by Cherie T. Buisson, DVM, CHPV
Certified Hospice and Palliative Care Veterinarian
Originally published on DrAndyRoark.com
Human beings are very intelligent, but we can also be as stubborn as mules. One of the hardest things we face is not jumping to conclusions in the face of certain events, and even trained scientists find they have to struggle against their own biases to rely on logic when examining cause and effect. With the dawn of social media, however, jumping to conclusions has gone from something that is annoying to an activity that really should be an Olympic event. Even worse, some people are so invested in the conclusions they have jumped to that they will believe an inflammatory and untrue post on social media before they will believe experts in the field.
Even though I know this, I am the first to want to jump to conclusions. When I give a medication, administer a vaccine or perform a procedure and something goes wrong, I always look first to see if what happened was my fault. It takes a supreme effort of will for me to think through the situation logically and to include all the possible causes in my rule-out list. Sometimes, my clients aren’t having it. Nope, they know in their hearts that the problem was caused by (insert “food with grains,” “vaccines,” “heartworm prevention,” etc.). Sometimes they are right. Many times, however, they are dead wrong. This article isn’t for any of those clients. This article is for the veterinarians who flog themselves for mistakes that may not have been mistakes at all. Let me give you three scenarios—all of which happened to me—that prove that cause and effect aren’t as simple as they seem.
Scenario # 1
I had a cat come in for an anesthetic procedure. The cat and owner were new to our practice and, when I examined the cat, I found that she was dehydrated and underweight. I canceled the procedure.
Instead, I drew blood and gave her some subcutaneous fluids. She spent the night in my clinic. The next morning, she had a seizure—the first of her life. She rapidly spiraled downward from there and ended up on manual ventilation. Her poor owner was devastated and had to euthanize her.
Now, if I had gone ahead and done the procedure, I (and the owner) would have assumed that the surgery and anesthesia was the problem. I would have torn apart my protocols and ruthlessly investigated how I could have done it better. If I hadn’t been able to find anything, I would have lamented that the cat had an underlying brain/heart/lung, etc. problem that I didn’t or couldn’t pick up on during the physical examination. I’m sure it would have scarred the owner for life, and she would have been reluctant to ever put a pet under anesthesia again.
Luckily, I listened to my gut. That instinct didn’t save my patient, but in the aftermath, I knew that there was no way I did something to cause a seizure based on only providing fluid therapy. It was still agonizing to explain to the owner, and I felt I had failed even though I did nothing wrong, but thankfully I had reached the right conclusion.
Another cat came to me for a rabies vaccination. He was three years old and appeared handsome and healthy. Two days after vaccination, however, he came back with congestive heart failure.
The owner was convinced the vaccine was the cause. I ordered an echocardiogram that showed the cat had severe heart disease that likely had been going on since birth. It’s possible that the vaccine triggered the heart failure, but there’s a big difference between a trigger and a cause. For example, being startled, running from the dog or the car ride to the vet could have upset his delicate balance and triggered the exact same series of events.
I was working a shift at a spay-neuter clinic when a client brought in three adorable kittens. As they were being checked in, the owner mentioned that they had been vomiting.
Upon further questioning, the owner revealed that the kittens had eaten lilies. We declined to perform surgery and told the owner to take them to the ER immediately. She refused (and was very upset that we wouldn’t do surgery), and all three kittens died the next day. The owner had declined presurgical blood work (typical in a charity clinic). If their physical examinations had been normal and I had proceeded with surgery, who would have been blamed? Likely not the poisonous plants, but the veterinarian who tried to help a client in need.
Cause and effect.
You’ll never get all of your clients to believe the information you provide, or avoid jumping to the wrong conclusions. The best you can do is take a thorough history, perform a thorough physical exam, provide recommendations, document them and never let anyone pressure you into doing something that makes you uncomfortable.