The Accidental Veterinarian Read online

  We have “the curse of knowledge.” This is the big one and the hardest one to overcome. A few years ago a Stanford University researcher conducted an experiment wherein she asked people to tap out the rhythm of a well-known song, like “Happy Birthday” or “Mary Had a Little Lamb,” and then asked other people to guess what the song was based on the tapping. The tappers predicted that the listeners would guess correctly 50% of the time. In reality only just over 2% of the listeners did! The tappers had the curse of knowledge. It is impossible for them not to hear the tune in their minds while tapping, and — here is the key point — it is almost as impossible for them to be able to imagine someone not hearing the same thing in their minds. Once you know something, it is very difficult to recreate the state of mind that existed when you didn’t know it.

  So veterinarians can no longer put themselves in the minds of people who don’t know the difference between a colon and a duodenum, or between an antibiotic and an anti-inflammatory or, my favourite, between the abdomen and the stomach. We’re not alone though. All professionals do this. Actually, all people with specialized knowledge do. Car mechanics and accountants are the worst in my experience.

  What can we do about this? If we have certain regular spiels, we should try them out on our unsuspecting family members or friends. And we should try to put ourselves in that unknowing frame of mind as often as possible. For my part, I am trying to learn to play the mountain dulcimer (yeah, yeah, whatever), and whenever my musical friends start talking about “in the key of . . .” and “quarter tones” and whatnot, they have the curse of knowledge, and I feel like the drooling guy in the wool cap who delivers the flyers. This make me humble. This gives me empathy, and empathy is a key ingredient in effective communication.

  I’ll close with an illustrative anecdote. A few years ago an elderly lady came in with a little white fluffy dog. We’ll call her Mrs. Winterbottom and the dog Priscilla. Mrs. Winterbottom was a very elegantly dressed woman with a lovely summer dress, matching shoes, a matching handbag and even a matching hat. She spoke very properly and politely.

  “Mrs. Winterbottom, we’re going to need to run a fecal on Priscilla.”

  Blank look.

  “I’d like to do a stool test.”

  Still blank.

  “Um, so, do you think you can collect one of her . . . um . . . bowel movements?”

  Dawning comprehension and a big smile. “You mean bring her shit!”

  Indeed. I think I’ll stick with “bowel movement.”

  Why Hasn’t the Doctor Called Me Back Yet?

  My father was dying of brain cancer. He had a glioblastoma removed from his left prefrontal cortex and was given months to live. He was a professor, and his intellectual capabilities were unimpaired, but his judgment and social graces, such as they were, had been annihilated. Told by the surgeon that they had removed the tumour using suction, my father delighted in pointing to the large scar on his forehead and loudly telling strangers that his brain had been removed by a vacuum cleaner. There were other surprising moments of levity, but otherwise this was a bleak time. He was too young for this, and we were not ready to lose him. Not nearly.

  A few weeks after the surgery an issue arose regarding one of his medications. I don’t recall which or why, but I do recall being quite anxious about it. It was not an emergency by any stretch, but the problem was beginning to spiral in our minds, so I phoned his oncologist to ask about it. He was unable to come to the phone, so his receptionist took a message. Ten minutes went by, then twenty, thirty, forty, fifty . . . By the time a full hour rolled around, I had checked twice to make sure the phone was working (dial tone? yes.) and my pacing had become obsessive. I couldn’t read. I couldn’t listen to music. I couldn’t concentrate on chores. I couldn’t think about anything except a recursive loop of “Why hasn’t he called me back yet!?!?”

  “Why?!?!?”

  “It would only take a minute!”

  At the two-hour mark, my tone had darkened. I was much quicker to anger in those days. “I can’t effing believe this! He can’t find a minute to help a dying man?”

  “The arrogant prick!!”

  I was beside myself. I left another message, trying to make my voice sound like cold steel, gleaming with sarcastic fury. But at least another hour passed before he called. When he did his tone was disarmingly pleasant and empathetic. He took the time needed to properly answer my questions, and the problem was sorted.

  All these many years later I still cringe when I think of how I reacted that day. I cringe in part in recognition of the different person I was then, and I cringe in part imagining how my own clients must sometimes feel when I am slow returning their calls. I know that most people are reasonable and understanding, but I know that some must be just like I was: in a vulnerable and slightly irrational emotional state, or perhaps just unaware of the workflow in a busy clinical setting.

  So, for the latter group, it is probably worthwhile explaining the “type of busy” that we often are. In some jobs you can be very busy doing one thing. You have a single important task in front of you that is fully occupying your time, but you can take regular breaks from it to quickly address other matters as they arise. Veterinary (and presumably human medical) practice is not like that. We generally have numerous simultaneous demands on our attention throughout our entire shift. We are constantly in triage mode, figuring out in what order to do things so that the least number of people with urgent problems are left waiting the least amount of time. Moreover, for telephone messages specifically, in some cases it may be a few hours before we even see the message, let alone try to fit it into our triage. Another factor is that estimating the length of a phone call is notoriously difficult, for both the client and the doctor, so we are sometimes unwilling to take the risk of being drawn into a long conversation and will leave it until a gap opens in our schedule or to the end of our shift. This is almost certainly what happened with my father’s oncologist. It was closer to ten minutes than one, and he was wise enough to leave it for the end of his day.

