Cherie Buisson, DVM, CHPV

For Best Results, Shut Your Mouth

November 9, 2015 by Cherie Buisson, DVM, CHPV

I learned about the effectiveness of silence from my first boss. I’ll be honest with you – he scared me to death. It took me the better part of a year to call him by his first name. Part of the intimidation factor was his silence. He would ask me a question, I would answer and then……nothing! For like 10 or 15 seconds! At the time, I found our communication frustrating. Shutting up is not one of my strong points. I love to talk, and I hate awkward silence. After three years of observing my boss and his penchant for silence, I still didn’t fully appreciate his method of communication.

Later, as I attended courses on management and communication, I began to realize the genius of closing one’s mouth. Here are some things I learned.

1. There is nothing wrong with thinking before you speak. In fact, I highly recommend it. While it doesn’t feel comfortable at first, it feels way more comfortable than blurting out something idiotic. Don’t be afraid to take the time you need to formulate an answer. ESPECIALLY if you take that time because you were listening to understand rather than reply. Really listen to what the other person is saying. Once they are done, take a second to come up with a response. As an introvert, this was incredibly difficult for me. I like to have my answer prepared ahead of time. The problem with that is you miss what the other person is saying (and their body language) when you’re inside your head writing prose.

I began to realize the genius of closing one’s mouth.

2. Uncomfortable silence is irresistible. People rush to fill it with all kinds of words. Here’s an example: I had a colleague who was frustrated at work. He was immersed in gossip and infighting. He and some of the other staff members had resorted to taking petty revenge on each other for both real and imagined slights. He was telling me about how one of his coworkers had refused to work for him when he wanted to go on vacation. He decided to wait for the next time she asked him to work for her and refuse no matter the circumstances. I didn’t really know what to say. “You’re kind of being a jerk” came to mind, but while I was rolling around in my head how to phrase that constructively, I realized that he was waiting for me to answer and getting uncomfortable. I started to open my mouth, and he said, “Of course, with my luck, it’ll be a sick kid or a death in the family and then that would make me kind of a jerk”. He said it, I didn’t. Win-win.

3. “I don’t exactly know how to respond to that” is almost as good as silence. I said that once to a client who was yelling at me because I “let” her husband spend $350 on the dog when they couldn’t afford it. The silence after I said it didn’t last long. She quickly said “I’m going to talk to my husband about this” and hung up on me. Great idea!

4. When you ask a client a question, stop and let them answer! How often do we shoot ourselves in the foot by recommending a product or service and then rush to offer a less expensive option or move on without letting them respond? Try this, “If we do the fluids, nausea medication and blood work, the total will be $300. Is that going to be ok with you?” Now, press your lips together like fleas are trying to get in. You can talk if they don’t say anything for 10 seconds. Count slowly.

5. When someone is talking to you, focus on them. Listen to what they say. Notice what they don’t say. If their face and body disagree with the words coming out of their mouth, STOP. I had a client wh agreed to a treatment plan for her elderly, chronically ill cat. Because I was watching her face as she spoke, I saw her eyes fill with tears. I reached out and touched her hand. “What did I say that upset you?” I asked her. She gave into the tears and told me her husband was on hospice care and she just didn’t think she could continue taking care of both him and the cat. Despite the fact that we had spoken about hospice care and euthanasia for the cat previously, she felt uncomfortable discussing it. I wouldn’t have had a clue if I hadn’t been listening and watching.

6. Sometimes the silence lasts for hours or days. There is nothing wrong with declining to talk about something until you’ve had time to think about it. “Let me look into that and get back to you” or “I can’t discuss this right now. Let me get my thoughts together and call you later”. If a client is being abusive on the phone, I will tell them that I’m unable to talk to them like this. I let them know I’m going to hang up the phone and we can talk when we’ve both had a chance to cool off. Then I hang up.

There’s nothing wrong with declining to talk until you’ve thought about the issue.

