Unexpected complication

Well, I ran into an issue that I really wasnt expecting...I contacted the veterinary medical board in State of California to find out if I could acquire a list of small animal veterinarians. Although I can find a listing of veterinarians on the governments website, I can not single out those that strictly work with small animal. Most veterinarians are small animal veterinarians, however it would save time if I could find a list of those that simply practice as small animal veterinarians.

How would that help me?

The focus of my capstone project is small animal veterinarians and family physicians; a list already determining all of the licensed small animal veterinarians in a state would reduce my additional steps of looking up every potential contributor to my capstone online to determine their primary patient species. Its not impossible, just incredibly tedious.

To get back to California...

When I spoke to the office of the veterinary medical board I came to one of my first official stand stills, they wanted me to fax them the jest of my capstone study. I immediately sent out the following statement...

In the United States, four of every 10 homes own a dog and three of every 10 homes own a cat1. Zoonotic disease accounts for approximately 60% of all infectious pathogens2. A collaborated effort between veterinary medicine and human medicine is required to reduce or eliminate zoonotic disease transmission. The purpose of the study “Friend or Foe? The working relationship between veterinary medicine and human medicine” is to evaluate current communication methods regarding reportable zoonotic diseases between members of both health professions and develop the means to create improved communication. During my video presentation, I will conclude with recommendations to improve communication between small animal veterinarians and family physicians.

Florida, California, Texas, and New York are the states in my study and are the best representation of the continental United States due to their climates, ecological factors, and economic standings all of which can influence the types of zoonotic diseases seen in each area3. Each states sample is determined by the states provided current licensed and practicing family physicians and small animal veterinarians. I am sending a request to complete my survey provided by a link through www.surveymonkey.com to a random 150 professionals from each profession in each state, ultimately requesting voluntary participation from 600 small animal veterinarians and 600 family practice physicians. In addition to the request for completing a survey, I am asking for participation in phone interviews and a web forum. The electronic survey will collect general information on the communication efforts between veterinarians and family practice physicians. However, the phone interview will provides specific viewpoints from the professional and a web forum will be offer a means for professionals to give a viewpoint in real time in an environment similar to that of brainstorming. Analyzed data provided by the electronic survey is anonymous, the phone interview may or may not be anonymous, and the web forum will not be anonymous. The consent form indicates the anonymity of the phone survey, denotes the lack of anonymity with the phone interview and web forum, and explains that declining involvement in the interview or forum does not affect the results or potential participation in either.

Approximately a week and a half later I received an email from the State of California that their legal department does not believe its a good idea to release the information to me. To be honest it did shock me. I'm not asking for information I do not already have access to through their website. The point of contacting them was to shorten my steps so that I do not have to look up every potential participant for my project. Prior to contacting the veterinary medical board in California, I had also contact the veterinary medical boards in Florida, New York, and Texas and had no problem getting information from them (when information was available, as some states do not make a distinction on the primary patient species).

So, what was the result?

I decided to not acquire information from veterinarians in the State of California. I really do not understand what the problem is, however at this point since I received correspondence in writing telling me they would not release the information to me, I do not want to cause a potential professional rift. If I was completing this survey as a professional having already attained my degree, I may have a difference of opinion on the matter.

Why was this unexpected?

Since the veterinary medical boards in most states provide the contact information for their licensed and practicing veterinarians I did not see it as a problem to contact them and ask them to narrow down their pre-established public list. Its one of those bureaucratic red tape situations that requires me to evaluate the scenario determining if the possibility of causing ripples in the pond is necessary (or should I take my business elsewhere...lol).

1 Crosby, Janet. (2009) Veterinary Medicine. Retrieved on December 8, 2009. Retrieved from
http://vetmedicine.about.com/diseasesall/a/aa051303a.htm
2 Rabinowitz, Peter M, Conti, Lisa A. (2010) Human-Animal Medicine Clinical Approach to Zoonoses, Toxicants and Other Shared Health Risks. Saunders.

3 Department for International Development. (2006) Zoonotic Diseases in Livestock. Retrieved on December 6, 2009. Retrieved from http://www.smallstock.info/info/health/zoonoses.htm

I propose...

