Tuesday, March 15, 2011

What's With All the Questions?

By Beth Guerra, DVM

It seems at times when patients come in on emergency that we have a thousand questions, ask the same question in multiple ways, repeat the same questions, or ask clients to repeat the same history over and over.  Why is this?
Number one, our patients can’t talk to us.  Symptoms can often be very vague or subtle.  Or, the causes to a particular symptom may have a 4 page long list and we are trying to pare down the possibilities.  An example would be a patient presenting for vomiting.  Common questions may be; does he have previous medical problems, taking any medications, recent vaccinations, eaten anything abnormal, coughing, diarrhea, blood in the vomit or stools?  Has the patient been anywhere new in the last 5-7 days, travelled outside the area, weight loss, increased thirst or urinations, type of food they eat, etc?  Our goal is to create a concise record in order to determine what tests are optimal to yield the most results for a given situation.  Does it make sense to run $500 worth of tests or not?  Do we need to recommend hospitalization?  How aggressive do we need to be, or is symptomatic care reasonable?
Another reason for repeated questioning is it sometimes sparks your memory.  I recall occasions in which a client’s answers changed after thinking more about some of the questions they had already answered.  Sometimes an answer might be different if is is asked a different way.  A thorough history can keep us from performing unnecessary tests.
Then there are the times that the barrage of questions reveals that the symptoms are misinterpreted.  For example, it is very important to determine whether a patient with bowel problems has symptoms consistent with the small intestine, large intestine or both.   Owners may think their pet is vomiting, but it may actually be coughing or gagging.  What may appear to be straining to defecate may actually be difficulty urinating.  What looks like a seizure is actually fainting from a heart problem.
Our veterinary patients also lack discretion, in particular when eating things they shouldn’t.  Animals are similar to infants in the sense they don’t realize that what they just ate may cause problems.  It is important to know if a dog is the type who gets into things, got into the trash 3-4 days ago, or likes to chew on rocks. 
Then there are the instances that a patient comes in for a procedure that may require anesthesia.   It is very important to know if the patient has had problems with anesthesia, or if they are already on medications, have heart problems, etc.  These questions help us to determine risk and to prepare for possible complications.
In essence, what may seem like an interrogation can be vitally important to the direction we go with a particular patient. 

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