DrAndyRoark.com

Articles, Videos, & Training on Pets & Veterinary Medicine

Nicole Palumbo, DVM

How to Decode a Bad Review

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It is the age of the Internet review. We all do it. A new restaurant pops up and we go online to look at the Google reviews. We judge this new place by the experiences of others instead of trusting in our own experience. We may not frequent these places because of a few bad reviews. Unfortunately, these reviews aren’t verified and can be widely inaccurate. There isn’t a system to double check the facts and this can make or break a business. So how does one decode these bad reviews for veterinary practices?

1. “ They are only in it for the money.”

For anyone who has worked in veterinary medicine, this statement makes us cringe. We are not rich and most veterinarians are struggling to pay bills due to the high cost of student loans. Our technicians only make slightly more than minimum wage. When we see this statement on reviews usually it means that diagnostics or surgery were recommended for this person’s pet and they were unable to come up with the money. Instead of being upset with themselves, they take it out on the practice. Many veterinary practices try to work with owners in these situations but we are not a charity and unfortunately, veterinary care costs money. If you see this statement in a 1-star review think hard about believing it.

2. “ They did extensive blood work and x-rays and told me nothing.”

This statement usually happens when owners do not understand the value of what was done to their pets. When we run lab work and take radiographs and everything comes back within normal range that is usually something to celebrate. That means we ruled out diabetes and kidney failure or other major diseases. If radiographs were “normal” that typically means we didn’t see any masses or foreign material in your dog or cat. The bill may seem like a shock when we “didn’t find anything wrong” but essentially we gave you peace of mind that your pet is healthy and ruled out a lot of terrible diseases. We hate seeing these reviews because usually, we get excited when we get to give owners good news and then feel disappointed when owners bash us because of it.

3. “ They couldn’t figure out what was wrong with my pet.”

This type of review tends to pop up because of a few situations. The first is that the owners wouldn’t let us do any diagnostics. Sometimes we can easily diagnose a problem from a physical exam but more often than not we need to do some investigation to be able to find what is wrong with your pet. Unfortunately, that means spending more than just the exam fee and a lot of people decline further diagnostic tests. The second situation is when we do find an answer but owners are non-compliant on treating. We see this a lot with skin allergy cases. Owners tend to ignore our medical advice regarding treatment plans to keep pets comfortable which means they usually come in with flared-up skin and secondary infections. They get frustrated with us because of their own non-compliance. That frustration is then sent out to the masses in a 1-star review that is unfortunately not true.

4. “I waited in a room for over an hour before I was seen. They don’t care.”

This review pops up with a lot of emergency clinics. Owners get upset because they came in for emergency services or even a regular appointment and have to wait for the veterinarian to be available. Usually what happens is there is limited staff or many emergencies to get through and each one has to be judged on its priority of urgency. If your dog came in for limping and two minutes later a hit by car animal showed up then typically that means your pet is less critical and is going to wait. We understand that even the smallest emergencies with your pet make you anxious but if your animal is stable and there are more pressing cases, you will have to wait for treatment. It doesn’t mean we don’t care and often we send a technician in the room to update you on the wait. We want to help your pet and we will but realize there may be more going on in the clinic.

5. “My pet’s incision got infected because they messed up the surgery,” or “My pet had surgery and died because they are incompetent.”

There are many explanations for incision infections and rarely is it the veterinarian’s fault. Occasionally there are animals that have suture reactions, which can cause the incision area to open up or become inflamed, but this is why we recommend close monitoring of the surgical site. More often than not incision complications are due to owners not listening to post-op instructions. Many owners do not keep the e-collar on at all times or do not keep the pet confined to help to heal. In the end, the pet suffers because they have to go through corrective surgeries, more antibiotics, and more trips to the veterinarian. Unfortunately, surgery is not risk-free and in a lot of emergency situations, pets can pass under anesthesia or sometimes a few days later. This doesn’t mean that the veterinarian messed up the surgery but with emotions running high sometimes owners need someone to blame for their grief. These statements are some of the worst because veterinarians cannot give their account of what happened.

Always know there are two sides to the story and a lot of the time anger gets the best of people when writing reviews. These lies can break a business and feeding into someone else’s opinions just makes things worse. Learn how to decode the false reviews and make your own educated decision about a business.

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

5 Ways to Help Vets and Pets This Holiday Season

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It is that time of year again where the clinic starts to fill up with goodies from our clients. Typically I call it the, “there goes all of my weight loss progress,” month. Daily we will get chocolates, cookies, cake platters, gift baskets filled with nuts and cheeses, and the occasional healthy dish like a fruit platter. It is a nice little sugar rush to get us through the holiday season. Although I do look forward to this time of the year, I can’t help think what else our owners could donate for a better holiday season. Don’t get me wrong, I am thankful for the treats but maybe this year we can share the love with others? Here a few suggestions to spread the love this holiday season.

