More on veterinarian wellbeing

Like Dr. Fox,¹ I too was disturbed by the findings of the recent Merck Animal Health Veterinary Wellbeing Study, but perhaps for different reasons.

I first became concerned about the future of the veterinary profession in 1996² and have been continually frustrated since then by the profession's failure to address what I believe to be the root cause of poor wellbeing: our inability to provide a less expensive way to produce effective veterinarians. Substantial curricular reform and minimization of preveterinary requirements have not occurred, and veterinary student indebtedness has ballooned as a result. The failure to address this root cause has resulted in the relative impoverishment of 1 or 2 generations of young veterinarians, with no improvement in sight. Suicide intervention, debt counseling, stress relief, and financial planning are all necessary but don't address the root cause. Although it is rather late in the game, I hope that the Association of American Veterinary Medical Colleges and AVMA will take action.

For me personally, as a food animal veterinarian, there are several reasons I may score higher in wellbeing. I am an older, white male who derives a great deal of satisfaction from keeping large numbers of animals from getting sick in the first place and providing the ultimate in the human-animal bond: food. I also have the satisfaction of working with a dedicated group of agreeable people acutely interested in keeping their animals healthy. That, to me, is personally much more satisfying than working with individual companion animals owned by multiple different people. I greatly appreciate those who have the patience and expertise to do so. But, I do not.

Eric Gonder, DVM, PhD

Butterball LLC Goldsboro, NC

Tracking quality of life for dogs with cancer

I want to congratulate Giuffrida et al¹ for their development and validation of the Canine Owner-Reported Quality of Life (CORQ) questionnaire, which was designed to measure quality of life (QOL) in dogs with cancer. With it, they have simplified previous questionnaires meant to measure health-related QOL.²

In their report, the authors discuss the discrepancy between veterinarian definitions of successful treatment in dogs with cancer and client expectations, with pet owners more interested in QOL and less so in tumor size or disease stage. Because owner-perceived QOL is such an important disease end point, it is critical to develop tools that allow veterinarians and other researchers to quantify QOL. Unfortunately, a previous study³ found that only 6% of published prospective studies involving dogs and cats with cancer measure QOL.

The sound scientific basis and relative scoring simplicity of the CORQ questionnaire will make it an invaluable tool in clinical veterinary oncology research, especially because it “emphasizes pet-centered domains such as vitality and companionship (rather than clinical signs of illness).”¹ As the authors point out, when the questionnaire was being developed, “interviews with pet owners proved to be the richest source of information and content validation, with most of the items retained in the questionnaire derived from owner feedback.”

In addition to being invaluable to clinical oncology researchers, frequent tracking of QOL by owners seems likely to improve patient care. As discussed elsewhere,^4,5 a practical daily instrument can be an important adjunct to other more refined tools; however, the full CORQ questionnaire does not seem to lend itself to daily tracking of QOL. As an alternative, in my practice, I ask owners to track 4 factors—behavior (acting like normal self), energy, appetite, and mood—on a daily basis and have found this to be an invaluable method to improve patient care over the past 10 years.

Involving our clients in the treatment of their pets improves treatment compliance and outcome.⁶ The CORQ questionnaire in conjunction with daily monitoring of QOL would seem to hold promise for improving care of individual dogs undergoing cancer treatment.

Jeff Feinman, VMD

Weston, Conn

The authors respond:

I appreciate Dr. Feinman's feedback regarding our recent article “Development and psychometric testing of the Canine Owner-Reported Quality of Life questionnaire, an instrument designed to measure quality of life in dogs with cancer.” Conscientious, compassionate veterinarians have long sought to incorporate practical quality-of-life (QOL) assessment into cancer case management. My co-authors and I sought to develop a standardized general QOL measurement tool that would be valid, user-friendly, and freely available to clinicians and researchers.

Although our primary aim was to provide a means to improve outcome assessment in veterinary clinical research, we are certainly pleased for the CORQ questionnaire to also be acknowledged as a valuable clinical tool.

We have found that asking dog owners to complete the CORQ and other relevant questionnaires at appointment check-in provides more complete and standardized information regarding owner perceptions of their dogs' recent experiences and also transfers the time burden of gathering this information to the client. Although the scoring system is useful for research purposes, it is not essential to calculate an overall score when the CORQ is used in everyday practice. Given the questionnaire format, it is possible for veterinarians to make at-a-glance evaluations and easily compare responses between visits. In our experience, using the CORQ this way results in a richer and more efficient discussion of issues potentially impacting QOL, as compared to routine client interviews.

Michelle A. Giuffrida, VMD, MSCE

University of California-Davis Davis, Calif

Dr. R. Tracy Rhodes

With the recent passing of Dr. Tracy Rhodes, veterinary medicine has lost a treasured member of its ranks, and I personally have lost a friend and mentor who defined what it means to be a great person and great professional. I worked with Tracy on the former AVMA Member Services Committee. At that time, he had been retired for more than 16 years, after spending decades in clinical practice; had served on the AVMA Executive Board (now Board of Directors); and was a director for the American Veterinary Medical Foundation. His marriage to Phyllis was nearing its 50-year anniversary, and their children had long since left the nest. In contrast, I had just graduated from veterinary school, was neck deep in studies for my PhD degree, and was receiving my first introduction to organized veterinary medicine. I was recently engaged and several years from having children. I had yet to be humbled by life, and Tracy had seen it all. We were at opposite ends of our careers, yet Tracy was willing to help and mentor me, praising me for things I did right and correcting me for things I did wrong. He was blunt and opinionated, but he was also a good listener and patient when he needed to be. He never spoke over others, included his wife in his professional life, and always opened doors—literally and figuratively—for others. As a blunt, opinionated veterinarian myself, I saw Tracy as a role model for what I could achieve in life and this profession. Many knew Tracy better than I did, but few respected or admired him more than I do.

Veterinary medicine continues to have many problems, with socioeconomic concerns, racial and cultural diversity, and student debt being just a few of the issues we face. But, it is a great profession with boundless potential. As a young veterinarian, I had a chance to see the AVMA with unfiltered eyes. And working with Tracy, I could see that he was there for all the right reasons and was willing to put in the time and effort necessary to fix some of veterinary medicine's deep-rooted problems. Tracy's passing means that there is an empty seat at the table for those who desire real progress in the profession. I write with the genuine hope that I, and others, can live up to this challenge.

Scott Takeo Aoki, DVM, PhD

Madison, Wis