firsters as quaint or old-fashioned and often make rubber chickens the butt of jokes. There is a small group of egg firsters known as “Gudetamas” who believe that no test should be spared in looking for potential problems-“vomiting,” if you will, tests all over their patients in an effort to adhere to the mythical yolk (gold) standard.

The verdict

While both camps have worthy goals and sound logic, I prefer to make my own way. I call it the path of the chicken omelet. I don't really care which came first, because I'd rather have my chicken and eat the egg, too. I definitely prefer to find problems early, because that prevents bigger issues down the road. It's better for my patients because they get to be healthier, and it's better for my clients because small problems are cheaper to fix than big ones.

I also prefer to offer wellness plans or packages for clients, because that helps pet owners budget wellness care into their regular financial plan while still allowing for unexpected illness problems. This also makes the illnesses easier to deal with, as the expense isn't seen as being an either-wellness-or-illness proposition.

That said, not every test is worth running and not every animal needs every test. We've seen a number of tests in the veterinary profession come and go-tests that initially seemed exciting, but in practice wound up being a neverending cycle of checking and rechecking the same test with no change in treatment or outcome. Even the rubber chickens have a point in that we should remember the No. 1 goal of a lab company is to sell lab tests.

In short, I believe we don't need to be in one camp or another. Regular wellness testing and respecting our clients' finances are both worthy objectives. Offering well-thought-out wellness options with testing catered to our patients' needs-instead of just running every test in the book-is good medicine. Giving clients financial options to better budget for their desired pet care is respectful to them without falling into the trap of “X-raying their pocket books” that veterinarians are so good at. Now, let's go out and make a chicken omelet.

Dr. Michael Nappier is assistant professor of community practice in the Department of Small Animal Clinical Sciences at the Virginia-Maryland College of Veterinary Medicine in Blacksburg, Virginia.