Originally Published: DVM Newsmagazine, May 1, 2012

 

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I’m a Veterinary Hypocrite, And You Probably Are Too

 

Special Sauce

Between the crab cake course and the chocolate mousse finale at a recent CE dinner I attended, I heard an orthopedist across the table utter the word “steroids.” I looked up immediately (and not just because I was out of crab cakes). As a “new-school” veterinarian brought up in the age of NSAIDs, the subject of steroids in orthopedic cases always gets my attention.

 

The orthopedist related how, as a resident years ago, he balked at using steroids. His team now uses them with such frequency that the drugs have earned a nickname: the “special sauce.” I saw looks of horror flash across the faces of most veterinarians under the age of 35, and nods of approval from our most senior colleagues. The orthopedist went on to discuss how and when steroids enter his treatment plans.

 

As I listened to his experience with the “special sauce” and observed the reactions around the table, I felt my brow furrow critically – and then I stopped myself. I reflected on how many times I have judged other veterinarians for their chosen course of action. I also thought about how many times – just like the orthopedist talking to us – I’ve said, “I’ll never do [X]…” and then done just that.

 

I thought back to the first time I used steroids in a limping dog. It hadn’t been my choice. The practice owner had come into the exam room with me, because the client was a longtime friend of his. He guided the conversation to a steroid injection, and the owner decided that’s what he wanted.

 

As I gave the injection, I felt like one of those subjects in psychology research instructed to press a button that will shock some poor test subject in another room. On more than one occasion, I had mentally (and even verbally) ripped doctors who had chosen this treatment. Yet, here I was, committing the very Vetalog sin I’d derided others for so many times.

 

I am relieved to report that the patient survived the injection and stopped limping after about 10 minutes. The client was thrilled, and the lameness did not recur. My boss slapped me on the back and said, “I told you so.”

 

Since then, while I have not used them with nearly enough frequency to qualify as a “steroid jockey,” I have employed steroids from time to time when a situation dictated the need.

 

But you know what else I’ve done? I have rolled my eyes at the medical records of others who have done the same.

 

 

Veterinary Hypocrisy

 

Thus is the nature of veterinary hypocrisy. We do what we have to do in the circumstances we are faced with. We then conveniently forget all we have done and pass judgment on our peers when their similar cases appear before us. We often do this with minimal knowledge of the circumstances the other practitioner was facing.

 

I remember working an emergency shift a few years ago when a patient presented from a referral hospital. Shortly after arrival, the patient began to show signs that her condition might be deteriorating. My colleague asked the owner if we could investigate by repeating some of the diagnostics that her referring veterinarian had done previously. The owner agreed.

 

The next morning, the referring veterinarian called in a rage. He believed that we had implied to the client that his tests “weren’t good enough.” I don’t know if he ever believed our version of the story, but I remember feeling insulted and telling our team that we would be sure never to treat other veterinarians the way he did.

 

Two years later: I arrived at work to a swarm of agitated technicians. They informed me that a client I had referred to a specialty hospital for an abdominal ultrasound had called and was angry. They said the specialty practice wanted to charge him emergency fees and admit his pet for care prior to performing the ultrasound. They also (rather easily, I admit) planted the idea in my mind that my client, who trusted me, was being gouged by the people I had recommended. I was furious. I called the referral hospital and let the attending veterinarian know that I would not stand for this!

 

After venting at the attending veterinarian, who swore that she didn’t know why the patient was at the hospital if not for immediate treatment of vomiting, I hung up the phone. I turned to my impromptu anger-support group and asked: “Liz did call and confirm that ultrasound appointment with radiology yesterday, right?” I was met with silence. Oops.

 

Fifteen minutes later, I had the attending veterinarian back on the line. “I just want to apologize,” I started. I went on to grovel, profusely, for quite some time.

 

I had done exactly what I swore I wouldn’t do to others. I had jumped to an inaccurate conclusion about why another doctor had made the choices she did, what her circumstances were, and what she had actually said to the pet owner. I was a hypocrite, and it definitely wasn’t the first time. Or the last, probably.

 

My resume of actions taken after swearing I never would (and harshly judging other veterinarians who did) is extensive. It includes numerous strange concessions to client demands, diagnostic testing waivers, decisions to refer cases, decisions not to refer cases, free-style diet modifications (“Just add some green beans”), etc. Needless to say, it’s not a short list. I’m willing to bet that, if you’ve been in practice a few years, yours probably isn’t short, either.

 

A Plea For Understanding

 

Experience is a profound teacher. Every year, we find ourselves in situations that we wouldn’t have imagined the year before. As they say, you just never know. No one has all the answers. None of us work in a vacuum without the limitations of finances, medical resources, staffing resources, personal experience, or the need for clear communication. Hypocrisy ends when we remember all of that, about others as well as ourselves.

 

We veterinarians strive to do our best to take care of our patients given the circumstances we face in any given moment. While this truth cannot exonerate us from poor decisions we have made (and we’ve all made poor decisions at one time or another), it can help us to improve our profession by making it a more forgiving and less judgmental place. Moreover, think of how many learning opportunities we would miss if we never discovered the exceptions to our long-held assumptions about what is “always” or “never” appropriate.

 

Judgment and hypocrisy are not limited to the veterinary field, and they will never go away. But let’s pledge, as a group of professionals, to minimize that behavior as much as possible. I’ll start with me.

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