Living with Each Other’s Choices

I feel like I’m sharing a well kept secret of veterinary medicine here. Except it shouldn’t be a well kept secret or a secret at all. Your pets; they belong to you. They are yours. You are the decision maker when it comes to their healthcare. Our job as veterinary professionals is to understand your problem, use our training and understanding to formulate an approach to the problem and finally, share all of that with you in the form of a recommendation.

That’s all it is. A recommendation. You are always in the driver’s seat. Sometimes, it seems like you don’t have a choice. Sometimes there are few options and sometimes decisions need to be made right away but you are always in control.

Right now I see emergencies exclusively, when I actually started this article I was doing a lot of dentistry, the parallels are very similar. When someone comes into the emergency clinic I work at right now, we often have to have difficult discussions about the problem at hand, how much it is going to cost to get a handle on the problem and the fact that we need a considerable amount of that money BEFORE we do anything with their pet. One tricky thing about quality veterinary care is that it is really expensive to provide. Our equipment, supplies and training cost just as much as the ones utilized by the health care teams who provide our own health care. The costs are essentially the same for all clinics, so if you are getting a great “deal” at your current veterinarian, I promise they’re cutting the costs somewhere. Our pets have many of the same health problems we do as their owners. And the treatments are also very similar in a lot of ways. One big difference, our patients more frequently need to be under anesthesia in order for us to do a satisfactory job. I’m not going to try to reason with a worked up house cat about, well anything really. Lacerations, porcupine quills, dentistry or even growth removals could all happen with local anesthesia in people, not so with pets. As a result, we have added costs in many areas based on the way our patients respond to care. When we are adding things like anesthesia, we are also adding risk as well, mitigating risk involves gathering additional information like blood-work, chest x rays or blood pressure measurements. This additional information also adds cost. All of it, from running blood-work to walking in the front door, is voluntary, but once we start down that path the veterinarian treating your pet has a responsibility. It is our responsibility to provide you with as thorough a plan as possible to give you the best opportunity to make an informed decision about your pet’s healthcare. What you choose to do with that plan is completely up to you.

If a person were to bring a dog having seizures to a veterinarian and task that veterinarian with figuring out why your dog is having seizures and what could be done about it, That seems like a pretty straight forward issue, make sure it’s otherwise healthy and put the dog on anti-convulsant medication and that should work, right? Maybe. I bet you would be successful most of the time with that approach. At least better than half the time, depending on the factors involved of course. If a client came to me and asked if we could just try medication, I would be willing to consider that approach so long as the client understood that we were taking a risk of missing the cause and potentially making things worse. If all I know is that you have a dog having seizures, the list of possible causes is pretty extensive; infections (viral and bacterial), parasites, toxin exposure, electrolyte abnormalities, congenital abnormalities, cancers, liver disease, kidney disease, metabolic diseases, trauma, nutritional deficiencies are just some of the causes of seizure activity in dogs. The better approach would be to fully examine the dog, discuss with them what the seizure activity looked like, how long it lasted, how often it occurred and how the dog recovered to determine first if it was truly a seizure, what kind of a seizure it was and where our diagnostic testing should start. There will be different approaches for patients in different age groups or breeds for example. Then we would present the dog’s owner with a comprehensive idea of where diagnostics should start and how we can expect things to proceed. In this situation the client can now take all of the provided information, process it and make a better informed decision. They could even take the recommendation, leave, go home, look everything up on the internet and come back with a series of questions for their veterinarian. From that conversation a diagnostic plan could be implemented and they could start down the path towards understanding their pet’s medical condition and needs but in order to get there, we need to present the owner with a complete plan.

One of my least favorite questions to answer when presenting a plan is which part of the plan is necessary. Personally, it bothers me because the idea that I would offer unnecessary testing is the same to me as asking if I’m trying to steal from you. The answer is no. Professionally, it’s a frustrating question because the only appropriate answer is, “It depends.” It depends on what you as the customer wants. Do you want to know why your dog is having seizures or do you just want to try something to see if we can reduce the number or duration of the seizures? Perhaps rather than asking how much of this is necessary, it might be better worded as, what is the minimal amount of information we need to have a reasonable chance at a positive result? Of course the answer to that is also, “It depends.” It depends on how extensive the problem is and what the solution is going to be. Sometimes, even the options available to us are incredibly limited. I still think we can have a satisfactory outcome every time just as long as we are communicating openly and understand what we are doing. Even if we chose the minimal amount of information path, if we communicated effectively,  going down a path with a lot of uncertainty surrounding our issue is alright.

Where we start to have trouble is when the communication breaks down. If we don’t have access to all of the information that makes sense for this problem then it becomes harder to come up with a treatment plan. Without a solid treatment plan we might not have the expected results, they may take longer or we may encounter complications. It’s possible everything will be completely fine but when things don’t get better or take a long time in getting better it’s also very possible that those missing pieces of information would have helped. It doesn’t mean we have to do everything recommended every time or right at the beginning. It means we have to be open and realistic about expectations. And we all have to be on the same page. And we all have to accept responsibility for our own decisions.

In no way am I typing this hoping that you start spending more money at your veterinarian’s office and I would feel awful if you took this to mean that I think you should spend more than you can afford. What I am trying to articulate is that both sides of the exam table are making decisions and as long as they are on the same page and can be frank and candid with one another, I expect every outcome to be satisfactory.

Thanks for reading.

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