Dr Mark A. Mitchell, an expert in herpetological medicine, shared his thought process for deductive reasoning during his lecture at the Veterinary Meeting & Expo.
Testing and diagnostics are a critical part of veterinary care, but atthe 2022 Veterinary Meeting & Expo (VMX) in Orlando, Florida, one speaker emphasized the importance of maintaining a strong foundation in physical examination.
“I'm often asked about test characteristics and validation of tests,” Mark A. Mitchell, DVM, MS, PhD, DECZM explained to attendees. “I'd like to remind everyone, however, [that] the most important test we do on every case is actually our physical exam and the history that comes with it.”
This can be especially important when it comes to reptiles. Mitchell says it can be a challenge to become an expert on these animals when there are more than 10,000 species of reptiles, with some 200 available through pet trade.
During his session, Tumors, Pathogens, and Idiopathy...Clinical Challenges for the Herpetological Veterinarian, Mitchell walked through a series of cases to demonstrate his thought process for analyzing and treating these patients.
Mitchell began his presentation by examining a case study of a boa constrictor patient. The snake presented with an issue in which the cranial half of its body slithered normally, but the caudal half would limply drag behind. There weren’t any other immediately apparent issues to the owner, but they noted that another boa constrictor had shown the same issue and subsequently died.
When attempting to diagnose a herpetological patient, Mitchell said it is important to begin from a mindset of scientific inquiry. “It’s important for us to recognize that we’re scientists, [and] we should use science to help follow through and answer the questions we’re after,” said Mitchell. “…especially when we get into herpetological medicine, we don’t always have a science…but if we’re using hypothetical deductive reasoning and we’re processing, we’re going to have greater success with our cases.”
As a professor and professional otherwise in a position to train and observe other veterinary professionals, Mitchell cautioned against dismissing the emphasis on a physical exam as obvious. According to Mitchell, clinicians should reexamine their process to ensure they are being as thorough as possible.
He said it is not uncommon to watch practitioners perform exams and see “…[we] may not always be as detailed as we think we are.” He added, “So I really like to stress the importance, especially in stoic species like reptiles who have evolved hundreds of millions of years to mask their illness, that we want to make sure we are doing everything we can to pick up anything that might be abnormal.
“If we keep things too broad, we can have huge amounts of differentials and run all kinds of diagnostics,” said Mitchell. “So, we want to try to narrow those things down as quickly as we can.”
Thinking about the problem in terms of this system can help the clinician put together differentials that may help the diagnosis and guide what diagnostics need to be done to get to the root of the problem.
For this particular boa constrictor case, Mitchell said he would put his focus on the musculoskeletal system, due to the issues with moving the caudal half of its body and the fact that he palpated a firm mass on the spine itself. For example, he said, “We might worry about things like neoplasia, abscess or some kind of infectious cause, granuloma, or hematoma…” Those potential causes inform the tests that could be done, followed by next steps depending on the results.
He added that there are numerous other systems that this problem could fall into, and the important thing is to logically process through each possibility, starting with the simplest and most likely.