Decisions, decisions, decisions.
A veterinarian makes them all the time. Our training provides us with the ability to offer Gold Standard Treatment to all of our patients and we would provide that treatment with no qualms except for the limitations animal owners often place upon us.
The biggest limitations are time and money. Other limitations may arise because of the pet’s temperament, allergies, reluctance to swallow pills or tendency to only eat food flavored like fish. Cats are particularly funny like that.
In most cases the veterinarian is in a position to offer multiple treatment options for an animal, whether it’s a pet or livestock, with any given symptom. Gold standard, the most obvious good decision, may include multiple diagnostics, intravenous fluids and both symptomatic management and direct treatment. That may be overkill in many scenarios. A dog that’s had a single bout of diarrhea, especially after eating something unusual, probably doesn’t warrant having abdominal radiographs taken, even though it’s Gold Standard.
In some cases, such as in Gastric Dilatation Volvulus, there are only two options: emergency surgery which may or may not succeed, or humane euthanasia. Neither of those decisions are obviously the right one, especially after considering factors like the dog’s age and other medical conditions. There is one obviously bad decision in this scenario though; doing nothing.
If you’re not familiar with medicine then it may confuse you to know that death is often considered neutral. Suffering and pain, especially when prolonged and extreme, are considered far worse. This is why we as veterinarians spend so much time talking about quality of life.
In the above example of the GDV ‘doing nothing’ is the obvious bad decision, and the other two choices are equal, so both these choices become ‘acceptable’ decisions. They’re not great. They’re not black and white. They are definitely two shades of grey.
Cancer treatment is another common scenario where multiple treatment options exist with no obvious good decision. Depending on the cancer type, e.g Osteosarcoma (bone tumor) options may include: surgery, chemotherapy, surgery followed by chemotherapy, palliative care, and euthanasia. In practice, as long as something is chosen with the welfare of the pet in mind, then those choices are good enough.
When multiple good enough choices exist I can make a recommendation but not push one more strongly than the other. I will steer them away from the obviously bad or worse choices but I always assume that an animal’s owner knows a bit more personal information about that animal than I do.
The medical decision spectrum also intersects other decision spectrums in relation to the owner’s finance and ability to care for the pet. An owner might be willing and able to manage a pet’s chemotherapy, but the price tag may preclude it.
Often we don’t get to make perfect decisions. If we put off all our decision making until a perfect scenario presented itself then we’d be paralyzed be indecision. Our job is to navigate the choices we’ve got, do our best, and guide our clients through this minefield into the ‘good’ side of the decision spectrum.
An option might not be perfect, but as long as it’s better than inaction, it’s worthwhile.