I missed a giant tumor last month. A dog (old, large-breed) came in for coughing, and the owners thought he had kennel cough, because he'd been groomed a week before. I was more worried about other things, given his age, and took chest rads. There might have been some hilar lymphadenopathy, but it wasn't dramatic. The cranial abdomen was also in the films, and I took a quick glance at it and noticed a little piece of bone in the stomach, but he has a history of dietary indiscretion so I didn't think too much of it, and went back to ruminating over whether the hilar lymph nodes were actually big or not. Well, he came back last week, for GI upset, and had a large splenic mass removed. So I went back and looked at the rads I took a month ago, and there is obviously a splenic mass on those films. It was squishing the stomach. I totally missed it.
I also (tentatively) diagnosed a dog with ALL this week. That was pretty bizarre! I can add this one to my list of patients who came in with diarrhea, and went home with terminal cancer. The peripheral blood was so screwy that our machine couldn't even read the CBC, so I made a smear, and there were abnormal lymphocytes EVERYWHERE. They almost outnumbered the RBCs in circulation! No peripheral lymphadenopathy. Giant spleen. Referred him to an oncologist, but it probably won't matter much. The owners were very upset, cried a lot, and asked very thoughtful questions - I was impressed. I'm very curious to see if the oncologist agrees that it's ALL.
Another dog came in with hematuria, and ended up having a giant bladder mass. That client can't afford surgery or chemotherapy, so she'll probably be euthanized soon. She was mildly coagulopathic and moderately thrombocytopenic, so I'm actually more worried about bleeding out than about the mass, in the short term. I didn't recommend a transfusion, because at my hospital it costs almost $1000 and the guy could barely afford the $500 in initial diagnostics, but in retrospect I wish I'd at least mentioned it.
On the pettier side, I got yelled at by a client this week on the phone. Her husband had brought in their geriatric cat on emergency, with urinary signs. I recommended a urinalysis, abdominal radiographs to look for uroliths (and tiny or giant kidneys), and bloodwork, both to look at her renal values and because she was also not eating very well. I didn't push him to do all those things, I just explained why I was recommending each thing, and he opted to follow that plan. She did end up having an uncomplicated UTI, and the wife was furious that I hadn't JUST done a urinalysis. She even talked to her regular vet, who AGREED with her that my plan was excessive and unnecessary. I explained that even if I'd just done a UA, the cat STILL could have had bladder stones, neoplasia, GI or liver disease, etc, and finding a UTI doesn't rule out any of those other possibilities. AND that I hadn't pushed her husband into following my recommendations, I just made and explained my plan, and he elected to follow it. She was still disgruntled when we got off the phone. The part that really galls me is her other vet telling her the rads and bloodwork were unnecessary and excessive. I would never say that about another doctor. Especially since I still think it was a perfectly reasonable plan.
Being a doctor is really stressful. REALLY stressful. I'm constantly worried about missing something, not ordering the right diagnostic tests, not interpreting the tests I DO order correctly, not asking the owner the right questions to elicit the complete history, making a mistake with a drug dose or combination . . . . . . . I frequently wake up at 4 AM and can't go back to sleep because I'm so worried about patients I should have pushed harder for, or should have done another diagnostic on, or should have explained something a different way to their owner, or should have emphasized something harder. It's stressful.