Canine Cushing's Case Files: The ins and outs of detection and treatment—Case file: Avoiding practitioner pitfalls with canine cushing's cases (Sponsored by Dechra Veterinary Products)

Jul 01, 2013

Dr. Andy Roark
Dr. Roark practices at Cleveland Park Animal Hospital in Greenville, S.C. He is a popular veterinary conference speaker and a regular contributor to several veterinary publications and websites. He can be found on Twitter @DrAndyRoark and Facebook (

Ironically, one of the biggest weaknesses veterinarians have is directly tied to a key reason many of us enter this profession. It's a trait that is also one of our greatest common strengths. Veterinarians derive great pleasure from addressing a problem and fixing it. We may even feel a strong need to solve problems immediately. Few things are more gratifying than "fixing" an ill or injured patient. Making an immediate difference for a patient, and for the people who love that animal, is energizing.

While this compulsion often drives veterinarians, it may also hold us back. Patients with Cushing's syndrome and other conditions that require long-term care and ongoing communication with pet owners often do not have an immediate emotional pay-off. In fact, it can be weeks before the earliest positive results are realized. These cases are marathons rather than sprints to glory. The extended and involved nature of these types of conditions can be daunting, and many practitioners feel a subtle, yet persistent desire to refer these patients away.

While some patients with advanced conditions do require referral to veterinary specialists, many cases, especially dogs with canine hyperadrenocorticism, are well within the case management capabilities of general practitioners. They simply require commitment from both the doctor and the client.

Correct the pitfalls that affect your cases

A 2007 review of treatment adherence in human psychiatric patients highlighted four predictors of treatment concordance problems associated with clinician factors: poor doctor-patient relationship, poor explanation/communication, poor empathy, and inadequate follow-up.1 By avoiding similar pitfalls in veterinary practice, we can improve patient care and successfully manage more of our canine patients with Cushing's syndrome and other chronic diseases.

Strengthen the doctor-client relationship

Weak doctor-client relationships can lead to client mistrust and low perceptions of value in the services received. A demonstrated long-term commitment to the resolution of a chronic disease such as Cushing's syndrome may be the single strongest medical tool that a veterinarian can employ. Trusted doctor-client relationships can take time to build, and ideally exist before a patient faces a diagnosis of a chronic disease. However, these relationships often must be forged as treatment progresses.