Podcast

Dr. Carolyn Brown is the Vice President of Medicine for Community Medicine at the ASPCA which provides basic and preventive care to pets living in underserved communities and HQHVSN surgeries to at risk cats and dogs via mobile and stationary clinics in New York City, Los Angeles and Miami. In this episode, she sits down with Dr. Andy Roark to discuss the push for a Spectrum of Care approach to veterinary medicine, pushback against the idea, and how that differs from what is currently being offered.

LINKS

JAVMA Article: avmajournals.avma.org/doi/full/10.24…ce=email-optin

ASPCAPro Spectrum of Care article resource: www.aspcapro.org/research/provide…ess-more-clients
ASPCA.org
ASPCAPro.org – ASPCApro.org provides tools and resources for animal welfare professionals, veterinary personnel and volunteers. We take a progressive approach to helping the country’s at-risk animals, promoting cutting edge research to advance the field.

Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688

Uncharted Culture Conference Oct 21-23: unchartedvet.com/uvc-culture/

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Carolyn Brown is a graduate of the College of Veterinary Medicine at Cornell University and has extensive experience in small animal medicine, shelter medicine and high quality, high volume spay/neuter HQHVSN) surgery including pediatric and TNR programs. Carolyn worked in general small animal private practice, at a for-profit low cost clinic and a large limited intake shelter and adoption center before joining the ASPCA in 2011. Carolyn is currently the Vice President of Medicine for Community Medicine at the ASPCA which provides basic and preventive care to pets living in underserved communities and HQHVSN surgeries to at risk cats and dogs via mobile and stationary clinics in New York City, Los Angeles and Miami. Dogs and cats in the care of shelters, rescue groups, foster programs and TNR practitioners also receive HQHVSN surgery through the department. In 2019, Community Medicine performed more than 68,000 surgeries. Carolyn determines and evaluates medical and surgical protocols for the department and maintains the program’s Standard Operating Procedure Manuals. She also leads a team that quantitatively and qualitatively evaluates the program’s medical standards of care and efficiency by carefully monitoring the metrics of the program on a monthly basis.

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

SHOW TRANSCRIPT

Dr. Andy Roark:

Welcome, welcome, welcome to The Cone of Shame Veterinary Podcast, I am your host, Dr. Andy Roark. For those of you who have listened for a while, you know that I have some concerns about accessibility in vet medicine. I worry about pet owners not being able to get access to care or not be able to afford it. I don’t want to live in a world where, only wealthy people get to have pets, that doesn’t seem right to me, it’s not what I got into this profession for and I think a lot of other people are having those thoughts. And at the same time, I don’t think it’s okay to continue to go on and not pay our support staff a living wage and to work until we burn out and to just, sort of, sacrifice ourselves to the profession.

Dr. Andy Roark:

So, that is a battle that I have been fighting for the last few years, really. And I’m looking for solutions and I’m looking for ideas. And in that vein, I’m happy to present to you today’s podcast. I’m talking to Dr. Carolyn Brown of the ASPCA and we talk about spectrum of care. There’s a JAVMA article about this that I’ll link in the notes. Spectrum of care is an approach to making care accessible. It is fundamentally changing the way that we think about and talk about medicine. There’s probably stuff in this podcast that you agree with, there’s probably stuff in this podcast you already do. I’m almost certain, there’s stuff in this podcast that you probably don’t agree with. That’s okay, this is all about exploring, it’s about looking at new ideas. These are ideas that I think are worth our thought and consideration. 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 Dr. Carolyn Brown to The Cone of Shame Veterinary Podcast. Thanks for being here.

Dr. Carolyn Brown:

Oh, thank you for having me.

Dr. Andy Roark:

It is my pleasure. You are the vice president of Medicine for the Community Medicine Department of the ASPCA. Is that correct?

Dr. Carolyn Brown:

Yep. That is correct.

Dr. Andy Roark:

What does that mean? What do you do in that role?

Dr. Carolyn Brown:

So, I oversee the quality and reach of medicine that the department provides. We provide preventive and basic care in New York City, Los Angeles and Miami, through stationary clinics and also mobile clinics.

Dr. Andy Roark:

You came into my radar this month, October 1, 2020, you were the first author on spectrum of care, more than treatment options, which was published in JAVMA. And I wanted to talk to you about spectrum of care. It’s something I think is really interesting, I think it’s starting to get discussed. I think it’s a big area that we need to move into in our profession and embracing it and talking a lot more about it. So, let me start really broad and just, sort of, ask you, what brought you to talk about spectrum of care? What is the problem that it addresses? And then we can go ahead and define spectrum of care, in that context.

Dr. Carolyn Brown:

So, spectrum of care is one mechanism we can use to increase access to care. And what it literally means is, offering treatment options to clients and patients, that range from the very simple, just monitoring cases or providing empirical care or palliative care, through a spectrum, a gradation, of increasing complexity and intensity, until we reach the most intensive, invasive and expensive treatment option. So, the spectrum of care is that full range and in order for veterinarians to increase access to care, we need to be able to access all of those options along the range.

Dr. Andy Roark:

When you talk about spectrum of care, in the individual vet clinic, are you talking about every clinic, sort of, having their own spectrum of care? Or are you talking about segmentation of clinics along the spectrum of care? Meaning, we have referral practices, we have, sort of, white glove concierge practices, we have more community focused practices. Or are you talking about, within a single practice, we should have, sort of, a variety of these services. How does that manifest?

Dr. Carolyn Brown:

I think it’s both. I think that there are certainly practices that are more geared to clients who come to the practice and expect very state-of-the-art care and are willing and able to pay for it. And there are clinics, at the other end, which I refer to as access to care clinics, that work with people and pet owners who have limited resources. But within any single practice, one should be able to offer a range of options, because there is no one treatment option that is the correct one for every patient and every family in a specific situation. And the options that we give should be tailored to that pet and that family’s needs.

Dr. Andy Roark:

When we start talking about spectrum of care, I hear a lot of people, sort of, say, is this a new idea? Haven’t veterinarians done this traditionally? And so, let me put that forward and say, how is, sort of, a spectrum of care approach different from what we’ve always done in vet medicine?

Dr. Carolyn Brown:

So, yes, veterinarians have always offered treatment options and we’ve always offered them, kind of, with our backs against the wall because we have to, not because we believe in them, not because we believe that there are multiple treatment options that are good medicine for each patient. And not because we believe that clients may want to choose different options, even if they are able to afford a certain option, they may choose another because that one fits better with their goals of care for their family and what they want for their pet.

Dr. Andy Roark:

So, when you put this forward, it’s not just about financial accessibility to you, it is very much about, sort of, a cultural fit or fitting. How did you put the values that they have for care for their pet, the family?

Dr. Carolyn Brown:

Yeah, exactly. And veterinarians generally assume that, the best treatment option for every pet is the most expensive, intensive and advanced. And there’s a lot of reasons why we think that, right? We think that because in society, usually, the most expensive thing is the best thing, so we’re a little brainwashed that way. And we also think that because our veterinary school training is done mostly at tertiary veterinary hospitals that have all the specialists and not only specialists but the best specialists, who are writing the books and the textbooks and the articles. And so, we come out of that school and we believe that there is one best treatment for every condition and that’s just not true.

Dr. Carolyn Brown:

It’s not true scientifically, there is very few conditions for which there is one proven best treatment option. And even if there is, what’s important to each family and what their goals of care for their pet are and what they would like to see happen for their pet, may be different than that best treatment. Even if it’s not about money, it might be about the pet’s temperament, that that pet doesn’t do well in the hospital. And so, if the treatment requires multiple visits or hospitalizations, the owner may choose not to pursue that treatment.

Dr. Andy Roark:

Yeah. This is why I wanted to have this conversation because I think you’re really hitting on things that I’ve seen in medicine, since vet school, that have been, sort of, the black and white model, that I felt like was, sort of, put forward was, a patient needs to be hospitalized and not hospitalizing always made me feel guilty. Even when I look at the specific situation, I look at the needs of the pet owners, I look at what they’re going to let me do. And I go, boy, treating this pet outpatient is going to be… First of all, it’s going to be what happens. And it’s just like, this is how this is going to go. And honestly, when I weigh the pros and cons, outpatient treatment just makes sense in this specific case.

Dr. Andy Roark:

But I feel like, a lot of us as veterinarians have this, sort of, guilt that was put on us in our training of, the gold standard medicine is the best medicine and we should always be striving to do the gold standard of medicine. Which means, if you don’t do the gold standard, then you’re coming up short. And as I’ve practiced years and years, I’ve come to really get a bad taste in my mouth about that idea and I, sort of, reject that idea that the highest standard of medicine is the “best medicine.” It just seems so case dependent to me. Do you agree?

Dr. Carolyn Brown:

Yeah, absolutely, it is. And there are a lot of barriers to veterinarians really successfully practicing a spectrum of care. And one of them is exactly what you said, it’s our own guilt and our own anxiety about strain from that gold standard that was placed in our brain so long ago. But in order for veterinarians to really effectively practice standard of care, to benefit their patients but also to benefit themselves and decrease their own stress and anxiety about practice, we have to embrace that multiple treatment options represent good medicine, that there’s not just one. What I hear a lot from veterinarians, when I talk to them, when I talk to veterinarians who work at access to care practices who are practicing or striving to provide lower cost medicine. One of the things I hear often is that, they feel like they are cutting corners, that they are making decisions or providing care that is substandard. And we really need to move away from that, we really need to accept that there are many different treatment options that represent good medicine.

Dr. Andy Roark:

Well, now we’re in the weeds, I think, a bit. So, I completely agree with your point about the training. I had Dr. Michael Blackwell on the podcast a couple months ago and we were talking about pet health equity and getting care for everybody and making it accessible. And he talked, I think, the words that he used that I liked were, we were in vet school sitting at the feet of the specialists and I do feel like that’s, kind of, a pretty good analogy for what it’s like in a lot of our training. And I like that you put, we are trained by specialists and we’re trained by specialists who write textbooks. And so, I think that that pressure is definitely there. When we talk about cutting corners and that feeling of cutting corners, when I said, we’re in the weeds now. I think that’s a murky part of our profession, isn’t it?

Dr. Andy Roark:

So, we talk about the standard of care and maintaining the standard of care and not going underneath the standard of care and then we talk about cutting corners. The problem is, nobody knows what the standard of care is. And I don’t know that it can be defined and it’s always changing but it’s how we’re measured. So, I think one of the pushbacks against accessibility in pet care, in some degree, is people go, well, I don’t want to get sued or I don’t want to end up in front of the state board because I didn’t do the thing that is a higher standard, I didn’t do a higher standard of care. And I don’t think either of us are saying, don’t offer people the option of doing higher standards of care, I think that that’s required. But there is, kind of, this nebulous, what is the standard of care? And that really determines whether or not we’re cutting corners.

Dr. Andy Roark:

How do you navigate that when people say, well, I don’t know what… no one wrote down what is reasonable and it’s highly subjective. How do we feel good about a spectrum of care when we don’t have a clean, clear standard of care?

Dr. Carolyn Brown:

Yeah. That is one of the big… That has been one of the things that it causes a lot of anxiety for veterinarians, right? Figuring out where that point is. And I think one of the things that happens is that, veterinarians default to the gold standard, to be sure that they are, at least, meeting the standard of care as defined in their practice act. But I think that one of the ways that we can let go of that anxiety is to understand that, all of those bad outcomes that happen, that veterinarians get sued, that their licenses get challenged, that there are bad reviews about them online, are mostly not about the medicine that they practice. Those complaints, those disgruntled clients, are happening mostly because of communication and because of a lack of bringing the client into the process and inviting them to be part of the decision-making process and being clear on what the expectations are of different treatments and different outcomes.

Dr. Andy Roark:

Yeah. That’s so true. The number of board complaints we see tied to communication or as you say, being left out of the process and feeling surprised by how things went or feeling uninformed. I think that we understate that in our own minds and we overstate what role the actual medicine plays in ending up in those cases. You’re a whole lot more likely to end up with a board complaint because of how you communicated something, than how it actually turned out medically, in my experience. And, again, that’s not giving a pass to negligence, in any way shape or form, but I really resonate with your statement about this being a communication. And I always say, part of this is about building and maintain trust, right? It’s understanding where people are and giving them options and supporting them in their decisions, as they go along.

Dr. Andy Roark:

Hey guys, I just want to jump on in here real fast and share with you some quick news from across the Dr. Andy Roark and Uncharted Veterinary conference world. Over at the Uncharted Veterinary Podcast, Stephanie Goss and I are breaking down, what’s it like to jump from a small practice to a big practice? We’ve got a manager who is in a small practice, looking at what it’d be like to be a manager in a big practice. And she’s feeling a bit overwhelmed by the possible change and Steph and I talk to her about what you need to know to move between small and big practices. If you ever thought about making a change from a big to a small or small to a big, it’s a good episode to run through, I think it’ll make you feel pretty good about yourself in your knowledge and your skills. Also, on the Uncharted side, if you have not registered for our Uncharted Culture Conference, you’re about out of time. It is going to run October 21st through the 23rd, it is all about culture.

Dr. Andy Roark:

This is for team leaders who love culture, who love having a great place to work, who love making their staff happy, who like that go to work in a place that makes them feel good about the fact that they spend a tone of their time there. If you are a culture practice, you should be here. You should be here and you should hang out with other people who are all about culture. And so, that’s what we’re doing. It is a virtual event, so zero travel time. I’ll put a link down the show notes, you can always head over to unchartedvet.com and find more or information. Let’s get back to it.

Dr. Andy Roark:

How do you see this, sort of, unfurling in the future? So, let’s say that spectrum of care really is embraced by that medicine and by individual practitioners across the country. What does that look like, in your mind? How is a world where this is the norm, how does it differ from what we have now?

Dr. Carolyn Brown:

So, moving forward, the first thing that should happen when we’re deciding what treatment options to present to owners and clients is that, we should be having conversations with them about what they would like to see. What are their goals of care? What’s important to them? What do they think is important to their pet’s happiness? And how would they like to see things going forward? We also need to, right upfront, have conversations with owners about, what are their resources? What are they financially able to put toward the care of their pet? And another big resource that we miss is time, right? So, how much time are they able to devote? Are they able to come for many visits and spend time at home doing treatments? And so, the first thing is to have that, kind of, open conversation, invite clients to tell you their story, tell you about their pet, tell you about what is going on and what their goals are and what they would like to see happen.

Dr. Carolyn Brown:

Then, ideally, the veterinarian would take that information and on the other side of their brain, they would have all of the treatment options that are available. And what the veterinarian would do at that point is match the closest treatment option to what the owner is describing as what would match for them and present that treatment option as the first option. Not that you don’t present other options but you start with something that seems like it will match what the owner is looking for and their resources and then, work out from there. Traditionally, what we do now is start with the gold standard, right? We all present the gold standard first and whether we know it or not, we are influencing clients and imparting in them that, that is the best treatment and that is the one we think they should pick, that very first one that we chose.

