In defense of the client's right to say No

When writing these op-ed pieces I simply try to stimulate conversation and share whatever small bits of wisdom I may have acquired. But these articles also have been a learning opportunity for me. I learned several things after my article concerning conservative therapy for cruciate ligament injuries.

First, merely suggesting the bare possibility that surgical correction of ACL injuries might not always be required can cause board-certified veterinary surgeons to begin boiling tar and plucking chickens while dragging out their old physics and geometry lecture notes. (Lectures I attended as well.)

Second, apparently non-veterinarians read this publication, too, and discuss the articles among themselves. I received several phone calls from pet owners across the country about that article as it related to their own pets. Of course, I couldn’t offer any specific advice for patients I had never seen, but that wasn’t what the callers wanted. They all seemed to be seeking my permission and blessing for their pets NOT to have surgery.

One call in particular stands out. The lady likes large breeds, and her current dog (weighing more than 160 lbs) injured his ACL six months ago. Her vet is pressing her mightily to schedule costly (her term) TPLO surgical repair. But her previous large dog also ruptured an ACL, had the TPLO surgery, never regained use of its leg and subsequently developed bone cancer near the site of the surgery and was euthanized.

Obviously, she’s just a little “gun-shy” about having the same surgery for this dog. Disturbingly, when I asked what other treatment options her vet had discussed, she told me he had said only that TPLO surgery was the dog’s “best chance” (for what, I am not exactly certain) and never mentioned any other possible solutions.

Some would say that the vet is the one to decide the best treatment plan for a patient, but I maintain that is not true and never was. The vet is the best one to know all the treatment options and to present the owner with all of the various pros, cons, costs and prognoses. He or she may even recommend one course of action over another. But the person to decide which plan makes the most sense for both the owner and the pet always has been and always will be the owner.

To a few of my colleagues I would respectfully suggest less dictation and more consultation and collaboration in the exam rooms. In my vet-school days this was referred to as developing a good tableside manner.

And to all you loving pet owners I would respectfully suggest that it is OK to politely say “No” to a doctor (veterinary or medical), make the best educated choice you can make (Who could possibly expect more?), and don’t ever feel guilty for choosing “less than the best” if the best doesn’t seem the right choice for you.

You have my permission.