Wow. This question really had me thinking. You obviously care for your cat, and you want someone who is thrilled that you are giving your 15 year old a chance. Someone who is supportive of your efforts at minimum. And for some reason, you are not getting that service or feeling at all. The truth is, there are many potential reasons behind the response you are experiencing. I’ll do my best to try and explain potential underlying issues. And I’m going to give you specific scripts to say at the end of my answer, that might help get what you need.

There can be so much behind the surface of an apathetic response. Since I don’t know anything else specific to this veterinarian or you as a client, keep in mind that some of it may or may not be applicable to you and this particular vet. But I am basing these answers on common issues I have witnessed behind the scenes, personal experiences, as well as sticky situations that are prevalent within the vet profession. My first answer will assume the vet is simply not motivated to help you, and will try to identify reasons for that. The second answer will assume the veterinarian actually cares about what is going on, but there is something causing the resistance in the interactions and relationship.

So here we go.

The veterinarian may not be interested or seems apathetic towards you and your 15 year old cat because of:

1. Discrimination based on age. Good old agism. It’s a cultural phenomenon in North America, and in human medicine, studies have shown that some physicians show less care or concern toward treating the medical problems of older people. It’s a real issue, and if it happens with people, it it will also happen with pets. So the vet may simply be of the personal opinion that when you reach a certain age, and have more than one problem, then you are extending their life for no good reason. Because after all, they are old and are closer towards the end of their life than the beginning.

People tell me in clinic every day that because their pet is older, they won’t do anything if an illness occurs. There was one lady who went out of her way to tell me multiple times in the course of a 15 minute appointment, that when her young dog got older she wouldn't pursue ANY intervention no matter what the problem was. I told her thanks for sharing that, and that she could stop sharing now. And vets are normal people who can be prone to agism as well. Of course, you, I and many people who read this blog think differently. We know that when our pets reach their golden years, it is something to be respected. In some ways, they took care of us, so it’s our turn to take care of them in their time of need. When someone has been in my life that long, the least I can do is offer them a chance to live without suffering. In that way, I respect the relationship between us.   

2. The vet isn't familiar with how to treat this condition(s), and isn't interested in learning how. Or it’s simply just not how they do things there. I learn new things every single week by talking to people and other vets who share their experiences. If it can have the potential to help my patients, I want to know about it. I know my clients want this. I'm obligated to do it.

Sadly, in both human and veterinary worlds, this isn't always the case. I’ve been in a clinic that REFUSED to order a larger sized syringe so I could administer fluids to patients who resented being handled (it’s a much quicker way so less stressful for some pets). It would have cost them next to nothing. They refused because “thats not the way we do things here”. I’ve been in human pain clinics where simple, inexpensive breakthrough techniques at reducing pain are noted and then subsequently ignored. Even though it means more suffering for the clients of that clinic. It doesn't matter how much peer-reviewed research, experience or personal communications from other physicians exist that support it. Because they were not interested in learning about it.  Or the Bureaucratic “we just don’t do that here” response.  It’s why checklist medicine sucks. If I can’t check that one off on my list we are not gonna do it.

3. The vet thinks you don’t value her services, will take up all her time and then bail on the bill. This kind of stuff happens regularly. Remember I'm not talking about you specifically, but It’s what can go through our heads. I will help people for free. The business consultants who visit the clinic tell us to stop doing things for free. There won’t ever be a time where money stops me from preventing pain or suffering or making someone feel happy or special. Im privileged to be in that sort of position.

So when people roll their eyes at me when I give them an estimate of what something costs, then say that they can get it cheaper over there in that clinic in Quebec, and if the dollar was better they would just cross the boarder and go to the US, Im already less interested in working with this person. Because I know the next thing I might hear is that I must have hidden costs, or every suggestion I make is met with “yeah but does he really need that”. Or “can you guarantee that if i spend money on this test then X, Y, Z will be true and he will get better”.

I will spend more time with someone with no money but values my time and experience, and less time with folks with sufficient funds but don’t respect the fact that yes, I do put food on the table, pay for daycare and mortgage with the money I earn from being a vet. I hope that didn't come off like a rant. Im not trying to do that here - just looking for explanations of what is going on.  

