um.......quoi?

so remember how i had the patient that i "mis-diagnosed"? i sent the cytology out to the state lab, and they agreed with my diagnosis of lymphoma.

now - the answer to this question might seem easy. call the owner and tell her that her dog - in all likelihood - has cancer, right?

wrong.

i'm an emergency doctor. i don't have an established relationship with this owner. further, she doesn't like me, and she was upset that i incorrectly diagnosed her dog. she was seen by her veterinarian for follow-up care after my diagnosis. that vet - with whom she does have an established relationship - diagnosed something different and is treating accordingly.

so there's the difficulty of navigating the emergency doctor/referring vet relationship to consider. and here's the other part of the dilemma: lymphoma can be a tricky diagnosis on cytology. usually it's very straightforward. unfortunately, there are occasions where lymphoid hyperplasia (hyperactive lymph node) occurs and can mimic lymphoma. i've know cytologists to say that the two can be mistaken for one another. it's possible the cytologist is wrong. possible but likely? biopsy is the gold standard diagnosis - which is what the referring vet offered to the owners. they declined.

the dog is doing well on antibiotics appropriate to the disease the referring vet diagnosed (doxycycline for suspected tick-borne disease) and prednisone (which will TREAT AND SHRINK lymphoma, if present).

i've done my part. the owner is not going to like me, regardless of what happens. the results have been sent to the regular vet and now she can decide what to do from here on out, right? i should be out of the picture. the ball is in the rDVM's court as to how to proceed. and yet, it niggles at me. the owner of said dog was rude to me on the phone, had no faith in my abilities (this was even apparent the night i saw the dog as a patient), and it irks me - ESPECIALLY when i see that the cytologist agrees with my assessment of the cytology.

it is no matter. if it is lymphoma, and the dog is only treated with steroids - it has about 1-3 months of life left - at the very most. so i'll have the real answer, one way or another eventually.

i need to learn to swallow that desire to be right about everything, to have people know i'm right and know i'm a good doctor, learn what i can from the situation (which was still a valuable lesson, despite the fact that i turned out to be right), and MOVE ON.

ok.

moving on now.

any minute the moving on will begin.

seriously.

i'm just worried that in all this tiptoeing around the referring vets and irate owners, the animal's well-being will suffer. and that is strictly against the creed of "first, do no harm." i'm doing harm if my patient's illness is not managed accordingly.

dammit.