Second Guessing

It's not easy being involved in literal life or death situations on a daily basis.  Honestly, I think this is one of the biggest sources of stress in my career, and I can't imagine what human medical professionals go through.  Multiple times per day I have to make decisions that will affect the life and health of my patients, sometimes in life-threatening circumstances.  I always try to use my years of knowledge and training to the best of my ability, but I'm an imperfect human and there is no way I can be right 100% of the time.  I know this may be a rude awakening for some people, but there is no doctor on the face of the earth that hasn't made mistakes or misdiagnosed cases.  Simply put, nobody is perfect and nobody can always be right.  Hopefully, though, with care, training, and a little luck the mistakes will be few and far between.

But doctors aren't the only ones who wrestle with serious decisions.  I can't make choices for my clients.  Instead I have to give them enough education and opinions that they can make their own decisions for their pets.  In the end, it comes down to choices from the owner, not from me, even though I can guide those thoughts and options.  This means that in many cases the client is ultimately responsible for the case outcome, as I can't do anything they don't approve.  Many clients know this and wrestle with tough decisions, such as whether to treat or euthanize.

On both sides of the issue this can lead to second-guessing yourself.  I'll often come home worrying about decisions I've made in cases, wondering if I prescribed the right treatment or handled it appropriately.  It drives my wife crazy, and honestly isn't the best thing for me mentally.  I know that some of my clients wrestle with similar thoughts, trying to figure out if they picked the best options.  When you're passionate and you care about something, you always want to do the best.  But because we're imperfect people, we realize that whichever option we pick may not always be the right one.  So after the fact we re-analyze things and may doubt our initial decisions.

Yes, recent cases brought this to mind.  I have recently been treating a case of nodular panniculitis, an immune-system disorder where the body attacks the subcutaneous fat, with a strong immunosuppressive drug.  The dog has been doing fine on the medication for a month, but developed sudden and severe anemia within the last week and ended up being euthanized as the emergency clinic yesterday.  When I found that out I scoured the record and the dosages, double-checking to make sure that I had made the right choices and calculated dosages correctly.  Yes, I had, but I still have to wonder if there was something else I could have done.  When I talked to the owner this morning, she was also second-guessing herself, wondering if she should have brought her pet to us sooner, when she was just starting to act a little strange.  I feel that I handled the case appropriately and the client made good decisions in the end, but we both still worried.

Another case came in today for some odd behavior and a possible ear infection.  We ended up diagnosing a life-threatening anemia due to destruction of the red blood cells by the immune system (yes, odd that both cases had similarities, but they really were different).  Treatment would have been costly and extensive and there would have been no promise of a cure; at the same time the pet couldn't survive without therapy.  In the end the client opted to euthanize her dog, but she wondered if she was making the right choice.  I tried to assure her that she was, but I'm sure there was still part of her that didn't listen to my words and doubted her decision.

Second-guessing yourself is human nature.  However, it doesn't help much and can lead to anxiety and depression.  Believe me, I know this first-hand.  But it's one thing to wonder if you locked the door to your car.  It's another thing completely to wonder if you chose the right diagnosis to start treating.  I wish I had great advice to give on how to overcome this problem, but I'm still struggling with it myself.  Really, this is just another peek behind the scenes, showing what goes on in the mind of a vet.

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