Philosophies of Medical Practice

Philosophies of Medical Practice
By Dr. Ed Mapes
Stonebridge Animal Hospital
McKinney, Tx

There is an old saying that describes how different seagoing ship’s captains carry about the business of conducting ocean voyages: “Different skippers, different long splices”. Crewmembers know to expect varying approaches to seamanship on different ships.

Doctors go about their business with similar individual approaches, reflecting diverse philosophies of practice. Not to say that one is right while another is wrong, but these varying modes of practice can absolutely produce different qualities of medicine.

I believe that any doctor’s responsibility is to do what’s necessary to make accurate diagnoses of patients’ disorders, and then recommend the best medicine or surgery necessary to make appropriate corrections to achieve the desired outcome. It is not a doctor’s primary task to make value judgments of our client’s abilities or desires to reach that outcome; those decisions are best left in the hands of those pet owners themselves.

Our inappropriate and incorrect decisions for pet owners alter the standard of patient care and very possibly the final outcome; we are not trained or able to make those decisions. Our training is in medicine – we learn to assess, make appropriate testing decisions, diagnose, and prescribe treatments – not to make our clients’ decisions for them.

I described in a previous article how veterinarians are actually medical detectives; our patients can’t relate information about their discomforts or problems so we must piece together various puzzle pieces to make diagnoses. It stands to reason that the more information (pieces) we have, the better our judgements will be.

Part of our responsibility is to recommend the best means necessary to gain that information: lab testing, radiographs, ultrasound, or whatever other testing would give us the information necessary to make the best decisions. We are able to narrow down the tests that we want, and should never recommend unnecessary procedures, but it is irresponsible to recommend less than what we really need. I don’t think pet owners come to the hospital to learn what might be wrong, or what could maybe work; they want our best assessment of what is wrong and what will fix it.

Treatment options are likewise based on the most accurate information we can give our clients to achieve the most desirable outcome for their pet. If an animal really needs a surgical procedure to relieve an abscessed tooth, we fail to meet our responsibility of care by recommending only pain medication instead. That is not the best medicine and the patient will suffer for it.

My philosophy is to make recommendations of the best diagnostics, medicine and surgery needed, to make the pet owner aware of this best-case scenario – our best chance of successful patient management. That is when I have fulfilled my obligation of providing the highest level of care.

We fully understand that pet owners have different situations that bear directly on their desire/ability to follow those recommendations. Factors such as age of the patient, life expectancy, financial concerns, and many more considerations can be very important. Once we outline the best medicine, then we should be perfectly willing to follow a Plan B course that is more to their liking or that better fits their needs.

We can try to make diagnoses based on less than ideal information; treat with empirical therapies that experience suggests may work, or forego the best course of treatment altogether if that is the clients’ desire. Their decisions must, however, be based on the best information that we can give them; pet owners should at least understand and have the option of that level of care.

A common mistake by practitioners is to make value judgments on behalf of their clients.
“Their dog has heartworm, but they’ll never pay to get it treated”.
“His cat needs abdominal surgery to remove the tumor, but he’ll never have it done”.
These judgments of our clients are made all the time by veterinarians. With those pre-determined concepts in their minds, the doctors all too often recommend a second rate course of therapy, or worse yet that euthanasia is the best course of action. Failure to recommend the best medicine results in patient suffering and sometimes even death, and so often can be avoided by simply doing the job we’re supposed to be doing.

Make sure to ask if the diagnostics and resulting therapeutic recommendations are the best available before agreeing to a plan outlined by your veterinarian. It may be that your doctor has made a value judgment for you, and it may not agree with what you would actually choose yourself.

Dr. Mapes is currently preparing to open a new veterinary hospital in McKinney soon – the Stonebridge Animal Hospital. For more information about Dr. Mapes, go to www.offshorevoyager.com.

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