Dr. Carolyn Brown:

And we know that because in human medicine, when people are making decisions about their own healthcare, the physician has a lot of influence. And we also know that when people are presented with a list of options, they just naturally gravitate toward that first choice. So, if the first choice is the gold standard, we’re communicating, consciously or subconsciously, to the client, that that’s the one, that’s the one they should pick. But if we start with one that better matches their goals of care and their resources, they have the freedom, the permission, to choose the one that is actually best for them.

Dr. Andy Roark:

Do you think there’s a danger of, that’s using spectrum of care as a justification to not advocate for a higher quality of care for pets? My concern is, if you gave me the out, would I get lazy over time and not advocate for a higher standard of care and just justify to myself and say, well, I gave them a spectrum of care and the first thing was some subQ fluids, some antibiotics and we’ll see what happens in the next couple of days. I always feel like we have to get up to advocate for our patients. Is there a danger of using spectrum of care to abdicate that position of advocate?

Dr. Carolyn Brown:

So, I think there’s two points here. One is, definitely offer the gold standard, the most expensive and intensive treatment. That should not be left off the list but it shouldn’t be the first thing on the list. The second thing, and I’ve had a lot of conversations with colleagues about this, about the idea that, as veterinarians, our job is to advocate for the patient, right? That we are there to make sure they get the best care possible. And my attitude toward this is always or has become, over time, that advocating for something that is not possible for that pet is not really helping them. All it’s doing is making their owner feel inadequate, shameful that they can’t provide what their pet needs and not creating a good environment for the relationship between the veterinarian and the client.

Dr. Andy Roark:

No, that’s a great answer. I’m going to sit with that a bit. I like that a lot, I think that that’s totally… I think that’s a great approach. How would we change the way that we train doctors, in order to implement spectrum of care and to better prepare graduates for this? One of the things that I see with a lot of young graduates, I see frustration in their first jobs when they come out and they’ll go to a rural practice. And I’m not saying, not all rural practices, but they will go to an underserved community, they will go to, how’d you put it? Access to care practice. And it’s not at all like what they were trained on in vet school and I think that there’s a whole lot of uncertainty in that. And that, sort of, feeling of I’m cutting corners.

Dr. Andy Roark:

Well, if you did the medicine you’re doing now in vet school, yes, you would 100% be accused of cutting corners. But the reality is, this is a very different type of medicine and you are dealing in the realities of the community that you’re working in. How do we change training to help people grasp that? And also to have the knowledge to practice across the spectrum.

Dr. Carolyn Brown:

That’s a really good question and something that we struggle with a lot at the ASPCA. There are veterinary schools that are working really hard to update their curriculum, to include work in underserved communities, to include more realistic scenarios of what students will find when they go out into practice. What we try to say or the way that we try to frame it to our new veterinarians is to say, in order to really practice veterinarian medicine well, you could have lots of bells and whistles, you could have lots of diagnostics and you could just read out results but the real art to being a veterinarian and the real skill is learning how to take a really, really good medical history, so that you can get the clues from a client that you need to figure out what to do. Learning how to do a really, really sensitive exam so that you can pick up everything that you need to and being able to come to conclusions about what’s going on with that pet, through those means, rather than just shotgun testing everything at the pet.

Dr. Andy Roark:

Yeah. That’s fascinating. I really love that, the history and the physical examination as guiding diagnostics. We’ve heard concern in the vet community, over probably the last decade or two, about a move away from emphasizing the physical exam towards shotgunning diagnostics. And I think your point about this is a starting position of, gosh, I think that makes so much sense. It feels very actionable as well. One of my favorite things to do with vet students when they come and visit the vet clinic is, I will, at some point, take them aside and I will pick up a pet and I will put the pet in front of them and I will say, this is my pet and I’m giving it to you to do a physical examination. And the physical examination costs $62 and I want you to show me a $62 physical examination.

Dr. Andy Roark:

And I think that sounds like a financial challenge and I don’t mean it to be other than, what I’m really saying is, I want you to show me the value. I want you to show me… I’m giving you a number to put in your mind but I want you to show me a value in this physical examination. And it’s always fascinating because there are vet students that absolutely rise to the challenge immediately and they start to ask me questions about my lifestyle with my pet and what I do with my pet and they’re examining the pet and they’re telling me what they’re doing. And there are other students who really seem to, kind of, freeze and not know how to respond to that or how to get started.

Dr. Andy Roark:

And I do it not to see their response but I do it because it’s my way of really tying to drill home the importance of that physical examination and that rapport with the pet owner in, sort of, a tangible way. And I do it when they’re visiting from vet school, so that they can still go back to vet school and think about it and practice and get that, sort of, ironed out. So, no, I love it. Are there ways that you see people getting this wrong? Meaning, people who are experimenting with spectrum of care, they’re trying to be more accessible to pet owner and they’re stumbling or they’re missing tricks. Is there anything like that, that holds people up?

Dr. Carolyn Brown:

So, the best way I can answer that is to tell you how I got derailed in my own career. And it has to do with what we talked about a little bit earlier, with offering the gold standard as the first treatment. And clients automatically wanting that and really… you could see on their face, you could feel it, how bad they felt that they were not able to provide that to their pet. And I would often then have to backtrack in my conversation with the client and say, hold on, if you had all the money in the world, maybe you still wouldn’t want to do this. It requires a lot of time away from your pet, your pet may be painful or have a long recovery, maybe you wouldn’t want to do that anyway. But by putting that choice first, I opened up that door so that the client would feel that.

Dr. Carolyn Brown:

And I spent a lot of the rest of my conversation with the owner, trying to make them feel better about the choice they ultimately were going to take. And I think, that’s really the crux, to me, that’s the crux of the problem, is that we are so focused on making sure, number one, we cover our own butts by making sure we’re offering that gold standard and documenting that the client has refused it. And also, trying to make sure that we don’t feel that anxiety about the level of care that we perform, that we’re offering that care first. And I think really getting into the mind of the owner and offering the options in a way that really gives them the freedom to decide what they want. And sometimes we have experiences in our own lives and with our own pets that, kind of, highlight what we’re trying to do with others. And is it okay if I tell you a story about one of my pets?

Dr. Andy Roark:

Oh, please.

Dr. Carolyn Brown:

About 10 years ago now, I had a 12 year old Cocker Spaniel and I was giving her a bath and I felt a little nodule at her anal gland. And within a week or two, I had done an excisional biopsy and sent the sample off. And the biopsy came back as an anal gland adenocarcinoma and it had clean margins but the margins were very narrow. And I was able to have a consultation with a veterinary oncologist and she told me that, what she recommended was that, I go back in and do a wide excision. There’s not a lot of space around this anal gland, as that’s not a little dog. Anal gland [inaudible 00:28:16] on a little dog but she said, I should go back in and do a wide excision and then, follow up with radiation. I certainly had the financial means to be able to do that, I also had the time to do it.

Dr. Carolyn Brown:

The field that we work in, our employers are generally very, very understanding of our needing to take time off to care for our pets. And I thought about it a lot and decided not to do it. I decided, based on not wanting to put the dog through it, other things that were going on in my life at that time, I decided I was just going to watch it. I wasn’t going to do either of those things. And sometimes you make those choices and they have happy endings and sometimes they have sad ending. And I was very lucky that it was a happy ending, that she lived for another five years and passed away from something unrelated to anal gland adenocarcinoma and never heard from it again. But I think if I did not have the knowledge I had, if I were not a veterinarian, I would’ve had a much harder to choice or felt much more guilty about not taking the path that was laid out by the oncologist.

Dr. Andy Roark:

Yeah. No, that’s a great story. It resonates, I think, with almost all of us. I think we’ve all seen cases where we know what the gold standard of care is and we also know that if it was our pet, we probably wouldn’t go that way, for different reasons. So, I think that makes a ton of sense. Thank you so much for being here, Dr. Carolyn Brown. Your article in JAVMA, spectrum of care, more than treatment options, just came out this month. I’ll put a link to it in the show notes. Where can people learn more about you, the Community Medicine Department and/or the ASPCA?

Dr. Carolyn Brown:

So, there’s information about the article at aspcapro.org/research, where you can see an overview and also see links to other information about access to care and community practice. And if someone has questions for me specifically, I can be reached at carolyn.brown@aspca.org.

Dr. Andy Roark:

Thanks so much for being here. Guys, that is our episode, I hope you enjoyed, I hope you got something out of it. As always, if you did, please share it with your friends and honestly, the other thing you could do, that’s always a big help for me, is write an honest review on iTunes, wherever you get your podcast. It helps people find the show, it gives us some feedback, it’s a nice little pat on the back for me and the team for putting on the podcast every week. So, anyway, guys, take care of yourselves. I hope you’re getting ready to have a great Halloween and that things are going pretty darn well in your practice. All right, stay safe everybody. Bye.

Dr. Tina Wismer (Senior Director of the ASPCA Animal Poison Control Center) and Dr. Andy Roark discuss the recent spike in house plant poisonings in dogs and cats, where this increase is coming from, and what steps doctors and technicians can take on the phone and in the clinic to address it.

LINKS

Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688

Empowering Your Team to Get Positive and Stay that Way (Workshop) Oct 9:: unchartedvet.com/product/empoweri…d-stay-that-way/

Uncharted Culture Conference Oct 21-23: unchartedvet.com/uvc-culture/

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

What’s on my Scrubs?! Card Game: drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Tina Wismer, DVM, MS, DABVT, DABT, is the Senior Director of the ASPCA Animal Poison Control Center. She earned her undergraduate degree from Ohio’s University of Findlay and received her DVM from Purdue University. Dr. Wismer worked in both small animal and emergency practice before joining the ASPCA Animal Poison Control Center in 1998. Dr. Wismer is a Diplomate of the American Board of Toxicology and the American Board of Veterinary Toxicology. She is an adjunct instructor at the University of Illinois, a visiting professor at St. Matthews University (Grand Cayman), a consultant for VIN (Veterinary Information Network) and a Master Gardener.

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

SHOW TRANSCRIPT

Dr. Andy Roark:

Welcome, welcome, welcome to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, today I sit down with my friend, Dr. Tina Wismer, from the ASPCA Poison Control Center, and we talk about the spike in house plant-related toxicity. Why is it happening? How big is the spike? What is it coming from? What are the house plants? What should we say to pet owners? What do we need to know for when these cases walk in the door? Guys, we get into it fast and furious. Just get it done. Give you some pearls that’ll make you smarter on your way to work. Isn’t that what we’re all here for? Guys, let’s get into this episode.

Kelsey Beth Carpenter:

This 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, Dr. Tina Wismer. Thanks for being back on the podcast.

Dr. Tina Wismer:

Thanks for inviting me.

Dr. Andy Roark:

Always. I always love it. I like to stay up-to-date in my toxins and just be prepared for what might walk in the door, so thanks for being here.

Dr. Tina Wismer:

Thank you.

Dr. Andy Roark:

I wanted to ask you about a trend in medicine over the pandemic. I’ve been reflecting back on the pandemic in the way that life is a little bit different now than it was before. I think it’s a fascinating exercise. House plant toxicosis is a growing trend. We are seeing more pets, dogs and cats, that are coming in after ingesting exotic plants. First of all, let me just ask you, is that true? And how do we know that?

Dr. Tina Wismer:

Yeah, it’s certainly true. Looking at our numbers from 2019 through end of 2020, we had almost 10,000 more plant-related calls in 2020 than we did in 2019, so a huge increase in our number of calls.

Dr. Andy Roark:

Just real quick. I’m assuming that people picked up indoor gardening as a pandemic thing. Is that the theory?

Dr. Tina Wismer:

Certainly. We saw a lot of people who decided that, okay, I can’t go outside. I can’t do things. Let’s bring the outside in.

Dr. Andy Roark:

Well, I live that. I have tomatoes for the first time ever, and my dog is an absolute monster and just eats… I haven’t gotten to eat any of the tomatoes. I haven’t gotten to eat any of these tomatoes. I had a bunch of tomatoes. My dog ate them all. I planted… For some reason, I planted one strawberry plant thinking that it would spread or it would have a lot… It did not. It made exactly one strawberry, and a squirrel ate it. That’s been my entire gardening experience from the pandemic. I am out of home gardening based on this one year. Okay. Indoor plants. What are the most common problem-solving house plants that we’re seeing?

Dr. Tina Wismer:

Right. Probably the biggest popularity during the pandemic was seen in succulents. When we think about succulents, it’s a pretty huge group of plants.

Dr. Andy Roark:

Right.

Dr. Tina Wismer:

But the nice thing about them is they’re really easy to take care of, right? They need a little bit of sun, you water them every few weeks, right. They’re really low maintenance.

Dr. Andy Roark:

Mm-hmm (affirmative).

Dr. Tina Wismer:

Fortunately, they’re also not very toxic.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

When we did have dogs and cats getting into them, you can see some mild stomach upset, but fortunately, that’s about it.

Dr. Andy Roark:

Okay, so lots of concern calls. Do you do anything for those? When you get that phone call and they say, oh, my cat or dog ate a succulent, anything you’re going to do other than just tell them to watch it and let us know if you need supportive GI care?

Dr. Tina Wismer:

Right. We may dilute with a little bit of milk or water if they’re not vomiting yet. Then if they do start vomiting, we’ll have the owners take away food and water for an hour or so. If they continue to vomit through that, then they get to come and see you at the veterinary clinic.

Dr. Andy Roark:

Talk to me a little bit about the dilution with milk or water. What exactly do you say to pet owners? I imagine a gallon of milk and a small cat and just hilarity or horror ensuing.

Dr. Tina Wismer:

Exactly. We do give recommendations for how much to give, and typically it’s a milliliter per pound, so a teaspoon of milk per five pounds of animal.

Dr. Andy Roark:

Is the goal to induce vomiting? I’m assuming that that’s not where we’re going with this. We’re just saying, just give them this amount and… Do they expect something to happen, or do we just tell them, just give it and then just wait and see what goes? Yeah. What are the expectations in the outcomes?

Dr. Tina Wismer:

Sure. With dilution, the expectation is to decrease the irritation to the stomach.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

A lot of these plants, like your succulent plants, may contain… They have white sap, which is irritating and somewhat related to soap compounds.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

If you think about your mother washes your mouth out with soap, you could see some gagging and vomiting, but it’s not expected to be serious. By diluting that out with some milk, we can hopefully stop you from having vomiting.

Dr. Andy Roark:

Great. I found that when my mouth was washed out with soap, adding water just made it worse. It was just more bubbles, more prolonged flavor, but no, I’m with you. Okay, cool. Succulents. Very, very common. Not a big deal. We’re coming out the other side pretty well. Are there more dangerous house plants that we’re seeing increases in?

Dr. Tina Wismer:

Yes. Probably one of the most dangerous house plants are actually these cute little potted sago or cycad palms. These actually can cause liver failure in both dogs and cats. They typically were used outside in the warm areas of the country: Florida, Texas.

Dr. Andy Roark:

Yeah.

Dr. Tina Wismer:

But you can now go to places like IKEA or Home Depot or Lowe’s and buy these little potted sago palms.

