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Thursday, April 26, 2012

Fighting Complacency

When I was in college I was a DJ for the univeristy radio station.  I loved modern music (of that time...80s to early 90s) and thought that I was very hip and aware of what was on the radio.  It was unimaginable to me to not be aware of every musician out there and I anticipated always being this way even as I got older.

Flash forward to today...I recognize the names of modern artists such as Adele, Katy Perry, and Lady GaGa, but I couldn't tell you a single song they did.  This is despite having the radio on at work every day.  Getting older made me appreciate the "old" music more and though I don't hate contemporary pop, I'm comfortable in what I grew up with.  I've learned that this is a natural tendency, and extends beyond music.

Recently fellow veterinary blogger "The Homless Parrot" wrote an entry on how she has to fight against herself getting lazy with working up cases.  After 15 years in practice, I can completely relate, and have seen this in myself.

On any given day it's a virtual certanty that I will see at least one case of diarrhea, ear infections, skin disorders, dental disease, and lameness.  Seriously, these problems are this frequent.  Most of these cases are routine and I'm going to diagnose and treat them the same way.  My years of practice have also shown me that some of these cases get better despite us rather than because of us, and in the others almost any treatment I use will be effective.  It is so very tempting to see that dog with gooey, itchy ears and just give it some medication.  It's very likely that that itchy skin dog has allergies and will respond to antibiotics and steroids.  But just doing that is poor medicine.

Early in my career I would see older vets who would just throw antibiotics or steroids at a case and call it a day.  "I'll never be like that," I would think.  "I'll always keep up with current medicine and do the right things."  For better or for worse, I can now understand those older doctors better.

So many cases we see are identical and are seen time and time again.  I can do these cases in my sleep, and have a set pattern of diagnostics and treatment.  In recent months I have had to fight the tendency to just treat based on experience and instincts, avoiding proper diagnostic work-ups.  The sad thing is that if I just treated, most of the time I'd be right, even without testing.

So why bother doing the ear swab or the skin scraping?  Why do we go through all of this if our treatment plan would work anyway?

Because it's good medicine, and some cases surprise you.

Just today I saw a 15 year old outside cat who was lethargic and loosing weight.  With that background I was thinking hyperthyroidism, kidney failure, feline leukemia, and a host of other problems.  I wasn't seriously concerned about the discharge coming out of his right ear.  So we worked up the case with a battery of blood tests, and an ear swab almost as an afterthought.  As it turns out there wasn't a darn thing abnormal in his blood or urine, but the ear was heavily infected with a bad bacteria (rods, for my veterinary audience).  If I had just gone on an educated guess, I would have started talking about euthanasia due to some likely bad and incurable diseases.  Because I took the time to work it up I was able to make the proper diagnosis.

Situations like this are not uncommon.  Yes, I have practiced long enough that most of my guesses are right.  But I would hate to misdiagnose or mistreat a pet because I guessed wrong.  Doing the tests keeps me from guessing wrong.

The longer you practice and the more you see the same cases day after day, the more complacent you can get.  This is human nature, like my situation with the music on the radio.  To be a good doctor you have to actively, consciously fight this tendency.