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Andy Roark DVM MS

Graduation: Embracing New Chapters With Intention

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It’s that time of the year again. The time to turn a new page, wrap up an important chapter, and start a new one. It’s graduation season.

A year ago I wrote about why I think graduations are important, and why we should have more of them. I still believe this strongly. Our lives are defined by impermanence, even if we seem dead set on convincing ourselves that they are not. Change is inevitable. We are not the same people we were four years ago (that was pre-pandemic!) and we will not be the same person four years from now. Graduations help us handle that change gracefully and with intention. They are an opportunity to reflect on where we have been, and to actively re-invent ourselves to meet the changes around us.

As this email arrives in your inbox, I will be driving through the beautiful Appalachian Mountains. I have been invited to share advice or words of encouragement at the graduation ceremony for the College of Veterinary Medicine class of 2023 at Lincoln Memorial University.

I have been asked to do a number of these in the past, and I always take them seriously. I try to think of what I could say that would actually be useful to someone who is just starting out. I definitely don’t want to lecture, because the path that I’ve taken in my career will not be the one any of them take. The world is a different place than it used to be, and the rate of change in our society seems to only be accelerating.

I also want to stay away from talking too much about what to expect in the coming years. As I said, the world is changing quickly and my track record for predicting what medicine will be like years in the future is pretty abysmal. 

Basically that leaves some thoughts about human nature. After all, people really don’t change. The clients that James Herriot wrote about in All Creatures Great and Small in 1972 are the same clients we see today. They just have different jobs, different commitments, and Apple watches. Underneath it all, they’re wired the exact same way.

Today, the things I wish I’d known about people when I left veterinary school include the following:

  1. Almost everyone is trying their best – It took me a long time to give people that grace and to allow them to simply be flawed human beings. 
  1. You don’t have the power to make other people happy – You’d better figure out what YOU need to be happy and how you’ll know that you are doing a good job, because getting that validation from others is a path to frustration.
  1. You choose how you struggle – You can have a job that no one cares about, or you can have one that really matters. Remember there are headaches that come with either choice. As graduates of veterinary school, these students have clearly chosen the latter. I hope they’ll own their choice.

I know these ideas seem really simple. I think most things in life that last are just that. I’ll find a way to dress the ideas up and maybe tell some stories of when I finally internalized these lessons, and then I’ll wish the students all the best luck in the world.

I’ll tell them that our profession is a great one. I’ll remind them to enjoy doing the mundane work of veterinary medicine, not just achieving an outcome. I’ll encourage them to remember that veterinary medicine is what they do, and not who they are. They should get comfortable taking off their white coats and being proud of who they are without stethoscopes.

Finally, before I go, I will share with them some bad news. I will try to shield them from a pain so many of us have felt in our profession. I will say to them, “I know that you are excited to get out into the world and help the people you care the most about… but know this: no matter how many degrees, honors or accolades you acquire… your family is not going to take your medical advice seriously. Just get ready for that.” 

And with that, I will depart.

Publix Supermarket & Turning Clients into Fans

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Tyler Grogan CVT, Creative Marketing Director at Uncharted Veterinary Conference, joins the podcast to discuss her favorite grocery store and how to turn veterinary clients into loyal fans.

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Links to Amazon.com are affiliate links and help support the show. (They’re also much smaller than normal links and easier to copy when typing up show notes!)

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Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/

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All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Tyler Grogan is a Certified Veterinary Technician with experience in specialty, emergency and general practice. She currently serves as the Creative Marketing Director for the Uncharted Veterinary Conference where she focuses on brand building, marketing, storytelling across multiple digital platforms, and exploring new ways to elevate the client experience.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I’m here today with one of my good friends, Tyler Grogan, CVT. She is the creative marketing director at the Uncharted Veterinary Conference, and I am talking with her about a lecture I saw her do back in December on turning clients into fans. And we talk about sports fans, we talk about Tyler’s not at all strange obsession with the grocery store Publix and the experiences that they create and what she’s learned from the Publix’s supermarket about veterinary clients and building client loyalty. This is a really fun conversation. This is an idea conversation if you like those conversations where people are talking about sort of abstract things and you go, “Oh man, this is really getting me thinking in new and interesting ways,” you’re going to love this episode. Gang, without further ado, let’s get into it.

Kelsey Beth Carpenter:
(Singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame, with Dr. Andy Roark.

Dr. Andy Roark:
Welcome to the podcast. Tyler Grogan, how are you?

Tyler Grogan:
I’m good. How are you Andy?

Dr. Andy Roark:
I am doing so good. It is so good to see you. I do enjoy when we get to catch up, which is very often since we live in the same town and we work for the same company and all those sorts of things. But I get to see you a lot, but I always enjoy seeing you. For those who don’t know you, you are a certified veterinary technician. You have been in social media and marketing for a number of years now. You are the creative marketing director for the Uncharted Veterinary Conference, which is where you and I both work. And yeah, you are always a breath of fresh air and one of the most positive people that I know, and I have just been so happy to get to know you over the last like what, six, eight years now. Something like that?

Tyler Grogan:
Yeah, we’re coming up on a decade of knowing each other.

Dr. Andy Roark:
Are we really? I was thinking it was getting up there.

Tyler Grogan:
Yeah, we met, I believe it was, it was then NAVC, but now VMX conference once upon a time. And then I showed up at Uncharted and haven’t left. So you’ve been stuck with me since.

Dr. Andy Roark:
Yeah, that’s true. You showed up for a conference and ended up with a job, and that’s how that went.

Tyler Grogan:
My plan worked brilliantly.

Dr. Andy Roark:
Well. I wanted to talk to you about some work that you’ve been doing. You have a lecture that I got to see back in December, and it’s called Turning Clients into Fans. And I wanted to bring you on here, one, because it’s our 200th episode of the podcast, and I was like, who do I want to talk to? I want to talk to my friend Tyler, just someone who I have gotten to be really close with. And then number two, I love when we take two different ideas and squish them together to understand the world. It’s how my brain works, it’s one of my favorite things. If people have ever heard me talk about time management, I talk about Red Dots and I talk about dragons, and I just talk about all of these wild things because I think that thinking about disparate things and then squishing them back into the question at hand or vet medicine specifically, I think that lets us see things in a new and interesting way.
And so you did this presentation that I got to see, called Turning Clients into fans, and you talked about Publix, the grocery store, in terms of how we should treat veterinary clients. And I want you to lay down your story and your thesis on how Publix informs the way we should think about seeing pet owners.

Tyler Grogan:
Yeah. So I love that you called it a thesis because as I dove into this topic, it definitely started to feel a bit like a research paper, which is always fun. I’m a naturally curious person. So it actually came up as a question in 2019 before the pandemic when we were at Fetch in Kansas City, and I saw a talk by Bill Schroeder about marketing. And he briefly touched on how there are fans for different businesses, and he actually used Uncharted as an example of a company that had fans. And so that always kind of stuck in my head. And I’ve always had that kind of question in the back of my mind of, okay, well it makes sense, but how does it get to that point? And so I took that from there and really thought about sports. And in veterinary medicine right now we’re experiencing a lot of change and we went through a lot of change, and that comes with a lot of new team members and a lot of new processes and a lot of new things.
And so it kind of made me ask this question. So again, putting thing one thing to another thing, kind of like how your brain works of how do sports have actual fans that endure so much change? They endure change for their staffing, their teams on a regular basis. And yet someone who is a fan of a sports team is a fan of the team. And I was like, okay, there’s this bigger question of how do you create this enduring, because really they’re customers, how do you create this enduring fanship? And Publix is a great example of a business taking some of those concepts.

Dr. Andy Roark:
I want to pause here for one second because I really like this idea. I’ve not really honestly processed it that way because when you look at professional sports, you have these free agents and you have people who come and they turn over and they get traded. And I know people who are absolutely rabid fans of a sports team. And I’m like, man, all of the people who are on that team, were not on that team five years ago, and they won’t be on that team five years from now. But the fans are often, they seem much more loyal than the actual players on the team, in a big way. And I understand there’s economic drivers for that. But I think this is really interesting.
It’s also really, honestly for a second, I kind of recoiled when you said, these fans are our customers. And I’m like, “Customers? Like I’m a Florida Gator customer?” And the truth is, yes, I am. I have a very expensive degree that I purchase from the University of Florida. And boy, their merchandise is ridiculously expensive. And yet, I still buy it and people buy it and give it to me because that’s where I’m from.
But you don’t think of fans as customers. But at their root, that’s exactly what they are. So I like that. And I had not really considered the idea of looking at this as a way of insulating vet practices against staff turnover because sometimes we have veterinarians that leave and sometimes we have staff that leave. And that’s just unfortunately, it’s part of the job. I don’t think there’s anything insidious about it other than people always, they have lives and they have spouses and they have needs and they move away to be close to family and things like that. And so how do you build this attachment to the team as opposed to the individual? I love that. So with you there. Talk to me about how Publix interfaces with US professional sports teams.

Tyler Grogan:
All right, so stick with me here. So like you said, you kind of recoiled at the thought of a fan being a customer, and I had a similar reaction of, wait a minute, but it makes sense. We’re spending money to participate in these types of things. And so again, the bigger question was how do we create this enduring fanship, and then how does that translate to business? And so sports was kind of a huge thing to look at and really translate to veterinary medicine. So I started thinking about what businesses do I consider myself a fan of and why? And the first one that came to mind was Publix, and it’s a grocery store for those of you who are maybe not from the south or the United States that have not heard of it, but it’s a grocery store chain in the southeast.
And I would say that I am a fan of Publix and there are people out there that are true fans of Publix. And that means that they’re out there buying merchandise or if you live out of state, they’re telling you that if you go visit this area of the country, you should go to Publix and have a Pub sub. It’s that level of involvement. And so what were they doing as a business that was creating that same level of, I want to be involved in this, I want to spend money here, I will choose this over any other place and that loyalty. So it was an easier leap for me to kind of think about, okay, let’s look at the business side of this rather than sports teams to really translate it to vet med.
And so it boiled down to a couple different areas of customer service, which were exceeding expectations consistently. So setting expectations of what you’re going to get. When you walk into a Publix store, it’s going to feel the same. You’re going to have a good experience. If you walk up to a counter and ask for help, they’re going to help you. It’s just always a positive experience. So meeting and exceeding expectations, and that’s on a consistent basis.
And then the other thing is creating an emotional attachment, which this one hit right on the head for me because vet med, we immediately have that leg up on any other business. We are going to establish emotional connection with our clients and customers right off the bat because a big part of their identity is their pets and being pet parents. And we have a great opportunity to connect with them on an emotional level that most other industries don’t get that. So we already have half of it, pretty much set up for us. The second half is really about meeting and exceeding expectations on a consistent basis. So what can veterinary practices do to accomplish that? There’s so many different things.