Dr. Andy Roark:

When I used to live in Florida, sago palm toxicity was something that we really worried about, and we definitely saw it. Help me understand. A potted sago, is it a miniature version? Is it a tiny thing? Is this a floor sitting plant? Help me get my head around this. I’m not familiar.

Dr. Tina Wismer:

Yeah. Most of these are actually the miniature versions. They typically sell them in a four to six inch pot, and they stand about eight to 12 inches tall.

Dr. Andy Roark:

Okay, so tiny. Yeah.

Dr. Tina Wismer:

Yeah. They’re not as toxic as the ones that grow outside, because the ones that grow outside, the most toxic part is the nut, or the fruit, that they make.

Dr. Andy Roark:

Right.

Dr. Tina Wismer:

These, of course, don’t mature enough to reach that point, nor do they have one of each sex to make the fruit.

Dr. Andy Roark:

Mm-hmm (affirmative).

Dr. Tina Wismer:

They certainly can still cause liver problems, but we don’t see the severe death that we see with the versions that are outside.

Dr. Andy Roark:

We’re mostly seeing pets eating the leaves, picking up the whole thing like a big chew toy, mouthing of the plant. Okay.

Dr. Tina Wismer:

Yeah.

Dr. Andy Roark:

Not super severe. What type of clinical presentation is this going to have? Again, I’m familiar with the sago palm, the big outdoor… I was always afraid of… The fruit is really the scary part for me. When the pet owner calls me, what are they going to tell me they’re seeing?

Dr. Tina Wismer:

Sure. We could see vomiting, sometimes with blood. If it’s been going on for a day or two, they may have decreased appetite. They may be anorexic. As we said, potentially bloody vomiting. Lethargy, so they need to come in and see you.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

When you check their blood work, they’ve got issues with their liver.

Dr. Andy Roark:

All right. General maintenance on is just going to be supportive liver care, lots of fluids, hospitalization.

Dr. Tina Wismer:

Yep. Fluids, monitor our liver values, liver protectants, and time.

Dr. Andy Roark:

Walk me through the use of liver protectants in case like this. What expectations you set for the pet owners?

Dr. Tina Wismer:

Sure. With sago palms, we typically use a combination product that includes both SAM-e and denamarin.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

Excuse me, SAM-e and milk thistle, so denamarin is the common trade name. What that helps with is to provide glutathione.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

That helps the liver heal, and it also helps reduce the reactive oxygen species that occur when we have liver damage.

Dr. Andy Roark:

Okay. About how long do you usually tell people that they’re going to be on these medications?

Dr. Tina Wismer:

Most of these guys are hospitalized for two to three days, and then we send them home on the medication for usually a couple of weeks.

Dr. Andy Roark:

A couple of weeks. Okay, and then just continue to monitor liver values and then take them off when you’re back to normal. Okay.

Dr. Andy Roark:

Gang, I just want to jump in here real fast with a couple quick announcements. Over at the Uncharted Veterinary Podcast, Stephanie Goss and I are talking about letting go of the guilt. We’ve got a question from the mail bag for a young doctor who needs some things to change in her practice. She’s asked about them changing and she’s asked that they change, and she’s not seeing anything. She’s feeling like this is not what she was promised, but she’s really struggling with guilt about just being like, hey, I’m out of here. How do you process through that? How do you know when it’s time to leave? How do you know when it’s time to push harder to get what you need?

Dr. Andy Roark:

We break that down so you can get that wherever you get podcasts. Unchartered Veterinary Podcast. It’s coming out this week. Over on the Uncharted Learning side of the house, we have workshop this Saturday, so two days from the day this podcast comes out. Empowering your team to get positive and stay that way, that’s October the ninth. It is a two-hour workshop is with the amazing Dr. Tracy Sands. I’ll put links down below, but buddy, you better get on that fast, because it is going to close. But if it closes and you’re like, ah, I didn’t make it, hey, don’t worry. It’s not the end of the world. We have the Uncharted Culture Conference. It’s October 21st through the 23rd. It is full-day virtual conference. It is all about getting a beautiful, wonderful, happy, healthy place to work. If your team is all about culture and you’re like, Andy, we have a wonderful place to work, I’m going to say, I’m just saying to you, we can go to the next level, because this is all about culture and the people who are going to be there are not people who generally have toxic cultures.

Dr. Andy Roark:

They’re going to be people who recognize the value in culture and love culture and love learning about culture. If you’re already rocking and rolling, hey, we still have good stuff for you. That’s going to be it for about now. As I said, I’m just going to let you guys go with that. I hope to see you at some of these events, and I will talk to you soon.

Dr. Andy Roark:

So far, the succulents. I totally saw succulents coming. Did not see potted palms coming.

Dr. Tina Wismer:

Potted palms.

Dr. Andy Roark:

Anything else?

Dr. Tina Wismer:

The other thing that we noticed during the pandemic is because we couldn’t get together, right, I couldn’t go to mom’s house for her birthday, I would send her a bouquet.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

So unfortunately, that meant we saw a lot of cats getting into lilies.

Dr. Andy Roark:

Okay, yeah. That makes a lot of sense. Can you review lily toxicity in cats? I know this is a classic. I think it’s always good to get a brush-up on what are we looking for, what are the presenting complaints, then what are going to be our staples of therapy.

Dr. Tina Wismer:

Sure. When we think about lilies and cats, they’re highly toxic. Even cats that just have pollen on them, they’re going to groom themselves off and become exposed and have kidney failure. Also, if they eat leaves or if they eat parts of the petal, they can get kidney failure. Typically, after exposure, within about two to six hours, they start to vomit. Then they become lethargic. You may notice an increased thirst and urination. However, as the days go by, they stop producing urine. They become anuric, and they die.

Dr. Tina Wismer:

Timeframe wise, we start to see our kidney values going up between about 12 to 18 hours post-ingestion.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

18 hours is this magic number. If we start to treat them in the first 18 hours, we have a good prognosis. If it’s after 18 hours, our prognosis goes down.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

Treatment. Most important part is fluids.

Dr. Andy Roark:

Mm-hmm (affirmative).

Dr. Tina Wismer:

We don’t know what the toxin is, but we know that it causes death of the renal tubular cells, and then this debris plugs up the tubules. It’s important that we keep up urine flow by using IV fluids.

Dr. Andy Roark:

OK. That totally makes sense. Can you… Talk to me a little bit about the 18 hours versus clinical signs. The hardest cases for me with toxins are when the pet is not yet showing symptoms and I’m trying to convince the owner, no, this is serious. And they go, no, look at her, she looks great. And I’m like, no, you’re not hearing me. This is going to be a problem. Yeah. When we look at this, at 18 hours, am I seeing clinical signs in the pet? Are we having vomiting? I know it’s a progressive condition. Yeah. Talk to me a little about that.

Dr. Tina Wismer:

Yeah. In that first 18 hours, we’ve usually started to vomit by then, and we may also be showing some increased thirst and urination.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

And lethargy. Yeah, it’s all about telling owners, okay, this is what we expect. This is what we need to prevent. Especially with lilies, I always tell them we don’t do kidney transplants in cats.

Dr. Andy Roark:

Yeah.

Dr. Tina Wismer:

At least not on a regular basis. We need to prevent it, otherwise, we may end up with a dead kitty.

Dr. Andy Roark:

Yeah. How do you quantify the plant toxins? Or do you even try? Do you just say when the pet owner comes in and they’re not showing any clinical signs and they’re like, oh, we have lilies on our table and I know that that’s bad, and I looked over and her nose was touching it, and maybe she ate a petal or maybe it just didn’t have a petal right there in that specific spot. I don’t know. Yeah. Do you even have those thoughts or are you just like, hey, look. It’s close enough that your cat’s going to spend the next 18 hours here on fluids and we’ll be checking renal values.

Dr. Tina Wismer:

Yes. Lilies are certainly that toxic that I would prophylactically start them on fluids before they show problems.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

Some of our other plants, we may wait until they show clinical signs, but lilies are not one of them. If there is a cat in the house and a lily in the house, I would treat them.

Dr. Andy Roark:

Okay, so lilies are a broad category, of course.

Dr. Tina Wismer:

Yeah.

Dr. Andy Roark:

I tend to think specifically… I, for whatever reason, white lilies are in my mind, are you just across the board lilies, tiger lilies, any type of lily that you would get from the florist, that’s a straight trip to the IV fluid line?

Dr. Tina Wismer:

That is a great comment. Lily, common name for lot of different flowers.

Dr. Andy Roark:

Right.

Dr. Tina Wismer:

We are talking about members of the Lilium family, so it is. It’s tiger lily, Easter lily, those beautiful stargazer lilies that they use in bouquets, they’re the pink with the little dots in them, all of Asiatic and Oriental lilies are Lilium and are problematic.

Dr. Andy Roark:

No, that’s good to know. Yeah. I’d always assumed a lot of the Asian lilies were problematic. That’s just not the generic lily that’s in my mind, so that’s good to know.

Dr. Tina Wismer:

Let’s just say, if you’re thinking about something like peace lily or calla lily, those are considered to be toxic plants, but they’re not kidney toxic in cats. It has to be a Lilium.

Dr. Andy Roark:

Okay. Are there any mistakes that you see general practitioners making with some of these toxins? If there was one thing you would say, look out for this, or this is a mistake that I see doctors make sometimes, what would you point to?

Dr. Tina Wismer:

Right. I think part of the issue is we have owners that look online or we look online and see, hey, this plant is toxic.

Dr. Andy Roark:

Mm-hmm (affirmative).

Dr. Tina Wismer:

With dogs and cats, many times with toxic plants, they don’t eat enough to cause problems.

Dr. Andy Roark:

Right.

Dr. Tina Wismer:

Unlike grazing animals. Horses, cattle, they can certainly get themselves into severe trouble. We probably see animals being over-treated when they don’t need to be. We know that inducing vomiting or giving a dose of activated charcoal, it can have adverse effects. It’s not benign therapy.

Dr. Andy Roark:

Okay. I want to unpack that a little bit because that’s really interesting me. That’s always been something I have looked at. I have wrestled with, the hey, I just want to get this checked out or just calling, nothing’s happening, but I did notice this. I am always wary of being a bit chicken little-ish of you have to come in and get this done and then nothing happens and the pet shows no clinical signs at any time, and the pet…

Dr. Tina Wismer:

Mm-hmm (affirmative).

Dr. Andy Roark:

I always feel like that’s a strain on the trust in our relationship with the pet owner. At the same time, I also do not want to regret not being aggressive enough. I really do feel pinched sometimes between not wanting to, not blowing this off, and also not going overboard to the point that the pet owner looks sideways at me, like do we really need to do this? Yeah. Can you help me with that? Are there general guidelines or thoughts that you have when you’re in practice that help guide you in that situation?

Dr. Tina Wismer:

Right. I would say that it’s going to depend. We’re talking about plants, right? It’s going to depend upon what type of plant. If it’s a sago palm or if it’s a lily in a cat, you probably can’t over-treat them.

Dr. Andy Roark:

Okay.

Dr. Tina Wismer:

But with our others, a lot of times, things like rhododendrons and azaleas… If you look in the tox books, it talks about severe cardiac signs and death.

Dr. Andy Roark:

Yeah.

Dr. Tina Wismer:

Dogs and cats, typically, they just have mild stomach upset because they don’t eat enough to be a problem. In those cases, what I usually recommend is for the owner, if they’re going to be home, to watch them. You’re going to watch them for four to six hours. If there’s any vomiting, then we’re going to go see the veterinarian, because we’re going to see vomiting before we see any of the cardiac signs.

Dr. Andy Roark:

Yeah. I love that, and I love that example, rhododendrons and azaleas. That’s exactly what I was talking about, from South Carolina… I’ve always lived and practiced on the East Coast, and there’s a whole lot of people that have azaleas as the fixture focal point of their landscaping. For one week out of the year, their house looks amazing because of its beautiful azalea… And then it’s just green plant. They’re super, super common, and the number of times that an anxious pet owner is… Generally the hyper-aware pet owner, this is their first dog, you know what I mean?

Dr. Andy Roark:

And they’re like, I looked… He was chewing on a branch outside and I looked it up and it said azalea branch, and now I’m very worried. When you look at it, it looks really severe. And I go, I have never seen a pet blow up from azalea or rhododendron, and I’ve always been around them, and I’ve seen those goofy dogs carry those branches around with… I just have never seen it go sideways, and so I’ve always wondered about exactly that.

Dr. Tina Wismer:

Yeah. Dogs and cats, not a big problem, but if you’re one of these people that has goats or horses or cattle, sheep, it’s definitely a problem.

Dr. Andy Roark:

Tina, thank you so much for being here. I really appreciate your time. Where can people learn more about you? How can they interface with the ASPCA?

Dr. Tina Wismer:

Sure, aspca.org, and we actually have a nice plant list of both toxic and non-toxic plants divided by toxic for dogs, toxic for cats, and toxic for horses.

Dr. Andy Roark:

That’s awesome. Thanks so much.

Dr. Tina Wismer:

You’re welcome.

Dr. Andy Roark:

And that is our episode. Guys, I hope you enjoyed it. I hope you got something out of it. I like these “how do you treat that” episodes. I think they’re really useful. I think they make me a better doctor. I hope that they make you guys better doctors and technicians. If there are topics you wish that I would cover, shoot me an email. The email address is podcast@drandyroark.com. That’s podcast@drandyroark.com, and I will talk to you guys next week.

On the 100th episode of the Cone of Shame Veterinary Podcast, Dr. Andy Roark talks with Jamie Holmes RVT, Administrative Manager at DrAndyRoark.com and Uncharted Veterinary Conference, about the start of the podcast, where it’s going, and why the stories we tell ourselves matter so much.

LINKS

Uncharted Podcast on iTunes: podcasts.apple.com/us/podcast/the-…st/id1449897688

Empowering Your Team to Get Positive and Stay that Way (Workshop) Oct 9:: unchartedvet.com/product/empoweri…d-stay-that-way/

Uncharted Culture Conference Oct 21-23: unchartedvet.com/uvc-culture/

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

What’s on my Scrubs?! Card Game: drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Jamie Holms is a licensed RVT with an extensive background in veterinary emergency and critical care. Jamie is an administrative rockstar, organizational aficionado, tea geek, and workaholic – not necessarily in that order.

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

SHOW TRANSCRIPT

Dr. Andy Roark:

Welcome, welcome, welcome to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, it’s the 100th episode of The Cone of Shame. I can’t believe it, 100 episodes. In this episode, I jump on with my dear friend, the administrative manager at DrAndyRoark.com and Uncharted Veterinary Conference. My go-to person, my right hand, the person who keeps me in line and helps me get all this stuff done, Jamie Holms. Jamie Holms is, I just can’t say enough good things about Jamie Holms. She is one of my favorite people. I talk to her about every day, about what we’re doing with Uncharted and with Dr. Andy Roark.

