Get a Second Opinion, revisited

A while back, I posted some thoughts on getting a second opinion, and today I follow up with some more.   The bottom line is (if you don’t believe it, scroll down to the bottom): If you want a second opinion, let me help you get the most out of it.

Yesterday I examined a little Schnauzer who had been throwing up for a couple of days.  This breed is famous for being overly susceptible to pancreatitis, so that was my first thought.  Her outward physical examination looked pretty much okay, eyes, ears, mouth, heart and lungs, etc.  She had no abdominal tenderness.   The most striking findings were a high fever (105.6) and that she had lost a significant amount of weight since her last visit in July — from 25 pounds down to 20.  I asked the owners if she had been on a diet (she actually looks better at 20 than at 25), but no, really they hadn’t been working at any kind of a weight loss program.  A significant and unexplained weight loss is a little disturbing.  Put that together with the vomiting and you start worrying about a lot of potential internal organ problems — liver disease, kidney disease, cancer (and pancreatitis, too, of course).

We did a complete blood count and biochemistry profile, revealing a high white blood cell count, with lots of immature infection fighters ("band cells" — they’re kicked out before they’re ready when the body has a sudden demand for them).  Her kidneys were not functioning well, either.  Blood Urea Nitrogen was two times normal (which can happen pretty fast) and Creatinine was three times normal (which takes a few days).  This little gal was a lot sicker than I had hoped to find.   

At this point, I felt we needed to get a urine specimen for microscopic analysis and culture, and an ultrasound exam of the abdomen to get a better look at her kidneys (and whatever else; that weight loss may have other factors).  She also needed to be on intravenous fluids and antibiotics to flush those kidneys and get those wastes eliminated — the high waste in the bloodstream was the most likely cause of the nausea she had been showing.

At this point, her owners felt that they were reaching the limit of their financial commitment, so I was compelled to stop the diagnostics and do second-best therapy, with subcutaneous fluids, and oral antibiotics to send home.  This is one of the unpleasant realities of veterinary medicine. 

I was definitely concerned about how well the dog would do on this second-best regimen, so we called to check on her this morning.  Lo and behold, while the dog does seem to be feeling better, the owners were at another clinic seeking a second opinion — they wanted to be sure it wasn’t an ear infection making the dog nauseated.

Now you might think that I would be hurt by this lack of trust.  After all, I did examine the dog’s ears and they were okay.  We had clear evidence of other, serious problems, which we began treating as best we could within the limitations set by the owner.  And truly, I can’t say that it made me feel good.

Here’s the thing, though: I understand that any time you give someone an answer they don’t want to hear (like "your dog is really sick and needs intensive diagnostics and intensive treatment"), people are going to be looking for a happier answer.  That is very natural.  Also, you don’t have to believe something just because I say it. 

What is important in these situations is to do what is in the best interest of the patient, and seeking a second opinion can certainly fit that category.  BUT… if that’s what you want to do, just say so.  That way I can give you copies of your medical records and lab-work so that the other doctor isn’t operating at a disadvantage.  Making him or her see the case with no knowledge of what went before can give them a skewed picture of what’s going on.  Aside from re-running tests you’ve already paid for somewhere else, the new results mean a lot more in relation to previous results and treatment than they do standing on their own.  [Fortunately, in this case we were able to fax copies to the second doctor.]

My job is to do what’s best for your pet. That’s the first priority, and delivering the service you want is the second.  If you want a second opinion, let me help you get the most out of it.

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