“What are you looking for?” asks a client as my hands press deep into the sides of his dog’s belly.
I’m surprised for a moment. It’s such a simple and reasonable question, but it hardly ever gets asked amidst the routine of a physical examination. I’m not even sure what to make of it at first. Is he skeptical? Does it look like I’m faking it? I’ve been doing this for so long that it feels entirely obvious what I’m looking for. But then I realize that maybe it’s not obvious at all because I have trouble finding an answer.
My immediate instinct is to say that I’m looking for problems—a broken tooth here or a stinky ear there. That seems to make sense, but on brief reflection I realize that’s not it. The truth is quite the opposite. I’m looking for normal, and hoping I find it. I don’t know how many thousands of physical examinations I’ve performed in my career, but each one gets added to this amalgamated notion of what a normal animal looks, sounds, smells and feels like.
Whether it be the slippery bulk of a dog’s spleen, the lunar beauty of a cat’s retina or the reassuring lub-dub of a healthy heart, these sensations are hardwired. The point of a physical exam is to find out if the patient in front of me matches those sensations, and to pay attention when she doesn’t.
The problem with looking for problems is that there’s just so many of them. To say that I’m looking for each individual entry in an infinite list is absurd, if not arrogant. Naturally, if I’m faced with a patient that has a specific predisposition (maybe he’s had seven ear infections before or his breed is prone to heart disease), I’m going to double-check the trouble spots. But on the balance, looking for problems is just too narrow and it’s a good way to blind yourself to things you weren’t expecting.
When you look for normal, however, it’s easier to notice when something violates well-established expectations. It’s that same sinking feeling you get when you notice your wallet isn’t in your pocket. You know right away that something is wrong and then you set about investigating why. And I’m not the only one in the exam room doing this.
I can’t possibly overstate how important pet owners are during a routine physical exam. While I’ve spent years learning to recognize normal across many different animals, the owner has spent years learning what normal means to that one in particular. They are the ones who notice if a dog is reluctant to climb stairs lately or if a cat has started spending more time at the water bowl. Those deviations from normal can be as revealing as anything I might stumble across during the visit.
For that reason, it’s vital that pets come in with someone who knows them well. Even the most meticulous physical examination can’t catch everything, and veterinarians rely on conversation to complete the picture. Routine vet visits are often treated like an errand that can be delegated to anybody in the family, but this can really limit the value of the experience. Nobody benefits when I ask if there’s any change in appetite, and get “I don’t know, my wife handles all that” in return.
That’s really the crux of what makes routine visits worthwhile. It’s not meant as a forum for me to let you know what’s wrong with your pet (although it can be). More often, it’s a chance for us to notice and discuss those little deviations from normal, and to decide on the best way to handle them before they veer off any further.