Dr. Andy Roark:

Anyway, she is somebody that I spend a lot of time parsing through ideas with and thoughts with. So I asked her to be on for our 100th episode, and we talk a little bit about where the podcast came from. We talk about what makes a good idea in your practice and in your career. Then we really get into an article that I have coming out. It’s about the stories that we tell ourselves, and why these internal narratives matters so much. Guys, that’s the podcast today. I hope you really enjoy it. Without further ado, 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, my dear friend, Jamie Holms. Thanks for being here.

Jamie Holms:

Oh my gosh. I’m so excited.

Dr. Andy Roark:

This is the 100th episode of The Cone of Shame Vet Podcast. I am actually… I’m having emotions. I’m having feelings about 100 episodes of The Cone of Shame Podcast. This has been a super fun and rewarding project, that I kind of started on a lark and was like, “I hope this works. We’ll see if people listen to it.” It has surpassed The Uncharted Vet Podcast, which is the first podcast that I started, as far as popularity and reach. Oh man, what a wild ride it’s been.

Jamie Holms:

Man, I remember those conversations on morning walks where we were like, “I wonder if anyone’s going to listen to this. Do you think this will work?” I would listen to this if this was available to me at this point in time, especially about the, how do I treat that?

Dr. Andy Roark:

Yeah. That was the thing for me. I found in my career that ideas where I genuinely say, “I would do this. I would pay for this. I would listen to this.” Those ideas work. They really work. When I have ideas where I’m like, “I wouldn’t really do this, but other people will.” Or I see trends that say that people want this. I wouldn’t want it, but that’s what they want. I’m not saying that I am the connoisseur of all tastes. I will tell you, whether it’s services at practice, whether it’s curbside, whether it’s texting, whether it’s booking appointments online, or whether it’s creative stuff of funny videos or online training or podcasts. If I wouldn’t honestly give my time to a thing, if I wasn’t making it, that’s usually a bad indicator.

Dr. Andy Roark:

I think part of it is just a value spot of, you would not get an hour of my time for what you’re proposing. That is a really good measuring stick of whether or not this thing is worthwhile. The other part is, maybe I’m just not the right guy. Whereas if I wouldn’t pay for this, then maybe I don’t understand it at a deep level. Maybe I’m not a big enough fan of the idea to really champion it well. I put that forward to a lot of vet clinics, especially people doing social media and stuff. I’m like, “Look, if you would not stop and read this post, it’s not good.” People go, “But pet owners would read it.” I go, “Hmm, maybe.” That’s sort of a subsistence level. If you really want to make something that people really like, make something that you would actually want to give your time to.

Dr. Andy Roark:

With Cone of Shame, the idea with Cone of Shame was… I told you this, I remember many times. I kept waiting for a podcast to come out that would be a half an hour long. That would be clinical stuff that I needed in the exam room, and not academic clinics. This is not throwing shade at anybody or any podcasts. There’s lots of great podcasts out there about lots of clinical stuff, and that stuff is great to know. My thought was always, “Hey, I want a podcast that if I listened for a half an hour, once a week, I’ll be better at my job.” My actual job, not just theoretically better, but what I do in the room will improve and get better.

Dr. Andy Roark:

That’s when we started off The Cone of Shame Podcast. It started a lot with the medicine stuff. How do you treat that? Then what I found was, I really enjoy having interesting conversations with people about vet medicine. Honestly, those episodes have gotten steadily more and more and more popular. The veterinary nurse practitioner episode from last week just went off like a shot. I go, “Wow, this is crazy. I can’t believe that we reach so many people, and it’s interesting to those people.”

Jamie Holms:

Yeah, absolutely. You had that conversation with Ken Yagi, who is a good friend of ours. I’m excited that he got to talk about something that he’s so passionate about. It’s such a great opportunity to share your passions with people. I love the perspective that the way that you came to this was by doing something that you wanted to participate in. I think we get that question a lot. How do you come up with these ideas? Where does it come from?

Dr. Andy Roark:

I mean, that really is the trick to all this, isn’t it? It’s just kind of looking at the vet space, or looking at your job, or looking at your life. Really starting to just think about, “What do I want, what would I do?” I mean, that sounds so simple, but I have found that to be the answer to so many things. Texting in practice is a great example, or online booking. I know that in my behavior I hate calling people on the phone, and I’m an extroverted person. I just go, “Oh, crap.” The idea of calling the doctor’s office to get an appointment for myself.

Dr. Andy Roark:

I go, “Oh,” but I’ll use their little website, which is really well-made, to jump on. Then they show me all the appointments, and I just pick the one that works for me, and then it’s done. I go, “Man, I use this.” When I start thinking about the practice, I go, “I would totally use this.” There’s other services. Again, I don’t want to roast any of them. There’s other services out there that are the classic example of a solution looking for a problem. You’re like, “I have never had the concern that you are trying to solve.”

Jamie Holms:

Yeah.

Dr. Andy Roark:

I have never really wrestled with that, and that is not something that I worry about. So I don’t know that I need a big solution to solve that problem.

Jamie Holms:

Yeah. I also am grateful to the pandemic for the opportunities that it’s provided to us. I love being able to fill the animals’ prescriptions through text messaging or an app. I love online booking, and I absolutely love texting with the practice.

Dr. Andy Roark:

The pandemic, for our profession, I think in the long-term is going to be a really good thing. That’s not to discount the personal hardships that people have had, of course. I really do think that our profession is going to benefit from getting shaken up the way that it was. Having people not be able to come into the building, so we experimented with curbside. I’m not saying that curbside is going to stick around forever. I think it will. It’s not going to be as prevalent as it was, but I think that there were a lot of people out there who were having problems. They don’t have a lot of space in their hospital. They were limited in what they could do by the number of exam rooms they had. All of a sudden, they were like, “Oh, this is another thing that we can do.”

Dr. Andy Roark:

It’s really curious. I’m hearing sort of split reviews. There are pet owners who are like, “There’s no way that you’re going to separate me from my pet. That’s not going to happen.” I hear other pet owners who are like, “If I can stay in my car on my phone, and listen to my own music, and you just take the dog and bring him back. I don’t have to be involved in that stress, sign me up.” It’s just interesting to me. I think things like that would never happen. There’s a ton of vet practices, a ton of vet practices who picked up texting because they were doing curbside service, or because the phones were just blowing up so much. It’s sort of like, necessity is the mother of invention. I think there’s a lot of things in the pandemic that have pushed us to do things that we wouldn’t otherwise do, or it would have taken 10 years. Some practices would never have gotten there. They just never would’ve made that jump.

Dr. Andy Roark:

I am optimistic about the long-term benefits of the pandemic. People say, “But, Andy, the caseload and we’re all so swamped. It’s been really brutal.” I go, “In the short-term that was bad. In the long-term, it’s good.” I think it’s good. It’s good for the financial health of our profession. Honestly, I think a lot of us needed to figure out some boundaries. This was the kick in the rear that we needed to do it. I think there’s a lot of those… I think we’re sort of a head space where a lot of people were like, “You know, we should really do a better job of unplugging and taking breaks. We should really do a better job of making sure our doctors get time to be away. We should really do a good job of making sure that, when our technicians request time off, they can get it. We should, and one day we’ll figure that out. Let’s go back to work now.”

Dr. Andy Roark:

That was just kind of how we lived until it became this flash point. This boiling point where it’s like, “Look, there’s no more, we should. It’s you do it, or you don’t do it. If you don’t do it, there is a material cost to that, and it’s going to be a smaller staff because people are going to leave.” I think that while it sucked in the short-term, I really do think it pushed us to get serious about taking care of ourselves. It couldn’t be one of those theoretical conversations anymore. We had to actually make changes, and I feel like a lot of practices have made changes.

Jamie Holms:

I agree with that. You and I talk a lot about perception and perspective, and how we see the world. I was hoping we could talk a little bit about the article you wrote recently about the stories that we tell ourselves, and how they matter.

Dr. Andy Roark:

Yeah. This is an article that we’re sort of looking at together. This is an article that’s coming out this week in Vet Team Brief. Or, not in Vet Team Brief, in Today’s Veterinary Business, another acronym. Today’s Veterinary Business, it was just a rearrangement of letters. In Today’s Veterinary Business about, the stories that we tell each other matter. I was thinking about what I see in our profession, and kind of the feeling that I get out there. I was looking around, and like I said, I think that where we’re going in the profession is good. I am big on changes that we’ve made. At the same time, I definitely recognize that there’s pain. I definitely recognize that people struggle. That burnout is very real. I see that.

Dr. Andy Roark:

When I look at social media, I see people making posts that say, “Check on your vet friends. They’re not okay.” I see posts to pet owners that say, “Please be patient. Know that we’re abandoning our families so that we can be with yours,” and things that. These are really heavy kind of dramatic statements. I look at them. I’ve thought a lot about them, because I see a lot of these. I think that they’re useful in that they’re a good barometer of where we are in our profession. You know what I mean? Where there are people out there who really are struggling, and there is sort of this feeling of being overwhelmed. I still have some concerns about posts like this and messaging like this that’s coming out.

Dr. Andy Roark:

The reason it just nags me is because I’m a huge believer in the idea that the stories that we tell ourselves really matter. The way that we see ourselves really matter. The way we present ourselves to the world, it matters. One, in how the world interacts with us. Two, the way we present ourself to the world is the story that we’re telling ourselves, or the things that we are making… They’re making themselves true for us. I wrote this article about the stories that we tell ourselves matter, just because I have concerns about the way that a lot of vet medicine talks about itself, and the perception that’s being put forward of who we are.

Jamie Holms:

No, I think it’s interesting. The first thing I think of when you say that the stories that we tell ourselves matter is, when you get up in the morning and you trip over the cat and you spill your coffee. You can either be like, “Yeah, I just spilled my coffee, and I need to make more coffee.” Or you can tell yourself, “It’s going to be a really horrible day.” Then you’re looking for all the horrible all the rest of the day, and you’re going to find it, right?

Dr. Andy Roark:

Yeah. Or you tell yourself, “I’m a klutz. I’ve always been a klutz. I wish I wasn’t a klutz. I am so klutzy, I’m the klutziest person that I know.” The truth is, when you tell yourself, “I am a klutz,” you come to see yourself that way. You back away from things. You identify as a klutz. The research kind of says that we do make that true. We define these things. I woke up a couple of days ago. We have a clock radio, and the clock radio kicks on and it plays a radio station. It kicked on, and it just played five consecutive minutes of advertisements. I got out of bed just so angry. Like, “God, just stupid…” My whole morning just went downhill from there. I started to tell myself, “Everything is awful, and this is stupid. I hate it. People are the worst.” You know what I mean?

Dr. Andy Roark:

It just spiraled from one thing to another thing. Then my wife was like, “Hey, can you wipe down the countertop if you spill egg on it?” I’m like, “You’re always making demands on me. It’s the worst…” Of course, I totally spilled egg on the countertop and it was not unreasonable to be like, “Could you wipe this up…” “Marriage is a crappy institution. Who thought of this? It was idiots.” The whole morning was craptacular, only because of the story that I told myself, and the negativity that I sort of held on to. Yeah, I mean I think that’s it. I think that’s a good example. When we drill into the science of it… I’ve just been thinking about this a lot.

Dr. Andy Roark:

Cognitive behavioral therapy is something that I’m really interested in. They use it a lot in therapy. We use it a lot in training people. This is just the basic way that our minds work. I love the simplicity of human beings. God, what a beautiful, simple animal. But the way our minds work, there’s a stimulus, and we have a thought about it. That thought then triggers an emotional reaction, how we feel about it. Then that emotional reaction, how we feel, it then triggers our actions. It’s not the thought that triggers our actions usually or drives them. It is the emotional response that we ultimately have of anger, fear, sadness, compassion, things like that. When we get into cognitive behavioral therapy and we talk about changing behaviors, really what we’re talking about is the importance of that thought, the stimulus and then thought.

Dr. Andy Roark:

It was catching that thought. The stories that we tell ourselves matter. When I knock over a fecal float at the vet clinic, and I think to myself, “There I go again. I’m such a klutz. I’m never going to get better.” The emotion that follows that is embarrassment or shame, or resignation of just a feeling of defeat. “God, I’m such a klutz.” Then our reaction to that is going to be driven by that feeling of shame or defeat. We’re going to apologize to everybody, because we’re such a klutz. Ultimately, we’re telling ourselves a story, but then we’re apologizing to people. We’re calling attention to the thing that we did that was negative, and we’re creating a reputation for ourselves. We’re doing all of these things, where we’re creating this reality around this story that we’ve made up.

Dr. Andy Roark:

One of the keys, I think, to really being happy in practice is being mindful of the stories that we tell ourselves. When I see people and they say, “Check on your vet friends, they’re not okay,” I worry about veterinarians telling themselves all day, “Hey, us veterinarians are not okay. We’re really in trouble.” There’s a fine line here, right? If we need help, we should get help, and we should normalize getting help. We should know that we have a stressful job, and mental health struggles in our profession and across professions are going up. We need to take real steps to normalize mental health, and to make it accessible, and to do all of those things. At the same time, we still do need to be mindful of what we put into our heads as far as the stories that we tell ourselves.

Dr. Andy Roark:

The example that I like to give as far as the stories that we tell ourselves. Imagine that you’re at the end of the day, and you have been planning to go to your kid’s sports recital event showcase. You’re really looking forward to it. Then a pet owner comes in 10 minutes before close, and you say, “I’m sorry, we’re not seeing any more appointments today.” They say, “How dare you? I cannot believe that you would turn me away. You are the worst. I mean, clearly you don’t care. You’re a monster. You have to see this. You’re the only vet that I trust. You’re the best vet in the world. I love you.” They go from patting your ego, to calling you a monster. They do all the things. I can picture two scenarios.

Dr. Andy Roark:

I can picture the scenario where the veterinarian has decided that, “This always happens. Pet owners always get what they want. Here I go again. I’m going to get sucked into this. I’m going to have to do what the pet owner wants. I always get mistreated, and no one appreciates the work that I do.” I can see those thoughts in a veterinarian’s mind. The other scenario is, the same veterinarian thinks, “Man, this is a hard job, and this is a hard decision. I feel bad for this person. At the same time, I also know that I have got to set good boundaries for myself. This is part of the job, is knowing what is possible and what is not possible. Taking care of myself, and knowing that it’s not going to make everybody happy. I mean, I’m going to do my best, but part of having a stressful job is setting boundaries in a stressful job, so that I can do the things I need to do in life so that I can keep coming back in here and doing what I need to do.”

Dr. Andy Roark:

Those two people are going to act very differently in that situation. The vet who’s like, “There we go again,” getting overwhelmed by the pet owners. They’re going to have an emotional reaction that’s probably despair. They’re probably going to feel defeated and crapped on, and then they’re going to just do it. They’re going to say, “Fine. I’ll do it,” and they just will. Or they’ll get angry, and then they’ll do it. Or they’ll just get real sad, and then probably stay and do it. They have decided there’s no way out. They’ve decided that they’re trapped. So they’re going to behave as if that’s true.

