Perspective: When do I seek a second opinion?
September 26, 2012
Veterinary Medicine is not an exact science. The solution to problems is rarely black or white. There are many, many shades of gray. Veterinarians spend many years in school learning about a wide variety of animal species and many variations of normal. There are standards of normal for species, for breeds, for different life stages of the different species and breeds. In some cases, a particular animal does not “read the book” and he or she doesn’t follow the accepted normal or exhibit the typical clinical signs associated with an illness. To top it off, under no circumstances do veterinary patients talk and tell their doctor where it hurts or how they feel.
As Veterinarians, we take a detailed history from the owner searching for clues in the history that may aid in the diagnosis or give us a working differential diagnosis list. We perform a complete physical exam—making note of those abnormalities and how those abnormalities fit with the presenting complaint. A differential diagnosis list is made—a list of the diseases or syndromes that can cause the presenting complaint and the physical changes noted. A diagnostic plan is formulated to help rule in or rule out those diseases or syndromes on the differential diagnosis list. Based on the results of the diagnostics, a treatment plan is formulated and carried out. Symptomatic therapy may also be used. This treatment is used to treat the general symptoms. For example, a dog with diarrhea may be fasted and fed a bland diet. Or, a dog with a lameness may be cage rested for a week.
It is important in the client-patient relationship that there is trust between the owner and the Veterinarian caring for the pet. The client should truly believe that their Veterinarian has the best interest of their pet at heart. Part of that relationship between the client and Veterinarian is an open dialogue and the ability to ask questions. The owner is the advocate for their pet’s health and healthcare. If there are questions, ask. If there is something in the treatment plan or diagnostic plan that is unclear, ask. The flip side to asking questions, however, is listening. Your Veterinarian has spent years training to practice medicine. Follow the instructions and treatment plan that he or she has given you. The internet has a wealth of information and a great deal of it is…NOT TRUE.
There are times when you have a great Veterinarian and a great working relationship—trust, open dialogue, yet, the pet is still not improving. You feel guilty because you are thinking about seeking a second opinion. You feel that in some way you are betraying or offending your Primary Care Veterinarian. The overwhelming majority of Veterinarians in instances such as this are comfortable with their client’s seeking a second opinion. In multi-doctor practices, Veterinarians often seek second opinions on an informal basis from each other. Cases and treatment plans are discussed to gain another perspective. It allows Veterinarians to take advantage of their colleagues’ expertise and experiences.
Veterinary Medicine continues to evolve and mirrors Human Medicine in many of its specialized treatment and diagnostic capabilities. There are Board Certified Veterinary Surgeons, Internal Medicine Specialists, Cardiologist, Ophthalmologists, Emergency and Critical Care Specialists, just to name a few disciplines. If your pet has a difficult case, you may be referred to one of those Specialists for a second opinion. The Specialists often work hand in hand with the Primary Care Veterinarian for resolution of the pet’s illness. Specialists are just that—they have chosen one discipline in which to study and train. Spending several years studying one area allows for more detailed knowledge of that area and more exposure to unusual and challenging cases.
If your pet is ill, seek help from your Veterinarian. Follow their recommendations for diagnostics and the treatment plan. Ask questions and communicate your pet’s progress or lack thereof. If necessary, have an open discussion with your Veterinarian about seeking a second opinion. Your Veterinarian can be an excellent resource on where to seek a second opinion, especially in more complex cases. Sometimes, two heads really are better than one.