It was a Sunday afternoon in August 2002 and I was visiting my brother. He had just come home from a camping trip with his friends. On the camping trip, he was hit in the eye with a piece of firewood and was having vision problems in that eye. The emergency room referred him to the on-call ophthalmologist. I drove him to the office where a bright young ophthalmologist met us. Based on her age, I assumed she was a fairly new graduate. Because it was the weekend and the office was closed, she was the only person in the office.
The doctor didn’t say much during her initial exam and, although she appeared smart and capable; I sensed that she was a little unsure of herself. She put some drops in my brother’s eyes to dilate them and said she would be back in a few minutes. It seemed to me she was gone a long time, much longer than it took for my brother’s eye to dilate. When she came back, she was full of confidence and had a list of differentials and a definitive treatment plan.
When she left again to write his prescriptions, I smiled and asked my brother “Did you see what just happened? She wasn’t sure what was wrong, but while your eyes were dilating, she went into her office and looked up what could be wrong. She came back knowing exactly what to do.” My brother thought about it for a second and said “You’re right! How did you know that?” I laughed and said “Because I do it all the time. When I see an emergency and I’m not sure what I’m looking at or what to do, I find a reason to leave the room and search my reference books.”
At the time, I was less than a year and a half out of vet school. I had just finished an internship and was working at my first “real” veterinary job. I had lots of mentorship during the day, working with two very experienced vets, but I was on my own when I was on-call and seeing emergencies. I felt like I needed to know all the answers, to always have a plan and never let the clients think I was in over my head. If I didn’t know what to do, the best way to handle it was to have a confident air, find an escape, and search for the answer. Basically I was faking it.
However, that trip to the ophthalmologist changed my perspective. Even though I could see right through the ophthalmologist’s initial act, I trusted that she had the resources to know how to treat this emergency. I realized that it wouldn’t have bothered me or my brother if she had told us “I’m not sure exactly what is wrong with your eye, but I will find out.”
That was fourteen years ago. Since that day, when I see something unusual, I have confidently told clients, in one way or another “I don’t know what is wrong with your pet, but I will use my resources to do my best to find out.” Sometimes that involves telling them I need to consult a reference book in my office and will be back in five minutes or that I will ask my colleague to come into the room to take a look at the pet. Other times I tell them I will post the case on VIN or email a specialist and call them in a few days with recommendations. Sometimes I have to tell them that I exhausted all my resources and I feel they need to be referred to a specialist. (Disclaimer: I always offer my clients the option of a referral but many times they decline on initial presentation)
Since graduating, I have gained more knowledge and experience, using past cases as part of my resources. However, there are still plenty of times I do not have the answers right at my fingertips and I am still telling clients “I don’t know what to do right now, but I know how to find out”.
Yesterday one of my favorite clients brought two of her pets in. She is a breeder (I know, it’s hard to believe that one of my favorite clients is a breeder, but she truly is an amazing pet owner!) and I have seen plenty of her dogs and many of them have unusual problems. Yesterday was no exception – she had questions that I couldn’t immediately answer. I told her I would consult a couple of specialists and get back to her with the answers. I laughed and said “Your dogs always keep me on my toes!” She responded “That’s what I like about you. If you don’t know the answer, you are always willing to dig to find out.”
Although most of my clients don’t verbalize it, I feel that they respect me more that I am honest with them and tell them I don’t have all the answers right now, but I know where to find them. I think the honesty builds trust between the clients and myself. It has also made me a better doctor, helping me to build my knowledge base. I know many veterinarians, especially new graduates feel you need to “fake it until you make it”. But I have learned that you never really make it in veterinary medicine. You will never have all the answers or know what to do in every situation.
Medicine is constantly changing and evolving and every patient is different. That is why it is called “practicing medicine”. Our clients want to see a confident and competent doctor, but that doesn’t mean they expect us to have all the answers. They want us to do what is best for their pet, and sometimes that means telling them you don’t know what to do right now. We have a lot of resources available to us in veterinary medicine. Use those resources and don’t be afraid to tell the clients what your resources are. Trust me, they will respect you and trust you more knowing you took the time to find out the best way to treat their pet.