Dr. Andy Roark:
I’m going to pause here for a second. I want to unpack this connection with Publix a little bit more because I want people to really understand it. And I think you did a really good job in the presentation of laying this out because I agree, my wife will drive past three grocery stores to get to Publix. It is the one. We have our Publix, it’s the one that we go to. I ask her why we do this, and she says, “Well, it’s because I know where everything is.” And I go, “But, how did we get to that point? Why did we not stop at the other grocery stores before we came here so many times that you now know where everything is? What got us to this place?” Because I do agree that now there’s the comfort, there’s a familiarity, there’s all these things.
And I do think that’s part of it. It’s called perceived switching cost. So this is true, and I learned about this in human medicine, but then it applies to vet medicine and applies to everything’s. In my wife’s mind, there is a switching cost, which means if we went to a different grocery store, she would have to figure out where specific things are versus she just knows where they are right now and this is easier. So there’s a cost of switching going somewhere else. And so that’s where we are now, but how do we get there? And so talk to me a little bit more about the fan experience for a grocery store, and I like some specific examples of how did this get created? How did this get built?

Tyler Grogan:
Yeah, for sure. So I’ll step back for a second to the sports example and this connection here. So part of making someone a fan of something is how they’re introduced to it, and there’s usually some level of socialization to that. So for sports, it’s usually my family was a fan of this team, and therefore I’m a fan of this team and within proximity of my home, et cetera. For something like Publix, for example, my mom would always shop at Publix. And so now I shop at Publix and I know what they can do if you need your seafood steamed for you, they’ll do it for you before you take it home so your house doesn’t smell like fish. That’s the level of customer service that they’re offering.
And so how do they reach that point of fanship? Well, again, I bring it back to they’re consistent. I walk in there and I know exactly what to expect. They are not only going to meet my expectations, but they’re going to exceed them. For example, I became a fan of Publix, starting from being a small child, but I recently moved to South Carolina, as you know. And when I walked into my local Publix, which was the first order of business, I walked over to the deli counter and they have usually a type of turkey that is one of my favorite for lunch meat sandwiches. I didn’t see it, I asked, they didn’t have it. And I was a little disappointed, which I think the deli counter attendant could tell. And I left without my turkey. And it was, oh man, this is like a thing, it’s just something that makes me feel comforted and I’m at home, but I can’t get it. So it’s no big deal.
Well, the next time I went to Publix, probably the week later, I went over to the deli counter to find maybe a new alternative, and there was the turkey in the deli counter, and I was like, “Whoa, wait, they have it.” And so I got myself a pound of it, I’m planning to eat it all week long, very excited. And now it’s still consistently there in the deli counter. And it’s not always on display, but they always do have it in stock. And I can’t help but feel like I was the person that made them keep that in stock. And I’m one customer out of hundreds that walk into that store all the time. That’s the level of types of things that happen at Publix that make people continue to go back and be a fan and recommend them above all others. So that for me was a moment of, “Oh, this is a new level. This is beyond loyal customer. This is, I’m going to tell people the story.”

Dr. Andy Roark:
Yeah. I like that. I think that’s a great example. It’s sort of probably a small thing from them is to say, “This was something that was requested. Let’s try it. Let’s see if anybody buys it.” And they got it. And people do buy it. One person, Tyler Grogan, who shows up every week and buys a pound.

Tyler Grogan:
It might only be me. I believe that it might only be me, but I want to think that people around might also buy the turkey and be like, “Wow, whoever thought this up, they had a great idea here.” But it makes me feel good to know that they have this, maybe it is just for me.

Dr. Andy Roark:
I imagine them hiding behind the counter and they’re like, “Hey, it’s her, it’s the turkey girl. Get it out the back.” And they go in the back and they get the same turkey and bring it forward, and then they put it back way after you leave.
If you dream of doing team training with your team, getting your people together, getting them on the same page, talking about how you guys work together in your practice, I’d love to help you. You can check out drandyroark.com and check out the store. I have two different team training courses. These are courses for teams to do together to get on the same page and to talk about how you do things. I have my Angry Clients course, and I have my Exam Room Toolkit course, and they are both available in there. Check them out. All right guys, let’s get back into this episode.
So I love it. I like this a lot. Go ahead and start to help me see the vision of how some of these concepts translate to vet medicine. What does it look like to start to apply some of these principles in a hospital?

Tyler Grogan:
Sure. This is so exciting, I love this part. So George Jenkins, the founder of Publix, was quoted to say, “Astonishment is not a feeling people soon forget.” And so I think about in vet medicine, these moments of when can we take it from this was a good experience to this was a memorable one, to this was something that really was meaningful for me. And we have so many opportunities to do that. It really is about setting the strong foundation of when I come to this vet practice, this is what my experience looks like, this is what I can expect, this is the level of transparent communication that I can expect from the entire team, from the practice. So setting that strong foundation is definitely step one.
But beyond that, you can create those moments. I think our friend, Dr. Michael Miller, does a really good job of this. An example that I love is during the pandemic when everyone with curbside, he started having a little post-it note packet in his pocket of his jacket, which I just rhymed. Great. I just decided to rap about it. He would have a post-it pad with him and he would take a photo with the pet, write a little note personally to the client, which could have even been just something as simple as, “Thanks for coming today,” and he would send that back out with the pet to the car. And he was just doing that on a regular basis and his clients loved it.

Dr. Andy Roark:
Sure.

Tyler Grogan:
They’re posting about it on their social media. Yeah. And so he took it from this, they’ve already established their curbside protocols and procedures and they’re following those. And then he took it to another level of just adding this little extra step and make someone feel special and seen that day and those little things can really add up to creating that experience and turning someone into somebody that’s going to become a fan for you.

Dr. Andy Roark:
That’s awesome. Man, that’s great. That’s a great example of just astonishment. I can imagine this thing coming out and you never expect it and it’s super cool. I guarantee those photos made it onto people’s refrigerators, like the old magnet on the fridge. I have no doubt. That’s what I would’ve done. And I love that. I’m also, a big Michael Miller fan. He’s been on the podcast a couple of times.
The last time he was on, we were talking about something, I think the title of the episode was like Leaders Shouldn’t Eat Last. I think it’s basically what it was. My favorite Michael Miller line was basically he was talking about being sort of a servant leadership to the extreme to point where he’s like, “Boy, we’ve created a job that no one else would want to do, and that’s a problem.” So anyway, he’s such a neat guy and he’s such a deep thinker and I’m not surprised that’s where that comes from. All right, I love it like it a lot. So we’re looking for those sort of types of ways of exceeding expectations, it’s sort of astonishing people and things like that. Do you have other examples or other things that you see that that stand out as ways that you’ve seen practices build fandoms?

Tyler Grogan:
Another really powerful example that I think speaks to the emotional connection piece of being a fan, it actually comes from an unexpected place maybe, which is euthanasia. Those are some of the most emotional moments for our clients in the times that we’re interacting with them, that we have this opportunity to create those connections. And if we meet and exceed expectations during those experiences, then those are the people that’ll come back with the pet that is the new addition to the family after that difficult loss. The card that goes out in the mail, maybe a few days afterward to them could be that little extra step. Some of these things we kind of think of as our normal because we are experiencing them on a regular basis. But for someone that maybe this was their pet of 20 years, this might be the first time that they’re experiencing this loss.
And to have that little extra checking in on them, or even just a quick email. For example, could be that extra step that makes me feel really, really important to these people. And I’m not just a person that walked in one time, I’m a person they care about. And so those are really powerful moments that we can connect with people in such a strong way. And so that’s another example. Outside of the practice, I heard a story recently of a company that they provide AutoShip for foods. And so a friend of mine’s family had a pet that passed away. They emailed the company and said, we need to cancel this AutoShip. And they were very nice emailed back and said, “Of course, we’ll cancel that for you. We’d just ask that you donate the food that you already have to a local shelter.”
But then they took it to the next level and they sent them a small bouquet of flowers to their home. And for a large company like this, that might have been just a very, very small investment. But that led to this family feeling very personally connected to this company and therefore, walking down the street of their neighborhood, telling all their neighbors about this experience. And who are they more likely now to maybe also get foods for their pet from? So it can be really powerful and have a lot of ripple effects to just make those little extra steps.

Dr. Andy Roark:
Yeah, I think that’s fantastic. That makes a ton of sense. So you talk about consistently exceeding expectations. I think that that’s an important thing. I think a lot of us, we have wonderful interactions, we’ll have a great conversation and we’ll say, “Oh, I saw this opportunity, I jumped in and helped this person. And it made me feel good, and they even wrote a thank you note because they were so impressed with it.” Talk to me a little bit about the consistent part of it. How do we start to build consistency into programs like this, in your mind?

Tyler Grogan:
Yeah, sure. So some of it comes down to setting up protocols and processes for your practice, which those, again, were kind of coming out of a time of significant and rapid changes during the pandemic. And so some of those processes might look radically different than when you opened your practice. A good example may be just your appointment protocols. How long in advance are we confirming appointments? How long are we going to expect people to be waiting? What are we letting them know? What are our steps because we are so busy at this point? What are our steps to letting people know that we’re running behind, or what our expectations are we setting around maybe how long they’ll be in the lobby or in their cars before they come in?
Some of those things, just sitting down and looking at those processes can really help to establish some consistency right off the bat. And then what I think is maybe the step to exceed the expectations is to set yourself up for success in those processes. There’s nothing to say that we could get this client in a room within 15 minutes of their arriving, but if we tell them that it may be a 25-minute wait and we get them in 10, that’s succeeding expectations. We’ve set ourselves up to succeed. We do this really well with things like lab work where we let them know perhaps that we know we’ll get the lab results back in three, four business days if it’s a regular testing. But we’ll let them know we’ll get back to them within seven to 10 business days. And then when we call them way ahead of that, it’s an exceeding of expectation. So yeah, there’s so many opportunities to just set yourself up for success. So I think there’s a lot there to dig into.
And you can look at one thing at a time. It seems like it can be overwhelming if you sit back and look at the whole picture. But I love something that you say, which is pick a hell and make it pretty. Pick something that is something you do all the time. Maybe it’s the thing that you’re known for, you’re known for your low stress handling appointments and you do really well with very fearful cats, for example. Look at that process. What makes it great? Look at what you’re doing now and you already know it’s doing well for you. And then where can you add in a couple layers of, we know we can do it this well, let’s say that we’re going to do it this well and set ourselves up to exceed their expectation. Let’s also give them a small toy when they leave without saying anything about it at any point before their visit. And then it’s going to be this extra step, this little extra thing that is part of your process, but it’s behind the scenes. So it’s exceeding expectations from the client perspective. There’s little things like that.

