Geeks on steroids

Playing "God" with clients is the veterinary version of "the revenge of the nerds."

Most of us went through high school making good grades and mostly enjoyingschoolwork. This, of course, earned us the appellation "geek".

We didn't like that so much, so we took on a few "normative"behaviors like smoking, drinking and cussin' to divert attention from thefact that we were making straight A's in geeky subjects like science andmath.

Nonetheless, while our cohorts went to begin careers as electricians,teachers and plumbers, we plodded on with geeky enthusiasm toward a degreein veterinary medicine. Fortunately, in vet school we were surrounded anddiluted by other geeks and that helped us get over the self-consciousnessassociated with "geekiness"-not that that slowed the smokin' anddrinking down between major tests.

Gospel zeal

Veterinary school also ingrained within us a religious zeal for veterinarymedicine that was nothing short of a gospel. That is, a gospel of veterinarytruths obtained by a smattering of research mixed with a healthy dose ofinference from human medical research.

Add to that private opinion held by professors with grade books and youarrive at the final eclectic elixir we use to approach all clinical problems.This, of course, was supported by "standard operating procedures"and other clinical preferences unique to each university.

In plain speech, this is the reality; research money is hard to comeby and clinical problems outweigh evidence-based research one thousand toone. Anyway, while listening to professor-type geeks, we developed a newpost-graduate geek personality and inherited a tendency to fill in the blankswhen pure evidence is lacking. This, of course, is acceptable since no horizontalauthority figure is present to lend oversight. Thus with a DVM degree wegraduate with a unique freedom and authority that allows us to enter a "spinzone" that even the paparazzi would envy.

Looking down from the pedestal

If you cannot recognize yourself anywhere in the preceding dialogue youhave been practicing in a cucumber patch.

The stress of day-to-day practice and the endless questions that clientsprovide us with almost ensure that we will be filling in a lot of blankswith less than perfect knowledge. The problem comes when we start believingour own press and begin lying even to ourselves.

Just because we have multiple years of veterinary training and practicalexperience doesn't mean that we can eschew the truth in search of expediency-evenif we are university faculty. Our patients and our personal growth as veterinariansdeserve more. Unfortunately we are human and make mistakes that we are proneto overlook.

Problems are bound to occur when we divulge knowledge to those who arein no position to question our authority. We owe the profession and ourclients total transparency and in almost every case an admission that we,in many cases, do not have an answer. There can be no shame in lack ofknowledge, only in the lack of its pursuit.

DVM myths

Here are some examples of mythologies that we perpetuate in the nameof veterinary medicine.

All cats and dogs need annual (you fill-in-the-blank) shots into perpetuity.

Neutering doesn't lead to weight gain in pets (this is really the veterinaryprofession lying to itself.)

All pets need supplemental vitamins (the plausibility increases withan overstock of vitamins).

I can see a little bit of narrowing of L1-L2.

Your pet almost died (or did die) from (fill-in-the-blank) anesthesia.(In this case, it is the anesthetic and not improper anesthetic managementthat is the scapegoat.) This has caused unbelievable hardship to veterinariansdown the line trying to care for this pet and the family's future pets.

No dog can ever eat scraps (this is a blanket condemnation that disallowsfurther conversation).

Your cat's sarcoma did not come from a vaccination (however little greenmen did come in and inject foreign material in the night).

Your dog is too old for surgery (lazy "vetitis").

At this hospital I can do almost any surgery a specialist can (even thoughyou have not been trained in advanced surgical technique and a suitablereferring specialist is available).

You fill in the blanks with your own stable of half-truths.

Price of ethics

Telling the whole truth takes time and energy. It also means that wemay have to swallow some crow and pride (maybe we don't know everything). Sometimes it means accepting at least some of the responsibility for apatient's death instead of diverting it to something or someone else-likeDr. Miller at St. Elsewhere University.

Either way if you practice in a way that leads to telling the unvarnishedtruth about what you truly know and can do, you will find that your clientswill respond in a positive way. Then, and only then, can a client/doctorrelationship based on mutual trust thrive. Otherwise, expect your professionto be a little less rewarding than billed-no lie.