Dr. Andy Roark:

The other veterinarian who’s decided, “Hey, this is a really stressful job. This is a really hard job. I hear this person, and I know I can’t make everybody happy. I’ve got to set these boundaries. If it was another night, then maybe I would be able to do it. Tonight is just not feasible for us to do this work tonight. I’m sorry. It’s not,” and that’s decided. That vet is a whole lot more likely to go home, and go to the sports recital performance event that they have been excited about. Again, it really does come down to what emotions do you have? Those emotions come from the thoughts that you tell yourself.

Dr. Andy Roark:

Hey guys, I just want to jump in real quick with some exciting things that we’ve got going on, over on The Uncharted Veterinary Podcast. Stephanie Goss and I talk about, what do you do when you’ve got the vet who never goes home, and who thinks that’s a good thing? They’re like, “Yep. You know how you know I’m a good vet, because I never leave. I also really never allow other people to leave either. We work hours past close every night. You know why? Because we’re the best.” How do you get that person to realize that maybe that’s not the best? Maybe staying hours after close is not a measure of success, and maybe it has consequences for both you and for the team. How do you get the person to change their mindset on that?

Dr. Andy Roark:

That is what we’re unpacking this week on Uncharted. You can get it wherever you get podcasts, Uncharted Veterinary Podcast, check it out. Also workshops, we have some workshops coming up at Uncharted Veterinary Conference. We have, empowering your team to get positive and stay that way. It’s a two-hour workshop on October 9th, with the amazing Dr. Tracy Sands. It is all about positivity. Getting your team into a good head space, and keeping them there. Check it out. It is free to Uncharted members. It is $99 to the public. It is going to be outstanding.

Dr. Andy Roark:

Also, if you’re feeling the positivity, if you’re feeling the team culture. If you’re like, “Man, I just want to better… We’ve got a good place to work, but I want it to go to the next level. I really want to have a great positive culture in my practice.” You should be at the Uncharted Culture Conference. It’s coming up October 21st through the 23rd. It is virtual, so you can get there real fast. Travel time is just you going to your desk. That’s all there is to it. Yeah. Uncharted Culture Conference, October 21st through the 23rd, is three days all about culture. It is workshops, it is discussion groups. It is meeting new people and making connections, and networking, and exchanging ideas about how to make your practice better. October 21st through the 23rd, head on over to Uncharted. I’ve got links for all of these things in the description down below. Check it out. I would love to see you at the Culture Conference.

Jamie Holms:

Where do you think these stories that we tell ourselves, where do they come from?

Dr. Andy Roark:

I think some of us come up with them ourselves, right? Some of them come from childhood, and you see a lot of that. On the flip side, the workaholic perfectionist who can’t go home, and they have to get everything right, and they have to do everything perfectly. Their story comes probably from a lifetime of people telling them that getting an A+ is the most important thing. Telling them that they have a calling. Telling them that they can’t let anyone down. Telling them that their value, their self-worth is tied up in the outcomes that they achieve. I think that the story of, “I cannot let this person down. I have to do this. I can’t make anyone unhappy.” I think that’s a lifetime of probably how we were raised, and hearing those stories. I think for a lot of them of feeling sort of despair, some of it comes from personal responsibility. Some of it over time is just us parsing through the experiences that we have again and again and again.

Dr. Andy Roark:

The last part is, I think a lot of it is the external stories that we hear. It used to be, I think a lot of the stories came from the people that we worked with. This is why a toxic culture in a vet clinic is so damaging. So damaging to the individuals who are there. It is really hard to be happy about your job when you’re surrounded by people who tell you that your job is awful. Most of us just don’t have the mental fortitude to do that. I don’t think I do. I think, if all day long people told me that the clients are stupid, it would be very hard for me to not ultimately let that sink into my mind that I work for stupid people, and these stupid clients are going to make me do their stupid thing. How do you enjoy your job, if that is the narrative in your head? I’m going to react as if I have stupid clients.

Dr. Andy Roark:

You’re going to see me get frustrated and exasperated and tired and burned out, because that is the thoughts that I’m having, and they’re triggering the appropriate emotions for those thoughts. That’s why surrounding yourself with people who tell you your job is bad or crappy or dead-end or frustrating, that it’s only a matter of time until that stuff sinks into your mind. I think a lot of times, a lot of practices, people won’t quite understand why they have these rules like, “We do not bad mouth the clients. We do not say negative things about the clients.” I know that some people think that that’s overkill, especially when people crack down in stuff like, “You do not roll your eyes at the clients. We do not allow that.” People go, “But that does not make any sense.”

Dr. Andy Roark:

It does, because it’s the beginning of a shifting baseline towards we talk negatively about clients. That negative talk, it can become so pervasive that it really does affect the job satisfaction of everyone in the building. I think that’s still a big point. I think if you’re in a practice where people tell you that your job is crappy, I think that you’re going to come to believe that your job is crappy. I think the other place that we now hear this, that we did not use to, is social media. For those of us who were on social media, and we scroll along and we look at posts, and we look at names and things like that. We now have this constant voice from other vet professionals, who are telling us what they think and looking to try to resonate with us. It can very much feel like you’re scrolling along and listening to vet medicine.

Dr. Andy Roark:

The problem with that, the real problem with that, there’s a couple. Number one is people don’t tend to post about just good things that happened in their day. One of the exercises I’ve picked up in the last month or so, that I’m really pretty religious about it all of a sudden, at least I’m going to keep up, I can tell just because I really do it and I like it. I jot down three good things from my day, at the end of the day. I just feel like it’s a battle against negativity bias, where we tend to remember bad things and let good things go. Every night, I write down three things that were good about my day. It’s amazing to me how mundane they are. I don’t have three amazing things, I’m like, “I won an Emmy. Then the Pope stopped by and blessed my house and children.” It’s not these, “Then a photography team made me look 6’2″ and chiseled from stone.” None of those things happen.

Dr. Andy Roark:

A good day is, “I walked around the lake at my wife’s work with our daughter, who rode her bike. I let her ride independently.” Meaning I just said, “You just go. I’ll meet you back at the car.” She did, and you just tell that this was a big girl moment for her. She felt the freedom of riding her bike around this park, and meeting me back at the car. I go, “That was one of my three things yesterday.” That was just a big thing. If you buy into the idea that when you think about things that were good about your day, most of them are mundane, well it’s easy to see why those things don’t show up on social media. No one’s like, “Hey, went for a nice walk today. It’s the first day that felt like fall. Gosh, it was beautiful.” That stuff doesn’t make it on social media.

Dr. Andy Roark:

Social media is the attention economy, right? It’s geared towards engagement, and things that get people to respond. Often that means that the crappy things get posted. I don’t mean crappy like the person who posted them is bad. I just mean they’re about struggles, adversities. They’re emotional. They’re cries for help. Those things do really well on social media, and they get hugely amplified and they get a big voice. If you buy what I’m saying about, the stories that you hear are what seeps into your mind., you’ve got to be really careful about social media. The stories that do well on social media are emotional.

Dr. Andy Roark:

They’re scary, they’re upsetting, they’re rage inducing, things like that. Sometimes they’re super happy, but mostly not. I feel like there’s this sort of a disproportionate number of voices that are struggling, that we see a lot in social media. I don’t think that we should… I’m not trying to say to ignore those voices, and I’m not saying those voices are bad. Again, I think it’s just kind of the system that we’re in. Where if you’re not careful, the narratives around you tend to shift to a negative place or an emotional place or a reactive place. It can really color the way that you see your job and what you do.

Jamie Holms:

Yeah. I agree with that entirely. In fact, I just finished reading a book called Factfulness: Ten Reasons We’re Wrong About the World – and Why Things Are Better Than You Think.

Dr. Andy Roark:

Really.

Jamie Holms:

I was shocked. It was one of those things where I’ve listened to… I’ve stepped away from social media. I don’t listen to the news, and I don’t read newspapers anymore. I still hear the narrative that things are harder, they’re getting worse. It turns out that our world is not quite as bad. In fact, in so many ways, it’s so much better than it used to be. I kept answering questions. They ask you a question like, “Has poverty increased or decreased,” and things that? I was so wrong, and I loved it. I loved being wrong. It was a really great experience to read it, and realize that this is just one… It’s really easy to skew that perspective. If you can go back and look at the information, and choose to take that in. I look at my own life. I think, my life isn’t very exciting, but I love it and there’s so much joy in it. You talked about that first day of fall feeling. I felt that the other day, and I was like, “Oh my gosh. The trees are changing color. What an awesome day.”

Dr. Andy Roark:

Yeah. I love that. I think that the pertinent question for most of us is, “What am I doing? What can I do? What am I doing? Where am I going?” It depends on the individual. I know that we’re all very different. I have gone through phases where I follow the news a lot, and I read a lot of news. I’ve gone through phases where I’ve really pulled very much back. I’m in a pretty balanced phase right now. I get morning email from The New York Times, and read through it. Skimming, and then I’m done. Basically a lot of it is, “What does this mean for me? What are the things that I need to engage with?” Other than that, I just… I have to put that stuff down. Again, I feel like, and I’m not trying to pick on The New York Times. I also have a subscription to The Wall Street Journal, and I read through their stuff.

Dr. Andy Roark:

In both cases, there’s a big lean towards emotional reaction, and getting people, drawing them in to get them to click and spend time. The best way to do that is to tell them a scary story. Again, I don’t know that a lot of this that we’re talking about is specific to vet medicine. I really do think a lot of it is living in the modern world. You look at the modern world, and you look at the United States, and it’s really climbing… Not to be scary, the super fast climbing rates of depression and anxiety and deaths of despair. All of these things are going up in our society. It’s not vet medicine specific. I think we as a culture are really wrestling with this idea of, what are we telling ourselves? What are the stories that we’re believing? I don’t know. That’s sort of the article that’s really coming out.

Dr. Andy Roark:

I think that we can make a lot of choices about the stories that we tell ourselves, and what we choose to put into our mind, and how we see our job, and what we hold on to. I think that that’s really important. I still don’t know, and again, I understand where this comes from. I still don’t know that things like public pleas to pet owners for patience. I understand why we do that, and why people do that. I look at it, I’m trying to do the math and I don’t really know the answer. Does the benefit of that, is it canceled out by the negativity of us living in this head space? Where we believe that this is necessary, and feel like we need to put this out. We need to tell the story about ourselves to the world. Again, I don’t have an answer. I’m not trying to judge.

Dr. Andy Roark:

I think the alternative that I have seen that speaks a lot to me is, I am seeing more and more clinics doing things like putting up patient or client rights and responsibilities in their clinic. Being like, “These are the rules for being our client.” It’s not out into the world on social media, it’s in the vet clinic. Meaning these are the people who I’m actually going to deal with. These are people who are actually bringing their pets in. Now I’m going to say to them, “Hey, this is what you can expect from us. This is how you’re going to be treated. These are your rights here, and they’ll be honored. These are your responsibilities, meaning this is how you’re going to treat us.”

Dr. Andy Roark:

The difference in the empowerment of something like that, as opposed to a story of, “Please help us. We’re overwhelmed,” as sort of a public plea. To me, that’s really important. How do we make more decisions that give us the narrative, that we have a stressful job and what we do is hard. We have moral challenges that other people don’t have. We struggle in unique ways maybe the other professions don’t struggle. And, we are strong people and we are smart people. We can handle this, and we can look out for each other. We’re going to have to make hard decisions, but we are capable of making those smart decisions. Ultimately, we are going to do the best that we can with a, I don’t want to say unwinnable, but there is no A+ perfect score in vet medicine. It just doesn’t work that way.

Jamie Holms:

That’s so true.

Dr. Andy Roark:

I mean, so it’s like, “Nope.” This is the hardest game. It’s like a war. It’s like there’s no war where there are no casualties. I hate to use a dark term like that, but there aren’t. We plan to fight this war, and we’re the good guys. We plan to win, and we plan to take care of ourselves along the way. Yeah, I guess that’s just sort of my thought. When we think about the stories that we tell ourselves, what are the stories of empowerment that are true and honest, and they don’t sugar coat the issues? They’re not like, “No, this is the greatest profession, and there’s no stress here. What are you talking about?” That’s toxic positivity. That’s, “Just look on the bright side.” No, that’s not what I’m talking about.

Dr. Andy Roark:

What I’m talking about is thinking seriously about, who are you, what does the future look like? What does it mean to be a technician, a doctor, a CSR? What does that mean? Then, what are the empowered narratives that you can tell yourself? How do you say, “This is a stressful profession? That is why we have these policies in place, to help our people rest and to take care of them.” We know that sometimes people aren’t going to this, but we believe that it is ultimately the best thing for our people. Also for the patients and the clients that we see over the long-term. Setting those types of narratives in our mind, I really think that that’s critically important. As we come out of the pandemic and we look at what the new normal is going to be, I think now is the time to start to think about who are we really? What are the stories that we tell ourselves?

Jamie Holms:

Yeah. I agree with that. You and I had a conversation recently that I think we should talk about here. We’ve talked about patterns that people do that consistently make themselves unhappy. I think we got to it by asking, “What can we do to make ourselves happy,” and ended up looking at maybe the opposite of that. Which is things that we regularly do that make ourselves unhappy.

Dr. Andy Roark:

Yeah. I think that there’s truth to that. It’s a whole lot easier for me to say what makes us unhappy than what makes us happy. It’s funny. It’s really hard to define happiness. I think that trying to does more harm than good. Things that make us unhappy, number one for me is fixation on happiness. I think that that happens a lot. I think that we really dial into this, “Am I happy? What does it mean to be happy? Was today a happy day? Why am I not happy? What do I need to do to be happy? What is the thing that’s going to make me happy?” We can 100% dig into happiness and contentment to the place that we don’t have happiness and contentment. It’s been my experience that the more you think about and focus on happiness, the less likely you are to actually feel it.

Dr. Andy Roark:

Yeah, I think a lot of times really fixating on this, it actually has counterproductive results. I think a lot of us… The big thing that I have been thinking a lot about and sort of focusing on really is, just enjoy the work. It’s just being present in the moment. It’s just doing the work, and not thinking too much about, “Does this make me happy? How do I feel about this?” Again, it’s something that I’ve leaned into a lot in the past. My life is really sort of this hyper analysis of happiness. Ultimately, I don’t know that I ever came away with a better understanding of it, but I spent a lot of time kind of tying myself in knots for reasons that I don’t know were really beneficial. Constant fixation on happiness is a big one.

Dr. Andy Roark:

The other one we’ve mentioned already. Surrounding yourself with people who tell you that you’re unhappy is absolutely a path to being unhappy, for the reasons that we talked about before. The last one is just having sort of unrealistic expectations of what our job is. I think a lot of us really look and think that we should be cuddling puppies and kittens all the time, and getting thank you notes. That’s happiness, and that’s going to show us like, “Oh yeah, I’m really good at my job. I know it, because I got these notes that are coming in. I’ve got these photos of me with kittens. It’s super great.” That’s not a realistic expectation of what it means to be happy. If that’s what you think it means to be happy, then you’re always going to feel you’re coming up short. For that, the big thing for me is, again, we’ve really got to just get our head straight around the idea of enjoying the work.

