April Kung, DVM ♦ February 10, 2019
Recently I had a difficult conversation with owners of a very sick pet. The pet needed to be hospitalized, that much was obvious. Hospitalization of a sick pet is expensive. That too, is a given. “But if we spend this money,” the pet owners wanted to know, “will he be alright?”
This is the same question asked over and over again of veterinarians everywhere. There are many permutations:
- “If I pay for x-rays, will you be able to tell me what’s wrong?”
- “If I pay for blood work, will you know what to do?”
- “If I pay for a specialist consultation and procedure, will we finally be done with this frustrating and expensive hunt for a definitive diagnosis?”
Other permutations include questions pertaining to treatment:
- “Now that we know Benji has pneumonia, these antibiotics you’re prescribing will fix him, right?”
- “Since you’ve fixed Fluffy’s urinary blockage, he’s now a perfectly healthy cat, correct?”
- “So after you perform this surgery, Max will be all better?”
At their core, each of these questions is asking for some sort of guarantee. It’s not that people are wrong for asking. After all, people expect that if they buy a new refrigerator, it will work – or be replaced. They expect if they hire someone to fix their furnace, if it doesn’t get fixed, they shouldn’t have to pay. They expect if they pay their water bill on time, there will be water when they turn on the faucet.
But living creatures are not refrigerators, surgery is not like fixing a furnace, and, as my cardiology professor in vet school was fond of saying, “Medicine isn’t engineering.” Doctors can’t guarantee anything. This is what people don’t understand. I didn’t understand it until I started practicing.
I was a second year veterinary student when my mother was in the hospital, on a ventilator, dying of sepsis. Even as a vet student, I didn’t understand why the doctors wouldn’t tell me they were going to make her better. I wanted them to tell me something concrete, to give me something I could hold onto. And I was angry because they wouldn’t. As a practicing veterinarian now though, I know why they wouldn’t. It’s because they couldn’t.
So, I try hard not to get frustrated when pet owners ask me for a guarantee. Even when the same pet owners ask me in ten different ways, twenty different times. I know where they’re coming from. They’re not trying to paint me into a corner any more than I was trying to paint my mother’s doctors into a corner. They just don’t understand, as I didn’t understand: There are no guarantees in medicine.
It’s hard to stick to my guns and refuse to guarantee anything, even though I desperately wish I could. When I’m dealing with emotional people looking to me for answers and hope, and especially as a veterinarian, people who may need to make decisions about spending more money than they can afford, there’s tremendous pressure to just tell them what they want to hear. “Everything’s going to be okay.” “I’m going to figure out what’s wrong.” “I can cure this.”
It would save a lot of time if I could say those things. It would get me out of the exam room and off the phone a whole hell of a lot quicker. I could get every pet owner to agree to my diagnostic and treatment cost estimates every time. I could finish my medical records and maybe even leave the hospital on time if I didn’t bother explaining to pet owners why I might not be able to give them the answers they want, and why I think they should spend the money anyway, plus the next ten possible steps we might have to take if what we do now doesn’t work.
I spend all day saying awful things like, “We could run these tests and still need to run more.” “You could see a specialist and still not get the answers you want.” “You may spend this money and your pet may still die.” It hurts me to say those things, and each of those sentences is only the beginning of a very long and difficult conversation. But time consuming and often exhausting conversations like that are the only way I can make people understand why I can’t give them a guarantee. Because for all we know about medicine, there is still too much we don’t know for any doctor to make any guarantee. The best I can do is to be honest about it.