  So, in the interest of reducing stress for both parties, here is “How to Contact Your Veterinarian”:

  By all means, please phone if you have any questions.

  If you feel the question is urgent, tell the receptionist so.

  Ask for a realistic guesstimate on when you are likely to hear back.

  Please make sure the receptionist knows which phone number you can be reached at. Many files list multiple work and cell numbers for multiple family members in addition to the home landline.

  Please make sure you specify if there are times you will not be available to be called back.

  Please use email sparingly and only if you are OK with waiting for a day or two for a response. Sometimes we’re quick with email, but sometimes we’re not. For a variety of practical reasons it is not given a high priority.

  The Lonesome Zebra

  Eddie pants nervously as I part his fur and examine the lump that Mr. Williamson is concerned about. I’m about to comment on it when Mr. Williamson asks the inevitable question: “Have you seen something like this before?”

  To which I reply, “Yes, I have. Many times. Daily in fact. But that doesn’t mean much.” And then I explain myself briefly. But as you and I have a lot more time right now, and as you are presumably more interested in these things than the average person, I will explain myself at much greater length here.

  It begins with the fact that humans are excellent at pattern recognition. This is largely a good thing, and it is one of the reasons our distant ancestors were able to avoid being eaten on the savannahs of Africa. Our brains are strongly wired to match everything new we encounter with past experience, whether consciously or unconsciously. That particular type of rustle in the tall grass? Could be a lion. Better keep quiet and slowly retreat.

  However, in medical diagnosis, pattern recognition is a problem. Som
e symptoms are what we call pathognomonic, meaning that they are specific to one particular disease, but the great majority are not. A red eye can be due to dozens of conditions. Coughing has scores of causes. And poor appetite can quite literally have hundreds of explanations. In veterinary school they try to beat pattern recognition out of us and replace it with a “problem-oriented” diagnostic process. I won’t explain what that is. Trust me that it is as boring as it is important.

  Eddie’s lump is small, loose under the skin, smooth in contour and slightly rubbery in firmness. Pattern recognition dictates that this is almost certainly a lipoma, which is a benign fatty growth. But only “almost certainly.” Eddie has never had one before — most dogs with lipomas have several — so I am wary of falling into that trap as a type of cancer called a mast cell tumour can feel very similar. I suggested collecting a few cells with a needle. Eddie was good for this as he was far more worried that I might be planning to trim his nails, which he hates more than anything in life. The needle aspirate just produced fat cells, so thankfully it was a benign lipoma.

  So what about the zebra advertised in the title of the essay? I apologize if you read this hoping for a wacky patient story, but no, nobody has consulted me about their zebra problems. Which is a good thing. Instead I am referring to an old aphorism taught to every medical and veterinary student, which highlights the flip side of this issue: “When you hear hoofbeats, think of horses not zebras.” In other words, although a set of symptoms could be the result of a bizarre rare disease, the common diseases are far more, well, common. Just as horses are far more common than zebras. Consequently, veterinarians have to exercise some balance and judgment and avoid freaking pet owners out with a laundry list of horrible possibilities accompanied by a wildly expensive diagnostic program.

  Balance. Judgment. Tricky things. Don’t obsess about the zebras, but don’t ignore them either.

  Be Kind to Your Veterinarian

  I came into this profession because of the animals, and I have stayed because of the people. Not because the animals have become any less enjoyable — far from it — but because the people have become more enjoyable. Or perhaps more accurately, my capacity to enjoy the people has improved. Regardless, it is the interaction with clients that makes or breaks most veterinary careers. So in aid of this, here is a list of the top seven ways clients can be kind to their veterinarian and improve that key interaction (listed from silliest to most serious):

  Please do not talk to me while I am using the stethoscope. It is a listening device. I cannot listen to two things at once and make reasonable sense of either. One plus one equals zero. For the play-along-at-home version, try following what your friend is quietly saying on the telephone while your toddler simultaneously tries to tell you a story about a problem in the bathroom.

  Please do not take personal offence if I tell you that your pet is overweight. A client once threatened to punch one of my partners for saying this. It is merely a statement of objectively measurable fact. I am not judging you. I have a volleyball-shaped cat. I get it.

  Please avoid introducing multiple chronic medical concerns in an appointment you have booked for a simple ear check. My schedule is generally full, and the receptionist has booked enough time for you for what she understood the visit to be about. Normally I am delighted to discuss the multiple chronic medical concerns, but we do need warning at the time of booking so that enough time is set aside. The domino effect of falling behind because of this can turn a pleasant day (sunshine! bunnies! roses!) into a hellish simulation of a combat zone (darkness! terror! chaos!).

