Prognosis not diagnosis

“Prognose, prognose, prognose” is a phrase uttered regularly by a vet I’ve spent a lot of EMS and pre-uni work experience with.

Anyone would think he’s trying to drive the point home.

But it makes a lot of sense: although we have myriad diagnostic tests available to us, they won’t always give us a definitive answer, and the owner of an animal, for whatever reason, will often choose the option of “we’ll try this and see” before resorting to getting a clear answer, if necessary.

Suck it and see

Although many vets (and future vets) are perfectionists by nature who would, ideally, want to establish exactly what’s going on before throwing anti-inflammatories (for example) at an animal, it’s not always possible or cost effective to do that – and that is something we have to accept.

The “suck it and see” approach, however, can be perfectly reasonable, depending on the situation.

In my vet’s words: “half the time I haven’t got a bloody clue what’s going on” – and that’s okay. You can’t always get to the bottom of why and what is occurring in your patients, but symptomatic treatment is often both a reasonable and successful approach.

His advice is that you don’t necessarily need a diagnosis, but you MUST give a prognosis. You must forecast what you expect to happen with the treatment given (and give time frames) and inform the client that if there isn’t a marked improvement, if things go backwards or the disease process/condition behaves in an unexpected way, they must bring the animal back for reassessment ASAP. That way, the client has the responsibility to judge for themselves whether something more needs to be done.

Red light green light

This vet also promoted the use of a simple “traffic light” system, through which you decide – on a case-by-case basis – whether you’d rate them a “green, amber or red”.

• Green – you know exactly what is wrong with the animal, you have treated accordingly and expect if to make a recovery (or, in the case of things like diabetes or atopy, can manage the condition successfully long term).
• Amber – you don’t really know what’s going on, but it isn’t immediately life-threatening and diagnostic tests aren’t urgent at this stage. The “suck and see” approach, by treating symptomatically or “just letting it run its course”, is appropriate for these patients (e.g. an unexplained episode of vomiting or diarrhoea).
• Red – not necessarily life-threatening but the patient needs diagnostic tests ASAP or admitting to the surgery for supportive/palliative care (e.g. suspected parvo, 10/10 lameness).

This simple system helps students (and vets) assess the severity/urgency of conditions seen in the consult room there and then, whether they have a diagnosis or not.

Importantly, he also said you can’t have two “ambers” in a row – if a patient sent away with symptomatic treatment returns a week later with no improvement, you must take further action and start testing.

There’s a limited amount that can be done in a 10-minute consult and the key is to be able to make a quick judgement on what the next step is during that time.

Even if you don’t have a diagnosis, prognose, prognose, prognose!