My daughter and I have chronic illnesses that took a long time and many doctors to diagnose. We’ve met some outstanding doctors and others that have frustrated us and dismissed our suffering.
I’m a veterinarian, and during this journey I’ve learned many things from the physicians we’ve met that have helped me be a better doctor for my patients. I’ve also thought a lot about how physicians can learn to be better doctors for their patients from veterinarians. Here’s my advice to human doctors:
1. Listen to your patients (or their caregivers).
You have a huge advantage over veterinarians, since most of your patients are able to speak to you directly about their symptoms and concerns. Yet, if you don’t listen to or dismiss your patients’ concerns, you lose this advantage. A good history will get you to the diagnosis sooner, almost every time. Listening to your patients validates their experiences and instills trust in your care. Veterinarians rely heavily on the observations of pet owners.
2. Don’t forget a comprehensive physical exam.
Yes, it’s admittedly more awkward to do a physical exam on a person than a pet, but it’s still important. Many times veterinarians find something highly significant on a physical exam that the pet owner had not noticed or not realized was a problem.
3. Think big picture.
Specialists in both human and veterinary medicine are becoming ever more abundant. The knowledge they have in their disciplines is deep and remarkable. However, many times it is helpful to step back and look at the whole patient, not just one or two body systems. Veterinarians in general practice often care for our patients from 6 to 8 weeks of age to death, and that breadth of knowledge of our individual patients helps us tremendously when choosing diagnostic and treatment options.
4. Don’t rely exclusively on initial test results.
It’s fine to reassure your patients when the initial tests you’ve run are normal, but that doesn’t mean your patient isn’t sick, just that it will take more work to get to the diagnosis. Fewer than 5% of our patients are covered by insurance, so we often must stop after the initial round of testing due to the pet owners’ financial limitations.
Our lack of a diagnosis does not mean the pet’s clinical signs aren’t real or that the pet is not sick. In these situations we empathize with our clients and help alleviate the pet’s clinical signs, which is much more compassionate than assuming patients’ undiagnosed illnesses are “all in their head”, as people with chronic illnesses have heard from their physicians far too often.
5. Learn to say, “I don’t know”.
The last line of the Veterinarian’s Oath is: “I accept as a lifelong obligation the continual improvement of my professional knowledge and competence”. This assumes we don’t know it all and we never will. Besides having to learn about multiple species of animals, veterinarians often don’t have access to the latest diagnostic tools or treatments, so saying “I don’t know” rolls off our tongues pretty easily.
I’ve found many physicians have a tough time saying, “I don’t know”, but I respect immensely the ones who do. Even better is when a veterinarian or a physician follows “I don’t know” with “I’ll help you find out”.
6. What you see in the exam room is not the whole story.
Many pet owners apologize to us and are embarrassed when their pet’s limp disappears or the cough is non-existent in the exam room. Yet, veterinarians know that the adrenaline rush pets experience when visiting us masks many of their clinical signs, and we reassure pet owners of that fact.
We encourage pet owners to video their pets at home when they are experiencing clinical signs so we get the full picture. Don’t discount what your patient is telling you because you don’t see evidence of it in the exam room. Ask how the symptoms are impacting your patient’s daily life. If your patient has a short video or picture, take the time to review it together.
7. Remember the zebras.
Yes, we’ve also heard the saying, “When you hear hoofbeats, think horses, not zebras” during our training. Common diseases and conditions (horses) are more likely to explain patients’ symptoms than uncommon diseases and conditions (zebras).
Veterinarians could be called upon to treat any kind of animal, so we might be more open to “zebras” than physicians – if our patients can be so varied, surely the diseases and conditions they suffer from can be as varied. You too could have a “zebra” come into your exam room one day – don’t miss it!
The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.
About the Author
Dr. Michaele M. Oberbroeckling received her DVM from the Iowa State University College of Veterinary Medicine in 1994. She is currently an associate veterinarian at VitalPet Kings Crossing Animal Hospital in Kingwood, Texas. Her daughter has a form of dysautonomia (Postural Orthostatic Tachycardia Syndrome). She also has dysautonomia, along with Sjogren’s Syndrome. These conditions are not actually rare, but can take months to years to diagnose. Learn more at: www.dysautonomiainternational.org and www.sjogrens.org.
