Veterinarians' words carry the authority of the healer

Aesculapian authority, the authority that society accords to healers, is both powerful and perilous—according to Bernard E. Rollin, PhD, a philosophy professor at Colorado State University.

Dr. Rollin spoke July 15, during the AVMA Annual Convention in Hawaii, about "Aesculapian Authority and Communication in Veterinary Medicine."

The ethicist indicated that explaining, eliciting consent, and empathizing are the three E's of communication. He said veterinarians must learn to explain medicine for clients without being patronizing. Eliciting consent for procedures is moral and prudent. And empathy requires veterinarians to imagine themselves in the position of the client.

"No one wants to feel that their animal's medical problems are to veterinarians as a clogged toilet is to a plumber," Dr. Rollin said.

The concept of Aesculapian authority from human medicine increasingly applies to veterinary medicine because of society's current view of pets. In the past 25 years, companion animal medicine has moved to a pediatrician model.

The authority of the healer is uniquely powerful, Dr. Rollin said. It compels patients to listen, follow orders, and undergo unpleasant procedures. Doctors reinforce their authority by never disagreeing in front of patients and always addressing one another as "Doctor." Veterinarians sometimes use this authority to convince an owner with a sick pet, similar to pediatricians attempting to convince a parent with a sick child, to agree to let them proceed with treatment.

The perils of Aesculapian authority include self-fulfilling prophecies and the consequences of miscommunication. Veterinarians should ensure that the client understands what they mean. Estimates and prognoses can confuse clients, so veterinarians need to explain the uncertainties of medicine.

"You can say the same thing five different ways, and that's not too much," Dr. Rollin said. "Do not ever, ever use any medical terminology without explanation."

Veterinarians need to take animals' histories by asking questions in many ways. People rarely fault someone for speaking plainly.

Dr. Rollin said veterinarians who tend toward the pediatrician model often have moral stress when asked to euthanize healthy animals. Aesculapian authority allows veterinarians to suggest alternatives to convenience euthanasia of an animal.

Conversely, the healer's authority allows a veterinarian to convince a client to let go of an animal in chronic pain. Dr. Rollin said veterinarians should answer when a client asks the question, "What would you do if it were your dog?" He said the veterinarian plays the role of counselor as well as doctor.

Dr. Rollin concluded by saying that the veterinary establishment needs to spend more time teaching ethics and communication.