Tuesday, March 18, 2014

How Many Sides Does Your Equation Have?

I'm going to stick my neck out and make a prediction. The pet owning public, who I refer to as "clients" are going to influence our profession so much so that IF YOU ARE NOT PERCEIVED AS A KIND, COMPASSIONATE, AND PROFICIENT veterinarian that you will never succeed in veterinary medicine. In some cases I believe that veterinary medicine is following very closely in the foot steps of human medicine. In almost all cases every veterinary disease has a human equivalent treatment option. The boundaries between your treatment options are really only limited by your ability to pay for it or believe in it. The list is long, varied and includes prosthetics, organ transplants, brain surgery, and even surpasses the human side by now offering cloning. The options are limitless and almost beyond the imagination of science fiction.

With this in mind I was saddened and shocked to hear from a veterinarian serving on my state medical board who forcefully and authoritatively reminded me that the one of the four treatment options available to owners was euthanasia. Euthanasia is an option as long as pets are considered property and owned I understand that. I don't necessarily participate in this particular kind of pet ownership, but it is the reality of the society we live in. But I would argue that we do not treat a disease or illness, or behavioral problem, or blatant irresponsibility on the owners part by killing a pet. We may perhaps resolve a problem with the option of euthanasia, but "treat"? If your physician came to you and offered to cure you of your ailment by killing you would you consider it an option? Seems absurd to me. But we have already agreed that my perspective is skewed.

The equation for a successful resolution to every client's pet concern is not always balanced. Sometimes the easy part is the diagnosis and the very difficult part is the treatment plan. When a client brings a pet in for what I know will be a long, expensive, or labor intensive treatment I know that I have to very carefully and honestly design a feasible and realistic plan and discuss what that pet will require for a successful outcome. The skill in being a veterinarian is part scholastic learning and part psychological mediation. Knowing your client, their unique individual thoughts and beliefs is a start in being able to openly and honestly discussing how to proceed down the path from identifying the problem to resolving it. Articles have been written about the subject of "knowing when to treat or euthanize."

Of particular interest was a an article written by Dr. Lore Haug on helping owners decide between treating or euthanizing behavioral problems. His article can be found here.

The take home points directed toward the veterinarian are valid and helpful but I found the articles all centered around an equation that had only two sides, the family and the pet. As if we veterinarians are just the tool to provide options?. The veterinarian is expected and recommended to remain an impartial unemotional tool, either the hand of healing or the executioner. I find this short sighted and short changing our clients. I also find it to be the singular most important problem in our field. This ridiculous expectation to detach yourself from your job, your patients, your clients, your reason for entering veterinary medicine, and your purpose.

Many of those on the  advisory board that reviewed his article explained that they believed that their responsibility was to assist the owners in making a "guilt free decision." Ugh, guilt, that awful emotional feeling that we are all supposed to shelter each other from. In actuality many of the experts advised against feeling anything. There were comments that included "Use your head not your heart," Dr. Philip VanVranken, "Make the decision guilt-free," Mili Bass DVM, "Help clients feel confident" Corey Entriken, DVM. Goodness, we are talking about putting pets to sleep! You can't undo that one.

Our clients come to us for advice. Advice includes all aspects of disease/behavioral/illness resolution. Even judges, who are supposed to be impartial vehicles of the justice system know that their personal opinions, life experiences, and interpretation of the law is skewed by their own bias.

When I was being reprimanded by the state board representative it was essentially because I refused to euthanize a four month old puppy with a pelvic fracture. I had discussed euthanasia with the owner and told her that this was one of her options (because I am REQUIRED TO DO THIS), but I prefaced it by stating that I would not do it. It was not the first time that I have refused to euthanize a pet, and for as long as the State of Maryland allows me to practice medicine, it won't be my last. At the end of my professional career I will never regret the refusals, but I do regret giving up on a few pets that maybe I could have made a difference for.

Now, I know that there are arguments and cases where almost every one would agree that a pet needed to be euthanized for the sake of the public's protection. It is my position that there are areas in veterinary medicine where I am not the expert. And when asked to act or treat as an expert that I need to defer to those who are. For example, if a client asked me to diagnose a heart condition I would in many cases need an echocardiograph to do so. Because I am not trained, nor do I have to needed equipment to do this, I would have to refer this case to a cardiologist. The same would go for the above mentioned organ transplants and brain surgery.

