Challenges in exotic animal medicine

Or Exotic Animal Medicine, how I see it.

POVM a 4 Step Process

• Problem-oriented veterinary medicine is a cyclical process directed toward identifying a specific diagnosis and implementing effective treatment.
• At each step mistakes can throw the system off track

Problems with POVM

• What test is validated?
• What drugs work?

What is the other option?

• Evidence-based veterinary medicine is a process used to guide clinical decision making, by integrating current best evidence with individual clinical expertise, client wishes, and patient needs.

Relatively new concept

• Introduced in 1992
• Has the potential to be considered "elitist"
• Does not mean personal experience and expertise should be thrown out of the window

This is where we go wrong

• Dr. A sees a patient with a disease that has to be treated with a drug B that has not been well researched in the species C.
• The drug B is given by Dr. A
• The client calls later to report that the animal died 8 hours later the same day.
• The owner (and Dr. A) now believe that it was drug B that killed the animal.

How to start?

• The process starts by composing a focused clinical question.
• Then answering that medical uncertainty through the use of critically appraising evidence.

Without evidence, there should be no conclusion

• Often no necropsy is performed (no toxicology data is collected) !!
• Often allometric scaling is not considered and the drug was overdosed!!
• Would you use the drug again? Or call you colleagues to warn them not to use the drug again in this species?

Finding evidence to answer the question

• Look in peer reviewed journals, books, online.
• And evaluate the evidence
• One of the most difficult parts.

Appraising the available evidence

• The evidence should be integrated with the client’s wishes, the specific patient’s needs, and the expertise and judgment of the attending veterinarian.
• Almost all exotic animal medicine review articles are “narrative,”citing published literature in support of the authors’opinions.

Final step: evaluate!

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