As veterinary professionals, we all understand the concept of diagnostics, the search to find out what is wrong with the animal so we can treat the problem, and give the pet owner some idea of what to expect in the future. If you’ve ever had to present a treatment plan to a client, then you know how this conversation goes. But have you stopped to think of all the factors that a client must consider when making a decision about diagnostics? Once again, my experience with my sick little kitty, Rosy, illuminates this small part of our job as veterinary professionals who are trying to heal the sick and support the family. Hang on as you enter the Twilight Zone…well, really just my muddled mind as I work through this experience of being the client. Rosy has been doing better this week, no vomiting, eating pretty well, drinking lots of water and stools almost look normal. Wow, maybe she’s not sick after all! Geez, now that I’ve mentally prepared myself somewhat for the inevitable loss of Rosy, maybe she’s not as sick and will be with me much longer. Her mood is good and she’s loving her daily brushing (since she isn’t grooming much). Blogger Katherine Dobbs with her cat, Rosy. Problem is, I’d like to know for sure, is she sick? I can’t deny the loss of weight from 8 pounds to 6 pounds in the last few months, and all the vomiting she used to do. Is it lymphoma? Is it renal failure? What is her prognosis? How long does she have left and how will things look when she goes downhill? How fast will that happen, anyway? So my technician brain says, “Diagnostics! Repeat labs! Get an ultrasound! Full thickness biopsy? Let’s go for it!” I would be the type of client who needs to know, who wants a name to call this sickness, who wants to be as prepared as possible. When I present treatment plans, and clients enter this type of debate with themselves, I would let them know that really they need to reflect on the type of person THEY are, not just what is going on with their pet. Can you live without knowing? Or would the results change anything you would do at this point? Can you just take it day by day, and ride the waves? Or must you have a definitive diagnosis, a solid perch on which to stand? So on my one shoulder, the little “technician” is sitting, screaming for diagnostics on Rosy. But on the other shoulder, the little “pet owner” is saying, wait, what about the other factors to consider? (Can you picture the cartoon character with the little devil on one shoulder, and angel on the other?) What would this mean for Rosy? Another trip to the vet, knowing that she hates it. Another blood draw, knowing she’ll need to be muzzled again. Maybe an ultrasound, and will she need sedated for that? A full thickness biopsy, often the only way to diagnose infiltrative lymphoma, which is what we suspect, would require full blown surgery…do I want to put Rosy through that, just so that I can get my answer? As your client is balancing these considerations, looming over the discussion is the dollar sign, a determining factor for most people, including those of us with pets who work in this profession. Would I spend the money if it would change Rosy’s future? I don’t intend to treat the lymphoma, so why do I want the lab report in black and white to tell me the name of her disease? I can’t stop renal failure, so do I really need to monitor her labs? There are no right or wrong answers. Not for our clients, and not for us as pet owners. You sometimes have to move with your heart, while considering your head, and still remember to hang on to each day as it comes. After all, with the ignorance of her bliss, that’s all Rosy is doing…waiting for her next brushing! http://www.veterinarypracticenews.com/images/vet-editorial-blog/Dobbs-with-Rosy-250px.jpg8/10/2012 11:10 AM
