You probably think of vets as all-knowing animal encyclopedia; knowledgeable in everything from cats and dogs, to emus, elephants and echidnas! Okay… maybe we’re being a bit too optimistic here. But certainly after five-plus years of university followed by a lifetime of experience, we do know a thing or two about animals. We are proud that pet owners come to us for advice every day. However, we really aren’t walking Wikipedias, and we often don’t know the answer. And that’s okay! So what do we do when faced with a problem we don’t know how to solve? In this article, we will go over some of the ways stuck, stumped and confused vets find the answer.
Table of contents
Diagnostic Process
This is probably the most important way vets diagnose disease in your pets. It is rare that we see an animal and immediately know why it is sick. Instead, we use the diagnostic process. This is basically a step-by-step approach to diagnosis where we gradually rule in or out diseases, getting us closer to a diagnosis. How exactly this works varies massively case-to-case and vet-to-vet, but there are some commonalities.
Almost all vets will start by taking a history.
The owner will describe why they brought their pet in and what is wrong. The vet will ask questions, such as how are they eating and drinking, any vomiting or diarrhoea, are they vaccinated, have they travelled abroad, has this happened before, and so on. This immediately helps narrow what area to focus on. If a dog is brought in for coughing, we know to focus on the respiratory system; vomiting and diarrhoea probably means a GI issue; and so on. The animal’s species, age, gender, reproductive status and other factors play a big part too.
We then perform a clinical exam.
This is a head to tail examination of your pet, looking at their eyes, ears, mouth and nose; their hydration status; their heart and lung sounds; palpating their abdomen; temperature; demeanour; etc. Depending on the history, we may examine certain areas more closely. Sometimes, these two steps are enough to make a likely diagnosis and administer treatment.
If we need more evidence, our initial diagnosis was wrong or the owner is keen for a definitive answer, we can consider further testing.
This, again, is highly variable depending on the specific case. It may include blood, urine or faecal tests, ultrasound or x-rays, biopsies, exploratory surgery, endoscopies and more. Taking a step-by-step approach is important. As an example, a dog with vomiting and diarrhoea may have a blood test initially. If this rules out issues with the organs, we can consider a faecal test. If this comes back as normal, we might want to ultrasound the abdomen.
At each stage, we are eliminating possible diagnoses and getting closer to the actual diagnosis. The journey there may only be one simple step, or many stages over weeks. When doing this process, it is important to remember that no test is 100% accurate, so things can be missed. Sometimes, repeating a test at a later date can alleviate this. It’s also worth remembering that not finding anything on a test is a result in itself – lots of diseases will have been ruled out.
For the vast majority of cases, the diagnostic approach is enough to obtain a diagnosis and start treatment. But this is not always the case. Sometimes we aren’t sure where to go next, or even where to start! What then?
Colleagues
No one person can know everything, and people are strongest working together. A veterinary practice will consist of a team of skilled individuals with their own knowledge, experience and interests, from vets, veterinary nurses, receptionists, support staff and others. Wise vets know to ask their colleagues, particularly the more experienced ones, for advice. One colleague may be more practised in interpreting x-rays, while another may be a good surgeon, and one may be great at client communication. Knowing who to speak to about which problem is important.
Some vet practices are lucky enough to have specialists or certificate holders who have done extra training in a field. Many practices have regular case discussions, where we discuss interesting cases to learn from each other. Two heads are often better than one. So having a colleague to chat to about a case can help identify new avenues of approach on the diagnostic process, identify things that have been missed, correct mistakes, or simply offer reassurance that you are doing a good job.
Textbooks
The old ways are still useful, and a good vet practice will have a library of veterinary textbooks containing a wealth of knowledge. The internet is great, but having a hard copy you know has been thoroughly researched and edited is important. Textbooks are likely to contain highly accurate information from experts. There are textbooks on a huge number of topics, ranging from broad guides on veterinary medicine, anatomy and surgery, to specific books focusing on one disease or body system.
