Have you ever taken your pet to the veterinary clinic for some problem and gotten the feeling that your veterinarian just wasn’t listening to you? Or you got the impression that the vet had already made up his or her mind regarding the cause and proper treatment of the problem before getting what you considered a complete history or thoroughly examining your animal?
At that time, you might have thought that the veterinarian simply didn’t care about your animal or you. But more often than not, these people really do care. It’s the way they’ve been trained that creates the problem. Fortunately, there are things you can do to help ensure the best care for your pet.
First a little background about the training. After World War II, veterinary medical education began patterning itself after human medical education. At the time, this was viewed as a boon for the animal population, but it was not without its hazards. One was the adoption of the problem-oriented method that reduces patients to, as the name implies, problems. So instead of Sophie being a somewhat overweight, timid beagle who lived in a family that included three boisterous young kids and 4 other animals, all of whom had recently moved into a new home, she became a urinary tract infection or even just a UTI.
There were and are many advantages to this system, one of the most important being that it eliminates numerous variables. Not only does that simplify and standardize teaching, it also simplifies and standardizes learning. Additionally, the problem-oriented method simplifies and standardizes treatment. And while of minimal interest to the average pet-owner, the standardization associated with the problem-oriented method also greatly facilitates records-keeping and data collection.
Once it was possible to collect all that data, the next step was to analyze it statistically and standardize the diagnostic and treatment process even more. Enter evidence-based medicine (EMB), the latest technological barrier to one-on-one veterinarian-client communication. It involves the clinician applying standardized algorithms—a kind of decision tree—to the problem and then collecting and interpreting data in accord with what the algorithm considers important while more or less ignoring everything else.
Given my bias regarding the need to explore the medical, behavioral, and bond implications that attend virtually every perceived animal problem, you might think that I have no use for either the problem-oriented approach or EMB. However, statistically speaking, if you’re lucky enough to have an animal whose problem fits these systems’ criteria, your animal should do all right, even if you personally find the approach cold and mechanical. If the approach doesn’t work for your animal, the process will be rerun using a different problem and/or algorithm until a match is found.
And this points out the two biggest flaws in these systems. The first is the aforementioned lack of quality communication with the owner or quality time spent examining the animal that these approaches either directly or indirectly promote. While some hospital administrators may see such interactions as a waste of time and therefore of no consequence, the number of malpractice suits triggered by such oversight strongly suggests clients do not agree. And for every lawsuit triggered by a lack of such meaningful interaction, there are probably thousands of folks who are irritated to one degree or another by their veterinarians treating them and their animals this way.
The second problem is that, if the veterinarian picks the wrong problem or algorithm and/or the animal falls outside the statistical norm for that problem or its treatment, the owner will need to invest more time and money to find the answer. Even if you have pet health insurance to pick up the tab, that doesn’t compensate for the time investment or any negative emotional affects this process may have on you or your animal. If you don’t have insurance or the wherewithal to pay on your own, then all you’ll have to show for your investment is knowledge about what your animal’s problem isn’t, but little or nothing about what it is.
So what can you do to stimulate those who have been trained in such a system to take a more comprehensive view? In an article in the September/October 2008 AARP Magazine, Jerome Groopman, MD (who wrote the book How Doctors Think) offers some suggestions for human patients that can benefit pet-owners, too. He proposes three simple questions that take into account the way medical minds are being trained to help avoid misdiagnosis, and I’ve adapted them for use in veterinary situations.
The first question is, “Is there anything else it could be?” This question immediately causes practitioners to think outside any problem box or algorithm that might be channeling their thoughts in one direction to the exclusion of everything else.
The second question is, “Could two things be going on to explain my animal’s symptoms?” Now in addition to enabling the veterinarian to think outside the problem-box, this one opens the door to thinking about more than one problem simultaneously.
Question Three: “Is there anything in my animal’s history, physical examination, laboratory findings or other tests that seems not to fit with your working diagnosis?” This is the kind of question that could lead owners who feel miffed about their veterinarian’s failure to do what they consider the basics to put an edge in their voice when they ask it. But do try to avoid succumbing to this temptation. Otherwise the question could come out sounding more like an accusation and alienate the veterinarian instead of ensuring quality care for your animal.
The reality is that, even though there unfortunately are those practitioners who are too rushed or lazy or lack the knowledge and skill to get a good history and do a quality physical examination and evaluate past medical history, others truly believe that the process they’ve been taught represents the highest standard of medical care. By keeping these three questions in mind, you can help them consider an alternative view that will enable them to refocus their energies on your specific animal rather than the process.
It would be convenient if medicine was a precise science, the teaching of which took into account all those variables that make up each animal’s behavior, physiology, and relationship with others in their particular environment. Alas, medical science is a very imprecise science that, at best, currently embraces methods that ensure accuracy relative to populations rather than individuals. To ensure the best care for any one animal, it’s up to each of us to provide the precise and meaningful information and guidance, if necessary, to transform our animals from a problem and statistical probability into individuals, each worthy of being treated as the unique beings they are.
If you have any comments regarding subject matter, favorite links, or anything you’d like to see discussed on or added to this site, please let me know at mm@mmilani.com.