7. If a client on the phone is just venting and upset, I give them 100% of my attention. I don’t say a word. Almost always, they will pause and say “Are you still there?” (This means you’re doing it right.) “Yes, I’m still here. I’m listening to everything you’re saying and taking notes to be sure I get it right. Is there anything else you want to tell me before I ask you to listen to me?” If there is, I continue to listen. If they end up not letting me speak at all, that’s ok. Until they get it all out, they’re not going to hear what I say anyway.

8. I hate it when people accuse me of doing something wrong, especially if that “something wrong” was declared wrong by the internet. I’ve gone back and forth with clients in person, by phone and in email about food, products, procedures and diseases. At some point, you just have to know they aren’t going to be educated and let it go. If that means letting them have the last word, so be it. It’s not worth the drain on your positive energy to continue beating your head against a brick wall. If there are subjects that really set you off, create a handout or a glossary item in your software that allows you to educate without having to type or talk it all out.

9. Turn off your phone. If you need to have a serious conversation with a client or staff member, everyone needs to be on DO NOT DISTURB notice. If you are performing euthanasia, shut it down. Unless there is a dire emergency, it can wait. Put your phone on airplane mode – don’t even let it be on vibrate. Nothing should distract you from the conversation.

10. Sit in silence and be still. Sometimes our brains are what need to be silent. If you are overwhelmed and upset, take 5 minutes in your car, locked in the bathroom or in the isolation ward to take a few deep breaths and shake it off. The veterinary world is amazingly noisy. Just a few minutes of quiet (heck, get some earplugs if you must) can make all the difference.

Sometimes our brains are what need to be silent.

Once you start practicing silent communication (otherwise known as listening), you will become much more adept at making your world a better place. You will get so much more out of listening than talking. Solutions become more obvious, tasks become simpler and letting loud people be loud without competing is a relief. So, take the pressure off, zip your lip and prepare become a lot better at communication – without saying anything at all!

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Why I Sedate Every Pet for Euthanasia – and You Should Too

October 25, 2015 by Cherie Buisson, DVM, CHPV

Sedation is one of the major controversies in end-of-life care medicine. I’m grateful that it isn’t as rare as it once was. When I talk to veterinarians about sedation, this is what I hear from those who don’t use sedation:

1. I don’t need sedation to hit a vein

2. Sedation takes too long

3. Sedation makes hitting the vein harder.

Can you spot the problem? Not one of these objections has anything to do with the owner or the pet! When it comes to euthanasia, it’s ALL about the owner and the pet. Have you ever watched a client before and after sedation? The difference is incredible! The tension leaves their face and body. They are able to focus on saying goodbye rather than wincing and being upset when their pet objects to handling. Most importantly, they get to spend a few minutes with their pet and see that there is no pain or anxiety. They know in those few precious moments that their pet is still alive and is no longer suffering. Some will even laugh through their tears at the sound of their pet snoring peacefully.

Do you know what it looks like to a client when you perform standing euthanasia on their pet? I do, because so many of my clients have told me about their past experiences and demanded sedation for their next pet.

“He just dropped dead.”

“It happened so fast.”

“One minute she was standing up and the next she was dead.”

“She died before I could touch her or tell her goodbye.”

That’s what they tell me.

We think a smooth euthanasia looks like a smooth surgical induction, don’t we? Perfect and peaceful? Not to our clients! There’s a reason for the “kissing corner” in hospitals when they take your loved one away to surgery. No one should have to see someone they love go from conscious to unconscious that fast. It’s scary. Have you ever seen someone faint? Even if they were caught and gently lowered to the ground, would you say it was a pleasant experience? Now imagine that it wasn’t unconsciousness – imagine it was death. How disturbing would that be?

