How long do you have to wait to see your doctor? If we’re talking about “you,” i.e., the human you, a recent survey of physicians' offices across 15 metropolitan areas showed that on average, you’ll sit tight for about 18.5 days before you’ll be seen for your appointment. If we’re talking about “you,” i.e, the pet owner you, and your furry companion needs to see a veterinary specialist, I am nearly certain that if you lived in the right area, you wouldn’t have to wait more than a day or so.
The explanation for the long wait times for human physicians is the shortage of providers per capita. There simply aren’t enough doctors to go around.
For veterinary medicine, our over-accommodating nature appears to stem from the opposite problem. The relative overabundance of specialists in certain regions creates significant competition amongst hospitals.
My immediate reaction to reading the survey was one of professional indignation: Why is it acceptable for humans to wait to deal with their own health issues while I’m expected to fit in every case as soon as an owner calls to schedule an appointment?
As a veterinary oncologist, I face not only the pressure of geographical competition amongst peers, but also owners who are typically highly anxious and emotional about their pet’s diagnosis. If I can’t figure out a way to fit a case in same day, there is a good chance they will find someone else who will.
There are certain cancers where time is very much of the essence. Pets with lymphoma should be started on treatment as soon as possible. Animals in discreet pain from their tumors (e.g., dogs with osteosarcoma or cats with oral tumors) should be evaluated rapidly.
Cases where cancer is suspected but not definitely diagnosed should also be offered appointments right away, so that testing can begin quickly and treatment options can be outlined in a rapid manner. These latter cases present the biggest challenges for me as an oncologist because of differences in my goals versus pet owners goals.
My mentor during my residency ingrained upon me the basic tenets of oncology, which are to “Name it, stage it, and treat it.” When urgency and emotions cloud judgment, the order of these events can be jumbled, ultimately compromising patient care.
Difficulties arise when owners become so concerned about the urgency of the situation that they want to know the prognosis of their pet’s condition before making decisions about performing diagnostic tests to obtain a diagnosis. The assumption is that they can be seen by an oncologist and treated right away based on presumption of disease, without “wasting time” with further tests.
For example, a dog may present to its primary care veterinarian for a several week history of vomiting. Its veterinarian will likely run several tests and may diagnosis the pet with a mass within its stomach and, concerned that the pet may have stomach cancer, refer the owners to see me for options.
Many owners are surprised when I tell them stomach cancer is a non-specific diagnosis, and with that limited information, I’m unable to tell them what the best plan of action for their pet would be or what their expected prognosis would be.
For example, a stomach mass could mean the pet has a gastric adenocarcinoma, which is typically an aggressive form of cancer with very limited treatment options and a poor prognosis. Stomach cancer could also represent a form of lymphoma, a relatively treatable condition with a fair prognosis. There are many other possibilities, with varying likely outcomes depending on disease origin.
Not all masses are tumors, and a stomach mass could also represent something called gastric hypertrophy, a benign condition where a region of the stomach becomes incredibly thick, taking on the appearance of tumor, but with no obvious cancer cells within the tissue.
In order to provide owners with an intelligent assessment of their pet’s condition and to even entertain possible treatment options and prognosis, we need to obtain a sample from the abnormal tissue (AKA: "Name it"). This is why I always recommend a biopsy, or at minimum an aspirate, of the mass before entertaining discussions about treatment options or prognosis.
I’m always willing to see cases as soon as possible, and completely understand why owners would want to see an oncologist immediately when the word “cancer” is mentioned. I wouldn’t want to wait 18.5 days for myself if my doctor tossed around the word “cancer.” I’m also more than willing to help work up cases where a definitive diagnosis was not yet obtained, as I’m fortunate to work in a hospital with advanced equipment and the other specialty services necessary to do so.
As much as I’m a proponent for moving quickly in cases where cancer is a concern, I still firmly believe it’s important to take the time to sort out exactly what the diagnosis is before making generalizations about what the outcome might be.
In summary, when it comes to veterinary oncology, we must remember to keep calm and remember to name it, stage it, and treat it … as quickly as possible. I still pride myself on being able to see cases much sooner than my human physician counterparts. I just need to make sure I keep my standard of medicine up to par with what they offer as well.
Dr. Joanne Intile