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Reflect on a medical case that you have recently dealt with that frustrated you or seemed difficult to diagnose and manage. Can you identify why the case was difficult?

There can be a multitude of reasons why complex medical cases are frustrating instead of fun.

 Was it due to the client (e.g. having unreal expectations that you could fix the problem at no cost to themselves? Unwilling or unable to pay for the diagnostic tests needed to reach a diagnosis? Unable to give a coherent history?)

 Was the case complex and didn’t seem to fit any recognisable pattern?

 Were you unable to recall all of the facts about a disease, and this biased your thinking?

 Did the signalment, especially breed and age, cloud your clinical reasoning, resulting in an incorrect differential list?

 Did the case seem to fit a pattern, but subsequent testing proved your initial diagnosis wrong?

 Did you seem to spend a lot of the client’s money on tests that weren’t particularly illuminating?

Can you add any other factors that have contributed to frustrations and difficulties you may have experienced with medical cases?

Apart from the client issues (and as discussed later, we may be able to help a little bit here as well), we hope that by the end of this book, we will have gone some way towards removing the common barriers to correct, quick and efficient diagnosis of medical cases and have made unravelling medical riddles fun rather than frustrating.