A veterinarian observed that his own fifteen-year-old cat had a slightly decreased appetite and a tiny bit of weight loss. When blood tests, X-rays, and ultrasound were all normal, the veterinarian decided to anesthetize his cat and biopsy its intestinal tract. Thus he learned that his cat had lymphoma, a type of cancer. A year later, when his cat was still alive and thriving with the help of chemotherapy, he started to present the case to other veterinarians. He described his surprise at the negative responses he’d received from other veterinarians, who’d felt that a fifteen-year-old cat was clearly past its prime and such extravagant diagnostics and heroic treatments were unnecessary. This story clearly exemplifies one of the heavy topics of disagreement about pets and indicates the broad range of value systems that exists among veterinarians, as well as among pet owners.
Personal values and medicine
Traditionally, doctors of Western medicine have assumed a paternalistic approach to diagnosing and treating patients. This attitude derives from the idea that Western medicine is based on science and that doctors understand that science and medicine in a way that laypersons cannot. For the sake of physician efficiency, clients and patients are kept less informed of the medical process and are expected to comply and get better.
Moreover, as science and medicine have evolved, there are more diagnostic and therapeutic options to choose from. Choices for a cat with renal disease, for example, might include blood tests, urine tests, X-rays, ultrasound, biopsy, transplant, dialysis, diuresis, special feeding, hospitalization, feeding tubes, medicines, and transfusions. Depending on the cat, the client, their relationship, and the client’s resources, not to mention the client’s spiritual and ethical beliefs, the best choices for each individual will be different. If decisions are based only on science, with the goal being longevity, our pets will be reduced to nothing more than furry test tubes and research animals.
Even when your veterinarian presents you with options, those options are still subject to that veterinarian’s values and experiences. Take myself, for example: I don’t believe in vaccinating six-week-old puppies with modified live virus vaccines; I don’t crop ears; I don’t take unnecessary anesthetic risks; and I will not surgically impregnate an animal. I don’t endorse treating unchecked arthritic dogs with aspirin. My approach to aging joints starts with a physical examination to evaluate the patient’s overall health, conformation, activity level, range of motion, and degree of discomfort. If indicated, blood work and/or radiographs might be recommended. I encourage weight management, physical therapy, hydrotherapy, nutritional supplements, acupuncture, regular exercise, heat, and massage — all with the intention of minimizing drug therapy. As much as I try to provide clients with options, there are some options and practices that I am not comfortable with. If those happen to be options that a client prefers, then I usually suggest the individual find a veterinarian who can support his or her values.
Levels of training and types of veterinary practices
Historically, most veterinarians ended their formal training at the level of the general practitioner and rose to the occasion when patients with special needs presented themselves. In recent years, there have been more opportunities for veterinarians to formally advance their training and become recognized as specialists, similar to specialists in human medicine.
As with any other health care professional, there are things to keep in mind when working with a specialist. First, specialists are still subject to their own biases. Suppose your pet has a lump. A surgeon might recommend surgery; an oncologist might recommend radiation and chemotherapy; and a naturopath might advise herbs, nutrition, and acupuncture. Second, specialists are trained to have expertise in diagnosing and treating specific problems; other knowledge and interests may have gotten archived. Moreover, depending on the practice, specialists do not always communicate well with one another. I once spoke with a surgeon who wanted to perform a fancy reconstructive surgery on a patient, unaware that the patient had a serious clotting problem. Meanwhile, the internal medicine doctor, an expert in clotting disorders, was advising against surgery without ever seeing the injured body part, which clearly required some form of surgical attention. Rather than pooling their expertise and resources, they were each speaking solely from their specialist perspectives and so were giving inadequate advice. Much like a symphony, you can have amazing musicians, but you still need a conductor in order to make music.
Another current trend is a rise in the number of corporate-owned veterinary practices and a decrease in the number of independent, private practices. On the plus side, the largest of these corporate practices and hospitals can usually share resources, have more money to invest in state-of-the-art equipment, and can purchase supplies in bulk quantities at lower costs. They can also more readily offer round-the-clock sophisticated veterinary care. However, it is less likely that one or two familiar veterinarians will be directly involved and accountable for everything that happens to your pet from admit to discharge; it is more likely that a number of people will be involved, and they will be doing their jobs according to established hospital protocol.
Finding a veterinarian
You will have to decide what traits are most important to you and work from there. Is it training and experience? I know veterinarians who are immensely talented but who have abrasive personalities, always run behind schedule, or are very financially driven. I know veterinarians who are open-minded to alternatives and integrative medicine and those who are not. There are veterinarians who believe that life is sacred and should always be prolonged, as well as those who think that diagnosing and treating older animals is a waste of medical resources. There are veterinarians who treat their own animals as members of the family and those who maintain more defined boundaries between animals and humans. There are veterinarians who will make choices for you and simply tell you what to do, and those who will provide information and options and let you decide what would work best for your animal companion.
Once you have determined which traits are most important to you, start looking and asking. In most cases, a general practitioner will become your primary care veterinarian, if not your complete care veterinarian. She or he is someone you should feel comfortable with. Most clients find their veterinarians, particularly general practice or primary care veterinarians, via the phone book or by word of mouth. If you are looking for a specialist, then you can start with the organizations that certify them.
Once you have a list of veterinarians to consider, start learning about them and their practices. Call the practice and ask them to send you any descriptive pamphlets. Check out their website if they have one. Arrange for a visit or a tour, and ask if you might meet the veterinarian. Keep your priorities in mind as you evaluate the practice and the specific doctor. If both seem to your liking, schedule a “new patient” appointment for your pet. This gives you an opportunity to observe the veterinarian in action with your animal companion (and allows you to solicit your animal companion’s opinion), and it allows the veterinarian to meet your animal companion as a healthy pet and have something to compare to should a problem arise in the future.
Finding a veterinarian with whom you are comfortable is much like finding anyone else with whom you would like to have a good working relationship. Sharing a short story or something special about your animal companion helps veterinarians get to know him or her more like you do, as a kindred spirit beyond the sum of his or her body parts. Providing the care that preserves these human-animal bonds is one of the greatest rewards of my profession.
From the book Kindred Spirit, Kindred Care, Copyright C2005 by Shannon Fujimoto Nakaya. Reprinted with the permission of New World Library, Novato, CA. www.newworldlibrary.com or 800-972-6657 ext. 52.