Dr. Andy Roark:

What I say to people is, “You know those days when you go into the vet clinic, and then you lose track of time and all of a sudden it’s lunchtime, or all a sudden it’s at the end of the day? We’re recording on Monday, and all of a sudden it’s Friday.” People go, “Yeah, yeah, totally. That happens to me all the time.” I go, “Man, that’s amazing. That’s happiness.” What it means when we lose track of time is that you are fully engaged in what you’re doing. When you look around at the end of the day, and the day is just gone, you were doing something that you were 100% engaged with. What I would say is, that is as close to happiness as you can usually get. You are doing something you are so focused on that the time slips away from you. People talk a lot about being in a state of flow.

Dr. Andy Roark:

That’s a state of flow. It is a competent person doing something that is challenging, but not challenging beyond the level of their competence. They are fully engaged. They are using their skills and their knowledge at a high level to do a challenging thing, and the time just slips away because you were fully engaged. I think a lot of times with our expectations we think about, “Oh, I’m going to feel great. I’m going to recognize how happy I am. There’s going to be a smile plastered on my face.” I’m like, “That’s not going to happen. What is going to happen is you’re going to look up and go, ‘Oh, is it time to go home already? Holy cripes.'” That’s happiness. I think if we come to believe that that’s happiness, I think that we’ll realize our jobs can be better than we thought they were.

Jamie Holms:

Yeah. I think it’s an interesting question, is happiness a journey? Is it a quest? I think sometimes it’s not this big end goal. It’s just part of everyday being.

Dr. Andy Roark:

Yeah, I agree with that. Yeah. Is a goal? Is it a quest? I talk a lot about happiness as a journey. That may even give it more weight, or make it stand alone more than it even should. It really is, happiness is just, it’s filling your days in an engaging way. I didn’t say joyful way. If that’s your expectation, you’re going to be disappointed. We don’t fill our days in joyful ways all day, every day. A lot of it is just filling your day in an engaging way, where you feel like you’re using the things that you know and that you’re interested in to make the world better. That’s it. That involves angry people sometimes, and it involves crying people sometimes, and it involves sickness and pain and death. All those things are involved in us using our skills, and they’re just baked into what we do for a living. I would make the strong argument that in that sadness is happiness, if you’re doing the work and you’re using your skills and you’re engaged in what you’re doing.

Jamie Holms:

Yeah. I agree with that. Let’s do a real quick social media hot take. Is happiness a choice?

Dr. Andy Roark:

Oh, is happiness a choice? Oh boy. I’ve always really liked the expression, “She was happy,” with the idea that a lot of times it is up to us. I’m trying to think of a good story. There’s a quote that I love. I’m going to butcher it, but it’s something basically like, “Choose to enjoy the snow, because if you don’t, it’s still snowing and now you’re just miserable.”

Jamie Holms:

Yes.

Dr. Andy Roark:

I feel like there’s a lot of truth to that. I think that that’s the choice that a lot of us make in vet medicine. Choose to enjoy the eccentric people, because they’re still coming. They’re going to come in, and you’re going to deal with them. You might as well just choose to like them. I really do like the term choose happy. People can get, there’s pushback to that too. The pushback is, to me it’s usually in extreme cases where you say, “If someone is clinically depressed, or they’re dealing with something that is truly traumatic, or really going through a very difficult time, telling them to choose happy is not helpful.” I completely agree with that. There are limits to choose happy. I’ll give you an example from a very real practice as well. Here I’m saying, “Enjoy this work. Enjoy the things that you do. Choose to be happy. Think about the story that you tell yourself.” All of that stuff is true.

Dr. Andy Roark:

If you’re in a toxic practice, where you’re surrounded by negativity and people telling you that things are awful, and you’re not being treated with respect and things like that, choosing happy and telling yourself a good story, that’s not the answer. The answer is to leave. The answer is to do what you need to do to be healthy. There’s nuance to this, right? Like everything, there’s nuance to this. Yes, you can choose to be happy. I think a lot of us can choose to be happy most of our time. And there are circumstances where you really can’t choose to be happy. The only answer to that is then to take action, and to remove yourself from that situation. I don’t know. I always worry that when I talk about focusing internally on how we see things and how we practice, I don’t ever want anyone to think that I’m hand-waving away people who are in a toxic environment, people who are being abused by clients or people they work with, stuff like that. That stuff is not okay, and that’s not a choose happy situation. That’s a take action situation.

Jamie Holms:

Absolutely. I agree with that completely.

Dr. Andy Roark:

Most cool. Well, thanks for hopping on and talking with me, Jamie. I always appreciate it. I appreciate you doing this. I think I enjoyed this conversation for our 100th episode, but I hope that people got something out of it. I really appreciate you spending the time to sit and chat with me.

Jamie Holms:

Any time, thanks for having me.

Dr. Andy Roark:

Awesome. Thanks guys. Hey guys, thanks a lot for tuning in, and we will see you next week. That’s our episode, guys. I hope you enjoyed it. I hope you got something out of it. Thank you for being here for a hundred episodes. Thanks for making this possible. I cannot believe how wonderful this journey has been, and how popular the show has gotten. I thank everyone who takes time to listen and participate, and send ideas and send encouragement. So just thank you, thank you, thank you. That’s all I got today. I’m not even going to ask you to leave an honest review, because I just want to say thanks. Anyway, guys, take care. Be well. Talk to you soon. Bye.

Ken Yagi MS, RVT, VTS (ECC) (SAIM) sits down with Dr. Andy Roarkto discuss a topic that gets people very fired up… Veterinary Nurse Practitioners. As we face an ongoing labor shortage, could the nurse practitioner model be an answer? How would this work given our current credentialing system? What are the dangers and drawbacks of this system? What would have to happen for Vet Nurse Practitioners to come to the profession? Let’s get into it!

LINKS

Empowering Your Team to Get Positive and Stay that Way (Workshop): unchartedvet.com/product/empoweri…d-stay-that-way/

Uncharted Culture Conference Oct 21-23: unchartedvet.com/uvc-culture/

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

What’s on my Scrubs?! Card Game: drandyroark.com/training-tools/

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 discovered and refined his role as a veterinary technician by promoting compassionate and progressive care for patients and their families. 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.

He has been awarded the NAVTA Veterinary Technician of the Year award in 2016, the California Veterinary Medical Association Veterinary Technician of the Year award in 2016, and the California RVT Association of the Year award in 2017. Ken has co-edited the Manual of Veterinary Transfusion Medicine and Blood Banking and has published various text chapters and articles in various publications. He gives presentations internationally on topics in ECC, transfusion medicine, and the veterinary nursing profession. 

Ken works to encourage further recognition of the vital role of the veterinary nurses and technicians through work with organizations such as the National Association of Veterinary Technicians in America co-chairing the Veterinary Nurse Initiative and serving as a board member of the Veterinary Emergency and Critical Care Society, the Academy of Veterinary Emergency and Critical Care Technicians and Nurses, and the Veterinary Innovation Council. 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.

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

SHOW TRANSCRIPT

Dr. Andy Roark: Welcome, welcome, welcome to The Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. And, guys, take your blood pressure medicine for this one, but we’re just talking. Nobody needs to get super fired up, we’re just talking. But, boy, are we talking about a topic that gets people real excited? We’re talking about veterinary nurse practitioners. At the Veterinary Innovation Summit recently there was a conversation that happened in a public forum about, hey, what about that nurse practitioners? And people got real feisty, real fast, apparently.

This is something that I’ve been thinking about, is something that a lot of people post about on social media. And of course they do. And pet owners ask about it because it’s what they see in their healthcare and they go, “Well, I don’t see a MD when I go and get medical care for wellness stuff and maybe I don’t have to see a vet for wellness stuff either.” And I get it, I get where the question comes from. I think sticking our head in the sand and not talking about it and thinking about it is probably the worst thing we could do, so here we are.

I get into this with Ken Yagi. He is the Chief Medical Officer at VEG. He’s a past president of NAVTA, the North American Vet Tech Association. He is a super technician. He has done all the things and he is generally a very thoughtful, very measured, very introspective person who I respect a lot and I respect his ideas and opinions a lot. And so I was just looking for someone that I could sit down with and say, “Let’s talk through this,” because I just, I don’t know what I don’t know. And so, guys, that’s the conversation today. And we really get into it and Ken’s got great perspective, really interesting, a really interesting guy, really interesting insight. And we talk a vet nurse practitioner. Without further ado, let’s get into this episode.

Kelsey Beth Carpenter: (singing).

Dr. Andy Roark: Welcome to The Cone of Shame veterinary podcast. Ken Yagi, thanks for being here.

Ken Yagi: Thanks for having me.

Dr. Andy Roark: Oh man, always a pleasure. Ken, you are, for those who don’t know, the Chief Veterinary Nursing Officer at Veterinary Emergency Group or VEG. I met you I think back when you were the President of NAVTA, the North American Veterinary Technician Association. You worked at Adobe Animal Hospital where the one and only Kelsey Beth Carpenter, who is a good friend of mine works and Jamie Holmes worked there as well. And in between Adobe Animal Hospital and VEG you were at Cornell. You have won all of the veterinary technician awards. You were California’s VMA’s Vet Tech of the Year. You have a number of other awards. I heard that you received a new award last night at the IVECCS conference. Tell me about that real quick.

Ken Yagi: It was the IVECC and the Academy of Veterinary Emergency Critical Care Technicians and Nurses Specialty Technician of the Year award.

Dr. Andy Roark: Very nice. And then you’ve got to be involved in the veterinary technicians specialists pinning ceremony. Tell me about that. What’s it like to be involved with that?

Ken Yagi: It’s an amazing experience, for sure, that each year the people who have gone through the VTS certification process and finally pass their exam, they come back and get pinned the next year and that’s a milestone for people. And I remember it being such a special experience for myself that made me say, “Wow, this is such a huge accomplishment. I want to do more and more in this profession and in my career.” And it’s just the closeness that we have of people who have over the course of the years mentored each other, encouraged other people to pursue this area of specialty and help them get there.

Because I can think of many, many names like Nancy Shafran, Harold Davis, Andrea Steele, Amy Newfield, people who have just pushed me one step at a time so that I can get to where I am. And each and every person in that room probably had different names they were thinking about as I was telling my story of how I came to be that they could replace and that circle just keeps growing. It’s such an amazing group of people that the pinning ceremony really represents that.

Dr. Andy Roark: Yeah. I think that of any group in vet medicine, the emergency and critical care circle is probably the most tight-knit group. And the reason I say that, I’ve been to a lot of vet meetings and a lot of vet conferences. And the IVECCS conference and the emergency critical care people always strike me as being a tight-knit group. And I really think, I’ve thought a lot about this, I really think it’s because they have this shared a challenge, almost a shared lifestyle that other people don’t necessarily understand or aren’t really a part of. They talk about, “We are the night walkers, we fear the sun. We sleep during the day while others live and live their lives.” And they bond over the experiences of emergency and critical care and just what it means to live that lifestyle.

But then also just it’s a different type of medicine. You don’t have necessarily the same relationships with clients because they’re coming to you on emergency basis. You see a different type of cases. You’re not doing Bordatella vaccines at 3:00 in the morning, generally stuff like that. And so I really do feel like this group has a lot in common more so than they have in common, maybe with the rest of the industry. And so I just feel like that’s a really tight-knit group. I think that’s always been the most interesting to me about the emergency critical care circles.

I brought you on because you are the most tapped into the veterinary technician world of almost anyone that I know. And I had something that I’ve been rolling around in my mind and it came to head about two, three weeks ago. There’s a conference called the Veterinary Innovation Summit. It happened in Kansas City a couple of weeks ago and I was not there. Apparently at the VIS, there was a discussion of the shortage of veterinarians and how there’s not enough veterinarians to get all of the workload done and how cases are up and a lot of people are feeling really overwhelmed. And the obvious follow-up question was something like, “Hey, have we thought about having the equivalent of a nurse practitioner in vet medicine? What if we had a type of technician or what if there was a way that technicians could move farther up and start to do some of the wellness work that veterinarians do?”

Maybe they could start to do some of the things that our veterinarians currently hold the reigns on and they could take some of the workload off of the veterinarians and what would that be like? And at that point, from my understanding, the room exploded and people were throwing chairs and a brawl broke out and the snack table was overturned and the whole place just went to hell in a hand basket. Because people get real excited when you start talking about veterinary nurse practitioners and them doing things that doctors do. And some people were like, “This is great, it’ll free doctors up. It’s good for capacity. The doctors can work at the top of their degree. The technicians can work at the top of their degree.” I think other people say, “Don’t, you dare take anything off of my plate,” and there’s a lot of emotion around the topic.

And I’m hearing this, I’m seeing it more and more online, again, our conversations are online, they immediately get real emotional and just the utility of the conversation falls apart. I don’t know as much about what’s possible and where we are as I would like to, so I wanted to just to talk to you about that. Can you, first of all, just start off real high level, can you give me a rundown on where we are in credentialing for technicians in general? In technician specialty, what does that let technicians do…. yeah, are we really elevating technicians in a way that is meaningful to their careers? Let me just start with that.

Ken Yagi: Sure. And just to start out I’ll say that that conversation has been around, the nurse practitioner conversation has been around since 2005, that there was an article published back then and back then people threw chairs at each other as well. More so now than today maybe but things have changed a little bit. But with that said, with a technician credentialing we do know that there’s 40 states that have a licensure within each of those states and there’s 10 states that have private credentialing which means there’s no requirement for anyone to be credentialed in order to practice as a veterinary technician.

But in all of these states, we basically are able to do things aside from what licensed veterinarians are or what’s restricted licensed veterinarians, which are things like providing a diagnosis, providing a prognosis, prescribing treatments and medications and performing surgery. Anything else is under the supervision of the veterinarian done by people who are non-veterinarians. And so in many of those states those people are licensed as, registered as, or certified as veterinary technicians and that’s what we tend to take on.

And some of those states would restrict what’s called the scope of practice, what veterinary technicians can actually do to those individuals who are licensed State of New York, State of California, those are the ones that stick out in my head just in the sense of where I’d been. And so that’s where there are conversations surrounding utilization, how do we divide up the types of activity and tasks that needs to be performed within a veterinary practice and function best as a team? And the topic of utilization obviously is a huge topic right now throughout veterinary medicine but for our profession, and that there are many people who come into this field who go through schooling, get credentialed, finally get out onto the clinic floor, and they feel like they haven’t been able to grow in the way that they want to do. They’re not serving the role that they imagined they would be because there’s a lack of utilization.

If the limit is everything except for those four things that is for now that’s restricted to licensed veterinarians, we’re not achieving quite that high. Heather Prendergast is a good friend of mine and I have done a good amount of workshopping, talking to people and doing some practice assessments in the level of utilization, for example. And the initial results that we were getting on that was people were utilizing their technicians maybe about 30 to 40% level, which is, there’s huge room for growth.

