oncologyoutlookSecond-Guessing a Valuable ExerciseSecond-Guessing a Valuable ExerciseDuring the midst of the long day of personal and professional choices, we hear from our client the "What would you do if it were your pet?" question in the examination room.During the midst of the long day of personal and professional choices, we hear from our client the "What would you do if it were your pet?" question in the examination room.Second-Guessing a Valuable ExerciseBy Kevin A. Hahn, DVM, Ph.D.Remember the days when there was just Coke or Pepsi? Can you believe the number of choices we face every moment during the day? From what color scrubs to wear, to which way to drive to avoid traffic jams, to what type of suture to use? Then, during the midst of the long day of personal and professional choices, we hear from our client the "What would you do if it were your pet?" question in the examination room. Some people enjoy the experience of choice. They learn about the condition, Web search diagnostic and treatment approaches, and delight in learning as much as they can about their pet's condition. In the end, they find the experience of choice quite fulfilling. But many others prefer a smaller number of choices, or no choice at all. When was the last time you heard the "What would you do?" question from one of your clients? Better put, how many times did you hear the question today? As an oncologist, it is generally the first question asked of me after I tell clients their pets' prognoses. Why do people sometimes value the opinion of another over their own? Is it from a lack of information or a lack of understanding? Is it the fear of making a mistake? Or is it an escape from accountability of the result? I believe the expectation of the client in asking "What would you do?" is that we are going to tell them what's "right" to do for their pet and no further harm or suffering will occur. Unfortunately, and regardless of our response, the process of second-guessing begins. Second-guessing is commonplace in today's society. It comes from having myriad choices and the regret of missing an unknown opportunity or benefit. Just as there are many brands of soft drinks, there are many different treatment choices. While everyone should agree that having choices is better than having no choice at all, I have observed an inverse relationship between the number of choices and client satisfaction. Making a choice can be paralyzing to pet owners. We can easily overwhelm pet owners with the facts about their pet's condition or, worse yet, the pet owner is overwhelmed by information and misinformation from other sources. While many of us may answer "the question" believing that it will help the client escape his paralysis and provide comfort, the opposite is likely to occur. Given too many choices and having the decision made by another leads to a greater degree of second guessing, hindsight and dissatisfaction, an outcome validated by many psychologists and client satisfaction surveys. Likewise, other social scientists have shown that by avoiding an answer to "What would you do?" we significantly increase the chances of owner dissatisfaction. It appears that a non-reversible decision is likely to make a person feel better about the choice made. This means presenting facts and objective (albeit realistic) outcomes. The alternative to the information overload approach would be to personalize the choices, provide examples or outcomes from similar choices by others and "package" or group some of the choices so that we limit the spectrum of choices. However, we should not purposely narrow the list of choices so as to mislead or misdirect the client to arrive at a more attractive or satisfying choice. To avoid the regrets or the "would've, could've, should've" interaction with your client, validate the positive aspects of the client's decision ("You are doing the very best for your pet's quality of life" or "This is a reasonable choice at this time") and not compare the pet's condition or outcome to those who only tend to do better. Reinforce why the current choice is medically appropriate. Maybe by narrowing the choices to only a few, the client will find reasons in hindsight to be grateful. I believe that second-guessing, or reflecting upon the choices in the context of the eventual patient outcome, is a valuable and good exercise. I think we all are second-guessers. We try to understand, rationalize, or perhaps attempt to improve an unhappy, unacceptable or negative outcome. If we don't re-evaluate our own performance in view of the patient outcome, we develop a pathologic self-confidence. We fail to find the improvements that could influence and benefit future decisions or events. I don't view the process of second-guessing as one of paralysis, hesitation or a lack of self confidence. Rather, if a decision is made without factual knowledge of an issue, then the process is reduced to poor guessing. While some may say, "Measure twice, cut once," I prefer to say, "When in doubt, check it out." Without reflection, there is no growth. ---Kevin A. Hahn, DVM, Ph.D., Dipl. ACVIM (Oncology), is director of Oncology Services at Gulf Coast Veterinary Specialists, Houston (www.gcvs.com/oncology), and is the oncology consultant for YourNetVet (www.yournetvet.com). 06-20-2007
