It’s just a three-word sentence, but uttering those words can make you feel like one of the 300 Spartans about to face the thousands of invading Persians at the battle of Thermopylae or like the guy who lets the winning World Cup goal by. For a medical practitioner, saying “I don’t know” sometimes feels like the ultimate declaration of defeat. After all, the doctor is supposed to have all the answers, right?
Sadly, we don’t. Not always. For one thing, it is mathematically (or some other --ally) impossible for one human brain to store every relevant piece of information regarding the health of even one species, let alone multiple. Drug dosages alone can consume more than the available neurons; this may explain an ailment common to veterinary students called forgot-how-to-breathe-osis. Another reality is that veterinarians may not recognize a disease on first glance.
Diagnosing a condition for the first time is sort of like spotting a celebrity at the mall.
“Hey, that looks kinda like…”
“Nah, it couldn’t be.”
“What would a disease like that be doing here?”
“Maybe it needed some new shoes.”
“Well, it does kind of have the right nose.”
“Yeah, but the eyes are all wrong.”
Ultimately, the practitioner is forced to go check People magazine – I mean the textbooks and journals – to be certain.
In the meantime, unlike the celebrity, the disease is not passing quietly and harmlessly through the food court. Instead, the patient is trying to fall off of the exam table, the owner is telling the veterinarian what the neighbor’s sister-in-law of a breeder’s cousin said, and the owner’s child is wailing, “What’s wrong with Spotty and when can we go hoooome? This place is boring and I want ice cream.”
The last words that any practitioner, particularly one whose lab coat has never been mended, wants to say are “I don’t know.” Yet sometimes those words are the only truth.
Often the answer lies within the veterinarian’s grasp. More time, more data, or another set of eyes is needed. When a veterinarian says, “I don’t know, but I’ll find out for you,” or “We need to run X test to know for sure,” or “Wow, I’ve never seen a dog turn into a Hydra [water serpent] before; I think we’d better send this one to a specialist,” trust that this veterinarian is speaking in the best interests of your pet.
Though it might feel more reassuring to have a veterinarian who always states with absolute assurance that he knows “exactly what the problem is,” the odds are against this certainty being reality unless your veterinarian is actually Merlin in disguise and has been practicing for over 1,000 years. Strange as it seems, while it can be difficult to utter the words “I don’t know,” faking knowledge is actually easy.
The temptation to “baffle ‘em with male bovine excrement” can be astoundingly strong. After all, we know that you are expecting us to have the answers; heck, you’re paying us to be the folks with the answers. We also know that you don’t want to know that we, too, think that thing on your horse’s leg looks really weird and a little gross. We know that you’d be happier with a simple answer like “Give this pill twice a day for three days and the alien demons will depart your cat, his skin will clear up, and fairies will clean your garage.”
But we also made some promises along the way, and while the veterinary oath doesn’t explicitly say “I solemnly swear not to use smoke, mirrors, and a good patter to distract my clients,” the implications are pretty clear that that’s a no-no.
While “I don’t know” may feel like an admission of ignorance or incompetence to both veterinarian and client, generally the opposite is true. I’ve spoken to other practitioners who felt as I do: as my career progressed and the longer I was in practice, the more comfortable I became saying, “You know, I don’t know, but I’ll see what I can do to find out.”
During my first months in practice - in the darkness of the pre-Google era - I would fake a coughing fit in order to dash into the back to look up a drug dose or parasite life cycle so that I could give the client an answer right then, even if the question didn’t pertain to the patient’s immediate needs.
When I went into ambulatory medicine, my options for subterfuge were more limited. My truck could only hold so many textbooks and there was no “back room” to take my patients into while I tried to figure things out. All of my assessment, thinking, and even research played out right there in front of the client. I found myself having to say “I don’t know” and even “I haven’t done this surgery before, so I’d like to schedule it when my boss and I can do it together.”
Strangely, the world didn’t end. I still found the answers, and many of my clients respected my honesty. Sure, there were some people who couldn’t believe that I didn’t have the diagnosis or cure for their animal at my fingertips, and some even transferred to another practitioner who was well known for always having an answer.
But I learned that when I sucked up the bitter milkshake of my fears and said, “I don’t know,” I often found better or more complete answers for my patients than I would have ever guessed were available. I learned that sometimes even the specialists don’t have the answers right away, sometimes colleagues with 30 years of practice experience were just as lost as I was, and sometimes I didn’t know the answer because there wasn’t one yet.
Sometimes, the best thing the veterinarian can do for both owner and animal is to say the words that may be hardest for the veterinarian to speak and hardest for the owner to hear: “I don’t know.”