Elusive patient history more like a suspense thriller

Elusive patient history more like a suspense thriller

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May 01, 2010

My mom used to say: "For those who believe, no explanation is necessary, and for those who don't believe, no explanation is possible."

Every time I see a client like Mrs. Devoid, I think of that expression. She showed up at my office for the first time about six years ago. (Mrs. Devoid, not my mom.)

Although her dog was "very sick" she was remarkably unable to give even a clue as to the history or symptoms. On top of that, Faith Devoid turned out to be one of those clients who never seemed to be satisfied. Her voice always had that questioning tone, which seems to imply that she doesn't believe you know what you're talking about.

"What do you think it is, Doctor?" she asked before I even had a chance to glance at the pooch. "I don't know yet," I explained. "Give me a chance to examine her, and to ask you a few questions."

She kept pressuring me for a quick diagnosis. It was as if she thought that I charge by the hour. The suspense was killing her. Meanwhile, I found that any attempt to get a straight answer from her produced suspense that was killing me. Finally, I explained that the dog, Rosy, appeared to be anemic and that blood tests would be necessary for a definitive diagnosis and prognosis.

After a brief discussion of anemia and its potential causes, I sent her home and kept Rosy for blood tests. On her way out, she stopped in the waiting room and lamented for all to hear, "My dog is very sick, and the doctor is completely baffled as to what the cause may be."

Within a day, with the aid of radiographs, blood tests and a bone-marrow biopsy, we were able to confirm the presence of a fatal malignancy.

"Where does cancer come from?" she asked.

I took a few minutes to explain some current theory on the matter, but also pointed out that if I had the answer to her question, the Nobel Prize Committee would beat a path to my door.

"Well then, where did Rosy get it?" she asked, as if I'd been talking to the wall.

I explained that I couldn't say for sure. As she was leaving, she stopped in the waiting room for another announcement.

"My dog is so sick that she may have to be put to sleep, and the doctor has no clue as to what she has or how she got it."

Another client of mine, Will Concur, represents a different attitude. A typical office call with him goes something like this:

"It's good that you brought him in today," I tell him. "Your cat is very sick. He has …" He cuts me off before I can utter another word. "Sick! So, that's it! I knew it! I knew there was something wrong. Can you fix him Doc?"

Again, I tried to explain what was wrong and how it should be treated. As the words flowed forth, I could see them travelling in one ear and out the other so fast it nearly blew his hat right off. His response was always the same.

"Medicine, huh? Sounds good to me! Thanks Doc."

To Mr. Concur, "sick" is a definitive diagnosis. The word medicine is treatment protocol. And "fixed" is one of only two possible outcomes.

Neither of these two client types, Faith Devoid (no explanation possible) or Will Concur (no explanation necessary) is ideal. Although I do favor one over the other. I don't mean that we veterinarians should put ourselves on a pedestal or treat our clients with ivory-tower insolence, but it is nice to have our opinion regarded as a worthy reflection of education and experience.

They both come to see me regularly. Mr. Concur never has a question. Mrs. Devoid always does, and it's always the same one. Every visit starts with, "Doctor, did you ever figure out what happened to my dog, Rosy?"

Each time she comes in, I go through the entire explanation all over again. Recently, however, I formulated a new answer. It goes something like this: "Did I ever figure it out? Nope!"

Dr. Obenski owns Allentown Clinic for Cats in Allentown, Pa.

For a complete list of articles by Dr. Obenski, visit http://dvm360.com/Obenski/