The five crucial components to a veterinary visit include recording a patient's vital signs, taking a complete medical history, performing a comprehensive physical exam, recommending laboratory tests, and discussing the utility of other ancillary studies. You might be surprised to learn that the most useful of those five pieces of the diagnostic puzzle has nothing to do with fancy machines or expensive laboratory tests. 


Any vet worth their weight in prednisone will tell you it’s the patient’s history and current physical exam that are the most crucial contributors to answering the proverbial question of “What’s going on with Fluffy?”


Veterinarians are trained in the art of obtaining a thorough medical history in school, where we’re exposed to a variety of interrogation techniques during our curriculum. The most important aspect ingrained in us, above all else, is to avoid asking closed-ended questions.


For example, when faced with an owner who is worried about the way their pet is breathing, instead of asking “Does Fluffy pant?” which can be answered with a simple “yes” or “no” response, we should inquire “Describe Fluffy’s breathing.” The latter allows for further probing, establishment of trust between the doctor and client, and, ultimately, a more open dialogue.


The goal of asking open-ended questions is to allow owners to not only give as much information as possible as to what they perceive is happening to their pets, but also to empower them to feel as though they are an active participant in the process.


It all sounds wonderfully productive in theory. However, at least once a day I find the tactic of asking open-ended questions about as successful in helping to achieve a diagnosis as attempting to communicate anything to my husband during Sunday night football. In other words, it just doesn’t work.


Here are three very typical scenarios where open-ended questions literally, without fail, detonate within my exam room:


Scenario #1: “The Disagreeable Husband/Wife Team”


ME: “How is Fluffy’s breathing?”


HUSBAND (with a slightly blank look): “She’s breathing fine.”


WIFE (looks at husband with shock and horror): “Fluffy’s breathing much harder than ever before. Especially at night. Sometimes it wakes me up and I can hear this noise, like it’s coming from deep in her lungs. It’s very raspy and loud.”


ME (struggling): “So Fluffy breathes harder at night? Tell me a little more about this. How long have you noticed this going on?”


HUSBAND (with a complete blank look): “I don’t know what she is talking about. Fluffy breathes the same way she has her whole life.”


WIFE (shooting daggers from both eyes that are designed to shred her husband’s soul): “Well with as much attention you pay to me, I’m not surprised you haven’t noticed that Fluffy breathes so poorly. She’s been doing it ever since last Thursday, right after Dr. Intile called us with the news about her cancer.”


ME (continuing to struggle): “So Fluffy started showing signs of labored breathing after she was diagnosed with her tumor on her paw?”


WIFE (interrupting my statement and still addressing her husband in an escalating loud voice): “I can’t believe you didn’t notice her breathing! She’s practically gasping for air, while you sit there and ignore her!!!”


ME (hands pressing into forehead): “Moving on…”



Scenario #2: "The Strong But Silent Type”


ME: “How is Fluffy’s breathing?


SST: “Fine”


ME: “It says here you brought Fluffy to see your primary doctor because she was coughing? Tell me more.”


SST: “She does cough”


ME: “When did you first notice the cough?”


SST: “A while ago”


ME: “When you say ‘a while ago’ do you mean a few weeks or months? Any idea how long it’s been going on?”


SST (Pausing): “For a while”


ME (hands pressing into forehead): “Moving on…”



Scenario #3: “The Busy Mom With 3 Children Under The Age Of 4”


ME: “How is Fluffy’s breathing?”


MOM: “Declan put that down! Do not put that in your mouth! Do you know you are in a VET HOSPITAL with TONS OF GERMS?! Madison, if you don’t stop hitting your brother, you will not get any ice cream! Sophia, sit down! I’m sorry — what did you say?”


ME: “Wow, looks like you have your hands full! Let’s try this again. How is Fluffy’s breathing?”


MOM: “Fluffy pants a lot. I noticed it back in — Declan stop going through the garbage and do NOT feed that paper towel to Fluffy! Madison and Sophia stop screaming right now! Here’s mommy’s iPad. Why don’t you watch some Elmo” Turning back to me, “I’m sorry, what did you say?”


ME: (hands pressing into dents that are now permanently located along my forehead) “Moving on… and could I please get my stethoscope back from little Declan’s mouth?”



Despite the communication difficulties, the bottom line is that each of the aforementioned are in the exam room because they love their pets and they want the best information available to help them make a decision about how to pursue their care. But making sure the information flows freely in both directions, from owner to myself and vice versa, can be challenging, to say the least.


It’s an understatement to say we could all stand to benefit from working on our communication skills every day. Likewise, no one single communication style will work for every owner, despite what my mentors in vet school taught me.


I’ve found that when faced with any one of the situations above, I have to accept it’s just one of those times where the “rules” don’t apply, and we all simply need a break from being open-ended.


Instead, a closed ended-question can be just the thing to help move the consult along and help get me to the actual answer of “What’s going on with Fluffy?” so I can move along to the next appointment, and start the adventure all over again!



Dr. Joanne Intile



Image: Kachalkina Veronika / Shutterstock