The disadvantage of textbooks is that they cannot be updated easily. Many textbooks will release new editions as new information is discovered. But this is only of benefit if the vet practice gets the newest book. And with veterinary medicine changing all the time, some aspects may quickly be out of date. Nevertheless, many facts won’t change, and textbooks aren’t likely to disappear from a vets’ anytime soon. We are often trawling through a textbook in between consults!
Journals and Magazines
Magazines can be pretty niche (just ask the Teddy Bear Times, Funeral Service Times, or Practical Poultry – all real UK magazines!), so it’s no surprise to hear there are multiple veterinary-related magazines and journals out there. Some of the most well known include In Practice, Vet Times, Vet Record and The Veterinary Nurse. These magazines are full of veterinary news, interesting cases, urgent reports, updates and a few light-hearted articles to enjoy during your morning coffee break. They are a good way to connect with the wider veterinary world and even voice opinions if you so desire. Coming out more regularly than textbooks, they tend to be more up to date so important information can be relayed quicker. For less urgent cases, a magazine may hold a surprise gem article that sparks a ‘eureka’ moment and helps you move a case forward.
CPD
Continued Professional Development (CPD) is how the Royal College of Veterinary Surgeons ensures we maintain and develop our knowledge in a formal and recorded way. Every vet must complete a certain number of hours of CPD each year to continue working. This regular intake of new information ensures that we are always learning and kept up to date with changes in the veterinary world.
CPD varies from online courses and webinars, to lectures and in person training. It is up to individual vets what specific CPD they partake in. Some may prefer a broad range of topics to have a good general spread, others may want to focus on an area they are weak in to improve, while others may have a specific interest or specialism they want to develop further.
New grad vets have a similar scheme called the Graduate Development Programme (GDP), where we must record and reflect on a number of cases. On busy days, it is easy to run on autopilot and not think back on specific events. So the GDP provides a structured way to learn from the many mistakes we will make as new grads, make changes or just record interesting things we have done.
Both CPD and GDP help vets learn new things or reflect on past events that help them improve in future cases.
Referral Practices and External Experts
There is a lot of knowledge packed into a veterinary practice. And often the answer to a difficult question is found somewhere inside. But sometimes the answer is beyond general practice, and specialist help is needed. This is where referral practices and external experts come in handy.
When you visit your local vet, they likely work in a general practice, the equivalent to a human GP. GPs can diagnose and treat a lot of things, but if the problem is too specific, they will refer you to a specialist. Vets do this too. Complicated cases that we are struggling to diagnose or treat may benefit from referral to a specialist. Specialists are specialists (of course) in one particular area, and often have high-tech equipment and techniques that general practices do not have. Common examples include neurological specialists, cardiology specialists or reproductive specialists. Their expertise may lead to a diagnosis and more advanced treatment, or just help guide the general practice vets on treatment.
Many referral centres are available to talk to over the phone about specific cases. So even if you don’t get referred, you can benefit from a referral vet’s advice. External laboratories are also good sources of experts to chat about the results of a specific test.
The Internet
You knew it was coming! Yes, even vets use Dr Google occasionally. However, it is important to use the internet correctly – the internet is hugely powerful and contains a vast wealth of instant knowledge. But its open use means there is also a lot of opinion, false information or even lies that can be easily confused with truth. We try to stick to legitimate sources we know are accurate, such as websites like Vetstream, Wikivet, MSD Vet Manual, eClinPath, NOAH and more – properly maintained and updated regularly, these sites are the cream of the crop for instant, up to date knowledge. For checking a quick fact, looking up a drug dose or finding out new legislation, the internet is the best source, provided you know where to look.
As owners, we don’t want to discourage your use of the internet, but always be aware of what sites you are on. Does the site sound legitimate or is it ‘petsfacts.com’? Is the maker of the site someone with credentials or just someone interested in the topic? Is the information presented as fact or opinion? Are there reputable sources available? If in doubt about something you’ve read online, please ask your vet first – at the very least, we can investigate before you do something that could cause harm to your pet. Google is great for general questions, but for something specialist or highly specific, seek a professional’s advice.
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