1. Donate to your clinic’s Angel Fund or Paw Prints fund.

These funds are usually set up at clinics to help those animals and families in need. Unfortunately, they run dry very often which means some animals that need our help cannot get it. Instead of giving that $50 cookie platter ask if you can donate to the clinic’s fund for animals in need.

2. Donate to your local shelter or Humane Society.

I hear it a lot, “I donate to the Humane Society of the United States so I don’t need to give to my local chapter.” Unfortunately, the HSUS is not directly related to any local humane societies and rarely do they donate that money back to local shelters. This time of year many animals are placed in shelters and food/supplies can run low. Donate a few bags of cat or dog food to help your local shelter stay afloat.

3. Foster for a local rescue.

This may not involve much money, but it will involve some time. Even if it’s just for a few weeks until a home is found for the little creature, you will do some good for the animal world.

4. Set up a vaccine/preventative medicine fund for a family member that may be getting a new puppy or kitten.

A lot of people don’t realize how expensive the early life of a pet can be and those first few months of vaccinations are critical. Some clinics will let you put deposits on a family member’s account for such occasions.

5. Write us a letter or postcard.

This takes time, but will definitely lift spirits more than a piece of cake. When owners write letters about how much we are appreciated and needed, it stays with us forever. I might not remember your cookie platter from last year, but I have kept every letter or note given to me from owners and when I’m feeling down it really encourages me to keep pushing forward.

I love the holiday season and the treats our clients give us but remember that you can do more and touch a lot more lives this holiday season. Of course, still, bring us some cookies – we do love them and during the crazy holiday season, it might be our only source of food throughout the day. Open your hearts and be generous this season.

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

The Consequences of Our Actions

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We do it sometimes without thinking. Maybe it is instinct. Maybe we don’t realize we are doing it. But as veterinarians, our actions and responses can create a domino effect for fellow veterinarians and ourselves. What exact action am I talking about? Well, that is the action of inadvertently misinforming clients. Again, I don’t think many of us intend to do it, but it happens all of the time.

When I was in veterinary school I had an ER department head say one of the single important things I’ve ever learned. The gist of it was to never judge another veterinarian based on what a client tells you. Unfortunately, we all know that clients lie, don’t always understand medical terms, and when things go wrong they tend to take it out on the primary veterinarian. As the second opinion or emergency veterinarian, we try to keep an open mind but some client’s stories can be quite compelling. Some clients leave out important details that make us judge the primary veterinarian poorly. Some details make us misinform clients of potential poor care. This leads to an already angry client then badmouthing and harassing the primary veterinarian because of what we allowed to transpire.

When in doubt call the primary veterinarian.

Sometimes clients will not give you that information. If so, take that as a red flag that they may not be completely honest with you, especially if you do not have complete records or any records at all. But if you do have the privilege of receiving that information a simple phone call can explain a lot of what may be going on. It will also help in diagnosing a potentially complicated case. I’ve had several second opinion allergy cases where the owners told me that their prior veterinarian told them nothing regarding treatment or testing. Luckily some of those clients brought their records or had them faxed- which showed in detail every appointment where seasonal allergies or food trials were explained and also declined by the owner. I could have just assumed that the prior veterinarian was lazy and didn’t want to deal with a skin workup but then I would be guilty of what we all should be avoiding.

Don’t judge what you don’t know.

Just because you were taught a procedure or testing sequence a certain way doesn’t mean that what the other veterinarian did was wrong.  Maybe you haven’t kept up on vaccination protocols or maybe your interest is in ophthalmology and you haven’t gone to any current lectures on urinary health. But that doesn’t mean you should dismiss or tell a client what the other veterinarian did was incorrect. We make advances every day in veterinary medicine- it’s impossible to keep up with it all.

Recently I learned that you could use blood serum to check for ketones if you don’t have urine available. If I didn’t know that fact and saw someone’s chart regarding checking ketones that way I might have gotten a little judgmental. But it would have been my ignorance that could have caused me to misinform a client regarding how to test “properly”. The same goes for a recent case of cystine stones. Again I was recently informed that a majority of cases could be resolved from neutering. Unfortunately, a second opinion veterinarian might not know this and could tell a client that they have never heard of it. That small slip of the tongue then creates chaos for the other veterinarian. Did you know there is a 2-year FELV vaccination out? I had to look it up because I thought someone’s records were marked incorrectly. Instead of deceiving the client, I took a few extra minutes to make sure I wasn’t giving out inaccurate information.