Dr. Andy Roark: Yeah. Talk to me a little bit more about that. When you say practices are using technicians at 30, 40% of their possible level, what do you see? Tell me what that looks like. Give me a contrast between a practice that’s at 30% utilization and a practice that’s at 75 or 80% utilization, what’s the difference in this one?

Ken Yagi: The difference probably has to do with many factors, but some of them that I could think about would be maybe the type of practice and more primarily how busy the practice might be. If there’s increased caseload then the veterinarian is not able to take care of everything that needs to be done on the animal and so then I think that’s where the technicians start to get utilized more and more out of necessity. If you think about the type of practice, the field that sticks out in the forefront of my mind obviously it’s emergency and critical care. In the emergency room there’s urgency, there’s a need to these people in and seen based on how life-threatening it is. And you need to have all the people available to perform all the tasks that are needed to help the animal in the most efficient way possible, and so out of necessity we utilize our technicians better.

Dr. Andy Roark: I guess, what I’m wondering is I think about my practice and I have no idea what percentage utilization our technicians are at. I guess that’s what I’m looking for you is for guidance is what exactly are technicians doing when they’re well-utilized compared to the majority of practices where they’re not well-utilized? What are the actual things that they do in their job that other people go, “Oh, I can’t believe technicians do that,” or, “Oh, we don’t use our technicians that way.”

Ken Yagi: Let me start the other end.

Dr. Andy Roark: Sure, sure.

Ken Yagi: Taking a look at where technicians may not be utilized very well, if veterinary technicians and the clinic is doing a lot of the clerical work, if they are doing reception work, if they’re doing a lot of the kennel work, and maybe they’re the ones that are, sure, showing people into the rooms and such, but if that’s on a regular basis then that’s the lowest end of utility that you could think about, that’s not what a technician is trained for. Then once you start going up further in that route then the technicians would be the ones that are drawing blood and submitting blood samples and maybe looking at the size and things like that. And then it gets more and more complicated and through placing IV catheters, placing urinary catheters, there’s that’s maybe the middle level where you’re still utilizing technicians to be a task doers, that there’s a task to be performed and then the technicians are performing those tasks based off of the doctor giving orders.

And then I think once it gets to the higher and higher end, it turns more into a thinking job in that are they assessing the patients, listening through the heart and lungs in terms of not just the rate but the characteristic of the sounds that they’re getting, making an assessment and trying to turn it into recommendations, problem list, and then recommendations on how to correct that. That’s one level that I would like to see technicians go further and further into so that they are actually a part of the decision making process of what happens to the patients.

A common example that I can bring up is CPR. How do you perform CPR on an animal and who tends to be the leader of that CPR effort, who’s giving the orders? It’s often the veterinarian, but at the same time a very well-trained technician who sees arrests more commonly, the person that is more experienced is the one that should be able to lead that code the best way possible. But by default, most people think that the veterinarian is the one that should be doing that. And so that’s another level of expertise experience training that veterinary technicians could obtain that puts them actually to be in the better position to lead the code so that the veterinarian can focus on what’s going on with this patient? Why has this patient arrested? What are the treatments for that? And then also taking on the direct client communication during that situation so that there’s no relaying happening and efficiency loss there.

Dr. Andy Roark: When people talk about the veterinary nurse practitioner idea, how does that look different? What exactly would that be? I know that people, they put that term out and go, “Oh, well, what about this?” Is there any sort of a vision around that about what that job role might look like or what those people might do?

Ken Yagi: When we think about nurse practitioner as taking a look at how the laws currently are set up where those four things are restricted to my sense of veterinarians, we could push technicians up right up to that level. And so some of the things that I think about that are very advanced that technicians could be doing. They should be doing ultrasound exams, they should be doing a thoracic synthesis, could they unblock a cat? Those are the kinds of things that within the law you can do because that’s not surgery, it doesn’t alter tissue. But at the same time those kinds of things need to happen once the veterinarian has some kind of a diagnosis and has prescribed that treatment.

The nurse practitioner goes beyond that in that now we’re talking about changing the laws so that people who are not licensed veterinarians can perform some of those tasks in terms of doing the physical examination process and being able to come up with a diagnosis, which then allows them to formulate plans to prescribe a certain treatment and obviously be able to carry that out too. But then on the human medicine side, nurse practitioners, physicians assistants, they can perform surgery as well.

Dr. Andy Roark: When these conversations come up, the people who are pushing it they generally are pushing towards having decreased workload, increased efficiency, utilizing technicians, probably raising technician salaries, all of these things that are probably really good for our industry. They’re probably, they’re definitely really good for technicians. What is the push back against this? What are the most common arguments against veterinary nurse practitioner position that you hear?

Ken Yagi: Well, what are you hearing out there?

Dr. Andy Roark: What do I hear about it? Yeah, that’s fair question. I guess what I hear is that there’s too much of a distance between veterinary technician credentialing and vet school. You talk about say, they’ll say a two-year credentialing program for technicians versus four years of undergraduate work and then four years of vet school. And you go, “Man, the difference between two years and what we have now and eight years for veterinarians.” You go, “Wow, that’s a massive difference.” And we would have to have infrastructure to bring nurse practitioners up to a level where they would be in between, truly be in between in their training, in between doctors and technicians.

I do hear some of that of, hey, this is not a small jump that we have from licensed technicians up to doctors now and so bridging that gap to really create something that is in between is going to require some infrastructure and some training that we don’t have. I also hear a lot of pushback about just actually changing state licensures to get things done and people are kind of, this fatalistic view and go, “Ah, that’s a bridge so far, I just don’t know if we can do it.”

And I think what they’re not saying, and this is just 100% my opinion, I think that veterinarians, I love veterinarians, I see myself as a veterinarian. I think a lot of us do have a scarcity mentality where even when we’re drowning in work, we still live in this fear that all of a sudden pet owners are going to stop coming in and we’re all going to be out of jobs and unemployed and so the idea of giving this work up. I think there’s a lot of reasons for it but I think a lot of people just really truly struggle with handing this work away and then the idea that you’re not getting this work back. Once you give it away, the genie is out of the bottle and you’re not getting this work back. And so I think those are the big ones I hear.

Ken Yagi: And I think that the last one that you mentioned is probably the one that stands out in the forefront of my mind, is that the history of this conversation and the opposition that it has faced originally was mostly related to the fact that it’s also the same in the human medicine field, by the way, as these professionals came out, is that we’re impeding on the veterinarian’s scope of practice and the human medicine side nurse practitioners largely have independent practice rights, and so then they can open their own practice. Then it turns into competition for veterinarians and that’s the historical look at all of that.

But when I said that things have changed that over the course of the year, is that we can’t keep up right now. There’s not enough veterinarians and all the practices are suffering in terms of trying to find enough people to be able to help all the patients that we’re seeing. And so we’re starting to see this demand rise up. And so that we’re starting to think about potential solutions to meeting that demand and that’s where this conversation is pushing more and more over to maybe the individuals or practices that felt like this maybe wasn’t a good idea is now starting to consider it more and more because it’s going to be helpful and they see that.

Dr. Andy Roark: Yeah. I had Dr. Dave Nicol on the podcast a couple of weeks back, and I love Dave and we generally get along really well and see eye to eye. We did not see eye to eye at the end of the podcast, which is fine. The biggest thing we did not see eye to eye bell on the end of the podcast is it’s always been my position that I like the fact that general practitioners in vet medicine do a lot of things. And I think that there’s a lot of ways for us to find our path and craft ourselves to the type of medicine that we want to practice and also to what pet owners need.

Dave, I think felt that there was a real danger of specialty medicine carving away at what we do and some local low cost options taking away some wellness care from your traditional vet clinic. And we didn’t really get into technician licensure but I can 100% see… I have a little bit of concern sometimes when I look and especially look at human medicine now that we’re talking about that. The general practitioner in human health care is pretty much gone. You can find one, you can find your GP but they are rare and they’re generally tied to pediatrics and internal medicine outlets.

And so I guess that my thought is when we talk about nurse practitioners, is that a step towards pushing our profession to mirror human medicine where people very quickly come in, they see a base level intake of physician or caregiver, and they quickly get pushed up to a specialist. I don’t know if the economics of our profession support that but I have those concerns. Does that mean anything when I say it to you?

Ken Yagi: Probably not something that I’ve thought about too much on. I could see that concern but when it comes to the nurse practitioner concept on all that I don’t know if it would necessarily should.

Dr. Andy Roark: No. I said it isn’t to rule it out. I have a hard time imagining a world where pet owners just readily plunk down the kind of cash that it takes to see a specialist, and rightfully so to see a specialist. You know what I mean there? There’s not a lot of them there, they’re hard to get to. I do have some concerns towards the career of the vet becoming one where, yep, you do a residency, that’s just what you do. And I go, “Man, the economics profession really don’t work that well right now and if the norm becomes doing four more years of the low wage work to get to a specialty place, I’m not sold on that being a good thing for doctors.”

And the other thing is we look at affordability and accessibility of vet care for the general population now and I go, “I don’t know that… I know that that’s not good for pet owners.” We already are hitting points where we get a lot of pushback about price and what medicine costs as a profession and I think we’re trying to address that. To me, but I hear that concern from other people and saying when you’ve got specialists and then if you have nurse practitioners, where does the general practitioner lie? And so as I think about pushback, I think it’s probably unstated but I think that that question, that question of identity is probably going to be the biggest driver of pushback, is who am I? If I’m no longer doing this work, if other people can do this work, I don’t know that I feel safe. And so I could see that just, I think a feeling of safety is going to have to come from somewhere and I don’t know what’s going to make that happen.

Ken Yagi: Right. And I think that when we talk about it in broad terms saying nurse practitioners are going to be able to diagnose, prognose, and prescribe and do surgery, it makes it feel like we’re just replacing veterinarians but that’s not what we’re talking about. That it would be the types of things that are going to require less training because I knew though that, I mean, the veterinarians have gone through their schooling and they have this expansive level of knowledge that they obtain. And then when we talk about nurse practitioners we’re talking about a master’s level degree is what it’s likely to be. I’m not saying that’s the only way to do it but that’s likely. And so they’re going to get some clinical decision-making skills. They’re going to have training in critical thinking and some of the medical aspect that that technicians don’t receive currently.

And so then if you can think about some of the lighter case, the types of cases that we see who have maybe it’s like the ear infection that we need to be taken care of, or some of the, well, skin conditions could get really horrible, but some of the less intensive cases are the ones that these nurse practitioner-type professionals would be taking care of, at least initially as the profession progresses. And then the veterinarian could be focusing on the more involved cases and then it’s maybe that the veterinarians are focusing on the more involved surgery cases, and so then they don’t have to be having their time taken up by some of the cases that require less attention and they can focus on the ones that are more and more involved. I hope that does.

Dr. Andy Roark: Yeah, now, it definitely does. I mean, we’ve talked a lot about practicing at the top of your licensure, meaning veterinarians are using the diagnostic and treatment skills that they were trained to use. Well, technicians get to practice at the top of their licensure as well and the thought being, if this is going to break out well for everyone as far as feeling like you’re doing rewarding work and then also financial compensation, let’s have more time to do surgeries or do advanced cases, then they’ll probably financially do just fine even if they’re not doing all of the lower level cases or the wellness work that they used to do.

Ken Yagi: If I can give an example in the emergency because I think it gives me a little bit more of a concrete examples to give. If we’re thinking about a situation where it’s an emergency room, the doctor is seeing a hemo abdomen case and performing a splenectomy and surgery and a patient comes in that just ate somebody’s underwear and they need to get that taken out, something like that. This nurse practitioner-type role could probably either do an endoscopy procedure in order to try to get that out or maybe it’s not that we go ahead and give it morphine to make the animal bond it out initially before that point and if they can’t get it out they move on to the endoscopy.

But that process of making that decision and going through those processes while the doctor is unavailable, those are the kinds of places where these nurse practitioners can be very functional and may not necessarily require the doctor to have to scrub out and then come in and come back out although it’s black days are pretty urgent emergency cases. That’s probably not the best example that I gave there. But that’s something else that they’re working on so that those patients still can be seen and we can continue to see the incoming patients without having to create bottlenecks.

Dr. Andy Roark: Yeah. That totally makes sense. Real quick, as we look to the future, because this is not imminent. So anyone whose blood is boiling, anyone who’s having to knock back some blood pressure medications, this is not immediately on the horizon. Ken, when you look ahead and look at the future, what are the things that would have to happen in order for something like this to move forward? Because we’re not there, this is definitely not upon us but it’s just looking down the road. What are the things that would have to happen to create a system like this?

Ken Yagi: I think it goes back to what you mentioned regarding the education of veterinary technicians. You said that there is associates. Most of the people that are out there as credentialed technicians are people who have gone through an associates degree and so then we need to move towards people having bachelor’s degrees of some kind that qualify for the next level. There is a need for an educational process, likely to be a master’s degree that teaches people the clinical judgment skills, the critical thinking abilities, coordination of care, different kinds of topics that technicians don’t currently get in their veterinary technology or nursing programs.

And then once we have people who are qualified to function at this type of level, there probably needs to be a certification process at sometime. Is an application process, is the examination process and who again it’s all of these, the educational process as well as the certification process. And then that’s where we have individuals that are able to show that they have additional skill sets that then will probably lead to the legislative changes that will allow states to say, “People with these credentials are able to have this type of scope of practice because they have higher qualifications.”

Dr. Andy Roark: Yeah, it sounds like a process.

Ken Yagi: Pretty, pretty huge process. But the process that the physician’s assistant profession has gone through, various practitioners have and most recently I’ve seen an article coming out saying that the respiratory therapists have recently graduated their first class of people who have obtained a master’s degree aimed towards advanced practice respiratory therapists. And so that’s the pathway that these professions are taking and we can definitely look at this for the veterinary profession as a whole as well.

And I think going to back to maybe the counter point of, or the opposition from people saying that we need to focus on other things first, standardizing the profession itself and that working on the utilization level of existing technicians, absolutely. Those are all important things that we need to be working on now but once we fix that and we still have this issue of credential technicians not having a further career pathway once they get there, then we’re going to run into the same thing where people are seeing ceilings, that practices are not willing to pay more for technicians because of a certain level of utility that they cap out at.

And so this is more… I see this as a solution for the future. That while we’re working on the things that we need to work on today, we need to be working on what’s going to be solutions for us in the future as well. And so that’s probably part of the reason why even though there might be some opposing voices to this, I see that there’s more and more supportive voices to it and it’s worth exploring so that our professionals can continue to grow.

Dr. Andy Roark: Hey guys, I just want to jump in real quick with a couple super awesome announcements over on the Uncharted Veterinary Podcast, came out yesterday. How do you teach accountability? We got a question in the mailbag about what do you do with the person who works for you who makes a ton of excuses, and it’s always somebody else’s fault and it’s always something that couldn’t be controlled and mistakes get made but it’s never my fault? How do you teach that person some accountability. That’s what Stephanie Goss and I get into. Free wherever you get your podcasts, Unchartered Veterinary Podcast, how do you teach accountability?

