Making Choices

Recently, when I asked folks what topics I should write about here, someone asked, ‘When your vet prescribes a new diet or treatment for your pet, how long should you attempt it before you give up and go back to what you were doing before?’  And I realized that this question brought up something more important than the request itself – and that is the fundamental mindset behind it, and the difference between traditional Western medicine’s classical approach to treatment and the mindset of hospice medicine.  And this mindset is one that can get in the way of successful care for many patients.

The challenge with this question is threefold.  First, by phrasing it that way and considering treatment from that approach, it assumes that the treatment itself is difficult, challenging, unpleasant, and generally something the pet is going to dislike and the client is going to struggle with.  It sets the asker in a frame of mind where the automatic assumption is that the treatment is going to fail or be impossible to carry out, and the only question is how long to go through the motions before getting permission to stop, instead of considering the potential for easy treatment, positive experiences for the caregiver, and success.

Second, it frames the question of treatment into an either/or situation.  Either you are treating with one specific plan or you are doing nothing.  It creates a false dichotomy, instead of allowing for a spectrum of options including multiple levels and methods of treatment.

Finally, it is based upon a total absence of communication between the client and their veterinarian.  It sets forth a situation where, when a client undertakes a treatment path and then faces challenges along that path, rather than talking to their pet’s health care team to let them know they’re having difficulty, they decide to cease all treatment.

In hospice, communication and choice are two of the core concepts of our practice.  The most important tool we have, both as pet caretakers and as doctors, is communication.  If a particular treatment is suggested – whether that be a special diet, an oral medication, a form of physical therapy, or any other intervention – and that treatment is either too challenging for the pet or caregiver or isn’t improving the pet’s quality of life, it’s critical that we know.  While we as doctors have a wealth of knowledge, resources, and experience at hand to offer to our patients, none of that can help if we’re not aware that it’s needed.

Having these resources also means that, if one plan isn’t working, we can help form another.  That may mean suggesting a second diet if the first isn’t palatable, a different medication if the first isn’t effective (or a different formulation if the pet isn’t willing or able to take the first), offering assistance or training to help implement specific treatments, or making a decision as a team to discontinue a particular treatment.

And that last statement is, for me, the most critical one.  While it may seem like semantics, I honestly feel that there’s a difference between giving up and choosing not to continue.  Giving up carries a connotation of failure, which can also lead to guilt and blame – two emotions that can be incredibly damaging and undeserved for caregivers, especially in a hospice environment.  Making a choice, with cooperation and support, is an active decision that is still focused around the well-being of the patient.  Ultimately, when we’re facing an end-of-life situation, we know that eventually the patient is going to pass.  We can postpone that day, and we can make every day along the path more comfortable and peaceful, but we can’t delay death forever.  In that environment and mindset, I don’t feel that any considered and informed decision about treatment, or stopping treatment, is giving up – it’s just prioritizing different factors in the patient’s life.

So – I don’t think of my clients as giving up at any point in their pets’ care, and I hope sincerely that they don’t either.  It is my ultimate goal to create an environment where they feel comfortable communicating with me about any challenges they face and supported in any decisions they make.  And I hope that those of you reading this can take this mindset into your day-to-day experiences with traditional wellness care as well.