Depending on the situation at hand, I try to provide as many options as I can, and give owners the information (and time, if I can) to make an informed decision that they will feel comfortable about when all is said and done. In some cases, the options may realistically be limited to two, or perhaps three if we get creative and start bending the rules. In others, I can sometimes come up with five or six pretty realistic paths we can toss around.
I try to come up with options that will meet with most budgets (from the near-destitute to the wealthy) and most views on pet ownership. Like it or not, we see people who don’t value their pets as much as I do, and I have to serve the owner’s as well as the pet’s interests. There’s no point in my demanding an MRI for someone who either can’t pay for it or thinks it’s a crazy thing to do. I still discuss it, but I don’t hold their feet to the fire.
Along with the options, I will usually offer up a recommendation for what I see as the best course of action. Sometimes, all the options are equally good, or equally crappy, and sometimes the one I see as best also has the biggest price tag (but not always). I have found that this combo of delivering options with a recommendation thrown in the mix seems to hit the right note of satisfying my conscience that I am doing right by the pet and the owners.
Human and veterinary medicine used to ascribe to a more paternalistic way of doing things; the doctor was always right, the doctor told you what to do, and the doctor usually drove the bus, wore the bossypants and made the decisions. No so anymore.
For human and animal patients alike, the age of the empowered patient and owner is here. People are educated about their health and the health of their pets, and rightly want to be a part of the decision-making process. I celebrate this, and find that discussions with educated and smart people are one of the joys of practice. We develop a plan together, and we all take pride in it if it works and we all take the lumps if it doesn’t. I get to bask in a little bit of the glow when things come out well, and I have a partner in crime if they don’t.
My options/recommendation scenario doesn’t always work, though. In order for it to work, the people on the other side of the exam table have to be able to actually make a decision when the time comes. There is a segment of the pet-owning public that gets stuck in an endless Möbius strip of uncertainty, obsession about blame or flat-out fear, and is unable to give me a go/no-go on any decision. I am not sure if this is the same contingent that really does want the decision pre-formed and handed to them, a lá 1950s-era Marcus Welby-style medicine or not.
In these cases, we may spend time in the exam room coming up with our two or ten options, but be met with blank stares and silence when it comes down to picking one. When I gently try and get an opinion from them about which direction they feel is right, in some cases nothing comes of it. Prodding or being insistent is not my style, and I think rarely bears fruit; the discussion usually just degenerates at that point and we don’t get anywhere.
I am sometimes met with angst (“I don’t know what to do!”), anger (“You’re the doctor; which is the best?”) or, more often than not, just crickets. We just sit there staring at each other.
I will usually give the family some time alone to discuss things, and then come back to answer questions and see if we can pick a path forward. Sometimes a little gentle power-of-suggestion stuff will work wonders, as in “I’ll give you some time to talk this over, and then when I come back you can let me know which way to proceed.”
What’s your take on this? Are there times when you just wish the doctor would make the call for you? Are there times when none of the options are attractive to you, and all the options suck? Have there been times when you felt a doctor did not give you all the options and merely made the decisions for you?
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