Dr. Andy Roark:
That makes a ton of sense. Tyler, for people who are inspired, who are fired up, who want to get deeper into this head space, do you have favorite resources that you recommend? Anything that you like or draw inspiration from?

Tyler Grogan:
Yeah, so when I was diving into learning more about Publix and their customer service, I did come across a book called A Piece of the Pie. It was written by an executive of their HR department, who was there for 25 years. And it’s got a lot of great stories of these moments of exceeding expectations that I really, really enjoyed. So that’s a great resource if people are interested in learning more.

Dr. Andy Roark:
That’s so great. I love stories like that where you can just pull examples from, and I walk around with an encyclopedic knowledge of customer service stories of Publix. The staff after a while is like, “Here he goes again,” and I’m telling Publix customer service stories. Perfect. I’ll put a link to that in the show notes. Tyler, thank you so much. Where can people find you online? Where can they see the wonderful work you do for Uncharted?

Tyler Grogan:
Yeah, so I am doing some workshops this year for the Uncharted community. That’ll be out for anyone who’d like to attend. So keep an eye out on our website for those coming out. If you’re in the community, I’ve got some things in there including some more information about this topic, and you’ll probably see me around any of the Uncharted events that are going on. So keep an eye out for me there. And definitely say hi if you’re coming to any of our Uncharted events, because I love to meet new people.

Dr. Andy Roark:
Oh, awesome. Tyler, thanks so much for being here. Guys, thanks for tuning in. Take care of yourselves.
And that is the episode. Guys, that’s what I got for you. I hope you enjoyed it, I hope you got something out of it. As always, if you did, share with your friends, write me an honest review wherever you get your podcasts. It is how people find the show. It always means the world to me. Gang, take care of yourselves. Be well. I’ll talk to you later on. Bye.

The Hope Rebellion

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The opposite of grimdark is hopepunk. 
Pass it on.
– Alexandra Rowland

Everything is deteriorating and the only smart outlook is a cynical one. At least that’s what I’m hearing. Well, nihilism, the belief that nothing matters, isn’t a worldview or a professional outlook I’m interested in. 

Yes, our profession is a hard one. There are challenges and uncertainties every day. There are angry people, diseases that can’t be cured, and treatments that can’t be afforded. There are fights with management, arguments among staff, and disagreements over how best to get our work done. Cancer isn’t fair. Pet owners make mistakes. Some people are just in it for the money. And those who are hurting emotionally tend to lash out and hurt others.

A lot of us in veterinary medicine think the enlightened response is “to fully accept and expect dark days.” These people protect themselves (and tell themselves they are protecting others) by anticipating the negative as if it’s a given. They signal their insight and experience in the world by telling others that hardship is coming, things are broken, and “that’s just the way it is.” 

After all, if something painful happens and you “called it,” it doesn’t hurt as much, right? 

Well, I have decided that the culture of despair and defeat is one that I’m not interested in being a part of. In fact, it’s one I’d like to see torn down. I think we need to revolt.

It’s time for a rebellion.

A rebellion against negativity and darkness, however, is not driven by positivity. Rather, the way to battle back is not telling ourselves that painful things are actually good and everything is fine. It’s not reminding people who are struggling that they should be grateful. That’s its own type of toxicity.

No. The rebellion against cynicism is defined by hope. 

In a world where fear and problems walk through our doors and appear on our phones, rebellion is stubborn, lip-curled, gritted-teeth optimism. 

Today, hope is punk rock. It’s the mindset of those who don’t want to be told what to do or think. Owning your power to step forward and make days brighter is leather, spikes, and chains. Helping when you don’t have to is an ace of spades face tattoo. And telling someone that they are making a positive difference in the world is a spiked mohawk. This is how we rebel.

So, what do you say? Do you want to be hopepunk with me? Do you want to flip off the doom and gloom system with a rebellious smile and kind words? Do you want to stick a finger in the eye of the doomsayers by asking the question “what if change actually causes things to get better?” If so, let’s get to work. 

We may not win the war against cynicism, but we can punch tiny holes in it all day, everyday, and no one can stop us.

Low-Cost Veterinary Clinical Diagnostics

by

Dr. Ryane Englar joins Dr. Andy Roark to discuss her new book Low-Cost Veterinary Clinical Diagnostics.

A practical guide to maximizing the diagnostic value of in-house quick assessment tests (QATs)

In Low-Cost Veterinary Clinical Diagnostics, the authors provide a hands-on resource designed to facilitate healthcare delivery across the spectrum of care.

Historically, clinicians have been taught to apply the gold standard approach to the practice of medicine. However, recent advances in veterinary medical care and associated technologies have made practitioners question whether a one-size-fits-all approach is truly best. After all, when we perform diagnostic tests, are we testing out of the desire for completeness, to cover all bases for the good of the patient? Or are we testing because we are expected to?

The reality is that gold standard care is not always advisable and not always possible. In clinical practice, veterinarians frequently encounter obstacles that limit their approaches to case management. Cost of care is a significant constraint that requires practitioners to rethink which diagnostic tests are essential.

Not every patient requires a complete blood count (CBC), chemistry profile, urinalysis, and fecal analysis to obtain diagnostic value. This text suggests that the “best” approach to case management be determined by the situation, the context, the patient, and the client.

While sophisticated panels of tests may remain the recommended approach to case management, Low-Cost Veterinary Clinical Diagnostics outlines entry-level, in-house diagnostic blood, urine, fecal, and body cavity fluid tests: how to perform them as well as the breadth and depth of patient-specific data that can be gleaned from quick assessment tests (QATs).

Readers will also find:

  • A thorough introduction to patient care considerations, communication strategies that facilitate cost-conscious shared decision-making
  • Comprehensive explorations of quick assessment tests (QATs) in hematology, including packed cell volume (PCV), total solids (TS), buffy coat analysis, blood smears, blood glucose, blood urea nitrogen (BUN), saline agglutination tests, and activated clotting time.
  • Practical discussions of quick assessment tests (QATs) involving urine, including urine color, dipstick analysis, specific gravity (USG), and urine sediment analysis
  • Pragmatic evaluation of fecal analysis, including considerations surrounding fecal color, volume, consistency, and odor; saline smears or wet mounts, and fecal flotation.
  • Discussion on body cavity fluid analysis
  • Sample case vignettes, complete with question and answer (Q&A)

Perfect for veterinary practitioners, veterinary technicians, veterinary and veterinary technician students, Low-Cost Veterinary Clinical Diagnostics offers a quick and easy reference guide to maximizing diagnostic value in those cases where care is cost-prohibitive.

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Low-Cost Veterinary Clinical Diagnostics (Published by Wiley-Blackwell): https://www.wiley.com/en-us/Low+Cost+Veterinary+Clinical+Diagnostics-p-9781119714507

Also available on Amazon:
https://www.amazon.com/Low-Cost-Veterinary-Clinical-Diagnostics-Sharon/dp/1119714508/ref=tmm_hrd_swatch_0?_encoding=UTF8&qid=1676300614&sr=8-1

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Ryane E. Englar, DVM, DABVP (Canine and Feline Practice) graduated from Cornell University College of Veterinary Medicine in 2008. She practiced as an associate veterinarian in companion animal practice before transitioning into the educational circuit as an advocate for pre-clinical training in primary care. She debuted in academia as a Clinical Instructor of the Community Practice Service at Cornell University’s Hospital for Animals. She then transitioned into the role of Assistant Professor as founding faculty at Midwestern University College of Veterinary Medicine. While at Midwestern University, she had the opportunity to teach the inaugural Class of 2018, the Class of 2019, and the Class of 2020. While training these remarkable young professionals, Dr. Englar became a Diplomat of the American Board of Veterinary Practitioners (ABVP). She then joined the faculty at Kansas State University between May 2017 and January 2020 to launch the Clinical Skills curriculum.

In February 2020, Dr. Englar reprised her role of founding faculty when she returned “home” to Tucson to join the University of Arizona College of Veterinary Medicine. She serves as a dual appointment Associate Professor of Practice and the Executive Director of Clinical and Professional Skills.

Dr. Englar is passionate about advancing education for generalists by thinking outside of the box to develop new course materials for the hands-on learner. This labor of love is preceded by six texts that collectively provide students, clinicians, and educators alike with functional, relatable, and practice-friendly tools for success:

• Performing the Small Animal Physical Examination (John Wiley & Sons, Inc., 2017)

• Writing Skills for Veterinarians (5M Publishing, Ltd., 2019)

• Common Clinical Presentations in Dogs and Cats (John Wiley & Sons, Inc., 2019)

• A Guide to Oral Communication in Veterinary Medicine (5M Publishing, Ltd., 2020)

• The Veterinary Workbook of Small Animal Clinical Cases (5M Books. Ltd, 2021)

• Low Cost Veterinary Clinical Diagnostics (John Wiley & Sons, Inc., 2023)

Dr. Englar’s students inspire her to write so that they have the resources that they need to not just survive but thrive in clinical practice.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I’m here with my friend Dr. Ryane Englar today, and we are talking about her new book, Low-cost Veterinary Clinical Diagnostics. Man, I get super geeked out about this. She’s hilarious and amazing, and she may take over the world. Definitely listen to the end of this podcast when we talk about her struggles in finding laboratories that would work with her and ultimately working with a crime scene investigation unit. Only veterinarian type problems here, only veterinarian type problems.
So anyway, she is incredible. This is such a fun conversation about the basics that we have put down and forgotten in vet medicine, about using sight, smell, sound, feel, I don’t want to say taste, but you knew I was thinking it. It’s all of those things where we’ve gotten pretty dependent in a lot of ways on our fancy diagnostics. And they’re great, they are wonderful, but boy, there’s some value in really just using our eyes and having experience of looking at samples. And is it possible that we could be extracting a lot more knowledge from just the most basic tests? Yeah, I think probably so. I’m curious what you guys think.
But anyway, just check this out. It’s such a good conversation. She’s really got me inspired to start looking at my game and figuring out where are the simple little holes in my basic knowledge that would make me a better vet and that would help me take better care of pets with basically no cost to the pet owners, just looking at what we’re already doing and getting a little bit more out of it. So anyway, guys, fun episode. Let’s get into it.

