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A question from owners that this veterinarian dreads answering…

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    June 20, 2018 1:57 PM EDT

    As a specialist in emergency and critical care for small animals, my job is to manage the most intensely ill dogs and cats that are presented to the veterinary hospital.  Examples include a dog that is hit by a car, a cat in congestive heart failure, a cat having an asthma attack, or a dog with a twisted stomach, among many other case scenarios.  Each of these situations is unique in terms of the disease pathology, systemic consequences, treatment options, and prognosis, but there is one unifying thread: all these pets have an owner (aka pet parent) with them who must decide whether and how to proceed with the recommended veterinary care.  And a question that pet owners often pose to me in these situations (the one I generally dread answering) goes something like this: “Doctor, if this was your pet, what would you do?” 

    I am avid follower of all things Gretchen Rubin (author of The Happiness Project and Happiness at Home) and regularly listen to her podcast Happier.  During one of the episodes about making a difficult decision, Gretchen’s “happiness hack” was to pose the question “If you were in my situation, what would you do?”  There is no doubt that this question is a powerful one because it forces the person being asked the question to remove their “professional” or “academic” hat and put on their “human” one.  Often this question garners insight or responses that were not shared during the initial exchange of scientific or logical information and can offer a sense of comfort to others. 

    I must admit to being in situations when I have posed this question to other people.   Whether I was looking for advice as to how to manage a difficult case or make a difficult decision, this question has been incredibly helpful for me and has given me relief in knowing that what I am considering doing is indeed what someone else who I trust would also do in my situation.  But I can also remember situations when I asked this very question and received an answer that did not align with my current line of thinking, leading me to question whether I was making the wrong decision or whether I should be doing something else. 

    And this is precisely why I cringe when owners ask me this question.  While some situations in the veterinary hospital are relatively cut and dry: for example, a dog has a bowel obstruction and needs surgery, if the surgery is delayed, the bowel could perforate leading to a much more critical and life-threatening scenario.  Other situations are much less clear: for example, a dog is diagnosed with bowel cancer and options include performing surgery, administering chemotherapy, or electing palliative care to provide pain and nausea relief.  In that situation, there is no right or wrong answer and what I might choose in that situation if it were my own pet could be completely different than what another person chooses. 

    When asked “What would you do if it was your pet?” there are so many things that make answering that question quite complicated.  For instance, my financial situation could be different, my mental band width to manage a sick pet long term might be different, my circumstance at home (i.e., my schedule, support system, living arrangement) might also be different.  All these factors are personal and affect the decision and ultimately determine what is best for that owner and their pet.  Because the bottom line is that it isn’t my pet, I’m not in that situation, nor can I presume to know all that affects that owner’s decision, so I would much rather leave that decision up to the owners who I firmly believe must make the decision that they feel most comfortable with. 

    That said, there are veterinary care providers out there who will gladly answer this question and take pride in doing so.  I posted a poll on my professional Facebook page a few months ago asking: “Do you answer the question when asked by clients ‘What would you do if you were in my situation?”.  More than 50 veterinarians and technicians responded, and the results revealed 2/3 said yes and 1/3 said no.  Those who wrote comments acknowledged that there are many factors to consider such as whether the owner has pet insurance, the evidence / research to support the options provided, other specifics regarding the owners’ situation, and ultimately what the owners’ goal is for their pet (e.g., longevity vs. quality of life).  Some also said that rather than saying what they would do, they share the options and then explain how they would advise a family member in that situation. 

    I’ve learned that the most important thing for me to acknowledge in these situations is that the owner is clearly struggling with their decision and to determine what I can do to help alleviate their stress in making the decision.  Sometimes asking the questions “How can I help you make this decision?”, “Tell me what it is that is holding you back from making a decision”, or “What do wish for most in this situation?” can help to uncover where the sticking points are and provide me with a way to help them talk through it without me making the decision for them.   

    Having been in situations before where I made a decision because someone else told me it was what they would do (and later having regretted that decision), I think the most important thing that we can do is to help pet owners come to the decision that they are most comfortable with on their own, but with compassion and patience.  Ultimately, I tell owners that no matter what their decision, they will be supported and often that allows them to breathe a sigh of relief and embrace their choice.

    Marie K. Holowaychuk, DVM, DACVECC is a small animal emergency and critical care specialist and certified yoga and meditation teacher with an invested interest in the health and well-being of veterinary professionals.  She facilitates wellness workshops, boot camps, and retreats for veterinarians, technicians, students, and other veterinary team members.  To sign up for newsletters containing information regarding these events and veterinary wellness topics, please click here.  More information can be found at www.criticalcarevet.ca.