Guest Blog: How to Manage a Case When You Cannot Confirm a Diagnosis
Guest blog by Dr Samyra Stuart-Altman @samyra.jamie | InkNaturally
We have all been there before. You are working up a case, and you just can’t quite connect the dots. As the results of your diagnostics start to roll in, you seem to have more questions than answers. You are starting to become stressed about what you will do next, and wondering if your patient will be ok. But you are also starting to worry about your clients – what will they think of me if I can’t give them an answer? How can I tell them I don’t know what is wrong with their pet? Will they not trust me anymore? And thus begins the snowball effect of self-doubt that so easily can be curtailed with some teachable thought patterns and easy tactics when dealing with those tricky cases.
Make a Problem List
Go back to the basics and make a problem list. Physically write them out on a piece of paper. Now ask yourself: can you connect the dots? If not, there may be more than one problem. If your effort to connect the dots looks like one of those crime-solving walls on a police detective show, it may be time to look for more than one suspect (or in this case, diagnosis).
Reach Out for Advice
Call a friend, colleague, or better yet, your mentor. There is a very good chance that they have seen this before. And if they haven’t, then they can validate you on how bizarre the case truly is!
When your colleagues are equally as stumped as you, reach out to an expert in the field. The availability of such experts may vary depending on where you practice. Some larger cities will have local specialty centres or veterinary colleges with board certified specialists that you may call or refer your patients to directly. There are however many cities and rural communities that are too remote for such amenities. Taking advantage of online internal medicine consultations can be an amazing resource for clinical insight. Some services are complimentary while others involve a consultation fee. Similarly, you may reach out to some services such as telemedicine for radiology consults. I have found all of these tactics to be incredibly helpful for some very complex cases that I have had in the past.
Keep your client updated
This is perhaps the most important piece of advice. Your clients are worried about their pet and they don’t want to be waiting and wondering. But there is a difference between waiting while wondering, and waiting while knowing that work is in progress. The first scenario is wrought with the stress of the unknown, while the second scenario allows for a more calm and collected waiting period.
Always be open with your clients. Let them know that their pet’s case presents a number of complicating symptoms and test results, and that you may need to seek input from an expert in the field before you can prescribe the safest and most effective treatment. Compare their pet’s condition to human medicine: “If these symptoms were happening to you, your doctor would refer you to an internist, infectious disease specialist and you would likely need specialized blood tests and a blood transfusion while they wait for results. I think we can agree that Fluffy’s condition is very serious, but I am going to connect with a veterinary specialist to help us make a plan for Fluffy as soon as possible.”
Clients appreciate being in the loop. If their pet’s case is so strange that you need to contact an expert, let them know! In almost all cases they are simply so appreciative of how you are willing to go the extra mile to care for their pet. Please believe me when I say that they don’t care that you don’t know all of the answers. They care that you know how to look for the answers, and that you care enough to put in the effort. And while we are on the subject, also keep them updated on a timeline. For example, “ I have submitted Fluffy’s internal medicine consult and I expect to hear back from them within three days. If Fluffy’s symptoms worsen before then, please call me right away, otherwise I will call you as soon as I hear back from the specialist.” Now your client knows how long to expect to wait before hearing an answer, and they have clear instructions on what to do if their pet’s condition worsens. I will also let my clients know how I will remember to check on their case: “The results of my consult go directly to my personal email folder, so there is absolutely no delay. I have however placed a message with myself to check in with you next week if I haven’t received the results by that time.” This type of communication will make the difference between an anxiously waiting client and a calmly waiting client.
Last but not least, be kind to yourself
We are our own worst critics. We expect ourselves to know everything, and we punish ourselves when we don’t. We dwell on the details of a case when the answer doesn’t come to us right away, and we doubt our abilities when an elusive diagnosis defies confirmation.
I think that a lot of this comes from self-imposed pressure from perceived client expectation. But when you really start to focus on being open in your communication with your clients, then you quickly realize that they are grateful for the time and effort you are investing into their pet’s care. If you can remind yourself of this, you can let your mind relax enough to enjoy the riddle of a case that sits before you.
Try to savour the challenges of a case, knowing that regardless of the outcome, you are doing everything you can for your patient. There will be times when this is more difficult than others, especially when the threat of an incurable disease is looming. And in those times you may have to take a mental pause and move on to other cases within your schedule. This is when I usually say to myself, “ I am just going to let my subconscious vet brain work on that for a while as I move on with my day.” This is my way of validating the importance of the case, but also the importance of continuing with my day and not letting myself be weighed down by the challenge.
The next time you encounter one of those crazy cases (and you know there will be many), approach the case in the spirit of resilience. Go back to the basics by making a list. Call on your peers and mentors for help and support. Know where and when to reach out to an expert. Be open and honest with your clients – they will stand by your side forever if you do this. And finally, be kind to your toughest critic: YOU.