Medicine From the Other Side of the Exam Table

        I haven’t blogged for a while.  Many reasons.  Certainly when I started to write blogs I intended to produce them uninterrupted until the end of time and maybe a little bit beyond.  But there were the holidays, my many tasks, the kids, etc.  Those things are my responsibilities, joys or distractions, depending on the moment.  The real emotional drain and time sink of late has been the medical issues with my aging parents.  Both parents are in their 80’s and time stops for no one.  The sand runs down the hourglass and time’s conveyor belt moves along its circuit with no pause button.  My mom had complications from a heart surgery that have left her in skilled nursing care and I recently returned from Tucson where my dad had an abdominal aneurysm repaired.  Dad came through surgery and my mom is stable and trying to recover.  It is very different for me being on the sidelines while medical care is provided.  I spend my days presenting options and being in charge of making things happen.  As my wife likes to point out, I don’t like it when I’m not in charge.  The veterinary and human worlds of medicine are not so different.  And, they are worlds apart.  Some things in human medicine are better.   Some aren’t.  The truths and our needs are the same.  We need to understand and participate in decisions.  Patients need to have advocates.  We need hope.  When we can’t have hope, we need honesty.  When we need honesty because we can’t have hope, we need empathy and support.

                In watching my parents care, I saw skill, talent, empathy, genuine concern, innovation, and efficiency.  I also saw indifference, rampant inefficiency, unnecessary roadblocks, resistance to patient advocacy, narrow thinking, and system failure.  Mom’s heart surgeon is the best.  He is an older guy who worked under the original guy who developed some of the first heart valve techniques in the ‘60’s.  I think he did Moses’ pacemaker.  As talented as he is, I’m not sure his team tried to see how prone mom was going to be to complications.  When things went south, the family was really out of the equation.  There was no one specifically in charge.  She was under anesthesia/heavy sedation for more than a week with only a vague plan.  Medicine was in charge of this.  Surgery was in charge of that.  As good as everyone was at their parts, they were individually reluctant to drive the bus.  Without central responsibility, it was hard to decide who to be mad at.  Or, who to direct the advocacy towards.  Her nursing staff was mostly fantastic and was the best at centralizing her decisions and care. 

                My brothers and I flew to Tucson several days before my father’s procedure to spend time with him.  We randomly cleaned his garage.  This had been his wife’s idea so we would throw away, or give away, anything that could be used in a task she considered dangerous.  All plumbing supplies, ladders and power saws needed to go.  Had I known I would’ve brought a bigger suitcase.  When he looks for these things later, everyone can share the blame for their absence or claim it was someone else.  I plan on phrases like, “Terry must have given away your conduit”, “I think Tom put your outlets somewhere”, and “Hmmm.  I don’t remember seeing a circular saw.”  We also organized his shop area, likely ensuring that he never finds anything again.  This was not intentional.  The morning of the procedure my two brothers, dad’s wife, and I waited in surgical waiting.  The chairs were right out of the inquisition on the comfort scale.  The surgery went well.  The doctor came out and updated us.  And then we waited.  Six hours later he final was transferred to an actual room and out of the recovery area.  This was at least 5 hours later than we were told.  It was not anything to do with his recovery, they just didn’t have a room and family can’t come into recovery.  My brothers had to leave for the airport and didn’t see him.  Surgical reception stonewalled them and still said they couldn’t see him.  Dad’s recovery nurse eventually came out and took his wife back to see him and I got to go back a few hours later.  His surgery was a success and we all agree that that was the most paramount issue.  But we have lives as well and need to be kept in the loop.  Either make sure there are enough rooms for the day’s patients or open up recovery to the family.  The family wasn’t an important part of the plan.  There was little consideration within the system for us.  I can empathize with this professionally.  We never get too busy for patient care but we can get busy enough to drop communication and for things to be delayed.  We all do our best but this struck me as a system failure beyond just a busy day. 

                In looking for the silver linings, watching medicine makes me reflect.  Human medicine can do miraculous things and has treatment modalities that we haven’t developed or we under-utilize.  Directed specialization creates healers that are exceptionally skilled and this allows so much care that wasn’t possible not very long ago.  But, it is too big sometimes.  There is disconnect and things get moving at a pace where they don’t stop and check in with the family and patient advocates.  We can do everything; we need to ask ourselves if we want everything.  As veterinary medicine advances and we have more equipment and more options, we need to keep to the things that got us here.  The needs of the patient, not their disease, should drive medical decisions.  The information needed to make those decisions should come through a doctor and staff that know their patient with full participation of a patient’s advocate.  The doctor-client/patient relationship is integral to medicine.  Veterinary medicine is far from perfect but I feel like as a clinic and as a profession we strive to protect this connection.  May we never lose that.

I missed seeing such a relationship at work with my mom and dad.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of Veterinary Practitioners