Kelsey Beth Carpenter:
(Singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:
Welcome to the podcast, Dr. Ryan Englar. How are you?

Dr. Ryane Englar:
Great. It’s good to be here. Thanks for having me.

Dr. Andy Roark:
Oh, always enjoy you. You’ve been on the show before and I was thrilled to have you back and I wanted to have you back because you have a new book out. For those who don’t know, you are an associate professor and executive director of Clinical and Professional Skills at the University of Arizona’s College of Veterinary Medicine. That is a long title. And you’re an author. This is not your first book, is it?

Dr. Ryane Englar:
No, this is number 11 if you count the ones that I been partners on.

Dr. Andy Roark:
Not quite the first book, no. But yes. So you have a brand new book out called Low-Cost Veterinary Diagnostics, and I was like, that’s an interesting title and I love that you have a book on this. And so I want to open this conversation up and basically just sort of say, tell me at a high level, tell me what this book is about. Let’s just start there so that I’m not picturing something in my mind that’s not true.

Dr. Ryane Englar:
Yeah, absolutely. The book started out, the original intent was to develop a clinical skills guide or manual for our students really with respect to blood diagnostic test, urine and fecal results. But then it quickly expanded into what it is today, which is really a tool that can be used by vet students, new graduates, seasoned graduates, veterinary members of the whole team so vet techs, really even clients for some degree. And what it is is really looking at what are the tests out there that are point of care that we use each and every day, and how can we maximize the data that we obtain from them?
And the classic example I’ll give from vet school is that by the time I got to fourth year vet school, the internists or a generalist on any service would say, here’s a patient, here’s the vignette, tell me what test you’re going to run. And I graduated from Cornell University. Very proud to be a graduate there. But every answer for every vignette was, we need a CBC, a chemistry panel, a urinalysis, two to three view chest reds, an abdominal ultrasound, maybe an MRI. So quickly it expanded and that was the gut reaction of that’s what they want to hear good, but we quickly lose sight sometimes of, and I learned that as an educator, why are we doing that?
If we’re going to ask a client to run a test, what do we need that for? What are we looking for? How are we going to interpret it? And so there’s a lot of information we forget. So the book was born out of what can we get and drill down and get the max out of a PCV. There’s an entire chapter on assessing the color and turbidity and smell of urine. A chapter on fecal consistency, fecal color, fecal odor. Really looking at expanding that tool set so that if we are in situations where we have to scale back, what can we do? And really, let’s not feel bad about scaling back. Let’s be like, yeah, let’s get the most out of this data, whether that’s blood, fecal or urine testing.

Dr. Andy Roark:
That’s fascinating. A lot of the mentors I had in medicine, they were much older than me. I think that’s often the way that it goes. And you kind of come in and they’re at the end of their career and they’ve got so much experience and so much knowledge. And there’s a couple of them, Dr. Mikey Schaer pops to mind. And that guy didn’t seem like he needed any diagnosis. He could just feel the pat and say, ah, I think it’s probably this. And darn if he wasn’t right all the freaking time.
And you always wonder, that stuff is so powerful. And he would just beat the drum on… He would ask you, “Where do you want to start?” And the answer was the physical exam. And if you said a bunch of stuff, he would shoot you down, which is rare because most people would said exactly what you said, which is we’re going to need this litany of tests and this big workup. And he would say, “Physical exam.” And then basically he’d be like, and then we’re going to see what we have and then we’re going to make a plan from there.
And he was so good. He was that guy who could walk in to the treatment room and he would sniff the air and point at a pet and go, that pet has parvo. And he was right. He was, that one right there, that’s got parvo. And it was incredible. And so I really love where you’re coming from. So I guess let me say this, if veterinarians, if vet technicians had more of this type of knowledge and were more comfortable just using their eyes, their ears, their nose and their touch, and looking at patients and looking at samples this way, where do you see the biggest areas of potential impact in taking this approach? What are things that you see that there’s such an opportunity here and we’re not pursuing it? What does that look like?

Dr. Ryane Englar:
Yeah, absolutely. I think for me, really it’s a matter of spectrum of care. And it’s really looking at cost for factors. Obviously looking at how can we partner to create a tailored treatment plan and diagnostic plan for a patient who may not be able to do the litany of tests So that’s kind of the first easy pass. When you look at the title, you say, oh yeah, that’s what it’s about when I can’t do everything. But then if we put that to the side and we think about it on a deeper scale, how do we actually create that partnership and communication with our client of putting that plan forward?
So if I’m going to convince a client to do test X, Y, or Z, I really need to make a case for Y. And what information am I going to get out of there and what am I going to do with that information? So we have to have not only the plan, but the expectation of, if I do this and I find result X, Y, and Z, how will that actually allow me to better treat your patient? And so I think it opens up those communication windows. It allows questioning, which I think sometimes we get that defensiveness of why is someone questioning why I want to do this certain test? And it can say, oh, well, let me tell you why. Let’s have that conversation about what is my hope for this pet so that we can actually make it custom so that we can apply what we need and the knowledge we have for pet specific care.

Dr. Andy Roark:
So one of the things I like a lot about you and is one of the reasons I first really wanted to talk to you is that as a professor of clinical and professional skills, you kind of walk this line between a clinical approach and then also a communication aspect, which is things that I’m most excited about. I really love that medicine from a challenge standpoint of knowing what to do medically and then also being able to communicate and negotiate, advocate for the pet, build a relationship with the pet owner and get them on board.
How does an approach like what you’re talking about change the way that we communicate with pet owners? Is it a different type… Do you break these out and you’re, oh, suddenly are you pushing more to say, let’s start with a PCV and then we’ll run a full blood panel based on what we see. Or do you go with a full blood panel and just extract extra amount of information? How do you parse that, I guess? And then how does that really, when the rubber meets the road and you have these skills or you have this focus on really looking deeply at what we’re doing and extracting the most information possible out of it, how does that change the way that you communicate?

Dr. Ryane Englar:
Those are all great questions. Man, I wish we had 22 hours straight on this podcast. So everybody gets some popcorn, sit down, it’s going to be a while. No, I’m kidding. I think the hardest part, is it does depend on the patient. It depends on the presenting complaint, and ultimately there’s immense value and wealth to doing some of those more advanced diagnostics. So an emergency situation, I may be more apt to opt for full panels, but I think where it really helps is in situations where we may want to do everything but can’t, there’s a limitation. Maybe the limitation is cost, that’s the most obvious, but maybe the limitation is we might not have the equipment. Maybe we don’t have every upgraded coagulation panel profile we need or would want. So we have to scale back and we have to say, well, what can I do now?
Maybe it’s a weekend and our machine is down and we don’t have the ability to get what we need, even if the client could afford that. And so I think it’s saying, what can we do and having a transparent conversation with the client. This is what I would like to do and why, and then it becomes a dialogue. And when that owner, which we’ve all been in that situation says, I’d love to do everything and I can’t. I can’t because of X, Y, or Z, cost is often a factor. Okay, let me prioritize, this is what I want to do, and this is actually how I can get the similar information.
It may not have every single panel item that a chemistry profile would, but this is what I’m going to do, and with this test, I can run out X, Y, and Z. And I think a great example, right, is the blood smear. The blood smear, I remember in clinical year, every single case that walked in the clinic, it didn’t matter how the blood was run, you had to run as a student, many blood smears that we went through, 10 and 15 and 20. We were so bad at creating them, but by the other point-

Dr. Andy Roark:
It wasn’t that we went through them, it was just that we were so bad at making them. Personally, I would take a dozen slides to get one that I was comfortable showing to another student like, oh, this is mine.

Dr. Ryane Englar:
That’s an A+. I went through a hundred, and then Cornell probably flagged me. It’s probably in my system in some records somewhere of all the boxes I went through. But that blood smear, so in school, we got used to looking at it and then-

Dr. Andy Roark:
I leverage my technicians that way. That was my workaround was I never got good at it. I just go, leverage your technicians. Not because I can’t make a blood smear, that’s not why, but because I value them, that’s why I let them do it.

Dr. Ryane Englar:
No. And you know what, they’re the ones who soar in our clinical skills lab teaching our students how to do it. So I’m all for that. I think where we get weak is we forget to look at those blood smears or have someone who has to go look at them, right?

Dr. Andy Roark:
True.

Dr. Ryane Englar:
And so days go by, weeks, years, and I’m cringing to say it, but there were many a day in private practice for [inaudible 00:12:44] that, I’m going to look at the automated analyzers.

Dr. Andy Roark:
Yeah. Well, I think that’s really different.

Dr. Ryane Englar:
We should.

Dr. Andy Roark:
Sorry. I think that’s really defensible. You know what I mean? Of we’ve got these awesome analyzers and they do all the things. You know what I mean? And you go, why do I need to look under the microscope when I’ve got this beautiful scatter plot that lays out all of the things? You know what I mean? And as we have artificial intelligence, it gets easier and easier. I think in life in general, it’s getting easier and easier to be a little bit intellectually lazy of just being like, you know what, let’s just pop into computer and see what the round comes.
And I know that there’s a downside to that. I feel like there’s a downside to that as far as our… I think we all really want to be James Harriet meets Crocodile Dundee who can just… it’s like bush medicine where if there was… we take great pride as a profession in how well we would do in a zombie apocalypse. I don’t know if you’ve noticed that, but there’s a lot of people.

Dr. Ryane Englar:
There’s all the memes out there.

Dr. Andy Roark:
Yeah, there’s a lot of memes. There’s a lot of people who take great pride in how well they think that vets would do in a zombie apocalypse. Those are the people who need to buy your book. I’d be, if you think you would make it, you should have this book because this is how you’ll continue to practice after the zombie apocalypse. Anyway, that was sort of a bit of a digression, but it’s just to say I feel… It’s almost like it’s easy just to spend more and more time on the couch if you have a more and more comfortable couch. It’s almost like we have a more and more comfortable couch in a lot of ways with our diagnostics and stuff. And you go, boy, the ability just to look at the blood smear, that’s real. No one can take that away from you. And man, what a useful tool in your toolbox. And I can tell you, I am 100% guilty of just look at scatter plot. You know what I mean? And just go, oh, let’s see what we got here and go on.