Sedation is for both the pet and the owner. Needles hurt. I dislike hearing a guarantee of “painless euthanasia”. If they can feel a needle, it’s uncomfortable. So why would we put ourselves, our clients or our patients through unnecessary discomfort? If that isn’t enough to convince you, let me try this: not sedating will drive clients away from your practice. I know, because they call me for help after they have had “a bad experience”. They insist upon sedation. They won’t go back to their last veterinarian because it wasn’t used.

Sedation has the secondary effect of calming the owner. It’s a twofer! The pet is asleep and the owner has a little bit of their burden removed. Sedation also allows me to let an owner get close to their pet during the euthanasia process. That contact is so important! When an owner brings their pet in for euthanasia, I allow them to remain with their pet throughout their passing. Breaking that bond isn’t necessary.

I know it’s tempting to whisk their pet away to put in an IV catheter, but have faith in your vein-hitting ability. Every second the owner spends apart from their pet is a second of increased anxiety and guilt. If that pet cries out or comes back shaved and bruised from unsuccessful attempts at a catheter – it’s even worse. Sedation is the ultimate safety net. I often miss a vein on the first try. With sedation, it’s only a big deal if I make it a big deal.

If you do it right, sedation typically takes no more than 10 minutes (that’s if you give it subcutaneously like I do). That gives you time to make a short phone call, answer an email or quickly scoot in to see a patient. I give my feline patients drug cocktails with whopping doses of acepromazine. My canine patients get both acepromazine and xylazine. I give myself two legs to get a vein for euthanasia. If I don’t, they get it IP or IC.

Yes, in front of the owner. For the record, I’ve only had to go IC twice. I almost always get the vein (and I’m not a great phlebotomist by any stretch of the imagination). We have a tendency to psych ourselves out with superstition about veins. The truth is, most dying pets have lousy veins anyway. I would much rather poke a pet multiple times while they are sleeping and can’t feel it than to wrestle with them and poke them multiple times while awake and stressed. I make sure to tell the owner that part of the reason for sedation is so that they don’t feel any more needles even if I have trouble accessing a vein. I’ve never had an owner express anything but relief and gratitude at this statement.

Instead of worrying about how euthanasia can be easier on you, worry about how to make the worst day of pet ownership easier on your client and patient. Pre-euthanasia sedation is becoming the norm. Those of us who do in-home euthanasia see every day how grateful our pet parents are for that moment of peace, just watching their beloved pet breathe.

Euthanasia can be less stressful for everyone if we take the time to be mindful of what constitutes a peaceful passing. By using sedation before euthanasia and keeping that pet in the presence of their owner, you will preserve and honor the Bond that is the reason we do what we do.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Why I Don’t Cry at Euthanasias

September 27, 2015 by Cherie Buisson, DVM, CHPV

“I don’t know how you do this. It must be so hard.”

Inevitably, a client will say this to me when I come to their home to euthanize their pet. My stock answer (which is completely true) is that I’m a basket case when it comes to losing my own pets, so if I can make that miserable process even a little bit easier for someone else, it’s worth it.

Over the years, I’ve heard comments about vets who don’t cry when they euthanize a pet. Remarks range from those about strength and control to those about coldness and lack of feeling. I can’t speak for all of us, but here’s how it works for me.

Calm by Necessity

When I euthanize a pet, I am on stage. Everything has to be just right. I have to watch the owner, the pet, the needle, the syringe, the vein, etc. I’m usually in a darkened room, often (for some strange reason) with a TV blaring. My eyes aren’t what they were at 30. If they tear up, I can’t see what I’m doing. Keeping my eyes free and clear is a simple necessity.

Each and every euthanasia is important to me. Every family that invites me into their home is trusting me to do something terrible in the name of something wonderful. That pressure keeps me from being emotional.

When the Tears Can’t Be Held

Once, I attended an in-home euthanasia with another veterinarian. I was only there to observe, and I wept like a baby. When the owner asked me to read a poem, I completely lost it. We all cried together over a beautiful little cat. I just can’t do that every day — there’d be nothing left of me.

