How do you do your research as a vet in practice?
Pete The Vet talks about how he manages mystery cases as a vet.
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Mystery cases are really the things that make my job enjoyable and fascinating. Most of my day’s work is made up of fairly routine stuff – you know the way- annual health checks, vaccinations, skin disease, dogs with arthritis, small lumps and bumps. These are the kind of medical cases I see when it comes to surgery it tends to be, again, routine sort of things such as spays, neuters, small tumour removals, maybe dentistry.
While I enjoy all those aspects of my work they’re not the highlights. What I find thoroughly enjoyable is the mystery cases: the dog that comes in with a strange combination of signs – you know like an increased thirst combined with weight loss combined with a cough – something like that.
The question you ask yourself is: “what’s the unifying factor?” “What’s the one underlying cause of all these different signs?”
Or perhaps there’s a cat that has very severe jaundice and perhaps it’s been vomiting twice a week and has become a fussy eater at the same time.
We all know that these cases need to be worked up and we all know, roughly, the standard route that we follow. The big question is that as we do this where do we get the information that we need to investigate mystery cases?
The 4 resources of information:
The most important tool is your own brain. We obviously use our own knowledge to get ourselves through our primary veterinary degree and after that, we’re all obliged to continue education, and that is so important; there are lots of different ways you can continue to educate yourself. By doing so you’re making sure that you yourself hold the most valuable resource when it comes to working out mystery cases.
The second way to get information for mystery cases is the combined knowledge of your colleagues. One of the real benefits of working in a multi-vet practice is that you can take a challenging case to the people you work with. In our clinic, we do rounds every morning, going through each of the hospitalized cases. This is often extended and one of the vets will come up and say: ‘well actually I’ve got this case that’s not in this room with us right now but I’m a bit baffled by it. Who wants to hear about it? Who can help me?’ Having a case conference like that can be a useful way of picking the brains of everybody in the building.
The third useful way of investigating a mystery case is with textbooks. Most veterinary clinics have a library of some sort, with a whole bunch of different tones of our favourite veterinary textbooks, both medical and surgical. Having half an hour free during the day to sit down and go through the books, whilst concentrating on your case is a useful thing to be able to do.
The fourth and final way of dealing with mystery cases is to use online resources. It’s really a remarkable aspect of our times that a complete encyclopedia of veterinary information is now available to us all, not by having to go to the local university library, nor by searching on Amazon for the latest textbooks, but literally by just searching online. The proviso is that you know where to search online. There are several different places that include resources like Vetstream, some veterinary discussion groups like Vetsurgeon.org, forums like the SPVS and others. My own favourite is Veterinary Information Network (VIN), where you pay a monthly subscription fee to have access to a vet only network of tens of thousands of other vets around the world.
How to harness the power of the web
What I would often do is first use VIN to research a case – in other words, to find out all about what I suspect, or perhaps to read about other similar cases that other vets have dealt with.
I would often then go on to write a full description of my case including the full history with all the test results, including any diagnostic images that I’ve taken. I would put the whole background together as a case report, submitting it to an appropriate section of VIN. It’s split up into different discussion boards, between the animal you are dealing with, and the criteria of the issue. What happens then is once you’ve submitted your case you wait and at the right time (24 hours usually), a paid Veterinary Information Network Consultant (VIN consultant) will read your case, giving you feedback, and as well as having useful ideas, if they feel that assistance is needed from some other expert, they’ll cross post your case towards some other discussion board, or somebody else might come in and give you extra feedback.
You then get notification by email that somebody’s made a comment on your case and you go back to the discussion posting, giving them some feedback. It’s often a to-ing and fro-ing of discussion until everyone agrees on the next step in the investigation and treatment process.
The VIN network is very good at coming back to you, e.g. a week later and asking how are you getting on. Sometimes even a year later you may get an email asking “whatever happened with that case that you that you worked up?”
VIN is my own favourite online resource, but there are many other helpful websites out there and you may have your own favourite one.
Whatever you do make sure that you investigate those mystery cases fully and properly. At the end of the day, there’s always unifying theory and you really don’t want it to be at the post-mortem. Discover this beforehand so you can give the best possible treatment and course of action to your patient.
We welcome any comments you have about your own ways of investigating challenging mystery cases and please comment below and I’ll talk to you again another time.