Before You See a Cancer Specialist, Have Records in Hand
As a veterinary specialist, I rely on a steady stream of referrals to keep my schedule full and maintain an active caseload. Sometimes pets are referred by their primary veterinarian, or another specialist, and in other cases, owners refer themselves.
As soon as the appointment is booked, we begin requesting the animal’s medical records so they can be reviewed ahead of time. This includes all pertinent labwork, exam notes, radiology reports, medications, etc. This seemingly simple task often turns out to be one of the most challenging aspects of the job.
The more information I have available at the time of a consult, the more valuable the time will be for owners. Knowing more about the patient before they arrive allows me to plan things such as reserving ultrasound times with our radiologist, or preparing surgeons in case we need a consult, or even plan time in our schedule for a biopsy or other more intensive procedure.
Most owners expect “same day service” for our diagnostics, and this can be greatly facilitated by planning things based on the information obtained from the records. Otherwise, I’m left to navigate the possibilities without guidance, leading to further time delay, expense, and even disappointment from owners.
Often, the most important component of the pet’s record would be the cytology and/or biopsy report. This will contain information about the diagnosis to date and help me understand the nature of the pet’s cancer. However, if this is the only piece of information available, it’s impossible for me to make a thorough assessment of their condition.
In those cases, owners are surprised when I ask them basic questions, such as “Where was the tumor located?” or “How big was the tumor when it was removed?” or “Did your primary veterinarian perform any bloodwork or radiographs?” Their standard answer is usually, “Well, isn’t in the record?”
They are typically stunned when I tell them, “No. The only thing I have is the biopsy report.” Imagine how complicated thing can be when more than one tumor was removed at the same time. Or when animals have been seen at more than one hospital. Even when I do have the actual exam notes, many times those exact details have never been recorded, so, ultimately, I can’t make a correct assessment.
Every once in a while I will receive a biopsy report where the only reported information is the “bottom line” diagnosis, and no microscopic description of the tissue is included. Some pathology services offer this as an option for veterinarians, presumably at a reduced fee.
What owners do not realize is the information garnered from the actual explanation of what is seen is so valuable for making further diagnostic and treatment recommendations. I would urge owners to reconsider selecting the less expensive options, even when they initially feel they would not consider further care for their pet should a diagnosis of cancer be obtained.
When I don’t have the entire description available, I never hesitate to tell owners they should consider having a second read on the biopsy so we can obtain the missing information. This can obviously delay definitive treatment, but ultimately leads to choosing the correct option for that particular pet.
For every new case I see, I write a thorough discharge summary, including the patient’s history, medications, physical exam findings, results of any diagnostic tests we perform that day, and a prognosis. It’s my practice to write the history portion of the discharge on the day prior to the actual appointment.
Writing the summary ahead of time helps me organize my thoughts about the case and also ensures that we have all the important information in place before the pet actually steps inside the hospital. If I catch missing lab reports or discover that the pet may have been seen at a different hospital, we can try to obtain that information before they are seen.
There are two main issues I face as an oncologist when portions of a pet’s records are not present at the time of their consultation:
The first is that it’s very difficult to rely on owners to provide the necessary details necessary to complete the picture. Most people do not possess the medical background required to understand their pet’s condition, so it’s unfair to expect them to know the exact details of specific portions of their pet’s healthcare. Even when they are able to provide the background information, emotions can cloud their recall and reliability.
The second concern is that if we are trying to obtain records once the animal arrives for its appointment, this can wind up wasting a good portion of the time assigned for the consultation. This not only wastes the pet owner’s time, it also places me behind schedule, leaving me with less time to spend helping other owners and their pets.
If your pet is referred to see a specialist, one of the most important things you can do is make sure your pet’s records arrive at the specialty hospital prior to your appointment. This may mean you have to take the extra step to call both your primary care veterinarian and the specialist’s office to make sure everything is in place.
It may require a little more input than you would expect for a typical veterinary appointment, but it will be well worth the effort in the long run for both you and your animal companion.
Dr. Joanne Intile