At my last physical, my doctor greeted me with a smile before sliding into a chair behind a computer. “Date of your last period?” she asked, without looking up from the screen. “Still taking a multivitamin?” She clicked through my latest labs, typed, typed some more, gave me a short lecture on the importance of vitamin D and then stood up from behind the computer to perform a quick exam. It was over within minutes.
My cats, Francesca and Isabella, had a very different experience at their annual checkup, which lasted well over 30 minutes. The veterinarian asked how I was doing and if I had any questions or concerns to discuss. Then he focused on his two patients, taking time to watch them walk around the room. Bending down to their level, he gently listened to their hearts, felt their abdomens and checked their teeth. After lovingly picking up Isabella and placing her on the scale, the vet praised her for having lost one pound. “Whatever you’re doing is working,” he said, noting Isabella’s progress in her chart.
On average, human patients spend about 20 minutes in the exam room and possibly only a fraction of that time with their doctors’ full attention. In one recent study, patients got about 11 seconds to speak before doctors interrupted them. What those interrupting doctors said next varied. But in only 40 out of 112 clinical interactions tracked by researchers did doctors ask why patients had come in for care.
After sitting through Francesca and Isabella’s appointment, I wondered if their vet would consider taking me on as a patient, too. I know that one pound is a big deal for a cat, but I’d appreciate the same level of enthusiasm from my primary care provider when I lose weight. I couldn’t help but think that doctors could stand to take a few pointers from vets. And I’m not alone; a growing number of experts agree that MDs need more exposure to the veterinary world. In fact, there are human and animal providers who say the two fields are more alike than they are different, and that doctor-vet collaboration would improve health and healthcare across all species.
The veterinary approach
Animals are vocal; they bark and purr, hiss and squawk. But they don’t talk. The simple fact that cats, dogs and domesticated pigs can’t describe or even point to their pain means that ongoing, direct engagement with patients is essential in veterinary care. Veterinarians have no choice but to become fluent in nonverbal communication. Learning how to extract diagnostic clues from an exam room, and the creatures inside it, is a fundamental part of their training — and something that physicians may be too rushed to practice.
“We like to teach the students that the first and one of the most important parts of the physical examination happens before the veterinarian touches the animal,” said Leslie Sharkey, professor and chair of clinical sciences at Cummings School of Veterinary Medicine at Tufts University. “Is the pet hiding? How it is walking? Does it seem bright and curious or disinterested and depressed?”
Pets sometimes hide their pain; it’s a survival strategy and a vestige of their days in the wild. So veterinarians will look for other signs of distress, often relying on owners to fill them in on what’s going on at home — has the animal been less active than usual, eating or drinking less? “Observation in an exam room is key,” said Virginia Rentko, medical director of the Cummings School of Veterinary Medicine’s Hospital for Large Animals and Foster Hospital for Small Animals at Tufts. “A hunched back may indicate abdominal pain and ‘walking on eggshells’ could indicate joint pain.”
“Jaguars have breast cancer, eagles get heart attacks. All these commonalities are really, really important.”
As my markedly different trips to the doctor and vet made me realize, connecting with patients isn’t a requisite in human healthcare. In doctors’ defense, practicing medicine is now only part of their job. Heightened patient-load demands, administrative work and mandatory use of electronic health record systems (EHR) are consuming an increasing share of their time and attention. In 2018, one study reported, doctors saw an average of about 20 patients a day, although physicians I spoke with anecdotally told me that number sounded low. According to another study, doctors spend about two hours doing computer work for every hour spent with patients. Veterinarians face these stressors too, albeit not to the same degree.
But EHR and administrative burdens aren’t going anywhere. Neither is the need for strong doctor-patient relationships, which can influence health outcomes. A patient who feels rushed or uncomfortable might be less inclined to ask an embarrassing question or point out a potentially cancerous mole. To provide quality care, doctors will need to communicate effectively in spite of screens. And even though veterinarians aren’t subject to identical job constraints, they still might be a source of guidance for overloaded doctors.
Crossing the species divide
Beyond taking cues from veterinary bedside manner, some experts argue that doctors should forge a collaborative relationship with pet providers in order to make headway on shared diseases and clinical challenges.
“The two fields are very much the same,” says cardiologist Barbara Natterson-Horowitz, co-author of the bestselling book Zoobiquity. The patients are too: “Jaguars have breast cancer, eagles get heart attacks. It’s still remarkably common for physicians to assume that human disease is unique to humans. All these commonalities are really, really important.”
As a cardiologist, Natterson-Horowitz spent her career treating human patients. Then, a little more than a decade ago, the Los Angeles Zoo asked her to perform cardiac imaging on a chimpanzee, her first non-human patient.
“I remember that experience well because of the extreme familiarity that I felt,” she told me, describing the scene at the zoo hospital: “A team of doctors around a patient, the EKG monitor, the pulse oximeter … It was inspiring. It was this moment of personal evolutionary connectedness to that chimpanzee who was lying there, and cultural commonality that I felt with the veterinarians in the room. Every physician, every veterinarian, every caregiver has that flipped experience of connecting with and becoming the patient.”
Now, Natterson-Horowitz works at the crossroads of human and veterinary medicine. She regularly leads interdisciplinary conferences to facilitate information-sharing on issues, such as pain management, where she sees relevant overlap. “It becomes extremely informative to learn from the animal experts in pain management whose patients never have words,” she said. “Veterinary specialists talk about how you use physiologic signs and behavioral signs to detect pain.”
Another area where collaboration makes sense, Natterson-Horowitz says, is mental health. “I believe in psychotherapy and psychotropics,” she said, “but I also think there’s something helpful about looking at the ecology of what’s going on in an animal’s life to induce these behaviors.” By studying maladaptive behaviors in animals, and how vets treat them, doctors could open up their understanding of human disorders and strategies to mitigate them.
Humans who self-harm (e.g., cutting) often can’t explain the behavior themselves, Natterson-Horowitz pointed out. Animals in captivity also exhibit self-harm. “Isolation is a powerful inducer of self-injury in animals,” she said. “This is a really critical piece of information.”
Learning about conditions associated with self-harm in animals could potentially help human patients. “There are a number of things that vets do extremely expertly to reduce self-injury that are behavioral,” said Natterson-Horowitz, “[like] decreasing boredom, creating purpose, restoring challenges in life, particularly foraging for food and occupying their mouths and paws, depending on what the animal is.” A vet, for instance, might put a goat into a horse’s stall to provide companionship and combat isolation.
Other experts share Natterson-Horowitz’s belief in the value of cross-species care. A growing, veterinarian-led movement called One Health was launched about 15 years ago. The original goal was to unite human and animal medical professionals — as two branches of the same field — to control outbreaks of zoonotic diseases such as Ebola, SARS, avian flu and rabies. Over time, proponents of One Health have sought to apply its philosophy more broadly: Joint initiatives are underway to fight antibiotic resistance; a team of vets and doctors is calling for coordinated treatment of owner-pet obesity; schools of medicine and veterinary medicine are encouraging interdisciplinary study.
This level of collaboration differs radically from the centuries-old practice of animal research, in which species from fruit flies to mice to dogs are studied as human proxies. Instead, this approach challenges human exceptionalism by putting humans and non-human animals, as Natterson-Horowitz calls them, on the same plane.