Dr. David Robbins' comments ("Doctor Debate: Wellness testing—good medicine or not?" May 2011) are interesting but have some
flaws in my opinion. To suggest that wellness testing is simply a matter of income generation seems to imply that veterinarians
work primarily on profit generation/motivation and less on the practice of good medicine. Savvy veterinarians realize that
small changes may indicate a bigger problem brewing. Sure, there will always be veterinarians who skim the lab work and look
only for high or low flags instead of at the results of individual tests as well as the panels as a whole to evaluate how
each system interrelates. But for those veterinarians who take the time to review the results and compare them (if applicable)
to previous test results, this is simply practicing good medicine.
PHILIP J. BRITTAN/GETTY IMAGES
I agree that defensive medicine is not a warranted reason for wellness testing, but I do not believe that we are far from
a much bigger arena of litigation than we currently encounter. So I do not see the harm in wellness testing or preanesthetic
testing. I personally know that as a 21-year-old healthy veterinary student I was required to have preanesthetic testing before
orthopedic surgery, and it was required again a decade later for a subsequent orthopedic surgery after my anterior cruciate
ligament ruptured while I was playing softball (I was healthy then, too). I am sure that we all can agree that, given an opportunity,
lawyers will inquire why lab work was not performed before any procedure. The assumption exists that a problem could have
been avoided by obtaining such information.
As to Dr. Robbins' comment on disease screening, I fully disagree that wellness profiles are not indicated. His statistics
seem to overlook that you evaluate lab results in conjunction with the patient's physical examination results. Many dehydrated
animals have normal hematocrits until you hydrate them and identify severe anemia. It is imperative that lab work be interpreted
based on not only its values but also on how it relates to the patient's physical findings. Microscopic hematuria, which can't
be noted by the owner, may reveal urinary calculi and possibly an underlying urinary tract infection. Screening for problems
may reveal diseases in which early intervention may be curative or at least allow for better management of the disease.