Importance Physical Exams and History Taking…why our vets know more than Dr Google

Scenario …..You notice over the past two weeks that your dog, Bobby, has developed a slowly worsening cough. What do you do? Quickly and because it is free, you consult Dr Google with the search words “causes of coughing in dogs”….up pop 450 sites with an array of information but then things get very confusing because there are lots of medical terms and names of diseases and before long you are convinced your dog has distemper or Legionnaires disease (both rare in dogs) and is about to die.

So, you ring the vet and get in right away…. 30 minutes later at the vets office…next appointment for Dr Burniston is to see a coughing dog. Vet comes into the room to see a coughing dog and an anxious owner. Here’s what happens then….

Before our vets begin to examine your pet we start by taking a complete history from you, the owner. No one brings their sick pet to the vet without having noticed something which is either suddenly and obviously different from their pets normal behaviour. Or it may be a subtle and long-standing change in things like appetite, water consumption and urination, vomiting or diarrhea, weakness, change in sleep patterns or respiratory effort, etc. Life style (active or sedentary, indoor or outdoors), the diet being fed, the number and types of other pets in the household, age of pet, vaccination and travel history and other pre-existing medical conditions and medications can provide important clues in helping determine what is going on in our patients. So we as vets need clear and honest answers from owners before we start the examination. Expect to be peppered with questions about your observations, often in your answers lies the clues that the vets needs to know to get to the root of the problem.

A physical examination, whether it is for a sick pet or as part of an annual vaccination visit, starts with a distant exam using our eyes, ears and nose. We are looking at body condition, movement coordination and mobility, coat and skin condition, abnormal body odours, abnormal breathing sounds or joint sounds. Then a hands on inspection of the surface of a pets body to check for skin masses, wounds or abscesses, lymph node enlargement, swollen joints, parasites such as fleas, lice and ticks, presence of skin diseases, paws and nails and then make an assessment of pain in any joints or the spine. Then begins an inspection of the head end i.e. the oral cavity, the ears and eyes and then the rear end i.e. the anal area and the genitalia. We may also take a core body temperature when necessary. In the thoracic cavity we listen to the heart and lungs and may concurrently feel the femoral pulse. Then the abdomen is palpated for any abnormal position, size or shape of organs like the kidney, spleen, liver, intestines and bladder. All the while, we will be talking to you about our physical findings…but internally we are silently deciding what is normal from abnormal, what we think may be causing the changes in your pets behaviour, how it all ties in with the history and signalment and be trying to sort out a diagnostic work up and treatment plan and how explain to the owner what we think is going on and how to get an answer.

Veterinarians really provide so much more than Dr Google because a vet in real life is the curator of the knowledge and so knows how to put all the pieces of the puzzle together, i.e. the signs and symptoms, the history and the clinical exam findings, and then craft a diagnostic and treatment plan for your pet. By the way…… the cough in Bobby, your 15 year old terrier, is happening at night, the vet heard a loud heart murmur on listening to the chest, and then based diagnostic workup using radiographs and ultrasound, he diagnosed Bobby congestive heart failure, which was then treated with two heart medications which make Bobby’s heart function so much better that he’s like a pup again!