About a week ago, after a day of diarrhea and a suggestion of abdominal pain, my wife and I took our beautiful 13-year-old cat Olivier (pictured above) to our local 24-hour veterinarian hospital at 1 a.m.
About 36 hours of blood tests, a urinary catheter placement, two ultrasounds (one with a fine needle guided biopsy and aspiration), IV hydration, and the first round of chemotherapy later, we took Olivier home with a preliminary diagnosis of lymphoma.
Now, some things went extremely well during this hospitalization that I believe we healthcare folks can learn from our "pet healthcare" friends. For example, my wife and I had 24/7 access to both our cat and our cat's excellent nurses. There was no "wait time" in the ER. They had immediate access to his notes from a prior ER visit, did a brief triage, and brought him right back to the exam room. Finally, at the time of discharge, we had a complete itemized bill of 53 separate tests, services, and procedures, all at a moderate price of $4,300.
An exact, complete bill given, without surprises, at the time of discharge! How often does that happen at your local people hospital?
So far, so good.
Now, a couple of things did happen which weren't quite as positive, but typical of many hospitalizations for both pets and people. There was a subtle but potentially significant information drop between the three hospitalists regarding handoffs, but being on the lookout for this type of issue I was able to prevent any problems here. And there was also one thing which occurred and, retrospectively, could have been a disaster. They inadvertently started the IV chemotherapy (Elspar - L-Asparaginase) 30 minutes before we gave informed consent!
Oops.
Well, no harm no foul, and I certainly was OK with starting chemotherapy. As a general rule in both people world and cat world, however, you want to be told all of the risks before treatment, not during. But hey, our little Olivier got home safe and sound, and that's what counts.
OK, I know what you are thinking. Sick cats aren't sick people.
I understand that sick cats are not sick people. In fact, having a death from multiple myeloma in my immediate family, I deeply understand this. But our cat is a big part of our family, and when push came to shove, the only thing that really mattered to my wife and me wasn't the wait time, or the isolated mistakes, or even the cost (although I did pause to consider what happens to those owners who don't have a few thousand dollars in their "kitty medical account").
No. What really mattered was that our fine little furry fellow got home safe and sound. That's the key point. In these times of significant physician frustration over EHR issues, malpractice risk, loss of autonomy, and the trend towards the dehumanization of both ourselves and our patients, the essence of our job remains the same: the thing that really counts is just doing our best to get our patients home safe and sound.
So, for those physicians at the early stages of their career, my advice is to relish the opportunity to do this.
And for those physicians mid-career, right in the thick of things? Don't forget to give yourself and your colleagues the occasional pat on the back, because what we do isn't easy, and slowing down to recognize this is OK.
And finally, for those physicians moving on from their clinical career—perhaps preparing for retirement, or perhaps due to some of the frustrations listed above—please take some time to appreciate what you have done, and recognize what a special gift thing it is to have helped out so many patients to get home safe and sound.
Remember that what you really do is practice a craft which only a very small part of the population can do: help the people who have a medical problem get home to their family, safe and sound, or offer comfort and care for those who can't.
Addendum: Our cat Olivier is home with a voracious appetite and is as happy as ever. It appears his lymphoma is not of aggressive type, and we are doing our best to select the most appropriate course of treatment. For now, we recognize how special every day is with our four-legged family member.
Dr. Matthew Rehrl is a physician who has served in a c-suite advisory role on social media within healthcare for over a decade. His current focus is the ethics of AI in healthcare. He currently is serving as a physician advisor to blockchain healthcare startup Citizen Health. He can be found on matthewrehrl.com and @matthewrehrl.
Dr. Rehrl is a 2018-2019 Doximity Author.