I handed in a revised proposal this week and it was accepted (whew!). The first time I completed the proposal for this class I felt a little lost. Although the textbooks provided valuable information, it really wasn't practical for actually writing the proposal. After doing days and days of research before I did the paper, just to determine the format... voila, its complete! I would upload it for you, but I can't seem to figure out how to upload a .doc document (it appears blogger only allows for video's and photo's), so I decided to copy and paste it. However, your not seeing the entire 19 page proposal, just the literature review portion.

I hope you enjoy!

LITERATURE REVIEW

Zoonotic diseases account for 60% of all human pathogenic disease causing organisms (Rabinowitz, Conti, 2010). In the United States, four in every 10 homes owns a dog and three in every 10 homes owns a cat (Crosby, 2009). Pets bring people, more specifically pet owners, into situations where they can contract a zoonotic disease. What roles do the veterinary medical profession and human medical profession have or promote jointly in controlling zoonotic disease in their communities? The provided literature is going to explain why the need is present to define roles of health professionals, give present day examples when communication has been especially important, and define collaboration.

We are at an unprecedented time. Pet ownership is high, traveling to other countries is common, and in addition we are at war; the combination is an open door to zoonotic diseases Americans may not otherwise had been exposed to or heard of. With the high profile coverage of swine flu, or H1N1, the realization became clear of the importance of proper education through medical channels to prevent transmission.

In response to zoonotic diseases, such as H1N1, the Center for Disease Control and Prevention (CDC) combined efforts of The National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED) and the National Center for Preparedness, Detection, and Control of Infectious Disease (NCPDCID) forming the National Center for Emerging Zoonotic Infectious Disease (NCEVID; National Center for Emerging and Infectious Zoonotic Disease, 2010). Of the multiple ways the NCEZID helps to control zoonotic disease transmission in the United States, two are making an important contribution to this research project through their surveillance of outbreaks and disease and through their reporting of disease and outbreaks to the community and medical professionals (National Center for Emerging and Zoonotic Infectious Diseases, 2010). The NCEZID uses the publication Emerging Infectious Disease as a medium for medical professionals offering the latest information on infectious disease concerns.

A rabies outbreak in coyote populations of suburban Massachusetts is an example of a zoonotic disease requiring veterinary and human health professionals to relay risks and prevention measures to the general public (Wang, Brown, Smole, Werner, Han, Farris, DeMaria, February 2010). Organizations such as the World Medical Association (WMA) provides additional means for health professionals to acquire information in the prevention and control of disease transmission, their function is to “constitute a free, open forum for frank discussion, not of clinical problems, but of matters related to medical ethics, medical education, socio-medical affairs and medical topics generally (World Medical Association Inc, 2009).” The WMA emphasizes the shared roles both veterinary professionals and human health professionals have in controlling communicable diseases, “By their very nature, the fields of human medicine and veterinary medicine are complementary and synergistic in confronting, controlling and preventing zoonotic diseases from infecting across species (World Medical Association Inc, 2005).” To prevent the spread of a communicable disease there must be collaboration between both health professions.

Many subtopics exist among professions from issues of immune system suppression, when to vaccinate (in reference to human vaccinations), and the variations of medical treatment depending on location and resources (rural areas versus cities and well-populated suburban areas). Each subtopic explores another need for regular communication between veterinary professionals and human health professionals.

Sitaram Aryal (2000/2001) issues the point of antibiotic resistance as an important topic for both veterinarians and physicians “The wide spread use of antibiotics in human and animal has raised the concern about the development of resistant and multi resistant bacteria that posses a potential danger to animal and men, as resistance may cause treatment failure.” The American Society of Health-System Pharmacists (2009) offers resources to lay persons regarding the importance of vaccinating against the rabies virus. This is a wonderful resource. However if those in the veterinary or human health profession are not informing the general public of rabies control measures, for example, how will the general public become acquainted with the resource? How will those needing information on disease transmission attributed to contaminated water or soil know to seek out the resources of The Board of Agriculture and Natural Resources (1999)?

