931217?1283481335
Arnold L Goldman, D.V.M.  
Male
Canton, CT

Specialties: general practice

Interests: critical care, oncology, surgery
Canton Animal Hospital LLC
800-693-9300
Canton, CT
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HOW DO/SHOULD DOCTORS THINK ABOUT TREATING PATIENTS?

Dec 15, 2009 - 5 comments

MY NOW OLD PROFESSOR MIKE SCHAER ACCUMULATED A SERIES OF SAYINGS WHICH SUM UP THE DESIRED APPROACH TO TREATMENT OF  ILLNESS IN ANIMALS. IN TOTAL, THEY DESCRIBE AN APPROACH WHICH BOTH PURSUES A DIAGNOSIS AND TREATS SIGNS OF ILLNESS SIMULTANEOUSLY. IT IS THE RECOGNITION OF THE NEED TO DO BOTH, IN THE ABSENCE OF COMPLETE INFORMATION, THAT IS THE ESSENCE OF ETHICAL PRACTICE. IT IS ALSO A WAY OF THINKING WHICH DISTINGUISHES THE ACCOMPLISHED CLINICIAN FROM ALL OTHERS. WE DO OUR PATIENTS NO SERVICE WHEN WE RUSH TO THE FIRST IMPULSE OF POSSIBLE DIAGNOSIS, NOR WHEN WE DELAY OFFERING RELIEF WHILE WE PURSUE A CONFIRMED ONE. FOOD FOR THOUGHT FOR ALL TO CONSIDER AND WHY MEDICINE IS OFTEN CONSIDERED AN ART AS MUCH AS A SCIENCE. INDEED, IT IS AN ART THAT REQUIRES EXTENSIVE TRAINING, EXTENSIVE EXPERIENCE AND A SCIENTIFIC THOUGHT PROCESS TO PERFORM WELL. SUCH A MIND NEVER THINKS OF POSSIBLE TREATMENTS FOR SIGNS AND SYMPTOMS, WITHOUT PURSUING THE DIAGNOSIS WHICH UNDERLIES THEM. STILL, WE ALL SEE THAT OCCUR QUITE A BIT. INDEED WE OFTEN SEE 'TREATMENTS IN SEARCH OF A DIAGNOSIS" WHICH MIGHT REQUIRE THEM.
SUCH AN APPROACH RUNS COUNTER TO THE HEART OF MEDICINE, WHICH IS SCIENCE.

"Uncle Mikey's" Maxims

1. Treat for the treatable.
2. Assumptions lead to trouble; therefore don't assume.
3. Always interpret clinical information within the context of the patient's presentation.
4. Avoid tunnel vision.
5. Treat your patient, not just its disease.
6. Avoid overmedicating.
7. Be honest with yourself.
8. Don't postpone today's urgencies until tomorrow.
9. Think that common things occur commonly.
10. Look closely at your patient; it will usually tell you what's wrong.
11. Never let your patient die without the benefit of the silver bullet.
12. When you hear hoofbeats, look for horses, but don't forget about the zebras.
13. Never sell the basics short-they are still the best buy in town.
14. If you don't think it, you won't find it.
15. Never let a biological specimen go to waste.
16. Disaster lurks whenever a patient's problem is "routine."
17. If it's not getting worse, give it a chance to get better.
18. Don't stray too far from the patient -- the diagnosis will appear eventually.
19. Don't give your patient a disease it doesn't deserve to have.
20. Don't let technology make you "decerebrate."
21. The necropsy is the clinician's trial by jury.
22. The wisdom of experience should never be ignored.

Michael Schaer, DVM




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562511 tn?1285904160
by Karen99, Dec 15, 2009
Uncle Mikey is a wise man with a great perspective on how to approach patients while practicing medicine.  I especially like #20 "Don't let technology make you decerebrate."   Practicing medicine is an art, and sometimes a lost art in the face of technology.  

Merry Christmas to you and Uncle Mikey.  Can I post this elsewhere with proper credits?

931217 tn?1283481335
by Arnold L Goldman, D.V.M.Blank, Dec 15, 2009
Feel free. I think people misunderstand what medicine is, overestimate unscientific approaches to illness and as well their own ability to tell the difference. It really does take the education, the training and a lifetime of study to approach the broad range of disease in a scientific manner. These maxims are intended to make students and seasoned practiioners think about how they arrive at their decisions. In short, how they use their judgment.

562511 tn?1285904160
by Karen99, Dec 15, 2009
For the most part, I've been greatly impressed with veterinarians who have to really LOOK at their animal patients more closely than people doctors have to, looking for clues without a lot of verbal communication from their patients.  This applies to #10.

Each of Uncle Mikey's observations hold great merit.

#5 Treat your patient, not just its disease. This reminds me of a visit to the vet with my dog Sugar Bear, a kind and gentle black lab. Sugar Bear took great exception to having a rectal temperature taken.  My vet at the time wanted to muzzle him because he growled when taking his temp and no one would come near him.  I found another vet who simply distracted him in a very simple way and made it possible to get beyond ground zero.  Knowing your patient and how to interact with them makes it possible to do what needs to be done.  

942557 tn?1272694819
by chasha33, Dec 15, 2009
That is a very impressive post.To many vets jump to easy assumptions and end up causing alot of distress on the furbaby and there parents.Been there Done That! It ends up costing alot of money to rule out a problem that wasnt even there.I am sure you remember me taking Diesel to the vet for swelling in his neck.There was never a ruptured disc and no murmur.So just like the things Uncle Mikey said,That should be the rule of thumb for all Drs.Thankyou for your post .God Bless

Avatar universal
by Jim Humphries, B.S., D.V.M.Blank, Dec 15, 2009
Great Maxims, we can all learn from and use every day both in life and in practice.  

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