Dr. Ryane Englar:
It’s absolutely me too, right? Easy. Like you said, I think that’s a perfect analogy about the couch. And so then what happens? We get the case where we can’t get that scattered plot and then we feel frozen and paralysis. And so having that ability to say, all right, let’s keep those skills fresh. We have a whole chapter in looking at the Buffy coat and how many times have I not looked at the Buffy coat in practice? And I’ll be honest with my students, I’m like, you know what, this textbook reignited a fire in me because it taught me the areas I got lazy or the things that I forgot or the things about the urine dipstick that I just took for granted. And then I realized, oh, that’s right, there’s a certain cleaner I cannot put in cats cages or dog kennel cages than an animal pee’s in the kennel in the hospital. I can’t just put the dipstick on that surface because it’s contaminated and now it’s going to cause a false positive or negative.
And so it has really cool little tips and tricks, some pointers. My co-author was amazing. Dr. Sharon Dial, she’s a clinical pathologist, so she filled in all the gaps that I had forgotten. So it was a learning experience for me. That’s what we hope. It’s really a celebration I want to think about it, not a critique or criticism of all the immense wealth of diagnostic testing we have. That has a place forever in my heart, of course, I respect it, but it’s looking at what else is there? Let’s celebrate what we can do when we are in that apocalypse, as you say.

Dr. Andy Roark:
Oh yeah. If you dream of doing team training with your team, getting your people together, getting them on the same page, talking about how you guys work together in your practice, I’d love to help you. You can check out drandyroark.com and check out the store. I have two different team training courses. These are courses for teams to do together to get on the same page and to talk about how you do things. I have my Angry Clients course, and I have my Exam Room Toolkit course, and they are both available and there so come out. All right, guys, let’s get back into this episode.
Well, I like this live. I’ve been thinking a lot about artificial intelligence recently. So the ChatGPT stuff I think is really interesting. I think it’s going to fundamentally change medicine. It’s definitely going to fundamentally change the way we interact with pet owners and the knowledge that they come with. These are big changes and they are right around the corner. And I look at that, and I do think a lot about how it’s going to interact with us. And I don’t think that artificial intelligence is going to replace practitioners. I think we need to adapt around it a bit so that we say we have these AI tools that are great and amazing, and also we should be just rock solid on the fundamentals so that we can leverage them to the maximum potential and know how to use them and still be entirely relevant and be confident and comfortable in our skin and in our role as the healthcare provider.
And so this book just really hits on that for me. I imagine what it was sort of writing this book, and to me you explained checking yourself and finding these areas. And to me, I think that that would be the most fascinating thing is I’m sure you sort of had these discoveries and unlocked these things that go deeper maybe than you had in the past. And you’re a very accomplished veterinarian. You’re boarded by the ABVP and you’ve been teaching this for a long time. But were there areas when you started to dig into the research for this book? Were there things that really unlocked for you? Were there areas that you were surprised by how much depth there was that you either weren’t using or weren’t really aware that you could get information from?

Dr. Ryane Englar:
Yeah, great point. I would say every single chapter, I think especially the ones that I had to write, and then Dr. Dial would go over them and we would sit side by side because each one of us would either lead a chapter or be the buddy up and help. And I think that for me, much of it was checking the knowledge that I knew and where did it come from? Like so many things in life, you have this saying or a motto or you’re like, I learned this 8,000 times in vet school, it has to be true. And then you write the book and you’re like, Hmm, is that real? Did that actually happen? Is that true? Did I make that up right? Did someone else tell me and I just assumed that it was true?
So I think for me, as with every book writing experience, just the literature review, finding out, oh, yes, that actually is documented and this is where it came from, is so helpful because then it does check yourself, is what I’m telling the next generation truly right or is it because I remember someone somewhere in my past told me to believe it and I just accepted it.

Dr. Andy Roark:
Were there any examples that come to your mind of things that you were like, oh no, this isn’t true?

Dr. Ryane Englar:
Gosh, I wish… You know what, there probably are thousands of them. I think for me it was just the reminder when we were going through I’m stuck on the same Buffy coat example of going through and when Dr. Dial and I reached and wrote the table of contents, I filled in what I knew, and she’s like, maybe we should do a Buffy coat chapter. And I’m like, what, the Buffy coat? What do I know about that?

Dr. Andy Roark:
Yeah, when you said that, that was the experience I had. Yeah, when you said that was the exact experience I had, was like, oh, the Buffy coat, what do I know about? Not much.

Dr. Ryane Englar:
Right. Or total protein, right? Again, I love to tell my students this because sometimes I think they just think I know everything, and I’m, oh no, that’s why there’s a library in my office, I need to reference stuff. Total protein, as a vet, I know how to get it right or my technicians use the refractometer, they get the value, they give it to me. I can interpret it, but how much do I really know deep? I can give you the differentials; high protein, low protein, but everything’s unpacking more and more so that it’s not just a one sentence answer. It’s let’s dig deeper beneath that.
And other areas of the book made me want to explore more. For example, you mentioned parvo, right, and smelling the smell of parvo. And for me, the chapter on fecal color odor consistency ignited my spark in another crazy area of my brain, which was why do clinical skills labs like the ones I teach, only focus on visual things and tactile things? There’s zero olfactory clinical labs in vet med and not in human healthcare, in the military, yes. So I’ve spent three years trying to create diagnostics work to develop olfactory cues that we can actually bring into the classroom. So in another six months-

Dr. Andy Roark:
You came up with a stink test.

Dr. Ryane Englar:
Yeah. So I’m working with a crime scene investigation lab on that, and they’re the only ones that would take bio samples because believe it or not, in my crazy quest, I found that most of the companies that use mass spectometry to evaluate scent are food companies like the cereal companies. Because if clients are like, my cornflakes stink, it smells like mold, we got to fix this, right? So they go to these labs. Well, I had lots of talks with these labs. They were wonderful people. I thought I was very clear about, we have fecal samples from dogs. And then we reached a point that was pivotal on every call. Wait a second, you would’ve sent fecal samples to my cereal lab? No, we’re not doing that. We’re not [inaudible 00:22:20]. So many doors got shut down, right?

Dr. Andy Roark:
Oh, yeah.

Dr. Ryane Englar:
They had them told and they’re like, wait, we’re not actually… So I finally found the crimes team investigation people, and now we’re hopeful, but-

Dr. Andy Roark:
This is amazing.

Dr. Ryane Englar:
That’s huge. So maybe in six months I’ll have that. I think the biggest downside is where are we going to test that? So nobody wants to be the Guinea pig in our faculty suite office to test the parvo scent.

Dr. Andy Roark:
Oh yeah, you have mad scientist problems. Did you know that? You run into the problems that great inventors like Dr. Frankenstein have run into again and again, which is people closing doors in your face, asking what you’re doing with a dead body, things like that. I love that you have a crime scene scene investigation team who’s, yeah, we’ll talk to you. That makes me so happy. What does a stink lab look like? I don’t know if that name’s going to stick. I don’t know if you like it, but to me, Ryane runs stink labs. What does this look like? Help me understand what this would even be like. I’m assuming that the old factory stuff is hard because it’s hard to quantify and say, oh, this is a five, this one’s a five. I don’t know how you do that with a smell. But yeah, it seems pretty sort of subjective. Help me understand, what does that look like from a training standpoint? I think it’s fascinating.

Dr. Ryane Englar:
No, that’s a great point. Basically what we’re looking at is we have to find the olfactory fingerprints of different disease processes in bio samples. And so parvo seemed to me the easiest starting point because it smells bloody. There’s this metallic component. If you pull all of us, there’s this [inaudible 00:24:14] component coming from the blood. And so my hope was we could find that compound in it. So you have to actually take a sample, pulverize it, there’s lots of ways to do that. And basically it has to run through a very fancy mass spectometry machine. That’s going to spit out a little pattern, we hope that can differentiate normal diarrhea that’s not parvo positive from diarrhea that is parvo positive.
So the hope is by going through enough samples, you can find the blueprint or fingerprint. So once you find the fingerprint, we now can identify what those compounds are and you can put them together kind of like a perfume factory into one little concoction. And it could be liquid or it could be infused on a little pad, kind of those scratch and sniff stickers that probably aren’t allowed anymore that we used when I was a kid. They’re probably very toxic, but haven’t seen them for a while to buy them for my niece. So something’s sketchy about that.
But the idea would be we would then be able to build that into a lab. And so the example I have, and it’s the only one I’ve found, when I was trying to figure out how to make this possible, I get a lot of simulation catalogs and I found one from a nursing program and they had a fake vomit, and they wouldn’t tell me what was in the fake vomit. They said, you’ll have to buy it.

Dr. Andy Roark:
It’s proprietary.

Dr. Ryane Englar:
Yeah, it’s proprietary. Buy it and call the manufacturer. So I said, all right, great. This was pre-crime lab. So I call, I order it. It arrives by FedEx. While I’m teaching another class, everything comes to this main depot. And all of a sudden students in my lab are, is somebody really sick in here? We’re in a classroom down the hall. They’re, somebody threw up. I don’t know where that’s coming from. And all of a sudden, a whole bunch of students run to the bathroom. They’re, we feel really ill. Somebody comes down from the main office, they’re like, Dr. Englar, there’s this package up front and it really stinks. And they hand me this box, and it had been crushed by the FedEx people. I love FedEx, no offense, but it was crushed. The whole thing was leaking this fluid and the whole… it smelled-

Dr. Andy Roark:
Mad scientist problems. That’s what this is.

Dr. Ryane Englar:
People were, don’t do it, Ryane. So now I’m going to have to do my test outside in Arizona because everyone does not want that. But especially after COE comes to visit, we don’t want the accredited bodies turned away. But my thought would be, if you can do this, parvo’s our first pilot. It’s very expensive and I have no grant money external to do it, so we have to do very few samples and hope for the best.
Then we could do things for the ketotic breath. You could do all kinds of different aromas, right? Pseudomonas for otitis, that horrible rancid smell that we all kind of know. And then we’re, we need to culture this here, that’s rank. It would be great to be able to recreate that. And it is, it’s very Jekyll and Hyde. So maybe my love of Broadway musicals has inspired it.
But things like that make me want to come to work, want to create things. Because if we can do that, then we know what… if you can just train someone to recognize that smell, but think about the utility at every other area. So if we forget just diagnostic, think about individuals that pass out in surgery because the smell of [inaudible 00:27:51] and they just need sensitization or desensitization. Or people who pass out because the smell of items in necropsy or the sight and smell of blood in surgery.
If you could partner with psychology departments and actually help individuals, maybe you could be the next neurosurgeon, but there’s some kind of a gap because blood smell makes you feel sick. So let’s recreate all of that, have its own little lab and figure out a way to get people to do what their strengths are. So yeah, I’m always thinking about things.

