How healthcare should work

Allow me to introduce Drake, an amazing dog who has been our companion for the past 10 years.  He was a gentle, sweet and beautiful dog and is the subject of this post.   He was put to sleep last Friday; it is that experience that serves as the impetus for this post.

For context, I need to go back a month.  My wife and I took our 2 dogs for a walk.  At the end of that walk, Drake seemed more tired than normal so we said to each other, "Maybe that's a little bit long for him."  After all, he was 12 so it seemed normal that he might be slowing down a bit.  However, after a brief rest, Drake stood up and it was clear that something was wrong.  He was favoring his right leg and seemed to be in pain.  

We let him rest and gave him some aspirin.  The following week, we took him to our vet, beginning what became a month of exploration and treatment.  Along the way, Drake got the best care from the kindest people.  They were thoughtful and considerate of his age, consultative and responsive.  Emails got quick responses; phone calls were returned; questions were answered.

We had a couple of moments where we thought things were improving but last week things took a turn for the worse.  Recognizing we may need support not available at their clinic, our vets recommended we see a doctor at regional veterinary hospital.  We called, discussed our situation and were able to make an appointment for later in the week.

We arrived at 10:45 and were quickly shown to an observation room.  The doctor entered shortly thereafter and what followed was amazing:

• The doctor had already requested Drake's records from our local vets and had reviewed everything in detail.  Instead of saying, "I've read Drake's file and here are 4 tests we need to run to better understand what's going on", she said, "I've read Drake's file; I'd like to hear from you what's happened over the last month".  And then she spent the next hour asking questions, listening, probing and explaining in detail what the information in Drake's file meant to her.  She worked through her hypotheses out loud; she made us part of the process.  At the same time, she and the team showed real tenderness to Drake (and our other dog, Humphree, who was with us at the time).  Only at the end of an hour, with a pretty complete understanding of what we thought and with the best information from primary care, did she recommend tests.
• Before any tests were run, the hospital team came in with a green sheet of paper.  This paper served 2 purposes.  The first was to serve as a discussion point for the diagnostics that would need to performed and what was expected to be achieved with each test.  We discussed the purpose and also talked through a sequence of tests and how each test would advance our understanding of the situation and how the subsequent test would leverage that information.  The second purpose was to serve as a fiscal estimate; each test had a dollar amount beside it and then it was totaled up with a range (depending on whether we would need to complete the sequence of tests).
• When the initial test results came back, we had another consultation.  Drake's platelets were low, so there was some concern about a biopsy that could result in substantial bleeding if his ability to clot were meaningfully compromised.  We had a thoughtful conversation about the risks entailed and decided that what we'd gain from the test outweighed the risks.  However, we did decide to reorder the tests and do X-rays first because we wanted him to be able to rest after the biopsy.
• While moving Drake during the X-rays, they determined he was in substantial pain so they stopped.  They had 2 scans to work from, so the doctor decided to analyze what information she had available.  Those 2 images were enough to confirm her worst suspicions; Drake had an aggressive cancer that had spread from his leg (our primary focus) to other parts of his body.
• Having determined this, the doctor reported these results immediately.  Meanwhile, a member of her team called the courier shuttling blood to an outside lab and stopped delivery of those samples, thereby eliminating unnecessary costs that would add nothing to the picture.
• We then discussed the results of the test and the right path forward.  The diagnosis fit the evidence; the speed of his decline, his lack of energy and his recent discomfort.  Collectively, we decided that putting him to sleep was the humane thing to do.  The doctor and her staff treated Drake like an old friend.  They comforted us like they'd known us for years (not hours) and we were given as much time as we needed to say goodbye to our dear companion.

I never expected to be taught a lesson in care from veterinary medicine.  However, if every human patient were treated this way, the healthcare experience would be different, care would be better and it would be more affordable overall.  There are three principles that emerged from this experience:

1. We experience the power of listening.  Patient-centered care (which sounds like an oxymoron) is a buzzword.  But, we still don't center care on the patient because we don't make time to listen to what the patient says is going on.  Far more is gained from asking a patient "how do you feel" than asking "what do the labs say".  Of course we need to do labs; but they need to be interpreted through the patient lens.  To see veterinarians navigate with a non-verbal patient using our observations as a proxy for how Drake was feeling and acting showed the real art of listening and treating with the patient at the center.  We were so grateful that they stopped running X-rays when they discovered that Drake was uncomfortable.  That consideration avoided unnecessary pain to a patient, pain that would ultimately have served no clinical purpose.
2. We were included in the decision process.  Neither my wife nor I have any medical training; even if we did, we aren't veterinarians.  Nevertheless, our veterinary teams made it clear that they wanted us to understand what was going on, what the tests were for and what we should expect from the results.  They allowed that educating us likely got them to a better outcome instead of thinking "I don't have time to educate lay people to a point where they know enough to make intelligent decisions."  Moreover, the decisions were financially informed.  We thought through the sequence of diagnosis and treatment and deferred more expensive tests to the end.   Deciding on a course of treatment without knowing the cost is making a decision with only partial information; standard medicine has a lot to learn from their veterinary brethren.
3. We were treated like people facing a difficult decision.  So many people get into medicine to care for people and then feel like the system doesn't let them care.  We learned from our vets and staffs how to continue to care and comfort even when the situation isn't headed in a direction no one would choose.  At no point were we rushed into a decision; however, when we chose a tough course of action, we were supported and affirmed.  In many cases in medicine, this would mean offering decisions to not treat or to choose hospice and then supporting people through those difficult choices.  Or it would be to just give people time to grieve as the reality of a difficult diagnosis becomes clear.  All of this takes time; time to talk, listen, consult and support.

We are grateful for the care Drake received and the kindness of the doctors to whom we were led.  The whole experience is a reminder that we can do better; we can care for people in a humane way, we can be considerate of the cost and we can afford to take the time to listen.