Don't Just Do Something, Stand There!
By Myrna Milani, BS, DVM
In a world in which a seemingly endless supply high-speed, high-tech options swell the ranks of the veterinary repertoire, the idea of doing nothing appears nothing short of malpractice. Logic says that the more options, the more likely one of them should perfectly fulfill our own, our patient's, and/or our client's needs at any given moment. However, we need only consider the role medical practitioners' choice to immediately dispense antibiotics "just in case" might now play in the much more serious problem of antibiotic resistance to realize that doing nothing might have its place in veterinary practice. Not only that, by taking the time to consciously do nothing we may actually improve our relationship with our clients and patients as well as improve our patients' health.
An old canon of human medicine maintains, "Don't just do something, stand there!" It sounds so simple, even enjoyable, doesn't it? However, for those who view themselves as action-based practitioners, even a momentary pause may give rise to all sorts of negative images. During that brief period of physical inactivity, those belonging to the time-is-money group may see dollar bills flying out the window at an alarming rate. Those raised with a strong work ethic may feel slovenly and demeaned when faced by such a void, let alone one of their own making. Facing no physical activity to absorb their energy, Type A-ers may shuffle and twitch nervously like race horses at the starting gate. Given these problems, let's consider a few of the benefits such planned pauses can gain for busy practitioners that would compensate for any difficulties inherent in developing this skill.
An old text on manners for young ladies warns young women not to barge into a room. Instead, advises the manners maven who wrote the tome, pause at the entrance just long enough to ascertain the events taking place within and chart a meaningful plan of action. She goes on to note that this simple pause enables the cultivated individual to act purposefully rather than merely react to events like those lacking this social grace. Veterinarians of both sexes entering an examination room would be wise to heed this same advice. Although rushing into the room and immediately commencing work does generate some of the drama associated with medical emergency television shows, that flurry of activity also may obliterate a lot of valuable client and patient input.
For example, Dr Busydoc rushes into the examination room so intent on getting right to work that he misses the apprehension on his client's face and the slight rigidness in his canine patient's body. Because of this, the animal's attempt to bite him comes as a complete surprise, and a routine physical which should have taken a few minutes becomes a debacle that takes twice as long. Worse, the owner's and animal's agitated states undermine the value of any history or physical information the veterinarian gleans during that time, which could negatively affect any diagnosis or treatment. However, if Dr Busydoc had first paused quietly for a few seconds upon entering the room to read the lay of the client-patient land, he could have formulated an approach that would have calmed his patient and client rather than upsetting them more.
We routinely hear how clients pay us for information as well as our services, but sometimes they wish we would just stand there with our mouths closed, too. Dr Busydoc feels so sure he knows exactly what Muffy's problem is that the idea of getting to a complete history from the cat's long-winded owner seems like a tremendous waste. But had he taken the time to just stand there and listen to his client, he would have gained two benefits from this "boring" interlude. First, he would have discovered that housecat Muffy had escaped into the busy streets two days previously, an event that raises the possibility that her hematuria could result from trauma rather than her usual cystitis. Second, his interest in what Muffy's owner had to say would have earned him his client's respect and gratitude rather than her frustration and even anger: "Dr Busydoc never listens to me!" she later fumes to her neighbor. "It makes me so mad!"
Other times, we don't want to pause long enough for clients to make up their minds regarding the treatment of their pets. As Bronco's owner mentally weighs the various options against any time, financial, or other limits that might affect her animal's treatment, Dr. Busydoc thinks about all the work piling up while his client dithers over what he considers a simple choice. As his impatience mounts, he begins to nudge her in one direction or another to speed up the process rather than waiting quietly for her to make up her mind.
Admittedly, offering our professional opinion regarding the best course of action will often short-circuit client introspection regarding what any treatment option specifically means to them. Whether this works, though, depends on how well we know the client. As long as Dr. Busydoc feels confident that Bronco's owner eventually would reach the same conclusion that he did regarding the best treatment for the animal, his impatience and interference poses no problem. If not, however, his reluctance to give her the time to make up her own mind could leave her feeling manipulated and resentful. Those negative feelings, in turn, could undermine her willingness to comply with his recommendations. In this situation, the relationship and animal health problems created by the veterinarian's unwillingness to just stand there could require a great deal of time and energy to resolve.
Spinoza rightfully noted that nature abhors a vacuum; create one and something will always rush in to fill it. However, that doesn't necessarily mean that we need to fill it with our activities or the sound of our own voices. For clinicians willing to stand quietly and create a vacuum of silence, a rush of new client, patient, and practice insights could be the reward.