Last week I gave a talk about One Health in primary care to a group of Family Medicine faculty, and we had a chance to discuss their personal experiences and perspectives on the concept of human health, animal health, and the environment intersecting in the primary care setting. Before the talk, I had sent them a link to our recent publication about One Health in medical education.
In my talk, I (of course) mentioned zoonotic disease risks from pets and wildlife, as well as animals serving as “sentinels” of environmental health hazards, and the potential for greater leveraging of the human animal bond in medical care. The faculty found these points interesting and possibly valuable, but had additional requests for more information, training, and best practice guidelines, including:
- How should they handle requests to sign certification letters for patients to have their animals declared service or emotional support animals?
- How do they know if their patients are abusing medications prescribed for pets, and what can they do to prevent such abuse?
- How could they provide more comprehensive occupational health services to veterinary workers, farm workers, and others with close animal contact?
- How do they respond to a patient who wants a letter in support of an animal assisted therapy program, and should their insurance pay for it?
- How do they counsel patients about prevention of animal bites?
- What should they do about the growing number of patients who want to bring their animals into the clinic and the examining room, and how should they handle dogfights or cat fights in the waiting room?
- Could the electronic medical record (EMR) be improved to capture better information about animals in the household, and other animal contacts?
- How should they counsel their patients (and trainees) going overseas in terms of animal related risks?
- How can they find out more about cancer detecting dogs, seizure dogs, and other types of advanced service animals that might benefit their patients?
We talked about these issues and went over the allotted time for the session. It was obvious there are a lot of One Health issues to address in primary care!
Peter Rabinowitz, MD MPH
March 6, 2017