I am extremely uncomfortable euthanizing for behavior conditions. Here's why. In almost all cases I believe that the failure of that pet to behave properly is the failing of a human being. Whether it be lack of socialization as a puppy, not neutering, not understanding the needs of the breed, not being able to handle the needs of the pet, or not seeking help before the tragedy struck (in spite of the plethora of red flags), etc. Ultimately we failed them. I also have been practicing long enough to know that life is not about looking for the easy answers to the hard questions. The day I start taking the easy road is the day I turn my back on why I decided to become a veterinarian, and what I believe this profession needs more of, which is ultimately caring for pets.

Here's where I know my perspective is skewed. Most of my colleagues have decided to practice medicine to make their clients happy. For some of us it requires us to turn our back on the emotional fulfilling side of our job. And we wonder why we are burning out?

We burn out because we slowly, methodically, consciously or subconsciously decide that NOT feeling anything makes this job easier. We are all malleable and the longer you practice medicine the more indifferent you are likely to become. Shielding ourselves and our clients from guilt is as deceitful and counterproductive as avoiding responsibility in the part we play in all of the lives our actions impact.

I know that this topic is fraught with complexities and I am not trying to diminish this. I just think that this sheltering each other from feeling something is destructive and feckless. Go out there and love someone, OR some pet, and if your heart is wounded or broken get back in the saddle and try again,, the best things in life are those we feel.

To find more information about all things pet related, share information about pets, or just to share your pets photos, stories, or experiences, you can find me and a whole bunch of other pet lovers at Pawbly.com or on Twitter @FreePetAdvice, or at the clinic Jarrettsville Vet.

And please, always be kind.

My pup Jekyll,
who came to me at 8 weeks old by his breeder requesting I put him down
 because he was given too much of the wrong de-wormer and prolapsed his rectum,,,
oh, he was brought to me 10 days after this happened.


  1. We had a Jack Russell that was diagnosed with a brain tumor. We couldn't afford the thousands of dollars that it would have cost to treat him and then there was no guarantee he would survive it. He had lost his senses, having seizures, stopped eating and walking into walls. Having to have him euthanized was one of the worst days in my entire life. Even though I know it was the right thing to do, it still doesn't keep me from feeling like a murderer and it doesn't keep me from crying every time I think about him. It makes me sick to even think that people suggest euthenization due to behavioral issues, that with the right attention and love can be fixed. Or even a broken bone! I have to wonder if there were a decent health care system in place if it would put a stop to this? In case you don't hear it enough, I think you are a wonderful Dr that deserves every good thing that comes your way. I love that you and your associates put your moral compasses first. Thank you for that!

    1. Thank You Kim for loving your JRT so much, for being such a champion of responsible dedicated pet care, and for taking the time to read and share your story with me.

      I appreciate your very kind words, and I hope that you still have a pet in your life,,any little Jack would be soo lucky to have you!


  2. I feel the emotion and strength of your comments. If all of us could directed our "what we really want to do for our pets", to make better decisions when that time comes, without the heavy financial side, so many more pets would be with us longer.

    Most people, who have had pets before, realize (I hope) all the responsibilities involved in their care. However, many never realize, or have a crystal ball, that tells us we will always have the resources at our disposal for an unexpected event. Without going into a long explanation here, the thing humans have, to help them with medical expenses, is insurance. It wasn't something developed overnight, but for the most part it helps many. This is where we need to go..affordable, comprehensive, realistic medical coverage for pet owners. Something that is fair to the Veterinary Practices, Insurer, and the pet owners. But most important to our pets. They don't have choice. Someday, someone will be able to open that door. Until then, we are still faced with that demon. Here again, I am talking about the responsible pet owners.

    I like your "Go out there and love someone, OR some pet, and if your heart is wounded or broken get back in the saddle and try again,, the best things in life are those we feel."

    1. Thank You for reading and for your perspective, I totally agree!

      Until that wonderful day arrives we all have to try to band together to find treatments, options, and resources to help the may pets in need.

      It's all about helping each other, and improving lives..two or four legged!


  3. Hello Kim,

    Many thanks for your kind words and for sharing your experience with me. My deepest sympathy for your loss. When you make a decision for your pet based on love it is never the wrong one.

    I wish you the best and hope that time helps to heal your wounds and that you only remember the wonderful times of joy that you shared.

    I know that life can be very hard, and that to extend your heart to loving another means that you might lose them but know that those treasured memories are never lost nor forgotten.

    I know it sounds crazy, but for me it always helps to immerse myself in helping another pet, and lord knows there is no shortage of pets in need.

    All my best,