Beware of Practitioners of Negativity

As in any profession, there are as many different approaches to the practice of veterinary medicine as there are veterinarians. No one method is wrong, however some may be better than others. I am a big believer in education of the client, walking them down the path of understanding the condition that is affecting their pet and explaining the best plan and the potential outcomes. It may seem intuitively obvious to you that this is the way any medical consultation should be handled, but it is not everyones approach. There are practitioners that do not take the time to create a complete plan and provide a picture of the reasonable expectations for the patient. They tend to take short cuts and, if they are not careful, they can become practitioners of negativity.

As my parents have aged, I have become increasingly aware of certain doctors making treatment choices based on their age and seemingly lowering their expectations for their patients.  How often have you heard of a veterinarian saying that the pet was too old, or the condition too ‘bad’ to treat?

“It’s too serious” or “ poor prognosis” with out an explanation or a discussion of options is quite frankly a cop out. I do not mean to imply that every disease can be cured. Unfortunately, ultimately, some disease does eventually lead to the demise of every organism. The issue at hand is how do we fend off disease and how well will the patient fair during that treatment process and how acceptable is the plan to it’s owners . I like to refer to it as our philosophical approach to the patients illness.  With each patient, each set of clients, and each disease process  a philosophy for the management of the illness has to be developed. This is even more important in veterinary medicine where the cost of the services, the amount of at home care the patient will need, and the cost of medications all play a roll in developing that ‘philosophy’. 

It takes a considerable amount of effort, continuing education, experience and time to be able to allow owners an idea of what is wrong with their pet, why it is an issue, what can be done and how their pet will recover. I recently had this discussion with an emergency doctor. I had  noticed that a number of her cases where given a grave prognosis and the owners had elected either euthanasia or ‘hospice-type’ care. There was a common thread among these patients, they all were older and they each had a hemoabdomen (free blood in the abdomen). We discussed these cases and what I appreciated was that her scope of understanding regarding possible causes and outcomes was limited. She needed to go beyond recognizing the condition was serious and realize what options were available. Now she is realizing that there are diagnostics that can define just how serious the condition is and identify the cause. Once this is understood the owners can be educated about the choices they have and potential outcomes. Some of these patients can go on to live normal lives, just because it ‘looks bad’ on initial presentation.

I have a friend that had an geriatric cat that had a number of illnesses. I tried to help her as best as I could long distance. She visited with specialists that appeared to be unenthused about managing a geriatric with multiple health problems. They provided palliative treatments. Here is where they really failed my friend, they did not explain that by following this conservative approach a certain outcome was to be expected. They also did not provide an over view of the potential benefits and risks of a more aggressive approach. My friend quickly became disenchanted with this practitioner. Later, when the pet was failing even more, she visited another veterinarian who played the ‘it’s bad’ card and recommended euthanasia. Again, that may have been a very appropriate choice under the circumstances, but it is a choice. A choice made by the owner with information and options, that is what a good practitioner owes their clients. 

Over my career I have managed patients that other clinicians had declared to have a poor prognosis or a serious condition. These owners wanted more choices, and we together crafted the plan that met their expectations and their pets needs. Many of these pets lived on, very happily, to far exceed their previously poor prognosis. 

Painting an inappropriately rosy picture is wrong, but educating and providing options is definitely the name of the game. Even with the benefit of information some clients are going to choose conservative plans, and that is alright. The important thing is they made educated decisions.