Dr. Andy Roark:
Well, I’ll tell you, I’ll help you out right here so I do escape rooms with my wife, and so we always go and we love them. And so anyway, we did an escape room and there were these little metal containers and they all looked identical except they had little holes punched in one end. And then there was this door and it had a little tray on it, and there were little symbols of different herbs and things like that. You would kind of sunflowers and things like that you would recognize. And the idea was you were supposed to smell these containers because they had a scent inside. And then when you put them onto the tray in the right order, the door would open. And I was just thinking that that could be like your exam. And when they put the things on the tray, the thing unlocks and they can leave. They can go home for the day and they’re done with lab. And so I don’t know, sit with that a little bit.

Dr. Ryane Englar:
Yeah, I love that idea.

Dr. Andy Roark:
It’s less mad scientists than you usually go, but-

Dr. Ryane Englar:
I could tone down a bit for you. I could make that work.

Dr. Andy Roark:
Or tone the door up a bit. I don’t know. I’m sure you can find a cursed door from an old temple, something like that, that would impress your colleagues. Anyway, Ryane, thank you so much for being here. I’m going to put a link to your book down in the show notes. Where can people find you? Where can they learn more?

Dr. Ryane Englar:
Yeah, absolutely. For this textbook, it’s published by Wiley-Blackwell. So you could go straight to the Wiley-Blackwell website for your country, right, the US, but there’s also European versions of that, and you can buy direct from Wiley-Blackwell. If you’re an instructor, I don’t know what the stipulations are, but there’s a link where instructors could request a free copy to look at, right, if you were thinking about incorporating it into your classroom.
So that’s the best reason to go to the Wiley site. Others, my students get a free access to the University of Arizona because we have an e-book user license that’s unlimited, but other students from other universities can go to amazon.com. Sometimes you’ll get a price break depending on how they do those algorithms. So I also have an author page on amazon.com, so you can also link to not just my other Wiley-Blackwell textbooks, but also my 5M textbooks and Taylor & Francis and Elsevier.

Dr. Andy Roark:
Awesome. I’ll put links in this show notes. Thanks for being here. Thanks for listening, everybody. Take care of yourselves.

Dr. Ryane Englar:
Thanks so much. Appreciate it.

Dr. Andy Roark:
And that is our episode, guys. That’s what I got for you. I hope you enjoyed it. I hope you got something out of it. Thanks to Ryane Englar for being here. Again, as always, if you enjoyed this episode, share it with your friend and or leave me an honest review wherever you get your podcast. That is how people find the show. It really means a lot to me. I always love it when people leave nice positive reviews and pats on the back and things like that, or even constructive feedback of things you’d like to see more of or things we could do differently. Anyway, guys, take care of yourselves. Be well. I’ll talk to you later on. Bye.

Is Convenience Leading Us Toward Misery?

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I know I’m not the only person who enjoyed practice back in 2020. That was when pet owners were being seen curbside, and vet medical teams were powering through appointments with pit crew-level efficiency. Seeing pets that way was, for us veterinarians, extremely convenient. It allowed us to stay in one spot, do our work without distraction, and focus on clear communication in bite-sized chunks. Many of the minor frictions that come with navigating the pet + owner experience were removed.

I also suspect that I am not the only one who recognized that there was a price being paid for this convenience. 

By removing the pet owner (and all the inefficiencies that come with them), it felt like I was losing something important. The longer we went curbside, the more convinced of this loss I became.

It’s not unreasonable to want a happier, more convenient, less irritating life. In fact, society seems fixated on helping to make that happen. We now have the ability to stream movies or TV on our phones, wireless headphones to summon music, podcasts or audiobooks at a moment’s notice, and texting and messaging apps to save us from awkwardness on the phones. Tired of traffic? Grab an Uber! Worried about missing the game? Stream it on your watch!

As I look around my living room right now, my dog is chewing his bone while I type on my laptop. Each of my children stare, completely immersed in their cell phones. No one is bored here. No one is inconvenienced by the behaviors of other family members. No one is doing anything other than what they want to do at this moment.

That’s wonderful… isn’t it? I’m not so convinced.

My Doubts About Convenience 

It’s so easy to remove the frictions of life, and in the moment it feels great. It’s awesome to not be bored. It’s great to be able to duck away when things quiet down in the clinic for a moment. It’s nice to get work done while my kids are entertained. 

That quiet time in the treatment room absolutely could be used for emails, or it could be used for just standing around and talking with the team. Getting the email done feels like the priority. However, in the long term, not spending time simply being present with my techs and fellow doctors would have negative consequences.

That’s often how this goes. Taking the easy and convenient path in the short term sets us up for loneliness and shallow connections in the long term. 

Inconvenience Can Become A Doorway 

No, we shouldn’t swear off the little things that make us happy. There’s nothing wrong with watching the show you love, listening to a podcast while you drive, or scrolling social media on your break. We do run into a problem, however, if we do them so regularly and quickly that we never see the opportunity to strike up a conversation with someone we don’t know (or who we love and care deeply about). At some point, inconvenience is the doorway to connection.

Working with clients while treating their pets is how we build relationships. Advertisements on the radio are our impetus to turn the volume down and talk to our friend. Turning off social media on our breaks and just asking a co-worker what they did over the weekend is a step toward building trust. 

Maybe we should start getting a bit more tolerant of irritation, boredom and inefficiency. Maybe taking the path that’s immediately fast and easy doesn’t get us where we want to in the long term. Maybe it’s good to be just uncomfortable enough that we make time for the mundane acts that build connection and a rich life.

The Well-Leveraged Technician – How Do Practices Actually Get There?

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Ken Yagi, MS, RVT, VTS (ECC), (SAIM) joins Dr. Andy Roark to talk about how practices actually go through the process of increasing their delegation to and utilization of technicians.

You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!

LINKS

Dr. Andy Roark Exam Room Communication Tool Box Team Training Course: https://drandyroark.com/on-demand-staff-training/

Dr. Andy Roark Charming the Angry Client Team Training Course: https://drandyroark.com/charming-the-angry-client/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Kenichiro Yagi, MS, RVT, VTS (ECC), (SAIM)

During his 20+ years in the field, Ken has dedicated his career to reimagining veterinary nursing. He obtained his VTS certification in emergency and critical care as well as small animal internal medicine and achieved his master’s degree in Veterinary Science. He is currently the Chief Veterinary Nursing Officer for Veterinary Emergency Group, and the Program Director for the RECOVER Initiative. Over the years, he has received the Veterinary Technician of the Year award by NAVTA, the Veterinary Technician of the Year award by the California Veterinary Medical Association, the RVT of the Year award by the California RVT Association, and the AVECCTN Specialty Technician of the Year award. Ken co-edited the Veterinary Technician and Nurse’s Daily Reference Guide for Canine and Feline, and the Manual of Veterinary Transfusion Medicine and Blood Banking, and publishes articles and presents internationally on topics in ECC, transfusion medicine, and the veterinary nursing profession.

Ken works to bring further recognition of the vital role of the veterinary technicians and nurses through work with organizations, being a Past President of National Association of Veterinary Technicians in America, and President of the Veterinary Emergency and Critical Care Society. He is also an advocate for the Open Hospital Concept, encouraging veterinary practices to invite the pet owners to “the back” as a part of the team.

Ken invites everyone to ask “Why?” to understand the “What” and “How” of our field, and to continually pursue new limits as veterinary professionals and individuals.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I’m here with the one and only Ken Yagi talking about how do you actually start using technicians more aggressively, holistically a assertively, than you have in the past?
How do we actually delegate stuff to technicians so that doctors get on board and the change actually gets made in the practice? That’s what I want to dig into. So Ken and I always talk high level stuff. We’re not doing that today. I really… What do you say in the practice? What are the steps that you have to take to try to change the way that a practice functions and really starts to utilize those technicians to take things off a doctor’s plates? And how do you get the doctors to allow the technicians to do that?
That’s what Ken and I get into today. It is a super fun episode, guys. I hope you’ll enjoy it. Let’s get into this episode.

Kelsey Beth Carpenter:
(Singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.

Dr. Andy Roark:
Welcome to the podcast, Ken Yagi. Thanks for being here.

Ken Yagi:
Thanks for having me.

Dr. Andy Roark:
Oh, always. I love having you on the show. You’ve been on a number of times.
For those who do not know you, you’re an RVT and a veterinary technician specialist in emergency critical care and small animal internal medicine. You have been the President of NAVTA, the North American Vet Tech Association, and you are currently the Chief Nursing Officer at VEG.
I didn’t miss anything, did I? I know I miss a lot. First of all, your bio just rolls on. It’s like the Iliad, but I think those are at least some of the points.

Ken Yagi:
Yep, sounds good.

Dr. Andy Roark:
Anything I should add that I woefully left out?

Ken Yagi:
The NAVTA is the National Association of Veterinary Technicians in America, no longer North American.

Dr. Andy Roark:
What did I say? The North American Vet Tech Association? I just make stuff up sometimes. Yeah.

Ken Yagi:
Yeah.

