Monocular Vision in Horses and Physicians

The horse that came into my life has made me think about many things from a different perspective. I have learned about the horse’s subtle ways of communicating, her extrasensory (compared to our own) perception, and her instincts of flight. I have also become more aware of the energy I bring to my relationship with her. With no learned tricks or horse management skills, I have established a way of communicating with her built solely on mutual respect and affection.

She always tries to see what I am looking at, my books and the picture of me and her on my iPhone. I know that horses have an almost 360 degree field of vision, but a very small area of binocular vision. They also have a blind spot right in front of their nose.

Monocular vision gives horses the ability to detect danger from almost every angle, but with fewer details than our human vision. A wind blown piece of paper can seem as threatening as an approaching predator.

Even when grazing lazily on warm summer afternoons, my horse has one ear turned in each direction and she maintains her 360 degree visual vigil. She is always multitasking.

This is where I have started to see parallels with my own workday. I seldom have the luxury of doing one thing at a time, namely take care of the patient in front of me. Today’s physicians, like horses on the savanna, seem to be having to keep a 360 degree field of awareness, even when we are alone with our patients in the exam room.

It is not enough to be doing the work of diagnosis, of weighing all the components of crafting a treatment plan: If I choose to prescribe a quinolone antibiotic, what is my patient’s kidney function, is he on blood thinners, did I double check the allergy list? I must also remember to print the patient information, even though I verbally warned my patient about the risk for tendon rupture. I must be aware if his insurance covers my choice of drug and, because he is on replacement steroids for his Addison’s disease, I need to submit a prior authorization request to Medicaid, which wants me to go on record that I am aware of the theoretically increased risk of tendon injury, even though my patient is only on replacement steroid therapy.

I must also be cognizant of the time, my schedule, the health maintenance reminders and the chronic disease monitoring my patient is due for.

All these considerations, which happen almost subconsciously, need to be documented in the medical record, both for medicolegal and for billing purposes. Watching out for all the pitfalls in patient care is probably a lot like grazing on the savanna for my Arabian and her ancestors.

Any wonder, then, that sometimes, at the end of a busy day, I feel as if I have done a lot more than the doctoring I bargained for.

Stepping into the ten foot stall of my 800 lb friend, I cannot afford to be edgy or distracted. This is when we spend time together inside, focusing on our shared field of binocular vision, where we share the depths of each other’s gaze, and where we share our territory with mutual respect.

This is the focus I must strive at maintaining every day, at work as well as in my dealings with those I love. I need my 360 awareness, but as a human being, and not an animal of prey, I need to keep my main focus straight ahead, or I will lose my depth and my courage.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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