So it all comes down to a rule of thumb – unless you have the whole story do not place judgment or inadvertently misinform a client. It’s much better for the client and patient to stay neutral and put effort into investigating and fixing the problem, not creating more. Inform yourself, don’t judge others’ treatment courses, and remember we all are human. Take a little extra time to fully understand the situation before placing biases that could land another veterinarian in hot water.

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

Why Veterinarians Should Aspire to Be Like Technicians

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I love my technicians. They are the most amazing people and have skills that combine every single specialization in the human nursing field. They don’t get paid enough, in my opinion, and deserve more respect than most clients give them. They are the people we should aspire to be like.

When I was fifteen I started working at my local veterinary clinic as kennel staff. I was always so excited when the technicians asked me to help them hold an animal or even trim nails. They were so eager to show me some of the tasks they do on a daily basis. In their spare time, they showed me how the in-house laboratory machine worked and how to read fecal samples. As I continued to work my way up to technician assistant, they continued to show me how many different things they knew how to do and forever instilled my respect for their job.

I don’t know how many of you worked at veterinary clinics before accepting your position in veterinary school. I could typically tell during 4th year which students had that experience versus not. They respected the technicians. The ones who stepped over vomit and instructed the technicians to clean it up, clearly they never learned that respect. But let’s get back to the point- the skill set I’m discussing isn’t how to clean up vomit… well maybe it is.

I’ve learned a few things from my fellow technicians that help me with my daily routine that I think we could all benefit from. I think they have helped me become a self-sufficient veterinarian who has the badass skills of a technician.

1. Learn to Multitask

We all are pretty good at multi-tasking. Some much more than others. Technicians have multiple jobs through a clinic and do them all extremely well. I’ve seen a technician run blood work, read a fecal, CBC slide, and ear cytology all within a matter of 5 minutes. Plus that technician still had patients to worry about. Sometimes we get wrapped up in whatever cases we are in and forget that other things are happening around us.

2. Your DVM doesn’t mean you can’t clean up feces or urine.

Be helpful. When there are no other technicians around, lend a hand to keep the balance of the day going. That might mean cleaning up the large pile of feces left by an aggressive dog but if you lend a hand once in a while your technicians will appreciate it and it is a humbling experience.

3. Compassion!

We all have loads of compassion but there is a huge difference between how technicians tend to their in-house patients and how we interact with them. We tend to keep track of the medical issues of a case versus emotional support to the patient. I’ve seen technicians hang out with their patients in the kennels, spend their lunches snuggling with the feline cases, and overall just giving them a little extra emotional encouragement. A well-loved patient tends to recover a little quicker than one that only gets touched during morning rounds.

4. Be flexible.

For those veterinarians working ER shifts, you know what I’m talking about. Sometimes a day isn’t going to go as you planned it. Some veterinarians get so stressed out by work-ins and unplanned surgeries. What do the technicians do? They push on through. They are supportive and will stay extra hours to help out, even if they aren’t scheduled to do that. Now I don’t think we should be so flexible to work ourselves to death, but there are steps to calmly approach bumps in the road without pulling your hair out.

5. Strengthen your skills.

We can remove spleens and fix broken bones, but sometimes those basic skills get forgotten. Most clinics have technicians that do blood draws, obtain urine, read stool samples, place IV catheters and that means you may not be doing those at all anymore. It never hurts to relearn and strengthen those skills. They can come in handy if you work on-call alone and need to place a catheter in a seizing dog or a dehydrated puppy. Every now and again ask a technician if you can draw your own blood or read that CBC slide. It will greatly improve the way you practice medicine.

There are many more skills that technicians can teach us. Remember, they are the backbone of the clinic and many of us would not be where we are today without the support of a technician.

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

Use Your Gut

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Veterinary medicine isn’t just about science. Sometimes it’s about a gut feeling. You know that feeling when you are doing a procedure and things just don’t seem right. Or when you are examining a dog and you get that feeling that it’s about to turn on you. That gut feeling usually helps us become better doctors. We use that gut feeling and our veterinary knowledge to help animals every day.

I went against my gut feeling recently and I lost a patient. The cat was in rough shape from the start. In fact, everyone at the clinic commented on how rough it looked. I had not seen the cat prior, but I was scheduled to do a procedure on it. The pre-surgical lab work was fairly normal. The cat was a mess. Not eating for several days. Lost almost 2 pounds since we had seen it initially. Extremely painful on mouth palpation with visible rotting teeth noted and a mass like-structure diverting the tongue. The cat also had a horrible head tilt and kept falling over. My goal was to get it through anesthesia to be able to help it long-term by diagnosing it with whatever was going on in its mouth. I kept telling myself if we removed the rotting teeth and knew what the mass-like tissue was then I could give this cat a good life. But in my gut, I kept hearing myself say, “this cat should not be anesthetized.”