There have been numerous situations that made me cry — every single euthanasia I’ve done for my parents, special clients whose pets I just couldn’t have fixed even with all the resources in the world, and those few that fell on days where I was too exhausted or sad to hold back. When technicians go with me on house calls, I let them know up front that they should have tissues on hand just in case. There is no shame in crying with the family, and there’s also no shame in being able to focus and fall apart in private later.

Noting Your Strengths and Weaknesses

I also hear about veterinarians who just aren’t good with people. They don’t express grief well or have walls up to protect themselves. I advise them to have a staff member who can address the emotional needs of the family. There’s no shame here either. If you have a weakness, team up with those who are strong in that area. No one is good at everything.

A Responsibility and a Privilege

Euthanasia is a privilege, a gift. That doesn’t mean we have to like it. Every time we give the gift of peace to a pet, we give up a bit of the peace in our hearts. Over time, we feel those missing pieces of peace more and more. I feel that, by having pets pass at home in a more relaxed environment, I’m able to take a few of those pieces back. Clients give me pieces back when they tell me what my visit meant to them. Staff members give it back when they support me.

People frequently tell me, “I wanted to be a vet until I realized I love animals too much to euthanize them.” I would argue that we love animals so much, we are willing to experience pain right down to our souls in order to keep them from hurting. What greater gift to give a friend than to suffer in their place?

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

After Pets Pass: 10 Tips For Those Left Behind

September 17, 2015 by Cherie Buisson, DVM, CHPV

Being a caretaker is difficult. Managing a pet with multiple illnesses and multiple medications or treatments is difficult. If you have been doing this, there’s something you should know: once your pet is gone, it will be difficult NOT doing those things. Be kind to yourself while you mourn the loss of your pet. Here are some things that can help:

1. It’s normal to feel relieved.

2. It’s normal to feel guilty about #1.

3. You should concentrate on #1 and kick #2 to the curb.

4. If there is something you’ve wanted to do but couldn’t because your pet was ill – do it. Be happy when you do it and know your pet would have wanted that for you.

5. If you can sleep longer and better because your pet is gone, SMILE – there’s little that pets love more than a good sleep. Your pet would have wanted that for you.

6. Take time if you need it. Do something that makes you feel good. You spoiled your pet rotten – he would have wanted the same for you.

7. If you need to cry – let it out. Keeping it in makes everything hurt worse.

8. Let your family, friends and other pets comfort you.

9. Seek professional help if you need it.

10. If you want a new pet soon after your loss, go for it! There are so many pets that need a good home. Don’t waste yours – your pet would have wanted a new friend for you. The timing of a new pet is different for everyone – you are not replacing your lost pet – you are honoring his memory by saving another life. However, if you’re exhausted with care-taking, wait until you have your strength back.

You sacrificed much in order to provide a good quality of life for your pet. You deserve a break and some time to recover. Feel whatever you need to feel for as long as you need to feel it, and your tears will eventually be replaced by happy memories.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Cause and Effect: The Problem With Blame

September 3, 2015 by Cherie Buisson, DVM, CHPV

Human beings are very intelligent, but we can also be stubborn as mules. One of the hardest things we face is not jumping to conclusions in the face of certain events, and even trained scientists find they have to struggle against their own biases to rely on logic when examining cause and effect. With the dawn of social media, however, jumping to conclusions has gone from something that is annoying to an activity that really should be an Olympic event. Even worse, some people are so invested in the conclusions they have jumped to that they will believe an inflammatory and untrue post on social media before they will believe experts in the field.

Even though I know this, I am the first to want to jump to conclusions. When I give a medication, administer a vaccine or perform a procedure and something goes wrong, I always look first to see if what happened was my fault. It takes a supreme effort of will for me to think through the situation logically and to include all the possible causes in my rule-out list. Sometimes, my clients aren’t having it. Nope, they know in their hearts that the problem was caused by (insert “food with grains”, “vaccines”, “heartworm prevention”, etc.). Sometimes they are right. Many times, however, they are dead wrong. This article isn’t for any of those clients. This article is for the veterinarians who flog themselves for mistakes that may not have been mistakes at all. Let me give you three scenarios—all of which happened to me—that prove that cause and effect aren’t as simple as they seem.

