Accurately record “no treatment”
Too often if a cow does not receive a treatment that has a withdrawal, the fact that they had clinical disease isn’t recorded. Or, if the disease is recorded, the fact that the case was not treated is not noted. Typically “no treatment” refers to a decision not to treat a clinical disease episode with antibiotics.
This is most commonly encountered in herds that make clinical mastitis treatment decisions based on milk culture results. Those clinical episodes that come back as no growth or Gram negative (coliform) are not treated with an intramammary antibiotic. The first step toward accurate and consistent health-data recording is to record the fact that no treatment was chosen. If treatment is recorded as a two-character remark, such as SP — spectramast or TD — today, then NT — no treatment should be as well. This practice also keeps disease remark entries consistent (the third simple rule of good recording).
“No treatment” may also be elected when it is decided to remove a cow from the herd as a result of a clinical disease episode. Two common data-recording problems are encountered in this situation. The first is when the clinical episode that resulted in removal is never recorded. Obviously, this results in censoring of clinical cases with arguably the worse outcome. The second involves interpreting the outcomes of no treatment. We are commonly asked to compare the outcomes between cases that receive no treatment versus antibiotic treatment. To do this accurately we need to know whether a no treatment decision was with the intent of keeping the cow or removing the cow. The intent can be communicated effectively using two different remark abbreviations (e.g., NT — no treat, intend to keep, BF — no treat, intend to remove). This allows exclusion of those cows that were not treated because they were to be removed from the analysis. Of course, such a comparison is predicated on the assumption that treatment and no treatment were applied without case-selection bias, which is seldom true. Nonetheless, differentiating the intent of no treatment is important for evaluating adherence to established treatment protocols. Accurate and consistent health-data recording fosters maintenance of a valid veterinary-client-patient relationship (VCPR) when you routinely evaluate the distribution of treatments.
We often find that the “lesion location” (foot for lameness, quarter for mastitis) is not recorded when “no treatment” is selected for a clinical case. This is problematic if you want to track clinical episode outcomes at the quarter or foot rather than the cow-level. For example, a cow has a clinical mastitis episode in the right rear quarter treated with intramammary antibiotics recorded. A month later the same cow has a clinical mastitis episode that received no treatment and the quarter is not recorded.