The Power of Words in Veterinary Medicine - The Unedited Version
The Power of Words in Veterinary Medicine (The Unedited Version)
A cancer diagnosis had become as common as a urinary tract infection. I had forgotten the impact of a poor prognosis.
In
our celebrity-driven, reality TV-obsessed world, it’s become pretty
apparent that in the year 2012, the classic objects of desire – money,
fame, and power – remain as coveted as ever. Although we veterinarians
tend to live in our own little bubble, by no means are we immune to the
ways of the real world. Speaking strictly for myself, I have no
desperate desire for fame. My small but devoted cadre of followers of my
clinic’s Facebook page and my personal blog is more than sufficient to
make me feel recognized. As for wealth, I certainly wouldn’t mind a
little more of it, but I do own my own practice and we’re doing pretty
well, and given the economic woes that many of my clients have
experienced these past few years, I consider myself fortunate to have a
steady job and a nice paycheck and there’s no justification for me to
whine about finances.
It’s
the “power” part of the equation that I find myself dwelling on
instead. Fame and wealth may seem elusive, but as a veterinarian, I
have more power than I have ever dreamed of. I suppose if I were to
broach the topic of power to a group of veterinarians, most would
suspect I was referring to the power one might acquire when advancing
from an associate position to becoming a partner or perhaps even a
practice owner, attaining the power to control one’s own life a little
better, i.e. less worrying about job security, fleeting benefits,
non-compete clauses, or sudden changes in schedule. However, this is
not the type of power that’s been occupying my thoughts. I’m referring
to the power we have, as veterinarians, to completely ravage the lives
of others with a simple sentence or two.
I
became aware of this power in the first few years of my veterinary
career, in the early ‘90s. While working at a feline-exclusive practice
in Maryland, I was scheduled to see an elderly client of ours. She was a
charming, delightful woman in her late 80’s, with a mind as sharp as a
tack. She cherished her cat and doted on him accordingly. She had
noticed he had recently begun to favor his right rear leg. “Maybe he
stepped on a piece of glass?” she wondered. “Or maybe he fell and
sprained it when I wasn’t watching? I’m just not sure.” I told her
that I would examine her cat and see if I could figure it out. I lifted
her cat out of his carrier so that I could bring him to the scale and
weigh him. As I picked him up, I could feel a large, firm mass
infiltrating his right hip and part of his sacrum. It was something the
client had not noticed. This was the early ‘90s, and vaccine-induced
sarcomas were hitting their peak. In our cats-only practice, we had seen
many of them. I knew from experience that this mass was undoubtedly a
sarcoma, that it was in a location that was not amenable to surgery, and
that this poor cat was doomed. I had grown quite fond of this client,
and my heart sunk as I carried the cat to the scale. After weighing
the cat, I brought him back to the exam table and performed my exam on
automatic-pilot, feigning concern about his mild dental tartar and his
waxy ears. All I could think about was the tumor, and how I was going
to break the news. At the completion of the exam, I looked at her and
said, gently, “I feel a mass on your cat’s hip, and I think that this is
likely the cause of his limp.” “A mass?” she asked. “A firm lump,
yes,” I replied. “Let me show you”. I put her hand on his bulging right
hip. I then placed her hand on his other, normal hip for comparison.
She immediately felt the difference. The conversation progressed to
talk of x-rays and biopsies. Although I tried to cushion the blow as
best I could, this client was very perceptive, and she could see right
through my feeble attempts. As the reality of the situation sunk in,
she looked at her cat as he peacefully sat on the exam table and she
quietly began to weep. Twenty years later, I still get choked up
thinking about it. I don’t recall the rest of the appointment or the
subsequent euthanasia not long after. I just remember how one phrase –
“I feel a mass on your cat’s hip” – ruined this poor woman’s life. The
power I yielded in that exam room was colossal, and my awareness of it
became deeply ingrained, becoming a significant (and eventually
subconscious) component of my style of practice for many years.
Somewhere
along the way, however, as the years progressed and the number of
cancer diagnoses under my belt multiplied, I started to take for granted
this enormous clout that veterinarians possess. In my own cats-only
veterinary hospital, we see many cats who present with weight loss,
inconsistent appetite, and vomiting. After ruling out common disorders
such as diabetes, hyperthyroidism, and chronic renal disease, we’re
often faced with a diagnosis of a gastrointestinal disorder. In about
60% of the cases, these cats end up having inflammatory bowel disease.
In the other 40%, we diagnose low-grade gastrointestinal lymphoma.
Practically every week (or at least every other), I find myself phoning a
client to tell them that the intestinal biopsies have revealed
low-grade lymphoma. I then launch into my “lymphoma talk”, telling them
that we should start the cat on prednisolone and chlorambucil, and that
as cancers go, this particular one has a decent prognosis, with a
median survival of around 25 months.
A
few months ago, I noticed on our appointment schedule a client whose
cat we had recently diagnosed with low-grade intestinal lymphoma. Her
prior veterinarian was (in my opinion) lackadaisical in terms of his
diagnostics, and the client left his practice with no explanation for
the weight loss. I had seen the cat initially, scheduled the work-up
(abdominal ultrasound, endoscopic biopsies, vitamin B12 and folate
levels, etc.), and came up with the lymphoma diagnosis. I called the
client, relayed the diagnosis, discussed the treatment and prognosis,
arranged for her to pick up the medications and begin treating. I asked
her to schedule a follow-up appointment with me in two weeks. In our
appointment book, however, the client was scheduled to see my associate,
a recent Cornell grad who, though still faced with a steep veterinary
learning curve, had already distinguished herself as being uncommonly
empathetic and compassionate, with a warm bedside manner and proficient
communication skills. I assumed that the scheduling of this client with
my associate (rather than with me) was inadvertent. However, when I
mentioned it to my associate, she tactfully informed me that the client
had actually requested the change. “I think you might have
underestimated just what a huge blow it was to this client to be told
that her cat had lymphoma. The woman has been crying every day since
the diagnosis. She has a million questions – about treatment, about
prognosis, about pain, about quality of life. But she was reluctant to
call you, because you seemed so…” She grasped for the right word.
“Flippant”, she finally said. “You came across as very matter-of-fact
about the diagnosis and treatment. I don’t know if you realize how much
this diagnosis affected this woman’s world.”
Ouch.
Here
I was, patting myself on the back for working up the case so
seamlessly, arriving at a diagnosis without really breaking a sweat.
Hearing these words was a total reality check. After 24 years of
practice, where a cancer diagnosis had become nearly as common as a
urinary tract infection, I realized that I had indeed begun to forget
the power of the veterinary spoken word. Duly humbled, I berated myself
for being such a dolt.
My associate said, “Hey, don’t worry about it.
She could have gone somewhere else for treatment. But she really is
grateful that you came up with the diagnosis and she wanted to stay with
our practice. So be thankful that she stuck with us. Just keep in mind
that a diagnosis of cancer – even low-grade GI lymphoma that carries a
decent prognosis – is still a diagnosis of cancer, and news like this is
like a fist in the face.” Pretty smart lady, my associate.
I
have resigned myself to the reality that I will never have the wealth
of a Warren Buffet or a Bill Gates, nor the fame (nor, sadly, the looks)
of a Brad Pitt or a George Clooney. However, I (and my fellow
veterinarians) will always have more power than we ever could imagine,
and we would be wise to take heed of this and never take it for
granted. To use this power with wisdom and compassion is an art form
that is difficult – but hopefully not impossible – to master.
Published in VETERINARY ECONOMICS May 2013. Edited version posted on DVM360 May 2013