The case of the 'missed' diagnosis and the 'golden' vet that caught it
Your older cat’s sudden bout of vomiting led your vet to tentatively conclude that his kidneys were failing. Indeed, his renal values were significantly elevated and abdominal X-rays were fairly normal. He was hospitalized. Your regular vet goes out of town and leaves the case to her associate.
When significant hydration failed to resolve the vomiting your vet’s associate solved the case by insisting on another round of labwork and X-rays, thereby eventually identifying the foreign body in her intestines. He was cured surgically almost a week after his initial presentation.
You’re pleased that he’s doing great but you’re more than a bit miffed that your regular vet missed such an obvious diagnosis. After all, isn’t it a stretch to say the kidneys caused the kind of vomiting brought on by something stuck in her intestines?
It’s not really the fact that you spent all this money hospitalizing her to begin with; it’s irksome more because he had to suffer in the meantime…because someone less experienced could be so much better that a vet you’ve trusted for years and years. It makes you distrust your earlier allegiance to your regular vet. You want to see the “golden vet” from now on.
Last Friday’s post on complications and sloppy work in veterinary medicine (and a post by fellow vet blogger whose post I can no longer find) gave rise to this topic: the near-inevitable success of the second vet on any given non-straightforward case.
Yes, the “golden vet” is sometimes yours truly…and sometimes it’s not. Unless we somehow manage to practice in a vacuum where no other veterinarians exist, we’ve all found ourselves on both sides of that second opinion dividing line that separates the “loser” vet from the “golden” one.
But the moral of the story is not that sometimes you win and sometimes you lose. The honest truth is more complex than that: Veterinarians granted the opportunity of offering a second opinion are much more likely to “happen upon” the solution. Three major reasons for this come to mind:
1-The second vet has the benefit of all your previous vet’s work. They know a whole lot more than your first vet did and they have the benefit of a “clean slate, “ as it were.
2-The pet’s owner is more willing to take things a step further, whereas with the initial vet they’ve lost some faith and have been more hesitant to accept taking the diagnostics or treatment in a different direction.
3-The animal’s condition has progressed in all that time (in the above example, instead of a dehydrated cat with elevated liver enzymes, the second vet has a hydrated cat with a painful belly and a climbing white blood cell count). The signs at this more advanced stage are now more indicative of the disease process.
Let’s face it, some conditions and their presentations are not amenable to easy diagnosis. That’s why any medically trained person will usually advance in an orderly fashion, identifying first the problems that are most likely to exist with any given set of symptoms and carefully ruling them out…step by step.
So when the first vet misses what seems like an obvious diagnosis to you (an invested party who may or may not be medically trained), the conditions that led to this clinician’s decisions are hard to second guess—that is, if said clinician explained the problems, was correct in his fundamental assessments and offered you all of your choices.
It’s hard sometimes to accept that suffering and expense are inevitably within the realm of the sick, especially when it’s YOUR loved one on the stainless steel table. But that’s the way it goes.
When my eleven year-old Frenchie, Sophie Sue, suffered abdominal surgery (after a workup by an internist and surgical team) on her way to being handed an eventual diagnosis of a brain tumor (by a neurologist and oncologist team), I could not fault the original specialists’ logic along the way. But I could see how someone might have.
No, in spite of how it looks, it’s almost never the case that the first vet sucked and the second vet rocked. More than likely, the difference lies in the simple luck of being the one on the “golden” end of the case.