“Collaboration and communication between human medicine and veterinary medicine have been limited in recent decades, yet the challenges of the 21st Century demand these two professions work together (World Medical Association, 2005).” Diseases such as H1N1, rabies, Monkeypox, and SARS have brought to the forefront the need for communication on all levels between medical professionals (Lynn, Marano, Treadwell, Bokma, 2006). Animals, people’s pets, furry children, and four legged friends and their relationship to people have created a concern for disease, health professionals need to be the medium offering methods to control zoonotic disease transmission. From the man who coined the term zoonosis, nineteenth century physician Dr. Rudolph Virchow to the modern day 1996 Nobel Peace Prize winners Dr. Rolf Zinkernagel (physician) and Dr. Peter C. Doherty (veterinarian), disease transmission risks between humans and animals have required communication (Rabinowitz, Conti, 2010).

Under the Patient Bill of Rights, “The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment and prognosis (Purtilo, Haddad, 1996).” From the Patient Bill of Rights to the veterinary oath of swearing to use “scientific knowledge and skills” to benefit the general public through the “…promotion of public health, and the advancement of medical knowledge (American Veterinary Medical Association, 2004)” the convergence of both health professions are necessary to move towards eventual eradication, and present day control, of zoonotic diseases. Each profession offers something the other cannot; one has expertise in veterinary medicine the other in human medicine. The health of one household affects the health of its surrounding community and requires effective communication between pet owner, physician, and veterinarian.

REFERENCES

American Society of Health-System Pharmacists. (2009) Rabies Vaccine. http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=meds&log$=drug_bottom_one&part=a607023

Aryal, Sitaram. (n.d) Antibiotic Resistance: A Concern to Veterinary and Human Medicine. http://www.narc.org.np/publicaton/pdf/journal
/Vol4/antibiotic_resistance_concern_veterinary_human_me.pdf

The Board on Agriculture and Natural Resources. http://dels.nas.edu/banr/
Center for Disease Control and Prevention. National Center of Zoonotic, Vector-Borne and Enteric Disease. http://www.cdc.gov.ncved/

David J, Rutal, William A. (2001) Risks and Prevention of Nosocomial Transmission of Rare Zoonotic Diseases. Healthcare Epidemiology 2001:32

Lynn, Tracey, Marano, Nina, Treadwell, Tracee, Bokma, Bob. (2006) Linking Human and Animal Health Surveillance for Emerging Diseases in the United States. Impact of Emerging Zoonotic Diseases on Animal Health 8th Biennial Conference of the Society for Tropical Veterinary Medicine Volume 1081. Blackwell Publishing.

Medline Plus. Animal Bites. http://www.nlm.nih.gov/medlineplus/animalbites.html

Medline Plus. Rural Health Concerns.
http://www.nlm.nih.gov/medlineplus/ruralhealthconcerns.html

Morgan, Juliette, Bornstein, Shari L, Karpati, Adam M, Bruce, Michael, Bolin, Carole A, Austin, Constance C, Woods, Christopher W, Lingappa, Jairam, Langkop, Carl, Davis, Belinda, Graham, Donald R, Proctor, Mary, Ashford, David A, Bajani, Mary, Bragg, Sandra L, Shutt, Kathleen, Perkins, Bradley A, Tappero, Jordan W. (2002) Outbreak of Leptospirosis among Triathlon Participants and Community Residents in Springfield, Illinois, 1998. CID 2002: 34.

Purtilo, Ruth, Haddad, Amy. (1996) Health Professional and Patient Interaction. W.B Saunders Company.

Olsen, Christopher W, Grant, Sara. (n.d.) Preventing Zoonotic Disease in
Immunocompromised Persons: The Role of Physicians and Veterinarians.
http://www.cdc.gov/ncidod/eid/vol5no1/grant.htm

Olson, Debra, Hoeppner, Mary, Larson, Susan, Ehrenberg, Anne, Leitheiser, Agnes T. (2008) Lifelong Learning for Public Health Practice Education: A Model Curriculum for Bioterrorism and Emergency Readiness. Practice Health Reports. 2008: 123

Rabinowitz, Peter, Conti, Lisa A. (2010) Human-Animal Medicine Clinical Approaches to Zoonoses, Toxicants and Other Shared Health Risks. Saunders
Survey Monkey. (2010) http://www.surveymonkey.com

World Medical Association. (n.d.) World Medical Association Resolution on Collaborating between Human and Veterinary Medicine. http://www.wma.net/en/30publications/10policies/v2/index.html