Veterinary medicine can be hard. Sometimes we get cases that really challenge us. It may be the clinical signs don’t add up, the client declined diagnostics that would give us a definitive diagnosis, or the pet isn’t responding to treatment the way we expect. When I have a tough medical case, I use all my resources to try to help my patient, including discussing the case with colleagues, posting the case on the Veterinary Information Network for experts to weigh in, and recommending referral to a specialist. I feel it is important to explore these avenues and talk through cases making sure I haven’t missed something, learn from other people’s experience, or just to hear that’s exactly how they would have treated the patient.
Even though I seek the advice of other veterinarians, it has always bothered me when a client asks to have their records sent to another general practitioner for a second opinion. Doubts immediately creep into my head – What did I do wrong? Do they not trust me? They wouldn’t go to a specialist so why do they think the doctor down the road knows more than me? Don’t they see how much time and effort I have put into this case?
It happened to me again last week. I have a case that has really challenged me. I cannot figure out what is wrong with the dog and why he refuses to eat. We have tried everything and he just isn’t responding. I consulted VIN and the consultant advised more tests, which were declined. I advised referral to a specialist, which was declined. The client and I had been communicating about her pet via email a few times a week. I hadn’t heard from her in a few days so I assumed he was doing better. But on my day off, I received a text message from one of my techs “You probably want to stop checking in on Bogsley, they had their records sent to another clinic.”
The doubts started to creep into my head when I read this, but I decided to bury them. I had been working very closely with Bogsley’s family for a month and I knew they were frustrated that he wasn’t responding to treatment. I decided to reach out to them and I called for an update. I left a message that I hadn’t heard from them in a few days and I wanted to check in and see if Bogsley was doing better. I purposely didn’t say anything about them seeking a second opinion. When I didn’t hear back from them for a few hours, the doubts came back again. Of course, they don’t want to update me. They don’t trust me anymore to take care of their dog.
A few hours later, I received an email from the clients. They updated me on Bogsley’s condition and that he wasn’t doing well. “I know that we should take Bogsley to a specialist like you recommended, but we just can’t afford to take the time off of work or the money a specialist would cost. We don’t mean to offend you, but we are taking him to another clinic tomorrow for a second opinion.”
As I read that, I realized that it wasn’t all about me. In fact, the decision to seek a second opinion had nothing to do with me. The clients needed to do all they could within their means to find out what was wrong with Bogsley. They may be desperate to help him and knew what I was doing wasn’t working. Or maybe she needed to hear from another person that Bogsley wasn’t going to get better and it was time to say goodbye.
I realized that I needed to let my insecurities go and wish Bogsley the best. I responded “I am not offended at all. I know you want to do what is best for Bogsley and I really hope that another vet can see something that I am missing.” My email was met with the reply “Thank you, Dr. Shepherd. That means a lot!”
After all these years in practice, I am continuing to learn, especially from the most challenging cases. Bogsley’s case taught me to let my insecurities go. The clients have their own reasons when they seek a second opinion and I shouldn’t be upset or offended when they ask for their records. I offered my best care and sometimes another set of eyes is what my patient needs.
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.