Ok now lets assume the vet isn't a jerk.

What if he actually cares about you and your 15 year old cat - why would he be resistant or seem apathetic? It’s possible that:

1. The veterinarian is fearful of treating conditions outside his experience and comfort range. He will never outright say that, but the typical response to fear is avoidance behaviour. A veterinarian is expected (legally) to have a basic level of competency in all areas of medicine and surgery upon graduation.  And most of us do. As time goes on, you find your calling. You find where you talents are. This is true even if you are a general practitioner. Some gravitate to surgery. Others to ophthalmology, behaviour or internal medicine. Some go into industry (i.e. work for companies or the government).

I am at a point in my career where I simply focus on my strengths, and leave other aspects of veterinary medicine to other vets who love doing those other things. As vets, we think we have to do it all and be equally as skilled in everything, or we are failures. We are not a “real vet”. There is fear written all over that.

I’ve paid my due’s in surgery, and I will do just fine with serving my people and pets if I never do another routine spay or neuter again. In depth knee or hip surgeries I could learn, but they are beyond how I want to help people with their pets on a daily basis.  If I was the only vet in town, and I had to do them, I would sweat those. I would refer them to someone who loved doing them if I could. Someone who ate, slept and drank knee surgeries. It could look like I was avoiding that procedure to someone actively requesting it.

Of course, many of us would just be candid and talk about our experience levels, but not all vets will. And if push came to shove, and I had to dust off a textbook to do that knee surgery, yup, I would be full of adrenaline and worried that I could screw it up. I’ve been there and done that when I was the only game in a small town. Where one vet flourishes, another vet can flounder. This veterinarian might be floundering in a world of complex, interrelated disease syndromes that he has limited experience with.

2. The vet has compassion fatigue. Remember, this part of the answer assumes the vet cares about what is going on. So why would any vet behave this way if they actually cared? In august a study got published showing psychological stress affecting 1 in 10 veterinarians. A 2010 study found that veterinarians are 4 times as likely to commit suicide as the average population. One of my online mentors, Dr. Sophia Yin, recently committed suicide. We see ten times the deaths that our human counterparts do, we experience trauma, aggressive patients, we sometimes see the worst in humanity with abuse cases, and immediately after performing euthanasia and witnessing profound pain in a person’s loss, I’ve got to swallow it all down and paint the largest smile on my face when I see the new family with the new puppy 10 minutes later. And many of us are likely in debt. And suck at running a vet clinic (because it requires business and administration skills that none of us got training for or got into this career to do).

It just can all just burn you out. When I started as a vet on Vancouver Island, I wondered why some of my more experienced colleagues simply never worked 5 days a week like I did. I assumed that it was because I was new and they were more established. Wow, must be a great schedule, working 3 days a week and then finding other things to do! I would head off to work, do three or four hours of surgery, then into appointments, then cover for reception while my nurse went for lunch (small town, small number of staff), then do 3 to 4 hours of appointments. With after hours on-call every so often in to the night. And I loved what I was doing. And a few years later, something happened. I started running out the hot water tank. My morning shower before work became longer and longer, and I would eventually just sit in the tub until the hot water became cold. The demands of clinic life were starting to circle and compress. And I found a way out of that funk, but not everyone does.

Compassion fatigue means that people who are there to help you are no longer equipped to do so. The well has run dry. The symptoms can be apathy, irritability, or close mindedness. Those are just a few ways it can manifest. You have many needs for your pet, and the more pets with multiple illnesses we see, the more loss we experience. And while this has nothing to do with your cats potential for success, it may be a reality of the situation.   

3. The vet thinks you could be one of those who eventually attack him or try to burn him in some way. The vet has got his back up and is in self-defence mode. This is just the worst. I hate talking about this sort of stuff, but it is worth talking about nonetheless. I'm sure in every profession, people meet this type. There is a combination of body language, phrases and questions that people present in the exam room that immediately gets the hairs standing on the back of my neck. And I'm happy if people give themselves away this way, because those are the easy (but not pleasant) situations to deal with once you have enough experience under your belt.

