Thread by @tjwebbmd

Thread: How a trip to the Veterinarian strengthened my resolve to train medical students in patient-centered care.

I teach clinical skills, patient communication, and doctoring at a medical school. This is my good boy Chuck. Today I had to bring him to the Vet.

2/ I should mention that most of these pictures are a few years old. We got Chuck (full name: Special Agent Carmichael) during 2nd year of medical school, and at 12 years old he now has a bit of grey around the paws and whiskers, but he's still as cute as ever.

3/ Our Vet in Waco was awesome; always took the time to explain the work-up and diagnosis, engaged in shared decision making, etc. Not all doctors love people but all vets love animals, so I just assumed that outside of somewhere like Banfield this was just how Vet visits were.

4/ We just moved, and today I brought Chuck to our new Vet for a sub-acute problem over the past 4 days. We mentioned that Monday would work for us too and we didn't think it was urgent, but they told us our other option would be the pet ED and wanted us to come in today.

5/ It felt like a bit of an overreaction, but we were grateful. We arrived and a Veterinary Assistant took his vitals and ran some tests. She was great; again, everyone at the Vet's office just loves dogs, and Chuck is particularly loveable (sure, I admit I'm biased).

6/ A little while later, the VA returned with two injections and explained that they would be followed by a prescription for two oral medications. I explained that I really preferred to wait on any treatment until the doctor had seen Chuck and we had discussed the treatment plan.

7/ I should clarify; Chuck has felt pretty well. No apparent pain, symptoms have been intermittent. My spouse and I are both medical but don't presume to know more about Veterinary medicine than most other pet owners. I wasn't opposed to the treatment, it just felt out of order.

8/ The VA seemed a little surprised but went to talk to the doctor again. She came back a few minutes later and said the doctor really recommend we go ahead with the injections. I explained that I wasn't opposed to them at all, I just wanted to understand the doctor's plan first.

9/ The doctor came in a little later. She didn't introduce herself to me (by now I was the 'difficult patient'), but that's fine; I introduced myself and thanked her sincerely for getting us in so quickly. I teach interpersonal skills for a living, I didn't mind bridging the gap.

10/ She stated right off that she was sticking to her original plan. I tried to explain that I wasn't opposed to it at all, I only wanted to know what she thought was causing his symptoms and better understand her treatment plan.

11/ She conducted her exam and I asked questions. Yes, I used some medical vernacular when asking questions for clarification's sake; but she wasn't really telling me anything at all, so I felt the need to be more thorough in trying to understand her diagnosis and plan.

12/ As she was leaving the room she turned back and asked, "Are you in the medical field?"

"Yes ma'am," I said, "I'm a family medicine doctor."

"How many years have you been in practice?"

"About 10 years."

"Well, it's 40 for me."

And then she was gone.

13/ (I should mention that I count 3rd and 4th year of med school and each year of residency in my 'years of practice', and you should too. I'll fight anyone on that hill. Heck, maybe you should count them twice).

14/ A few minutes later the VA returned to ask if I wanted to be addressed as Dr. Webb from now on. "No, just TJ is fine."

We got the injections and the oral meds, paid (the cost was very reasonable, credit where credit is due!), and went home.

15/ On the drive home I reflected on how easy it was to become the "difficulty patient," even with a posture of learning, kind and conciliatory manners, and offering frequent thanks. All it took was the slightest bit of advocacy to make the doctor feel challenged or threatened.

16/ And the thought that I kept coming back to over and over again was, "Oh my God, we do this to people. All the time."

17/ I train students and residents that medical decision making is always shared (I lectured on it yesterday). That we listen carefully and empathetically, that we seek to understand the whole person, and then use our medical knowledge to educate and empower our patient.

18/ Only then do we suggest tests, treatments, medications, and procedures for our patient to consider; once they have been equipped with the best understanding of the situation we can give, based in turn on us seeking the most thorough understanding of their experience possible.

19/ At the Vet's office, all I had done was to ask that the doctor see Chuck first and help me understand what was happening to him before beginning treatment, and then hinted at the fact that I might have some concept of the medical realities we were dealing with.

20/ This had been enough; I was challenging the doctor. I was arrogant, and needed to be put in my place (I would have happily admitted that I had 0 years of clinical experience on dogs!). I probably wanted to be addressed as Dr. from now on and have my MD all over the paperwork.

21/ This is the experience of thousands upon thousands of human patients and patient advocates all over the country. We doctors cut corners and skip the part where we share our knowledge with the patient, and then take umbrage if we are asked to explain ourselves.

22/ We drink from mugs that say "Don't confuse your Google search with my Medical Degree" and look at a patient's own research like they are trying to hand us a live skunk, and say things like "if they don't want the treatment I recommend why do they even come here at all?"

23/ We center ourselves and our egos in their care, and then gaslight or humiliate them (or worse) when they dare to demand better.

None of this was a revelation to me; it's the very reason I took this job. But my trip to the Vet drove it home in a new and personal way.

24/ It doesn't have to be this way. We can be our patients' best advocates and allies, and they can be our best teachers, our best preservative against burn-out, and our best means of maintaining professional accountability and personal humility throughout a lifetime in medicine.

Fin/ All it takes is for us to understand that our first loyalty is to our patient, commit to centering and empowering them in their care, come to them in humility knowing we still have so much to learn from them, and be willing to work every day to earn and keep their trust.