I ignored my gut. Yes, the cat was rough, but to help it I needed to do this procedure. The cat did fairly well under anesthesia but did not recover well. Although the blood levels were pretty stable it kept having bloody discharge from its mouth – presumably from its biopsy site that of course didn’t bleed much when I was suturing it. I kept the cat on IV fluids hoping to get it through recovery quicker but the cat started to have fluid come out of its nose and mouth and I could hear crackles in the lung fields. The cat was a DNR so all I could do was comfort it as it took its last breaths. I couldn’t give the owner any answers. We canceled the biopsy; it wouldn’t help bring the cat back. All I could offer was my deepest sympathies.

For days after the failed procedure, I racked my brain with all of the things that could have happened. Maybe I should have canceled the procedure and just hospitalized the cat? Maybe I should have recommended chest radiographs before anesthesia? Maybe we should have done a longer course of antibiotics before doing the procedure? There were a lot of maybes floating through my mind. In the end, the cat was likely going to pass away no matter what decision I made. But that gut feeling was making it harder to accept.

In life, we learn from our mistakes. In veterinary medicine, we learn from not listening to our gut. Even when everything is done perfectly if we have that gut feeling that something just isn’t right then act on it. It may not actually change the outcome but it will make you feel like you did right by yourself and your patient.

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

6 Ways to Improve Communication in Your Hospital

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I firmly believe that 99 percent of the problems in veterinary hospitals can be overcome with better communication. This is a subject that we hear about in our daily lives, not just in our jobs. Communication can solve a lot of management issues, personnel issues, pet owner/veterinarian issues, etc. Yet so many practices act like this is a tough subject to breach. So many managers are managing under the misconception that everything is fine. After working at three veterinary clinics in the past 17 years I can tell you if you aren’t communicating you are going to be dealing with a lot of drama.

1. Communication with staff is key.

When people are left out of the loop, gossip, miscommunication, and mistakes start to happen. Changing a policy is one of the hardest things to breach because most of the time it isn’t delegated properly. Once a decision is made by the owners then that new policy needs to be communicated multiple times to the managers and staff. Word of mouth is not a good option. Memos, emails, and having the direct manager train everyone on a new policy will create less chaos, less confusion, and fewer mistakes. This may seem like a simple concept but this problem happens daily at most clinics.

2. Once you set a policy do not allow exceptions for certain staff versus other staff.

One way to make an employee feel less valued is to allow a few staff members to change their schedule based on their lifestyle but not allow it for another employee. This creates frustration and the feeling that certain employees are better than others. If you choose to allow exceptions then you must offer the same to all employees. The same goes for associates at the clinic- if you allow one to continue to leave early you cannot get mad at the other for asking for the same exception.

3. If a staff member quits, gets fired, or is taking time off you need to inform everyone at the clinic.

It sounds ridiculous but many clinics will hide this information or not acknowledge that a staff member left and it creates a lot of gossip and misinformation spread around the office. You do not need to give anyone specific details but informing staff can save you a lot of grief later on. The same concept goes for if someone new is hired- let staff know a week before they are supposed to start so they are aware of the changes.

4. Do not hide internal conflict or its resolution.

If two employees get into a shouting match or one feels uncomfortable by the other actions you need to inform those employees when the conflict has been resolved. If nothing is ever said or a meeting is never set up then those employees and the people who witnessed the conflict will assume that either you don’t care, you took one person’s side over the other, or they will start believing that the staff can just walk all over the owners without punishment.

5. Follow up on feedback.

If you have a suggestion box make sure you are communicating with the people who make suggestions that their ideas were discussed and appreciated. Many employees will feel like their ideas were brushed off if they are never brought up in a monthly meeting or if they are never asked to help with a solution. All it takes is the acknowledgment to make an employee feel valued.

6. Obviously, communication with clients is very important.

A lot of owners only half-listen to what you are telling them. It’s not that they don’t care or understand but you are throwing a lot of information at them when they are already stressed about their animal. Make sure that your technicians go over the information a second time and also make sure that you send home discharge instructions going over what was discussed. When it comes to paperwork just having a technician or receptionist go over everything is detail can alleviate a lot of frustration later on.

Many managers and owners right now are saying to themselves, “what does this person know, she isn’t a manager or an owner”. That is true but I have also worked in veterinary clinics since I was 15 and had the chance to work in every single position- from kennel to veterinarian. After 17 years, hundreds of clinic meetings, hundreds of doctor meeting, and becoming friends with multiple staff members that have either left or are in process of leaving, I can tell you that communication, or lack thereof, is what is causing 99% of the stress in your clinic. Open communication is best- forgetting to inform staff members of even the smallest things can cause a feeling of uncertainty around the clinic.

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