10 Oct 2017
Many a client has told Nick Marsh it's a shame pets can't tell vets where it hurts. He's not so convinced, however…
Nick Marsh
Job Title
Original image © Andy Short / Fotolia.
“It must be so difficult,” the old woman says, as I listen to her cat’s chest.
As ever, this puts me in the awkward position of either taking the stethoscope out of my ears and interrupting my clinical exam, or politely ignoring her so I can listen. As usual, I opt for the third, least satisfactory option, of vaguely waving at my ears in the hope that the woman will realise I’ve actually put my stethoscope on her cat’s ribs for a reason.
“I mean,“ the old lady continues, undaunted. “They can’t actually tell you, can they? Where it hurts, I mean. If only they could talk.”
I nod politely. The woman smiles as if this isn’t the 456th time I have heard this particular idea. I worry when I hear it, because I suspect people say it when it looks as though I have no idea what’s going on with their animal. As I put down my stethoscope, and start to talk to her about the heart murmur I have just heard, I think back to her comment.
I often respond with something like: “Well, he’s doing everything he can to tell me his leg hurts without speaking, you see.”
Clinical exams can tell you so much about your patient: where it hurts, how much it hurts, where it doesn’t hurt, whether they feel sick, and whether they seem painful even if you can’t find anywhere that actually hurts.
The main advantage, I think, of your patients not being able to say anything is they can’t actively mislead you.
I suspect (although I don’t know for sure) one of the main skills of being a human GP is filtering out all the things their patients say to them – sifting through the white lies, the misdirections, the emphasis on irrelevant points because the patient has already decided what is wrong with them and is trying to lead you to that conclusion. I suspect very little of is active conscious lying, but I am also strongly suspicious it goes on.
A good history can be as valuable as a clinical exam, if not more so – but the operative word in that sentence is “good”. I wonder if this sort of exchange, sadly familiar to me, rings a few bells with anyone else out there?:
Me: So, you say he hasn’t been eating well?
Client: Oh, no, hardly at all!
Me: Has he eaten anything at all?
Client: Hardly anything.
Me: I mean, has he eaten anything, anything at all in the last 48 hours?
Client: Oh, very little, hardly anything.
Me: So, he has eaten something?
Client: Not really, no.
Me: Right, so what has he actually eaten in the last 48 hours?
Client: Hardly anything.
Me: [cries inside].
And another:
Me: So, how long has she been quiet like this?
Husband: About two days
Wife: [looks at husband in disgust] What do you mean, two days? It’s been at least three weeks.
Me: Right, well, has she been sick the whole time?
Husband: No.
Wife: [simultaneously] Yes. [nudges husband in horror] Oh, God, Trevor, you never even look at her, how would you know?
Husband: [turning to wife] I’m the one who bloody walks her, aren’t I?
Wife: Only ‘cos I make you. You’d rather sit on the bloody sofa all day.
Me: [tickles dogs ears and sighs softly as the room descends into argument]
I’ve spent many long hours in consulting rooms trying to work out if a pet is polydipsic or not – it seems almost impossible for clients to tell or, heaven forbid, measure the water intake.
I am not immune to such blindness myself – I don’t know how long my own cat was diabetic before I (or, more accurately, my wife) noticed, but I do have a vague memory of filling up the water bowls more often than I had, possibly for several weeks before.
Histories rely on people’s memories, and their perceptions, neither of which are quite as good as we like to think they are. We have busy lives, and events jumble into one.
Having the pets chipping into the arguments as well as the clients is unlikely to help – I can’t imagine that my diagnostic ability would be raised significantly by trying to tease out from a hamster exactly when it started hurting when it went for a wee.
I look into the cat’s eyes as the old woman begins to tell me exactly what amazing and heroic things the Supervet got up to on the telly last night, and a thought crosses my mind:
Thank heavens they can’t talk as well.
