One recent month, I spent nearly 400 hours in places I never imagined I’d be: on four hospital floors dedicated to human neurosurgery, watching my mom deteriorate from a Grade 4, IDH-wildtype glioblastoma. I quickly learned that it’s arguably the most aggressive form of malignant brain tumor you can have growing in your skull. Ironically, my mom started her journey by going to the hospital for a total knee replacement. A poor recovery led to ambulance rides, emergency rooms, operating suites, neurosurgical ICUs and, finally, a brain rehab hospital. One recurring theme throughout this experience — a rollercoaster for my family — is frustration over the lack of transparency, which I will soon tell you about.
Why is medical transparency so difficult? Why don’t all patients receive it? And, most importantly, how can we, as veterinarians, continue to learn, lead and be the patient advocates our clients deserve?
The word “transparency” is everywhere today — on social media and in politics, therapy sessions and relationships. It has become a buzzword, but what is medical transparency? In human medicine, it means openly sharing clear, accurate and accessible information about health care processes, costs, outcomes and decisions with patients, providers and the public. Medical transparency is based on the belief that patients and their families have the right to understand the care they receive, the associated costs, and the risks and benefits involved. While most veterinary professionals seem aligned with the principle, we mainly focus on four key categories of transparency related to our patients and caregivers: clinical, financial, outcome/prognosis and organizational.
We Are Clinicians at Our Core
As my mother’s medical power of attorney and a nerdy scientist and clinician, I knew I was probably every nurse and resident’s nightmare. I asked numerous questions, reviewed her medical records thoroughly, and double-checked each of her 17 medications by name and dose. It didn’t take long for one of my mom’s rotating medical team members to ask, “Are you in the medical field?” The interesting part was always the response after I said, “Yes, I’m a veterinarian.” The nurses got excited, the residents responded in various ways, and the attendings usually nodded.
I recall many times when the roles were reversed. A pet owner with human medicine training would ask me about a patient’s diagnosis and treatment. Veterinarians can feel frustrated and even threatened when an animal caregiver doesn’t immediately agree with us or comply with our recommendations. In hindsight, I know that my body language communicated those emotions, whether intentionally or not.
Instead of defaulting to that negative place, which can unintentionally weaken the veterinarian-client relationship, let’s practice being transparent clinical advocates for the patient. We have a responsibility to share exam and diagnostic results, along with our interpretations and treatment options, in language that pet owners can understand and use in informed decision-making.
The Elephant in the Room
While assisting my mom, I’ve spent hours lost in endless Medicare phone prompts. Senior citizens with some medical plans can only use certain pharmacies and drugs. Their access to skilled care facilities and the number of days covered are limited. Physical rehabilitation is restricted to specific care centers. The list goes on. However, one privilege we did have was enough financial coverage, which allowed us to avoid regretfully declining treatment.
That isn’t always the case for our clients. The cost of veterinary care rears its head daily. For some clients, financial discussions don’t necessarily influence medical decisions or treatment options. However, for many others, accessibility and costs are significant concerns. Feelings of shame, embarrassment and vulnerability can trigger negative online reviews and social media posts.
Sure, our industry offers pet health insurance and payment plans, but we are still years away from human medicine’s level of coverage. Veterinary teams must remain transparent about the price of diagnostics, treatments, and follow-up exams or procedures.
Such an approach isn’t always easy, especially when a client asks why an abdominal ultrasound costs what it does. However, we must have those conversations and reframe our fees as providing value. We can also outline reasonable, step-by-step or palliative options so pet owners feel empowered rather than guilty.
Outcomes and Prognoses
Upon hearing a terminal diagnosis in human medicine, every family member asks the same question: “How much time does she have?” Every physician offers a different answer, sometimes providing wild guesses and, when pressed, avoiding the subject altogether. I once questioned one of my mom’s lab results and was met with the response, “Are you a neurologist? I’m the expert here.”
All families want to spend as much quality time as possible with an ailing loved one — whether human or animal — and we want to know how much of it remains. The truth is, we don’t know exactly. My mom’s neurooncologist shared the sobering statistics behind Grade 4 IDH-wildtype glioblastomas. However, a patient’s median life expectancy is just that: a median.
In contrast, veterinarians often lack the luxury of long, retrospective studies of success rates and prognoses. Many of our cases involve probabilities rather than published statistics. However, we can be transparent about what we do know, including what various treatments realistically can achieve. We are much more knowledgeable about end-of-life decisions and care, and we openly advocate for our patients when their quality of life is compromised.
The Visible Medical Record
There is a lot of downtime when someone sits with their thoughts in a hospital setting. For my mom, a series of MRIs, EEGs and lab tests was rushed, but the results were a much longer wait. I kept checking the online portal but only seemed to access the findings after my mom was discharged from one specialty service to another. And I didn’t realize until three days after my mom’s seven-hour craniotomy that the team had surgical pathology results intraoperatively but hadn’t shared them with me.
I tried to see things from the doctors’ perspective. Sharing terrible news repeatedly can increase a caregiver’s compassion fatigue. A report is also not considered final until all the molecular markers are in, which took almost a week in my mother’s case.
Today’s advances mean more veterinary practices are adopting real-time records and client portals for sharing lab results and invoices. This service greatly enhances transparency and appeals to the largest pet owner demographic — millennials and Gen Zers — by emphasizing education and the importance of understanding their financial investment. We have a strong incentive to invest in AI-powered technology to efficiently and accurately enhance our recordkeeping systems.
Transparency is crucial in human and veterinary medicine. In our industry, it involves openly sharing information about patient care, costs and outcomes so our clients can make informed, value-based decisions. Many complaints about today’s veterinary care do not arise from the outcomes but from pet owners feeling surprised by the costs or the prognosis. Transparency can help. We experience less moral distress when clients make truly informed choices. When we balance clinical empathy, medical transparency and compassion, we discover the true reward of clinical practice.
A STICKY SITUATION
Richard Drew, an engineer at 3M, is credited with the 1930 invention of transparent cellophane tape. According to the American Chemical Society, Drew invented Scotch Masking Tape five years earlier, marking 3M’s entry into tape manufacturing.