Monday, September 1, 2014

Get the most out of your pet's appointment: Can we talk?

Mrs. Ernest’s forehead was creased in concentration as I tried to extract a medical history for Chunder, the little dog she held snugly in her arms.
“How long has Chunder been vomiting?” I inquired.
“Oh, let’s see, he’s 7 years old, so I’d say about six years.” (The intake information that our technician took said he’d started vomiting three days ago and had been fine prior to that.)  
“How often during the past six years has he vomited?” I asked.  “Once a day?  Once a week?  Once a month?” 
“Just a few times a year, usually after he eats grass or goose poop,” replied Mrs. Earnest. 
“So the recent vomiting episode — it says here that it started three days ago.  Is that correct?”
“Oh, no, he started vomiting two weeks ago.  He hasn’t felt well for the past month,” she answered.

If you think conversations like that are a rarity, think again!  They are a daily occurrence at animal hospitals everywhere.  And unfortunately, they can actually affect the quality of care. A concise, orderly history of your pet’s ills is imperative in helping us diagnose and treat your little buddy.  So how can you, as your pet’s guardian, help clarify your communications to your veterinarian?

We’ve all been told to write a list of our concerns when we visit our own physicians.  Lists are a big help for veterinarians, too, but pet owners need to prioritize the list and discuss the problem that is of the most concern to them at the beginning of the appointment.  Sure, I want to take a look at the minuscule lump (which took you five minutes to find for me), but first tell me about your pet’s decreased appetite over the past two months.  The lump can wait, or can be addressed at a later date. 


Before you take your pet to his veterinary appointment, sit down and chronicle the problem on paper — at home and in a quiet place.  When did your pet’s symptoms first appear?  For acute problems, that isn’t difficult to determine; it’s pretty hard to forget the six piles of diarrhea you had to clean up before your yoga class on Monday evening!  But the onset of problems that have been going on for a long time can be much more difficult to pinpoint.  It’s often useful to ask other family members when they noticed the first occurrence of said ailment.

The next thing to record is exactly what you noticed that was unusual.  It’s not helpful to say, “He’s just not himself.”  Why is he not himself? Make a list of specific things that aren’t normal:


  • He’s always eaten his meal in less than a minute, but now it takes him two hours to finish it.
  • He stopped getting up to greet me when I get home from work.
  • He stopped eating his favorite treats.
  • He started urinating in the house, which he’s never done before.
  • Suddenly he stopped jumping on my bed at night.

When you come to the office, bring your written history with you, and choose your cohorts wisely.  Unless the appointment involves life-or-death decisions, it’s best not to bring the entire family; a few of you will suffice.  Having several people chiming in with their opinions and contradictions isn’t helpful, which is another good reason to interview your family at home.  You don’t have to leave well-behaved kids at home, though.  In fact, parents often hush up kids who try to answer my questions, but I’ve found that children of many ages can offer valuable insight into their pet’s behavior.  They might also confess to having fed that pet a pile of greasy french fries!  

Veterinarians are trained to interview clients in a way that gives us the most useful information.  You might feel impatient when we ask seemingly inane questions, but there’s a good reason for us to delve into things that you feel are inconsequential:  They are important clues to us.  But there might be times when we don’t ask you about something you think is relevant.  Make sure you speak up:  “Let me tell you what else I’m seeing that I think may be important (or is unusual, worrisome, etc.).” 

An oft-quoted statistic in the veterinary community is that clients forget 85% of what we tell them by the time they get home.  If you aren’t absolutely clear about the doctor’s diagnosis or instructions, make sure you repeat them or ask questions:  “So are you telling me that Chunder needs x-rays if he’s not better in one week?  Are you saying that I should give him this medication until he feels better, or until it’s gone?  What exactly does ‘exercise restriction’ mean for my dog?”  And we don’t mind writing down our instructions, so don’t be afraid to ask us to do so.

It’s helpful to tell your doctor your expectations.  If your dog has been limping for the past two years and you want us to stop the limping, we need to know that.  You won’t be happy with us if we palliate the limp, which is probably the best we can do, when what you expect is a cure.   We’ll need to make sure your expectations are realistic, then decide on a common goal.  That’s especially important with serious problems, where simply improving your pet’s quality of life, rather than a cure, might be our goal.

Finally, don’t be afraid to tell us your fears.  Pet owners often are secretly afraid that we will find cancer, while we might be thinking that that diagnosis isn’t very likely.  Usually we can alleviate your anxiety with diagnostics, a good plan, and some calming words. 

Being a doctor is very much like being a detective.  Without good clues, obtained by our examination and your careful observations, we can’t solve the puzzle.  As the great Sherlock Holmes said: “Data! Data! Data! I can’t make bricks without clay."