I spend a great deal of time asking owners questions about their pet.
What did you notice about your pet’s behavior that made you bring him to the vet?
When did you first notice the mass?
Is she vomiting or having diarrhea?
What do you know about your pet’s diagnosis?
I ask questions to gain a better understanding of the animal’s disease and how afflicted they are by their condition. I want to make sure owners comprehend my recommendations and the options I’m presenting them with. I need to know we are all on the same page regarding our expectations. But this inquisitive dialogue is rarely one-sided.
Owners ask me a tremendous amount of questions, too. Some are predictable and some are more specific, while others can be remarkably probing.
One question I am routinely asked is, “What else should I be asking you?”
I used to find that particular inquiry rather peculiar, but I’ve grown to embrace it for what it represents in terms of ensuring good communication between my clients and myself.
The following are examples of the types of questions I try to ensure are addressed for my patients, even if the owners do not think to ask them in the first place.
1. “How long will my pet live if I do everything you are telling me to do, and how long will they live if I don’t?”
This is the most reasonable question to ask a veterinary oncologist, and also the most difficult to answer. As an evidence based doctor, I use the results of previously published research to help guide my treatment recommendations. Data from the studies offers information regarding what patients would potentially benefit from a particular treatment plan and what their expected prognosis would be.
However, veterinary research studies, in particular those associated with oncology, are notoriously weak in that they tend to enroll low numbers of patients, lack standardization of methodology, and are absent of untreated control groups with which to accurately compare outcome.
Juxtaposed against research studies are my personal clinical experiences, which often influence how I think a patient could respond to treatment. Though reasonable to consider, if I practiced medicine solely on the basis of experience, I’d be subjecting my owners and their pets to an incredible amount of bias.
The question I can answer is, “What do you think is a reasonable outcome for my pet if we do the treatment you’ve outlined?”
2. “How will I know when it’s time?”
When owners ask me this, I always take a few seconds to pause before starting to respond. Veterinary patients are blessed with the option of euthanasia to relieve suffering. We alleviate the pain and debilitation associated with fatal diseases so death can occur with dignity and peace. Because we make this decision for our pets, it is nearly impossible to quantitate when “enough is enough” from the outside.
Most owners assume quality of life is a discreetly calculable parameter. In many ways we can measure a patient’s quality of life, but it does not exist as a line in the sand that is crossed at a specific moment. A pet’s quality of life exists on a continuum from excellent to poor; a virtual sliding scale of what is acceptable versus not.
I am trained to make sure that pets do not suffer. But even that barometer is different for each veterinarian. There are many who would state that administering chemotherapy to an animal is akin to torture and will equate it to a poor quality of life. I, obviously, vehemently disagree.
The question I can answer is, “Can you help me understand what signs to look for that indicate my pet’s disease is progressing?”
3. Will my pet become sick from chemotherapy?
Though I know 75% of my patients experience no adverse signs from their treatments, the converse of this statement means that 25% will. And 5% will experience severe toxicities that could be life threatening.
When all things are otherwise equal, and patients are in good health other than their cancer, I have a very hard time predicting which ones will fall into the latter category.
It’s easier to foretell a poor reaction to treatment when lab work tells me a patient’s liver or kidneys are failing, or when a pet is showing significant adverse clinical signs prior to starting treatment. Those pets are more likely to become ill from treatment because they are already unwell. For the average pet with cancer, I can’t discern who might not fare well with chemotherapy.
The question I can answer is, “Do you have any specific concerns about my pet’s ability to withstand the treatment you’re offering?”
I realize I’m being idealistic when I ask for alternative phrasing of those particular questions. Likewise, it’s just as easy for me to answer the original question by saying “I can’t answer your question directly, but here’s what I can tell you…” to ensure expectations are met.
The take home message is, don’t be afraid to query your vet with “What other questions should I be asking you?”
They probably have an excellent idea of what it is you didn’t even know you were thinking about in the first place.