In the depth of my despair when Apollo was dying, the medical resident at the specialty hospital made a comment I will never forget.
He was dying of a blood clot, a sequelae of hyperthyroidism and heart disease. I was in shambles, having come home from the gym to find him immobile on the couch, and rushed in straightaway, sweaty and spandex-y. I scribbled his medical history as quickly as I could, which the resident pored over with her intern as I sat in the room planning to say goodbye. I knew at that point it was coming, I was just waiting for confirmation of the diagnosis.
I had checked ‘yes’ to allergies, in the interest of being thorough.
“What allergies?” the resident asked.
“Food allergies,” I said. “Chicken.”
She paused, and shared a knowing glance with the intern. “And how do you know this?”
I blinked. “I’m sorry?”
“How do you know he has food allergies? Did you just assume, or did you actually test him?”
“I….I did an elimination diet, 10 weeks…not the full 12…. but it was obvious by that point,” I stammered, though what I really wanted to say is “WHAT THE HECK (ok maybe another word) DOES THAT HAVE TO DO WITH THE PROBLEM AT HAND?? WHO CARES HOW HE WAS DIAGNOSED WITH AN UNRELATED MANAGED CHRONIC CONDITION A DECADE AGO??”
But you know, I just sat there because what are you going to do.
Now, I understand that a teaching hospital is going to teach, but from the patient perspective I suppose I would appreciate the teaching being limited to the issue at hand instead of using an emergency cardiac event to make a point on dermatology. I don’t know if it was that, or the way she asked the question as if she were sure I was going to give the wrong answer, that rubbed me the wrong way. I also had to tell her not once but twice that I didn’t want to hospitalize him on the off chance his clot might dissolve enough to give us another month at home. We didn’t hit it off.
Fortunately I didn’t see her after that and was turned over to the lovely cardiologist who looked and talked like Oberyn Martell and understood when I said, “Please confirm my suspicion so I can give him a peaceful goodbye at home”, but it really reminded me, from the other side of the table, how hard it is to be a patient advocate for our pets. I knew what I was doing and I still had to push a little. It was a lonely experience.
It’s even worse in human medicine, as this ER physician who was hit by a car will attest to. Without someone who knows what’s going on to oversee the process and keep the focus on the overall wellbeing of the patient, things fall through the cracks. Flustered and underinformed family members get confused. Specialists focus on this problem or that problem and not the patient. How can we do better?
In human medicine, many hospitals now have designated patient advocates who serve as an invaluable liaison between a family and a healthcare provider. In veterinary medicine, it’s not something I’ve ever heard of, so we’re stuck with ourselves, the vet clinic, or the internet to help us make sense of complicated issues, to understand why the vet wants to do this or that and to empower clients to make informed decisions, including “No.” It’s not the ideal system, clearly.
I wonder if people would benefit from a neutral third party patient advocate group in veterinary medicine. I think things are only going to get more complicated from here on out, and as both a patient and a vet I think that sort of thing could only help. Food for thought.
Have you ever felt confused and not sure how to proceed with your pet? Would it have been helpful to have a pet care advocate to serve as a liaison?