Sometimes pet owners aren’t interested in logic. Sometimes vets aren’t either.

Scenario # 1

I had a cat come in for an anesthetic procedure. The cat and owner were new to our practice and, when I examined the cat, I found that she was dehydrated and underweight. I canceled the procedure.

Instead, I drew blood and gave her some subcutaneous fluids. She spent the night in my clinic. The next morning, she had a seizure—the first of her life. She rapidly spiraled downward from there and ended up on manual ventilation. Her poor owner was devastated and had to euthanize her.

Now, if I had gone ahead and done the procedure, I (and the owner) would have assumed that the surgery and anesthesia was the problem. I would have torn apart my protocols and ruthlessly investigated how I could have done it better. If I hadn’t been able to find anything, I would have lamented that the cat had an underlying brain/heart/lung, etc. problem that I didn’t or couldn’t pick up on during the physical examination. I’m sure it would have scarred the owner for life, and she would have been reluctant to ever put a pet under anesthesia again.

Luckily, I listened to my gut. That instinct didn’t save my patient, but in the aftermath I knew that there was no way I did something to cause a seizure based on only providing fluid therapy. It was still agonizing to explain to the owner, and I felt I had failed even though I did nothing wrong, but thankfully I had reached the right conclusion.

Scenario #2

Another cat came to me for a rabies vaccination. He was 3 years old and appeared handsome and healthy. Two days after vaccination, however, he came back with congestive heart failure.

The owner was convinced the vaccine was the cause. I ordered an echocardiogram that showed the cat had severe heart disease that likely had been going on since birth. It’s possible that the vaccine triggered the heart failure, but there’s a big difference between a trigger and a cause. For example, being startled, running from the dog or the car ride to the vet could have upset his delicate balance and triggered the exact same series of events.

Scenario #3

I was working a shift at a spay-neuter clinic when a client brought in three adorable kittens. As they were being checked in, the owner mentioned that they had been vomiting.

Upon further questioning, the owner revealed that the kittens had eaten lilies. We declined to perform surgery and told the owner to take them to the ER immediately. She refused (and was very upset that we wouldn’t do surgery), and all three kittens died the next day. The owner had declined presurgical blood work (typical in a charity clinic). If their physical examinations had been normal and I had proceeded with surgery, who would have been blamed? Likely not the poisonous plants, but the veterinarian who tried to help a client in need.

Cause and effect.

You’ll never get all of your clients to believe the information you provide, or avoid jumping to the wrong conclusions. The best you can do is take a thorough history, perform a thorough physical exam, provide recommendations, document them and never let anyone pressure you into doing something that makes you uncomfortable.

You’ll never get all of your clients to believe everything you say. Do your best.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Coping With Vet Shaming

August 17, 2015 by Cherie Buisson, DVM, CHPV

One of the hardest things about being a doctor is constantly being told you are wrong. Our clients tell us that Dr. Google, the breeder or their mother says so. Our colleagues debate online as to whether allowing clients to decline presurgical bloodwork makes you a bad doctor. If you do shelter or spay/neuter clinic work, you are constantly shamed for all the horrors you must be committing. I am envious of my veterinary brethren who can let this go. I am not one of those people. I try not to take things personally, but sometimes the negativity is overwhelming.

Here’s the thing: none of those people have to sleep on your pillow at night. None of them have a care in the world about the protection of your license. None of them is technically able to “cast the first stone”. There will always be someone practicing better medicine than you. Someone, some where will also be practicing far worse medicine than you.

I’ve had clients try to shame me for refusing them a prescription without an examination or for refusing to prescribe inappropriate treatment. I explained that I don’t do those things for my mother, so I’m certainly not going to do them for someone I barely know. Some vets would do both of those things with no problem. If you are one of them, you won’t find any shaming here. I don’t worry about what everyone else is doing.