Dr. Andy Roark:
I’m sorry. Hey. Yeah, we pride ourself on factual accuracy here on the Cone of Shame and I’m glad that you caught that.
All right, enough of that. Let’s talk brass tacks here, Ken Yagi. You and I, when I usually have you on, we talk at a high level about where technicians are going and how technicians interface with medicine overall. And we future-cast a lot and things like that.
And that stuff is always fun and I do really like it, but I am about as pragmatic as they come when I get into how do I actually get things done. I like to get things done. And I look at a lot of practices and I think I see a lot of my colleagues who are like, “Yes, I want to use my technicians more.”
And I see a lot of techs who are like “Hey, buddy. Put us in, coach. We’re ready.”
But we’ve got these established systems and workflows and ways that we’ve done things in practice. And breaking out of the old way of doing things is hard. And a lot of people say, “I want to do this, Andy, but it’s scary.”
The idea of giving up control and saying, I’ve been doing catheter placement forever and I know that I’m really good at it. And so the idea of letting people who are not as good as me do it, is terrifying and it doesn’t make any sense. And I go, “Well, you have to give people repetitions and a chance to use their skills. It’s not fair to not let anyone do stuff and then dunk on them because you do it better than they do it.”
I go, “Well, that’s dumb.”
But still, this stepping back part is really, really hard. And so what I wanted to talk with you about today is how do we actually make a change in a practice that hasn’t been leveraging their technicians? So yeah, I want to get into the weeds and pick your brain about things that you’ve seen, where practices have actually made changes. And people who have been established techs have not come out and gone into a new practice, but they’ve gone into an established practice and over time they have grown in that practice and that practice has evolved.
Because medicine changes, guys. And I really think that if you’re practicing medicine the way you were five, 10 years ago, then you haven’t grown and it’s time to grow. So I want to help people grow today.
So Ken, when I lay that out at first, how does that sound?

Ken Yagi:
That sounds great, so let’s get right into that.

Dr. Andy Roark:
All right, so let’s go to work. So where do we start here?
I’ve got my practice and I’m like, I don’t know, am I lever… I think I’m leveraging my technicians, but I don’t really know. Help me get my arms around what I’m even looking at here.

Ken Yagi:
Yeah. So I’ve been looking into this quite a while and I have survey responses and things like that. When it comes to… One of the reasons why people don’t get utilized, it’s actually kind of surprising to see on the survey. There’s a response that says we don’t have issues with utilizing technicians, and that one actually gets picked the most.
And so it made me think about, well, maybe people don’t actually realize that just being busy and having people run around like crazy and trying to get things done is different from well utilized technicians because that’s just busy people that are trying to get everything done. And the other thing might be that they’re just not aware of what good utilization looks like.
I have a quick exercise that I just want to throw out there that’s sure for everyone that we can do, and that’ll be a good place to start. I’m going to read off 10 different things that could be done in a veterinary practice and the people who are listening, I want you to think about whether that’s gets done most of the time by a doctor or by your nurse, and keep track of that and we’ll tally it at the end.
The first one is IV catheter replacement. Next one is calculating fluid rates. Hospitalized patient assessment. Urinary catheterization for urine collection. Client education on diabetes. Ultrasound exam. Anal gland expression. Nasogastric tube placement. Creating an anesthetic plans and administering it. And then the last one is unblocking cats.

Dr. Andy Roark:
I’m at five. I’m just going with by what happens in the practice where I work. So I was like, I’m at five. I’ll be honest.

Ken Yagi:
Yeah, yeah, exactly. That’s what we want to be doing. So for you, five of those fit into technicians are doing it most of the time, is that correct?

Dr. Andy Roark:
Yes.

Ken Yagi:
Yep. So then if you take a quick tally of that, so that’s like 50% out of 100% for me, because all of these things should be able to be done by a technician with supervision, of course, but a well-trained one.
And so then I would say that you have 50% potential of utilizing technicians better in your practice.

Dr. Andy Roark:
Yeah. I believe that. I think there’s the possibility to get better. I think that’s why… Honestly, you write the book you want to read, the reason I want to have this podcast. What does evolution like that look like in the practice where I work?
And so yeah, I know that there’s upward possibility. So that totally tracks to me.

Ken Yagi:
So, the first step is to go through this thought process to take a look at what happens in your practice, which of those could be done by technicians that you’re not utilizing them for. And that gives you the awareness of how much more room there is to grow in your practice for utilizing technicians.
And that’s the first place to start. You need to know where you’re at in order to change it.

Dr. Andy Roark:
Yeah. No, I like that assessment. Just doing that, I go, okay. I love the questions as well because they’re concrete examples of things that technicians could do that they often aren’t. And I go, oh, okay. Yes, it is true that my techs could unblock a cat and they generally don’t. But they could and I get it.
So I like that there are specific examples and just the questions themselves open up your mind to how technicians could be utilized. I really like that exercise.

Ken Yagi:
And I also be a little bit cautious and say that unblocking cats, I’m putting it out there. Right? That’s one of the highest end things that technicians could do because it’s a high risk procedure. What if the urethra tears?

Dr. Andy Roark:
Sure, yeah.

Ken Yagi:
And I would definitely consult the Practice Act to make sure that what you’re trying to get technicians to do is definitely legal.

Dr. Andy Roark:
Yeah. Oh, well that’s important. Yeah.

Ken Yagi:
But with that said, there’s so much more that we could be utilizing our technicians for than we do today.

Dr. Andy Roark:
Yeah. No, I do think that’s good, but what I think… So I realize the sample, so let’s stay with this for a second. So we’re talking about unblocking cats. I think you put your finger right on the valid concerns that doctors have where they go, yes, I have technicians who could do this, but I’m the one who’s going to have to make the phone call if we punch through the urethra and now we’ve got real problems.
And it’s not even about saying, I think that someone else is better than me or not as skilled as me, but it’s almost like if I’m the one held responsible and there’s going to be a mistake made, I would like to be the one who makes the mistake because at least I’ll know then that I’m the one who messed up and now I have to deal with the consequences.
So I think that that’s a very valid emotional response that people have. And so that sort of brings me around to, I think there’s nuance here as far as what are we comfortable with? And in my impression, Rome was not built in a day. I think a lot of people expect that the path to tech utilization is a huge leap forward. Or one day we walk in and say, guys, the rules are changing and we lay down all of these things. I just can’t imagine that’s the case.
So let’s start to talk a little bit about what increased utilization actually look like as it takes hold in the practice. Can we do that?

Ken Yagi:
Absolutely. Yeah.

Dr. Andy Roark:
Where’s the push usually come from? Is it usually… I mean just in your experience. We’re talking a hundred percent anecdotally here. Is it usually, is it an owner, manager, up the chain sort of decision? Is this usually doctor driven where the doctors say, I want to let delegate more effectively to technicians? Let’s talk about changing our protocols? Or is it usually technician driven? What have you seen that has actually accomplished results?

Ken Yagi:
It needs to come from all different directions, but I would say that the push from the veterinary technicians and nurses side has existed for a long time. We’ve been saying we’d like to be utilized, and that hasn’t changed things too rapidly.
I think that the practice management is starting to look at it a lot more commonly now, because of the shortage that we have out there. We need to see as many patients or even more patients in a more efficient manner. And so, one of the ways that we can do that is through more efficiently utilizing every single team member, not just the veterinary nurses. So then we need to think about it that way.
And knowing that the path to retention is also to be able to pay these people better. Having a more efficient team that’s able to bring in more revenue through the utilization is seen as partial solution to the shortage that we have today. And so, I think we’re starting to see a lot more of the practice management paying attention to efficiently using the team members while balancing it with some of the concerns that come up, like the one that you mentioned regarding liability issues.

Dr. Andy Roark:
Yeah, that tracks with what I’ve seen. And now that you say that, I go, okay. Yeah, I get it. Well, I think one of the things that I have seen as a recent movement is, I don’t know if it’s driven by corporation of medicine and we suddenly have these outside entities that are very focused on business and operations in a way that… And most independent practices never used to be.
I don’t know if it’s really coming from them. I don’t know if our whole profession is just evolving. I don’t know if it’s a labor shortage that’s really pushed us, but the operational efficiency is a really big deal now across practices. And I’ve talked to a number of people who have voiced frustration to me where they say that we have this plan, we’ve come up with this way of getting things done. We’ve got these systems for delegating effectively to technicians and other paraprofessionals.
We’ve got all these things that we have figured out and the doctors won’t do it. And the doctors, they won’t delegate. They won’t delegate to the technicians, they won’t use them or they don’t want to use this system that we’ve come up with. So I’ve heard that. And again, I’m not in those practices. I don’t know. I don’t like to think that the doctors are probably the most likely obstacle to evolution this way, but it seems to me that they probably are as a doctor because they’re the ones who feel that they’re held responsible when things go wrong.
And so, I think it’s understandable that they would be the most hesitant to say, okay, I’m going to open this up. I’m going to step back from what I’ve done previously. And it’s not just about belief in our own skills, but it is… There’s a liability part to as well where I go, well, my license is the one that’s going to be come after if this goes badly.
Does that resonate with you, Ken, when I say that? Does that feel like what you’ve seen as well? Am I overstating the pushback that doctors tend to give to these initiatives?

Ken Yagi:
No, I think that it’s definitely true that doctors have the liability on their mind because it is under their supervision that all these things happen. And if something goes wrong with their patients and it goes to the veteran medical board, they are definitely the primary person that’s called up to defend. And so, there’s certainly that worry there.
I’m also going to say though, it’s not everyone that feels that way. I think that there are many doctors that are very pro-utilization and making sure that they can do their job better by having trained individuals that can help them to perform the procedures that they need to perform or that delegate the tasks that they need to delegate.
And I think that’s the key point is that yes, there is a liability, but the liability falls both on the doctor and the licensed professional, the RVTs, LVTs, CVTs that have their own license that they will ultimately need to defend, as well.
And so, at the very highest level, I would say that nobody should be doing anything in the practice that they’re not trained well enough to do. Not an all or nothing thing where we say all of a sudden everyone should be doing a hundred percent of what’s legally possible and let’s just start doing that tomorrow.
And I think getting there by good training and also starting with the maybe smaller things, lower risk items that will be comfortable enough for the team to start allowing the nursing team to be able to do and gradually getting to the point that you have higher end things being done by the entire team would be good.
But there are probably individuals within each of those teams that are very high caliber that won’t be satisfied with the lower level of utilization that you want to retain. And so a more individualized plan on who’s the person to have these tasks appropriately delegated to them and identifying that within the practice would be important.

Dr. Andy Roark:
If you dream of doing team training with your team, getting your people together, getting them on the same page, talking about how you guys work together in your practice, I’d love to help you. You can check out DrAndyRoark.com and check out the store. I have two different team training courses. These are courses for teams to do together to get on the same page and to talk about how you do things. I have my Angry Clients Course and I have my Exam Room Toolkit Course, and they are both available and there, so come out. All right guys, let’s get back into this episode.
So there’s a couple pieces of this I want to unpack. So first I really like your idea of starting with lower stress, lower risk things that people can get on board with and just starting to build the habit of delegating and letting people do more and start to grow in small steps. That totally makes sense to me.
Talk to more about what an individualized plan looks like in practice in a way that doesn’t hack people off. It’s not like, hey, we’re going to let Amanda do this, but we’re not going to let David do it. And go.
So yeah, help me… What kind of messaging is around that? Because it makes sense to me where you say, I do have some people that I think could do it. They’re licensed technicians. And I have some people who are licensed technicians that I’m like, I’m not comfortable doing this, at least to start. What does messaging around that look like where I say, we’re going to try this with one or two people as opposed to, yes, you have your RVT and so now jump in and go for it?

