Yesterday, I saw an 8-year-old Doberman who had been urinating inappropriately in the house. His name is Bowser and his owner brought him in about two weeks ago for an initial examination with a different doctor.
When Bowser first presented, his physical examination was normal and his bladder was completely empty. After a discussion about Bowser’s behavior, and given that a urinalysis was not possible at the time, it was decided that Bowser would be started on a supplement to help address the issue. His condition would be monitored.
When my technician presented Bowser’s case to me, she made a point to mention that a urinalysis wasn’t performed during the last visit.
When I entered the exam room, Bowser’s owner also brought up the fact that a urinalysis wasn’t possible last time and that is part of what prompted him to bring Bowser back.
Well, I knew what I had to do. I did a thorough physical examination (finding nothing of significance, just like last time) and then pronounced with confidence that what we need is a urinalysis.
The owner did not react with the high-five that I was hoping for. Instead, he crossed his arms and narrowed his eyes. “Oooo-kay,” he said. “Is there any chance that we might need to look at Bowser’s blood to find an answer?”
I just stared at him for a moment as my mind jerked and shuddered like an engine that was suddenly missing gears. “Sure,” I responded. “He’s an eight-year-old doberman. He could have Cushing’s disease, diabetes, kidney disease, or a number of other conditions that would cause him to urinate more frequently or inappropriately.”
That’s when the guy hit me with his zinger. “Well, why haven’t we been talking about that?”
I have been kicking myself ever since that face-palm appointment. This case was vet medicine 101, and I had to be rescued by the client. How could that happen? I’m sure bloodwork was discussed in Bowser’s first visit, but it didn’t catch my eye in the record.
I fell into what I like to call “the chute.” The chute happens when you pick up a case that already has momentum. I looked at the medical record and grabbed onto the lack of a urinalysis, then my technician mentioned urine, and then the pet owner said it.
At that point, I was hurtling down a mental playground slide. The idea of stopping and asking “Is this really all I should be thinking about?” just didn’t occur to me.
I am going to be vulnerable and say that this isn’t the first time I’ve fallen into the chute. It’s easy when we’re busy to pick up a trail that’s laid out before us without questioning whether or not it goes exactly where we think it should. And there are significant drawbacks to insisting on starting every case absolutely from the beginning, especially when you work with highly competent professionals all around you.
Still, we should all remember that there are dangers in just diving down a chute that is laid before us. We need to balance the desire to go fast with the need to keep an eye on the bigger picture. I was reminded of that yesterday in the room with Bowser.
P.S. Bowser’s CBC and chemistry came back totally normal, so at least I was spared the embarrassment of having to hear the pet owner say “Good thing I asked about blood work!”