Ultimately, peer pressure isn’t going to be an acceptable excuse if my license comes under scrutiny. I told the University of Florida Vet School class of 2015, “If the explanation for what you are about to do starts with ‘Against my better judgment, I………’ – DON’T DO IT”.

As veterinarians, we seem to spend an inordinate amount of time trying to please people and trying to keep people from taking things away from us. I was always taught to act from a position of power. Neither of these stances are powerful. Instead, spend your time trying to be happy and achieve your goals – it’s a whole lot healthier.

My mentor has never once complained to me about shelters offering vaccines, low-cost practices, online pharmacies or new clinics opening down the street. Do you know why? Because she only worries about her practice and how to make it better. She participates in clinical trials (you wouldn’t believe what a benefit these are to vets and clients alike), practices higher and higher standards of care and is always looking for ways to make her clinic stand out as excellent. She doesn’t waste her time trying to figure out how to make other veterinarians look bad. Tearing others down doesn’t make you look better. Standing confidently no matter what everyone else is doing DOES.

We should all strive to be better doctors, but remember that there is no one out there practicing perfect medicine. There are a whole lot of things that get in the way of practicing “ideal medicine”. Vet school is like a self defense class – you can learn how to do it perfectly in theory, but when it happens in real life, things get ugly. I think that being a really terrific doctor hinges not on how you execute the perfect workup of a case but on how you handle the cases where you must act without all the information. If I could always run every test I wanted, medicine would be easier. If all my patients and clients did what I told them, medicine would be easier. If medicine were easier, everyone would do it.

If you are watching everything your nearby clinics are doing – stop. If you are struggling constantly to satisfy difficult clients – stop. If you are staying up at night worrying how you are going to keep the specialty practice, corporate practice or clinic down the street from stealing your clients – STOP. Instead, try one or more of these:

1. Fire clients that make everyone’s life miserable. Ask your staff – are there clients that make you not want to come to work? Here’s a hint – if their name on the caller ID causes a clinic-wide groan and coin-flipping for who answers the phone, that’s your target. Decide who gives you the biggest headaches, and let them go. Focus on spoiling your good clients rotten. Your staff can’t concentrate on retaining clients with excellent customer service if they are required to be abused.

2. If you aren’t recommending lab work with every annual examination – start. Many clients are happy to do what’s best for their pet, but you have to let them know what’s best. This improves your medicine, increases revenue and protects pets by catching problems early.

3. Recommend that pets with chronic disease (kidney failure, thyroid problems, diabetes, etc) come in a minimum of every three months for a recheck and labs. Call to remind their owners – your software can probably link a reminder to the “Kidney Recheck” exam so you don’t have to remember. Even if they decline the kidney recheck, blood pressure and urine sample and only come in for the labs (they should be weighed as well) – that’s more information than you would have had on that patient otherwise.

4. Get involved with clinical trials. This is time consuming and best for a detail-oriented team. It’s a way to draw patients to your practice and to help people with financial issues get free services without giving them away yourself. In addition, you can be part of getting new medications approved and know what’s ahead for the veterinary profession!

5. Weigh all of your patients at every visit. If the elderly cat is losing weight at her nail trim, that should trigger your staff to ask if the owner is trying to get the cat to lose weight. If not, they should recommend a workup.

6. You look over records from other veterinarians all the time. As you’re reading – see if there’s anything they have been doing that would be a good idea for your practice. If you hire a relief vet – look over the record of every patient they saw – any habits there that you could adopt? Search for ways to make yourself more successful as a doctor and a business person, and the clinic down the street just won’t matter.

The rule for athletes applies to us as well: You have no competition. Don’t compare yourself to others or try to be better than anyone except the doctor you were yesterday.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Cherie Buisson, DVM, CHPV

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

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