I can offer a personal testimony on this issue. I have not reviewed the relevant scientific literature, if any.
I have one patient who uses an anxiety dog and says she gets great benefit from it. She had the dog before I knew her, so I can’t comment on how much improvement it may have produced. I also don’t know what special training, if any, it may have received, but I can say that it appears to be a very well trained dog, and I can’t imagine anyone other than the severely allergic or dog-phobic from objecting to its presence.
When I first met her (having been previously warned, um, brought up to date on her history, by clinic staff), she produced a tattered, semi-legible letter from her previous shrink telling whom it may concern that she had a medical necessity to keep poochie with her at all times to avert crippling anxiety attacks. She asked me to retype it on fresh letterhead with my name, as it was looking rather raggedy having been carried around in her purse for years.
My thought process was approximately as follows:
I have never heard of this treatment modality before. If I sign this letter, I will be abusing my position as a doctor by falsely implying that I have the slightest clue how to evaluate whether a patient would benefit from having an anxiety dog and how to judge whether a particular dog is well suited for this purpose.
:dubious: Surely her previous psychiatrist would not have signed such a letter if she did not have specialized expertise and experience in this matter, and I can safely rely on her professional judgment…right?
:eek: If I don’t sign the letter, she will have a huge meltdown in my office, I will be way behind schedule by the time I can get her out the door, and my boss, her boss, and his boss will have to waste many hours of their valuable time pretending to take her hysterical complaints about me seriously. Our doctor-patient relationship will be terminally poisoned before it even gets started.
It’s such a cute puppy!!
This is clearly a woman with legitimately severe psychiatric illness. Despite many years of treatment, she can’t work, has no meaningful relationships, and doesn’t leave her house unless absolutely necessary and sometimes not even then. She sure ain’t going on no cruises! If, by signing this letter, I can bring a bit of pleasure into her life and make it more likely that she will be able to make it to her crucially necessary doctor’s appointments (she’s a wreck physically, too), I’m not going to lose much sleep over it even if it is a tad ethically dubious.
I would like to say that my decision to sign the letter was based entirely on weighing
against :dubious: and
, and that I was able to disregard considerations of :eek: and :D. Hopefully, I would have been able to say no to someone who just wanted to take her pet Yorkie on a cruise.