  Please do not show up at random hoping to catch me “when I have a minute” to ask me some questions. I never have a minute that is not scheduled (see above). And I am too polite to tell you that, so I will squeeze this conversation in and fall behind in my appointment schedule (see above again). Please make an appointment, leave a phone message, or email if you have a non-urgent question.

  Please do not ask me why I can’t figure out what’s wrong with your pet moments after you’ve declined most of the tests I’ve recommended. For every set of symptoms and physical exam findings, there are dozens of possible causes. My crystal ball is broken today. In fact, it is broken every day, and I see little chance of it being fixed any time soon.

  Please do not confuse anecdotes with statistics. Making decisions about your pet’s health based on anecdotes would be like me taking up heavy drinking and smoking because my grandfather drank an entire bottle of wine by himself every day and smoked steadily and lived in great health to 93 years of age (a true story, actually). So when I say, “Vaccinations are proven to be very effective at preventing disease” (statistic), do not reply with “Our farm dogs never had shots and they got pretty old” (anecdote). Statistics get a bad rep when they are used to mislead, but without them we’d still be chanting and sacrificing chickens whenever anything went wrong.

  Please do not bring me your pet when you’ve already made up your mind to euthanize, telling me that you’ve “tried everything” when what you’ve actually done is “tried everything you and your neighbour whose daughter used to work at a kennel could think of and everything on the first page of Google hits.” Maybe I could have helped if you’d contacted me much earlier before things went this far, or maybe not. We’ll never know now, will we? This makes me very sad.

  And who wants to be sad?

  Fortunately, the above applies to a small minority of clients, so I’m not sad very often. And I’ve never been punched by a client. And I only drink part of a bottle of wine.

  The Ugly

  The Good

  Fluffy kittens, puppies who wag their whole hind ends, difficult cases solved, lives saved, tricky procedures mastered, grateful clients, happy staff, appointments all running on time and so much more. Did I mention fluffy kittens?

  The Bad

  Screaming cats, biting dogs, cases gone sideways, lives lost, procedures failed, angry clients, grumpy staff, running three appointments behind and so much more.

  The Ugly

  This is what I want to talk about today. Briefly. Briefly because it aggravates me too much. The Bad is part of what we signed up for, and honestly, it is swamped by the Good, so most of us shake off the Bad pretty easily. But we didn’t sign up for the Ugly. The Ugly is clients who are not only angry, but who are unreasonable, disruptive and abusive.

  In the past I might have slotted them under the Bad as generally these stressful encounters were face to face, more or less private and blew over quickly. Now these abusive clients take to social media and vet ratings sites to become trolls and give their venom a sustained public life online. This is thankfully extremely rare, but even one can have a dramatic impact on a veterinarian’s peace of mind. These people generally have mental health issues, which most readers of their rants will spot, but nonetheless even the most ridiculous slander, once out there, will have some impact. I’ve been lucky, but a couple of my colleagues have been attacked this way recently.

  Maybe eventually social media and ratings sites will find a way to weed this out, but in the meantime, if you like your veterinarian, the very kindest thing you can do is to go on Google, Facebook and VetRatingz.com and write positive reviews. And bring in a fluffy kitten. Or two.

  All the Wacky People

  But it’s time to lighten up. Fortunately, for every client who behaves in an ugly fashion, there is at least one who behaves in a wacky and ultimately harmlessly entertaining fashion. On my blog the most popular posts by far were the heaviest and darkest ones. I’m not sure what to make of that. It does not reflect the reality of practice, which is a daily teeter-totter of happy and sad, amusing and stressful, heavy and light.

  As I’ve mentioned before, veterinary medicine may be fundamentally about animals, but it is also far more about people than you might expect. The world is full of all manner of interesting people, but it seems that the most interesting one
s all own animals. This is why veterinarians make great dinner party guests. If you can prevent them from telling gross-out stories (oh, but the urge is so strong . . .), they often have some fantastic wacky people stories.

  In no particular order, here are the inductees to my Wacky People Hall of Fame:

  The young man who had his beloved ferret freeze-dried after death and mounted on the mantlepiece in what he described as a “heroic pose.”

  The elderly woman who kept an astonishingly detailed diary of her perfectly healthy cat’s eliminations on reams of loose leaf and then would proceed to try to read two months’ worth aloud to me. “On March 13 he had one regular sized bowel movement at 6:03 in the morning and then . . .”

  The man who missed his appointment because the bus driver wouldn’t let him on. He had had his sick four-foot-long ball python draped around his shoulders.

  The woman who phoned because she wanted me to talk to her canary. Not knowing how else to respond, I agreed. Once the bird had apparently been brought to the phone I said, “Hello, how are you?” in what can best be described as a tentative voice. There was some faint chirping on the other end of the line. The woman came back on, thanked me and hung up.

  The woman who came to visit her dead dog the day after the euthanasia in order to groom him before the crematorium picked him up. He was a very large dog. She bathed him, shampooed him, blow-dried him and brushed him out, humming all along. It was deeply strange, but also heartrending.