For many older people, an animal is their most constant companion, but concern for a pet's welfare can become a practical barrier to healthcare. Patients may delay seeking care, worry about coming to hospital, or discharge themselves because there is a pet at home.
A patient's bond with her dog
In a recent column for the Guardian, Australian oncologist Ranjana Srivastava describes a patient who, despite cognitive impairment, managed at home with little help beyond an occasional carer. After a fall, she was admitted to hospital and has been waiting for residential care for weeks. The patient can recall little about her life, but her descriptions of her small brown dog are unwavering: he curls up on her lap when she knits, follows her around her apartment, and jumps into her lap when she settles into her armchair.
The paramedic who rescued her noted that a neighbour had offered to take the dog until the patient's return, but this time she is not going home. The patient longs for her dog, but there is no easy provision to reunite them. The neighbour cannot bring the dog in, and the hospital will not allow it, citing concerns about other patients and potential distress or safety risks.
Pets as social determinants of health
Srivastava writes that relationships with pets matter to wellbeing, providing physical activity, psychological comfort, and social connection. She points to a recent essay in the New England Journal of Medicine on human-animal relationships, which recognises that the wellbeing of humans and their pets is intertwined.
In the past, social history in medicine often consisted of just two questions: does the patient smoke, and does the patient drink? Today, doctors ask about living arrangements, services, falls history, and family involvement. Srivastava suggests adding another question: are you concerned about a pet?
Addressing the gap in care
The solution cannot be another mental responsibility casually added to the medical worklist, she argues, but ignoring the issue does not obscure the problem. For many people, pets are part of the social determinants of health. Hospitals cannot take on this responsibility alone, but it is time to ask how they can work effectively with community services and animal welfare agencies to care for the whole patient.
During the patient's care, one doctor from the team sat with her and heard her retell the story about her dog, never letting their interest drift, even as their hearts slightly broke each time. Every one of them would have brought in her dog, if only they could. Eventually, the team rotated out, leaving her in the hands of another team, hoping they would continue the ritual.