The worst is when you just don’t see the attack coming. I'm experiencing this right now. The owners of a pet I had helped successfully save the life of is trying to damage me professionally and personally. I opened my mailbox today, and in it was another letter letting me know it will likely take another 6 months to resolve this issue. This is time I could be spending my helping pets, people, writing on this blog and doing what I think is right. But now I have to dedicate even more effort into this, and it’s already taken a year. It doesn't matter that my medicine and techniques were found to be completely and 100% indicated and proper, which is partly why he is still alive today. Because there are narcissistic people with trust issues, and I have no say in why and what they do.

For some people,  the first reaction to a problem is to find someone to blame. Vets are always in situations that can defy prediction. So if anything happens that isn't exactly to plan, we have a huge bullseye painted on our back. If another client came into the room, reminding me of these people I am dealing with, I would run, not walk away from them. Effing run.

 
It has taken some time and reflection to deal with this - because I don’t want to be that jaded vet. I don’t want that experience to colour my interactions with other people. Because that is the easiest and most natural thing to do. But I can see how easy it is to slip into those shoes and wear them every day. But instead I have to remember all the lesson’s from when my mom took me to church when I was a little kid. Turn the other cheek and forgive these people. Because they can’t help themselves. They are who they are. They will be like that till the day they die. You know who didn't die? The pet who I protected from pain and helped save.

So, is your vet jaded by a similar set of circumstances? Are there any trust issues or something in the interaction that didn't get off on the right foot that we can rectify?  

I hope all of that didn't come off as a rant. This is not a "woes me I'm a vet and my life is so hard so please excuse my bad behaviour". Nope, I'm quite willing to call an @#$# an @#$#. Be it a vet or other health provider. This is just a look at behind the scenes and minds of people who work in this industry. And you are caught up in some of the bad parts of it.

But maybe we can make this better: THE SCRIPTS

Here are some specific, word for word “can't refuse” scripts. You can use them when talking with your vet and their staff. Why am I calling it "can't refuse?" Because if they do refuse after saying these scripts, you know there are trust issues, burnout or ageism as described above. If they agree to help you after saying these phrases, then you will be building bridges to reduce defensiveness, increase willingness to learn new things and will remind them of their mandate for compassion and teamwork. These will help you suss out the underlying motivations or issues here.

Try the following:

Dr. ______, can you help me figure out where my cat’s kidneys are staged according to IRIS (have chart and pamphlet printed out - see this website: ). I am interested in staging his kidneys, so together we can make a plan. Can I book a recheck appointment where we can go over his staging next week?

With this script you have identified that you are a person who actively wants to treat their pet. Many people want to do nothing because they look OK on the outside. You have also established that you are asking for reasonable, evidence based assessments, and that there is mutual respect in terms of valuing each others time. You are also providing education without embarrassing a person who might not have CKD all worked out in their brain. It is a complex illness to deal with and not everyone lives, breathes and drinks CKD. To say no to this script is a red flag - something is wrong with the relationship.

Dr.______, I realize she is 15, and I know that even if we try to treat her she might get worse. Even though that might happen, she’s been in my life 15 years, so I owe it to her to try. I understand it might not work. Can we begin with (problem #1), and then talk about “Problem #2” at my next recheck appointment next week?  

By using this script you are identify that you are willing to share responsibility. You are letting them know that you are willing to try, and you wont resort to blame transfer or attacks if things don't work as expected. The treatments for pancreatitis and CKD can be quite similar (and sometimes one caused the other - see this post: http://www.iwillhelpyourcat.com/dr-kris-qa/#/pancreas-and-kidney-one-two-punch/), so even if you are addressing one, chances are you will make the other better at the same time.

Hi Girls (I'm not being sexist, the veterinary industry in 90% women), watch this video, this cat really reminds me of ______ (your cats name). Then give them a link (https://vimeo.com/104575332) or show the front staff or reception the “zack versus illness” video:

 Sharing something like Zacks video will let them know where you are coming from at what your values are without having to say a word. And then the nurse with the golden heart will go out of her way to help you - and well established nurses have a lot on sway in a vet clinic]

None of that works? Find out if there is a mobile (large and small animal hospital) in the area. A “salt of the earth” farm vet who is very interested in helping may be more valuable to you than a small animal vet who for some reason isn't.

Best of luck,

Dr. k