I (Henri Bianucci) recently attended a local association meeting at which an invited speaker talked about “Fear Free” veterinary visits, a topic trending in the veterinary community.

The object is to design a physical environment and patient flow that minimize fear and stress for the patients. She stressed the importance of improved client services to boost the perception of value in the face of ever-increasing competition.

The range and form of veterinary services have expanded exponentially over the past decade, with the upward curve growing steeper each year. Human medicine tends to set the trends for our profession. It used to lead by a decade or so, but that time has shortened in recent years as health care innovations pour in at an astounding rate. Radiation therapy, stem cell therapy, mobilization of the body’s immune system to fight cancer, cloning and genetic profiling are just a few examples of advanced treatments that a decade or two ago would have been veterinary science fiction but are now readily available — for a price.

As in the human field, innovation has driven specialization, which has moved more complex cases into the realm of specialists and away from the general practitioners who used to handle them.

Emergency/critical care centers also are multiplying, handling cases that used to be seen by the family veterinarian. Low-cost spay and neuter facilities, some associated with animal shelters and some for profit, are now common and are absorbing some of the cases that would have been seen by general practitioners.

A new source of competition is coming into view in the form of telemedicine. This is where a veterinarian consults on a case remotely. It may be a specialist consulting with a general practitioner about a case, but it now has come to include a veterinarian consulting directly with a client about a pet he or she has never seen. The laws governing this vary from state to state, and seem to be selectively enforced.

In general, it is not legal to provide medical advice unless there is a bona fide client-patient relationship, but the guidelines are not uniform. In the human arena, telemedicine generated revenues of $240 million in 2013, and have been projected to balloon to $1.9 billion by 2018. If veterinary medicine follows suit, as history suggests it will, this will become another significant source of competition.

Add to this the burgeoning number of new general practices that are opening, and it becomes clear that to succeed in general practice, one must provide excellent service and create a pleasant experience for the patient and client.

But as a pet owner, one should consider one more important reason to stick with your family veterinarian. In the wake of a barrage of creative ideas to make practices stand out, the heart and soul of medical practice is being lost: the thorough physical exam.

This week, three of my colleagues referred their patients to me for surgery, and all three happened to have the same problem: anal sac aadenocarcinoma (cancer). Like skunks, dogs have a pair of glands near the anus that produce a foul-smelling material that they use to mark their territory. Skunks have weaponized these structures for self-defense.

These glands are prone to a type of cancer that is highly malignant, tending to spread to local lymph nodes, liver, and lungs. Because of their location, these tumors often go undetected until they are in an advanced stage. This can mean a much more extensive surgery will be necessary, or that it’s too late for any surgery at all.

The best prognosis for these tumors is yielded when they are detected early. All three of these dogs had tumors that were so small I could hardly feel them, even though they were sent to me with records telling me exactly where they were.

I was so impressed that these veterinarians had performed their examinations in such a meticulous manner during routine check-ups, allowing them to detect something that could easily have been overlooked. These dogs had no clinical symptoms indicating their presence, as is so often the case with cancer. This is why it is known as the silent killer.

All three of the dogs had surgery and the tumors were removed completely with no evidence of having spread.

They have been given the best possible shot at a long-term remission or cure because their veterinarian knew what to look for, and then actually took the time and effort to look.

Bells and whistles are nice, but advanced diagnostics and therapies stand on the foundation of the physical exam. When performed regularly and thoroughly, nothing will do more to keep your pet healthy and by your side for as long as possible.

Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to petdocs@postandcourier.com.

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