Ken Yagi:
I can definitely see your point in if we individualize it to the point that only a certain people are able to do certain things, then it would create some tension within the team. I think trying to do this more systematic way would be good.
What we’ve done is we’ve put together a path of growth for people. There are different categories of individuals on the nursing team. There’s something called hospital assistants who might have very little clinical experience and they’re coming in and serving as true assistants that don’t do a whole lot of clinical work. So that’s one type of people.
And then we have veterinary assistants who are not licensed but have gained enough practical and clinical experience that they can function at a higher level in the clinics. And then people who have become credentialed from there that are veterinary nurses. We only hire credentialed veterinary technicians to be our veterinary nurses and draw a line there who are also very clinical in nature. They have knowledge of the why behind the things that they do that allows them to determine when their patient’s in trouble, be able to troubleshoot when things go wrong, and they have the knowledge set to be able to do so.
So just as a basic. Then there’s VTSs, too, right? Veterinary technician specialists that have higher experience and knowledge level and they went through a certification process. So let’s just say there’s four different buckets that people fall into. So then hospital assistants can be utilized in this fashion. Veterinary assistants can be utilized in this fashion. Veterinary nurses are utilized in this fashion. VTSs can do the highest end things.
So if we can bucket them into different categories and then assign the types of tasks that each of these people would primarily be able to be utilized in, then you have a starting place to say it’s not just that I like this person and how they do this particular procedure, so I’m going to let them do that. But this person, maybe I don’t have a good enough relationship with, so I’m going to shy away from working with that individual and then creating a very antagonistic feeling.

Dr. Andy Roark:
I like that. And I think that makes a ton of sense. Also likes about the personal development path. I think that that’s like if you want to keep people engaged and talk to them as an individual about where they’re going and start to lay those things down, I think that that’s such a healthy approach in keeping people growing and growing.
So I want to circle back to, there was three pieces I wanted pull out of what you said earlier, and the first was small steps to start. The second one is this individualized plan. And the third part is the skill training that we talked about. And so, I think back to when I graduated from vet school and my skills were pretty darn ephemeral at the time, meaning if I didn’t get into practice and start using those skills, I don’t know that I would’ve had them a few years later. Because we learned a lot in vet school, we learned a lot in vet school, but you don’t get to do a whole lot.
You are sort of didactically learning and learning and writing notes and sort of taking in. But then there’s the getting into practice and getting that repetition. So if I have… Let’s say I have a technician and he went to school and he got his credentials and he’s come into a practice and he didn’t really get to do a lot of the more advanced work for a couple of years.
And now we start to say, now we’ve got some opportunities for you. I want that person to be successful. Can you talk to me a little bit about how you would look at skill training for technicians when I’m actually… We’re actually going to let them do it now.
I feel like we’d been setting them up for failure if we said, “You were trained three years ago. Jump in there and do it.”
Help me bridge that skill gap.

Ken Yagi:
Yeah, so I think that one of the first places that you need to start is defining what that task really is. And that if it’s as simple as IV catheter replacement, for example, what does that mean? How is it done? Is there a standard that’s set in the practice that people are expected to do it a certain way? Because if one of the reasons why doctors don’t necessarily delegate to a certain technician might be that it’s faster to get it done themselves or get it done right if they do it, in the exact way that they want to see it happen, then we need to be able to communicate some of that to the team members on how a certain thing is being expected to be performed in that part of your practice.
So do you have guidelines? Do you have protocols? That needs to exist first in order to train against. And then the next step is the training part, which can also be somewhat challenging. That if you have a shortage of people and you’re struggling to keep up with the workload that you have, how do you gain the time in order to train these individuals appropriately? And that’s a harder one to tackle.
But having a system first, having standards set, having assistants trained, do you have somebody who’s dedicated to coordinate the training? Have you established a peer-to-peer training type culture within the hospital that allows people who are knowledgeable enough and well-trained enough to do the training, actually do it?
And then the rest of it is people having each other’s backs to find the time to help each other grow and that being a norm.

Dr. Andy Roark:
Yeah, no, that makes sense. It’s basically figure out what done looks like and then make an action step plan to get to done. And that’s super simple advice, but I’ve found it to be true again and again.

Ken Yagi:
And I guess one more thing that I’ll insert with that is, I think there’s maybe a little bit of a tendency for us to, when we set guidelines and protocols or certain ways that things are supposed to be done, being too rigid in it. And that there’s probably things that we want to make sure happens. If it’s a IV catheter example, we want it to be done in a aseptic manner. We want the catheter to stay in that. We want it to be painless as possible for the patient.
And there’s probably things to pay attention to do that, but how exactly do we need to tape the catheter or dictating it to that very micromanaged level is probably not the way to go. And so I just want to make sure that we’re aware that protocol or guidelines doesn’t mean exactly how it needs to be done, because there’s more than one way to get the goals accomplished.
And I think that’s a trap that we fall into sometimes, too, that makes it a unpleasant experience for the people who are learning.

Dr. Andy Roark:
I love that you said that. I have been… I actually am… I’m halfway through writing an article right now on the difference in protocols and context and leading with protocols and context where it’s a balance. So there’s so many people… I love what you said and just, I have a hundred percent worked at places where it was like, this is how many pieces of tape we use and this is how they go.
And I understand because it’s about consistency and quality control. And at the same time, if you hire smart people who are very good at what they do and you take away their agency and their ability to look at the situation and adapt to what is best in this specific case, the ultimate outcome is less than it would be.
I always say don’t hire smart, great, motivated people and then put them into a system that doesn’t let them make any decisions or affect the outcome on the ground.
And the same thing as don’t hire smart people and give them no guidance and then be frustrated when things are all done every different way. It is a balance of that. But I don’t think I’ve ever had anyone say that the hyper-nuanced, anal-retentive way of this tape, pieces of tape, and this is how we did it. I’ve never had anyone push back against that, but it’s always bothered me of what are we doing here really?
I don’t know. I love that nod towards balance. Let me… Last question. Are there any pitfalls that you see with practices that are starting to utilize technicians? How does this blow up and go off the rails and end up just locked back down tighter than it ever was before?
What are the mistakes that get made that really just tank initiatives to empower technicians?

Ken Yagi:
Having a plan on gradually improving utilization is the first point. And I say that because if we try to go from zero to 60 in a snap of a finger to get everyone utilized and we start letting people do all these things and they should just teach each other and just get it out there and put it out there, mistakes are bound to happen.
Mistakes as in something affected patient care. The client complained because they had a poor experience. The doctors got reinforced in the feeling that they should have done it themselves, because look what happened because I delegated this particular task this person.
So I think doing that in a more planned, gradual manner is the first thing that I think about when I think about that. But also being tolerant in understanding that there will be mistakes that will happen when we start letting people do new things and making sure that people understand that as we try to push the boundaries here a little bit, whatever that boundary is for your specific practice, there are going to be unideal situations that will arise.
But the point of that is to, when something like that happens, the important thing to think about as you approach it is not to then say, oh, see, it didn’t work, so now we have to revert. Let’s not let anyone place nasal gastric tubes ever again. Or doctors will always have to do urinary catheters or something like that, and doing a little bit of a knee-jerk reaction to that.
Instead of doing that, you really have to take the time to evaluate, well, what went wrong here? Was the person not trained well enough? Did the doctor not provide good enough instructions? Was it a difficult case that was going to happen with regardless of who was doing it? And just evaluating each of those situations, learning from it, adjusting for the next time, and providing the right guidance that each of these individuals need to do it better the next time, I think, is one thing that I want to make sure that people understand.
That it won’t always go perfectly. We just need to improve it for the next time. And that gradual improvement as you do it more and more is what will get you there.
Can I throw in one more thing?

Dr. Andy Roark:
Yeah, sure.

Ken Yagi:
When we talk about utilization and issues surrounding it, we often point to the doctor is not letting the technicians do this or the practice management isn’t paying attention to utilization enough and creating systems and whatnot.
But I think there’s a third piece to that, and that last piece is that for all the veterinary nurses out there that are wanting to be utilized better, I think we should self-reflect a little bit too to say, are we the type of people that foster good trust that allows people to delegate the task to us?
Do we have the knowledge and skills that allow us to appropriately do this? And are we making sure that we’re not overextending ourselves and putting patients at risk? Do we follow through and deliver when tasks are delegated to us and make sure that it’s done instead of forgetting it or dropping the ball sometimes? Are we treating the doctors respectfully and creating a safe place for them to come back and ask questions about how things were done or clarifications about the things that we’ve done without us getting defensive? Because that could definitely prevent doctors from wanting to delegate further.
And so, it’s always… I guess it’s more than a two-way street in terms of making sure that utilization is something that naturally happens in the hospital. So for all the veterinary technicians and nurses out there, be that person, is a message that I want to send.

Dr. Andy Roark:
Yeah, I love that. It’s definitely a dance that we do together. We want to be trusted and we want to be empowered, and then we need to make sure that we’re able to accomplish the things that we set out to do.
You know what I mean? And trust is cyclical that way of we give trust to someone else and they validate and reward that trust and we continue to spin up. So anyway, I love that point.
Well Ken, where can people find you online? Where can they learn more about you and/or VEG?

Ken Yagi:
I’m on LinkedIn, Instagram, and Facebook, and happy to chat through any of that.

Dr. Andy Roark:
Awesome. Thanks so much for being here.
Hey guys, take care of yourselves, everybody have a great weekend.
And that is our show. That’s what I got for you guys. I hope you enjoyed it. I hope you got something out of it. As always, if you did, share it with your friends, write me an honest review wherever you get your podcast. That always means the world.
Thanks again to Ken for being here. Guys, take care of yourselves. I said at the end of the recording with Ken, like, have a great weekend. It’s Wednesday. I don’t know why I said that. I’m think I’m done with this week.
I’m sure other people know how that feels. And regardless of what day it is, have a great day and a great next two days as if it was a great weekend, even if you’re listening on Monday.
Anyway, that’s all I got. Take care everybody. Bye.