Wednesday, July 4, 2007

Doctor and patient: a special bond

When the “best” just isn’t…

Yesterday our hospital received a call from our local specialty clinic regarding a mutual patient I referred for chronic shoulder lameness. Usually, these calls are the routine requests for histories, notes on the patient’s progress, discussion of a pending surgery, or surgical follow ups.

This call though, was a bit different and brought home the importance of the doctor/patient bond. From the doctors point of view, the essence of this relationship is to be true to the patients own unique needs. The patient (patient’s owner in our case) needs to feel they are not being judged or coldly analyzed, but that they are in a receptive relationship- you could say, almost intimate with respect to the information shared- where their concerns and problems are acknowledged and considered.

The call from the clinic was regarding a blood test level of a replacement hormone they thought was too high. The “best” and ideal level needed to be lower. In and of itself, this was no problem, as reviewing the dynamics of blood tests, or for that matter, the moving dynamics of any illness is an important part of keeping on top of things. What was frustrating was that this was the second call from the clinic. Earlier, I had had a detailed conversation with the patient’s owner regarding this test, what it meant, and what we together were going to do about it.

You see Matilda, our patient, had a looming problem- she was getting on in years and her limp was getting worse. Both issues were feeding on themselves as exercise had always helped keep an old shoulder injury fairly stable and pain free. Recently, we had found she was developing hypothyroidism, a common condition in geriatric dogs, which complicated the matter.

In addition, her owners had recently been going through a huge life changing transition. Life, as happens so often, had sucked them into survival mode as a family crisis, a job loss, financial demands all left Matilda with less walks. This added layer of problems occurred just as her condition worsened.

So, we had a fat, painful, and unhappy dog with very concerned and loving owners who were reaching out to find any way to make things better. Through time, we had tried a series of approaches from pain management, thyroid supplementation, special diets, and varying exercise regimes with minimal effect. The owner’s personal situation eventually improved, but Matilda was now stuck in her own rut.

The fascinating thing about many medical situations is that they are hardly ever a straight black and white affair. Often, careful consideration and communication between practitioner and, in this case the owners, often helps dial in on the best approach to a problem. So it was with Matilda, as we decided to increase her hormone medicine and continue pain control with the goal of getting her to lose some weight as exercise was what helped the most for her.

We evaluated her for any other potential risks and issues and together with the owners developed a plan for the next year. A referral to the specialty clinic confirmed there was no other concern we needed to be aware of and they concurred that pain management and weight loss were the main issues.

During the following months, Matilda began to improve, at first slowly, then at a quicker pace to the point she had lost significant weight, was actually sound (not lame), frisky, and “her old self” according to her proud owners.

So needless to say, when we received a second phone call from the referral clinic about the follow up blood value it was a bit frustrating. Though, they were just doing there job, they were implicitly wanting us to lower those dosages. We let them know things were under control and - in a nice way- told them to bug off.

Watching a happy bouncing Matilda and the smiles on her owner’s faces reminded me of how important a good “family” doctor/patient bond is. Whatever the outcome (sometimes it can be quite sad), it is this type of relationship that can be most fruitful in reaching the most relevant and appropriate paths- whatever they might be.

No comments: