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Monday, July 22, 2013

Instant Expert....Just Add Textbook

Any clients who read this post are in for a shock.  Your vet doesn't know everything.  *GASP*  No matter how much you love your vet or think they walk on water, they don't know all there is about every disease out there.  "But every time I come in he/she always seems to knowledgeable!"  Ah, but there's a reason for that.


When I go to conferences the busiest vendors are always the textbook publishers.  These books are not directed at veterinary students, but instead are bought by experienced practitioners.  Every good vet has a decent library of books in their office, many of which are coming apart at the binding because of being opened so many times.  One of the things I emphasize to new graduates is that there is no shame in looking things up.  Every vet does so daily.

Often right before we go into a room.

A few days ago I had a dog come in for a discussion about Addison's disease.  This is a disorder where the body doesn't produce enough steroids and can be life-threatening.  Thankfully it's a very treatable disease with and excellent prognosis.  But I don't see a case every week, so the small details were a bit fuzzy.  In fact, it's been a few years since I've had a confirmed case come to me.  My memory remembered the basic lab values (decreased sodium and increased potassium, often with kidney values out of whack), the very vague symptoms (lethargy and weakness), the confirmatory test (ACTH stimulation) and general treatment (steroid supplementation).  However, the specifics of the disease escaped me, especially specific values and dosages.  So before I went into the room I pulled out one of my textbooks and read the section on Addison's disease to refresh my memory.  By the time I went into the room I could talk to the clients like I diagnosed this disease every day.

This is in no way deceitful or dishonest.  There is so much to know in medicine that nobody could possibly keep all of the information in their memory.  One of my associate doctors has a seemingly encyclopedic knowledge of even obscure veterinary diseases and treatments.  Sometimes I shake my head at the facts that she easily spouts.  Yet even she looks things up daily.

Yes, talking about this is a bit like pulling back the wizard's curtain in Oz.  But I want clients to know that doctors aren't all-knowing, despite our best intentions.  And I want veterinary students to know that having to look things up doesn't mean that you aren't a good doctor.  Sometimes all of us need a little help.


  1. As an owner of a dog with Addison's Disease, I'm pretty sure that most owners of A-dogs end up knowing more about the disease and its treatment than the average veterinarian. We do so because we don't have much choice. ;o) I was very lucky that my vet IS familiar with Addison's Disease and my dog was diagnosed in a couple of days. I've heard many stories of dogs that repeatedly crash, go into the clinic and bounce back after receiving fluids & steroids only to go home and crash a few days later because their vet isn't familiar with the disease or its symptoms.

    I also feel very lucky that my vet kept up on the cutting edge news and was familiar with the protocol introduced by Dr. Julia Bates of starting dogs out on a dosage of Percorten-V MUCH lower than recommended by the manufacturer. Had we dosed my dog by weight based on the manufacturer's recommendation he would have been given over 3x as much as his body needs. Instead it only took us 4 months of reducing to find his perfect numbers (and this is, by the way, a HUGE savings when you look at the cost of that drug!).

    I know the low-dose protocol is starting to get a stronger foothold amongst veterinarians who are aware of it, but unfortunately most are still following the manufacturer's recommendation.

    If you are ever interested in learning more than a book could ever tell you about this disease, just look up the Addison Dogs Yahoo Group. They were a wealth of knowledge for me when my dog was diagnosed.

  2. Dr. Bern,

    It's nice to know that even experienced doctors have to look things up! I'm still in my first year of practice and it's overwhelming how many hours a week I spend on VIN and looking things up online ;-)

    Katie Johnson, DVM

  3. This is a great blog! If I had read this 12 years ago, I would have saved myself a lot of stress and would have probably realized that I am not the only one feeling the pressure of trying to make everyone happy. One of the hardest lesson in life to learn is that we will not get along with every human being out there not matter how hard we may try. Accepting the fact that not all clients will like us is hard, but it is part of growing up as a person and a vet.

    I did laugh out loud about your comments about text books, that was awesome, funny and yet so true! I guess the cat is out of the bag now! :)

    Dr Cindy Lizotte

  4. At my first job our book shelf was in one of the exam rooms that doubled as an office. If I needed a book for the case that was in that room I was always too embarrassed to take it with me on my way out to the lab/pharmacy. So I would leave, find another tech and send them in after the book so the client wouldn't know I needed it for their pet!


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