And that is out now over on the Uncharted side of the house because we have a new workshop. It is coming out on October the 9th. It is from 3:00 to 5:00 PM Eastern, 12:00 to 2:00 Pacific. This is Dr. Tracy Sands teaching empowering your team to get positive and stay that way. Guys, do you have a team that is tired? That is burned out, that is worn down that has slipped slowly into negativity and just being bummed, or being down, or being down on the clients, or being down on the work? Because it’s understandable, it’s been a hard time for a lot of us and people have felt that and your team may be feeling that. If they are feeling that don’t throw your hands up, don’t just let it go, it’s time to put that work in and push those guys back towards being positive, get them back to enjoying their job and feeling good about what they’re doing.

That’s what this workshop is about. It is two hours, it is hands-on. Dr. Tracy Sands is amazing, she’s a good friend of mine, I highly recommend. This workshop is free to Uncharted members. It is $99 to the public, you do not want to miss it. Also the Uncharted Culture Conference is coming at you October 21st through the 23rd, that is also virtual. It is going to be all about building culture in your practice. It is a three-day online event all about culture and you’re going to hear from a large variety of speakers. They’re going to be all sorts of sessions on all sorts of things.

If you’re a culture junkie, if you want your practice to run smoothly and be a great place to work, guys, the Uncharted Culture Conference is for you. Check it out, links in the show notes. Head over to unchartedvet.com as always to learn about what we have going on there. Gang, without further ado, let’s get back into this episode. I heard recently about a new technician program associated with LMU. Are you familiar with that? Does that ring any bells?

Ken Yagi: You’re probably talking about the master’s program that LMU is proposing. Yep.

Dr. Andy Roark:             Can you tell me a little bit about… I just recently heard about LMU, Lincoln Memorial University’s College of Vet Medicine is doing a masters program for technicians and it’s integrated in with the training of veterinarians. It was the first time I heard about the program. Are you familiar and how does that fit in with our conversation?

Ken Yagi: Yeah, I am familiar with that being put in place, that there’s work being done on it. I don’t know too much about the content of it and what the courses look like and all those kinds of things. But I think that those types of degrees being put forward by schools is going to be one of the first steps in which we move towards this nurse practitioner role. We do need people with additional training. We know that there’s a certain curriculum standard that the AVMA-accredited programs follow and they are not going to take veterinary technicians to be able to function in the way that we want nurse practitioners to function unless those standards change in that drastic manner. And so this is the master’s degree that we’re looking for to be on top of our current education for creating the individuals that are able to have the skillset that they need to function the way that we want them to.

Dr. Andy Roark: As we wrap up our conversation, I want to go back to one thing that you said that was a new idea to me. Independent practice ownership, the idea that if there were veterinary nurse practitioners they might have their own locations or their own clinical practices. Do you see that? And I know that that’s something in humans that was not uncommon. Yeah. How does that fit into the future of medicine? Do you think that something like that is possible?

Ken Yagi: Possible is a tricky word. That’s possible? Sure. But at the same time I don’t think that’s what we’re looking for right now. But I think talking about independent practice rights for veterinary technicians or veterinary nurse practitioners, that’s something that scares a lot of people out there. And that’s not what we’re looking for, we just want a way to find more people to come into this field that can serve different functions so that we can make up a team. Serving under the license of the veterinarian is totally fine, that we just want to find ways to help more patients and bring in more and more professionals that are able to serve the functions that we need on the floor so that they can take on the workload because we’re struggling and we need solutions and that’s why we’re talking about this today.

Dr. Andy Roark: Yeah. I think when people start to talk about things like radical changes, a vet nurse practitioner, things like that, a lot of people catastrophize. They go to, “Oh my God. If we do this then suddenly vet technicians will have their own hospitals and there’ll be half the price of regular hospitals. And they’ll do all the things that we do even if they’re not supposed to because who’s going to catch them? And, my, I’ll be living in the forest in an abandoned minivan and eating dirt and squirrels that I catch.” And they just goes down this road of, if we do this then it will lead to this and this and this will be a complete overhaul of our system and the poor general practice doctor is going to be obliterated. And I think that’s human nature, is to catastrophize that way.

And then the pushback is, if we don’t do this then we will be overwhelmed to the point that burnout will go to 100% and no one will be… the old timers in our profession will have worked for seven years and those will be the most senior people because no one else will last more than a year before they’re toast. And again, both of these are completely ludicrous situations. I think the answer is clearly in the middle. I think that we’re going to compromise and there’ll be a lot of pushing back and forth and ultimately I think it’s from, to kill a Mockingbird, they talk about there is a compromise to the point that no one was happy and that was probably the best outcome. And it’s I suspect that’s 100% where we’ll be in 10 years from now looking back, we will make something work.

And I do think looking at the constraints that we have, the manpower that we have, the rising caseload that we have, the problem with burnout that we have, I do think we’ve got to build in efficiencies. The AVMA published that study a couple of weeks ago saying that inefficiency was a much bigger problem than increasing caseload and, boy, that hacked some people off. But I think that there… I don’t know how much truth there is to that because I don’t want people sending me angry emails, but I believe that there is at least some truth to that.

We really do have to figure out some efficiencies because in some way we have to accept the situation and go, “We have the people that we have and we have the educational system that we have and we have the caseload that we have.” And what we’re doing, I’m not convinced it’s working, I think we need to make some changes. That may not be radically overhauling the system, I don’t think it is, but I do think that there are a number of probably smaller measures that we need to make.

Ken Yagi: And I think that one of the reasons why I’m so invested in this idea is because over the course of my time seeing people out there, one of the common things that I hear is, “I’ve hit a ceiling. I don’t have room for growth.” Or, “I don’t see future growth in this profession and so I’m going to look elsewhere.” Then those are the people that go to human medicine, they become nurse practitioners in the human medicine field. And this is one of those solutions that we can put in place that allows people who are the most ambitious, who are the brightest, they are most driven that want to continue growing and expand on how they can help animals better to stay in the field. And that’s why I think this is hugely important for our profession.

Dr. Andy Roark: Well, you and I have both seen some well-known veterinary technician specialists leave and go into research, leave clinical practicing and go into research, and that’s been in the last year or two. And some of the people who lecture and who are just brilliant and wonderful for our profession have gone other places and I think it’s really sad. I don’t like that, I think a lot about that. I had a technician talk to me one time, it was a conversation I always remember, but she was just so disheartened and despondent. And this is someone I worked with. I liked this person and she did good job. And she was just talking about leaving and I basically pinned her down on why? What is the thing that’s making this an issue?

And she pointed to another technician who had been in the practice for 30 years, doing the exact same job and she was like, “I cannot be here in 30 years doing the exact same job I’m doing now.” And that’s always stuck with me when I think about technicians. And I get it, in that moment it very much made sense to me. I think we should all be learning and we should all be growing and we should all be moving forward and I feel like that, I feel that ceiling for technicians is something that we as a profession have to figure out.

And if we don’t figure it out then the technicians will figure out their own path and that will be leaving practices and going into industry and going into research or going into other things and that’s not what I want from my practice. I don’t want to lose my best people that way, I got to figure out how to figure out how to keep them growing and keep them engaged, and I think that that is a worthy challenge for us veterinarians to keep our people.

Ken Yagi: And I’ll also add that when you think about people leaving the field or changing their specialty area because they feel they don’t have anywhere else to go, I also see it even within the single clinical setting or the practice setting, I should say. There are three different pathways that people could take as they grow as a veterinary technician. Some of them, and many of them go into management, the leadership-type side, and so they have the ability to become practice managers or hospital managers or something like that, and then they actually deviate from what they wanted to do which is take care of the animals.

And then there’s the education pathway. They become trainers. They go out and conduct CE, things like that, because that’s the next place that they can feel like they’re growing. But when you think about the clinical pathway, the pure clinical pathway, there’s a very low ceiling and early cap to that. And so we need to continue growing the clinical pathway and this is the nurse practitioner role is exactly that.

Dr. Andy Roark: Yeah, now, I think that that is a really good point. And I think, yeah, it’s… Thanks for having this conversation with me. It’s a lot to think about, it’s definitely something I’m going to continue to think on and digest but I really appreciate you taking time to talk through with me. Where can people find you or learn more about your exploit?

Ken Yagi: First place that you could probably go is the Veterinary Emergency Group website. There’s a nursing section that details a lot of the things that we are doing to change the field out there. And you can always find me at kenyagi@gmail.com. Email me there if you want to talk further about anything that I’m doing.

Dr. Andy Roark: Cool. Thanks a lot, Ken.

Ken Yagi: Take care.

Dr. Andy Roark: And that is our episode. Guys, I hope you enjoyed it. I hope you got something out of it. I really enjoyed my conversation with Ken and it had its ups and downs and there were some places that definitely stressed me out just thinking about the future. But the future is scary and change is scary and I just I think that starting to have these conversations and think about what’s possible, I think that’s so much more healthy than just putting our head in the sand and not investigating possibilities. I just, I don’t know, a just a key piece in my life and philosophy is we should look at this, we should talk this, but we should see what’s possible.

Anyway, guys, that’s it. I hope you enjoyed it. If you did, please write me an honest review on iTunes or wherever you get your podcast, it means the world to me. If you didn’t, just you can send me an email, I guess. It’s podcast@drandyroark.com. But you don’t need to share that with the world, that can just be between you and me. I’m fine with that. Anyway, guys, take care of yourselves. Be well, I’ll talk to you soon. Bye.

Dr. Cherie Buisson of A Happy Vet and Helping Hand Pet Hospice is on the podcast to discuss a popular article she wrote on why we should learn to forgive. In a time when so many of us seem to be living with a low-level of anger, forgiveness is more important than ever. But what about when the people we are angry at don’t care about or deserve our forgiveness? Let’s get into this episode.

LINKS

Why You Should Learn to Forgive (Original Article): drandyroark.com/?s=why+you+should+forgive

TEAM POWER: Adding Value to Your Visits: unchartedvet.com/product/adding-v…your-vet-visits/

Uncharted Culture Conference Oct 21-23: unchartedvet.com/uvc-culture/

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

What’s on my Scrubs?! Card Game: drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

CHERIE BUISSON, DVM, CHPV
Dr. Cherie Buisson is a 2000 graduate of Mississippi State University College of Veterinary Medicine. She is certified in Hospice and Palliative Care, Low-Stress Handling (TM), and QPR Suicide Prevention. She teaches her colleagues about hospice, euthanasia, compassion fatigue, burnout, and how to be happy in their chosen profession. She is the owner of Helping Hands Pet Hospice in Seminole, FL and the founder of A Happy Vet, a website promoting wellness in the veterinary community.

Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram

Show Transcript:

Dr. Andy Roark:

Welcome. Welcome. Welcome, to the Cone of Shame Veterinary Podcast. I am your host, Dr. Andrew Roark. Guys, I got a great episode today. This is one that I needed. We posted an article from Dr. Cherie Buisson recently through our social media channels and the articles a couple of years old. And when I saw it on social, I was like, oh man, that’s amazing. That’s exactly what I need right now. And the article blew up being a repost from earlier on. It was like a 2017, 2018 article. It blew up and there were so many comments. Like I need this. The article is, oh, Why You Should Learn to Forgive. And so I bring on Dr. Buisson and we talk a bit about forgiveness and I don’t know, this has been a thing that I’ve been working on in the month of September.

Dr. Andy Roark:

I’m having my own sort of mindfulness month where I’m going, I need to take it down a notch. I think I need to relax a little bit and get in into a more positive head space. And I need to be more forgiving of other people. I think a lot of us feel that. I think a lot of people are carrying a lot of frustration around. And so, yeah, I think it’s time to try to let that go. And so anyway, that’s what we talk about today. Guys, I hope you really enjoy this episode. Let’s get into it.

Kelsey Beth Carpenter (Singer):

This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to Cone of Shame, with Dr. Andy Roark.

Dr. Andy Roark:

Welcome Dr. Cherie Buisson. Thank you for being here.

Dr. Cherie Buisson:

It’s my pleasure. I’m always happy to join you on the podcast.

Dr. Andy Roark:

I know. I love it. And we always have the best stuff to talk about because you are writing wonderful things and making wonderful lectures and you make it really easy to find interesting things to talk about with you. So welcome back.

Dr. Cherie Buisson:

Well, thank you very much.

Dr. Andy Roark:

Yeah. So what I want to talk with you about today is, it’s interesting in that I have an article over on the doctor in your website that you wrote a couple years ago, and my team found it recently and pulled it and published it through social media again, just to say, “Hey, guys, you should see this.” And so I saw it with the audience and I saw it come out and I was like, “Man, what is this, Why You Should Learn to Forgive?”

Dr. Andy Roark:

And I clicked on it again. I recognized it as being something that you’d written a while back. And then I was like, oh my God, this is so perfect for right now. I’m not kidding. I literally set out for September, and I try to make personal for myself every month, is kind of where I am right now. It’s a new habit I picked up. So far I really love it because it’s like just got to do this for 30 days. And then if I love it-

Dr. Cherie Buisson:

Oh, that’s good.

Dr. Andy Roark:

… I’ll keep doing it. Or if it comes natural, I’ll say, and if I hate it, then it’s just 30 days and I’ll be out. But for September I had already decided, I was like, I need to, I need to forgive people. I need to get more forgiving about other people so that I can be more forgiving of myself. I just say that because boy, I just feel like there’s a lot of anger and there’s just a lot of frustration out there. I feel it in myself and I’m really actively working against it to find peace. And so this article really resonated. So with that preamble yeah, tell me a little bit about the article. Tell me about your premise and where you’re coming from.

Dr. Cherie Buisson:

Well, the article and I don’t remember what made me want to write it, I just, I always write and speak about things that I’m not good at. Everybody’s like, “You’re such an expert in it.” No, I’m bad at this and that’s why I work on it so hard. And forgiveness is one of the big ones, because I can hold a grudge like nobody’s business. I mean, I can hold a grudge for what am I? 46 now. So I mean probably 36 years maybe. And I tend to be really sensitive and take things personally, which I’m also trying not to do. I got divorced and I’ve had business deals go bad and there’s just a lot. I started seeing all this stuff online about forgiveness. And they had a little cartoon of a girl on the monkey bar.

Dr. Cherie Buisson:

She was hanging and it said, in order to move forward, you have to let go. And it just, it hit me like a ton of bricks. And I was like, okay, I’ve got to start letting go of some of this stuff. And I’m like, and if I need to let go, I bet a bunch of the veterinary profession needs to let some things go. People outside the profession too, because I’ve heard from them about the article. It’s just, every time I say that we should be forgiving people are like, “But that’s condoning the behavior.” And I’m like, no, because I’m not good at that. I can’t condone bad behavior. And that’s the thing we all need to get past, is I felt the same way. If I forgive somebody that means what they did was okay.

Dr. Cherie Buisson:

And it doesn’t at all because you can forgive them without them ever knowing about it, which is the awesome thing. Because I’m not super confrontational. And I don’t like intimate conversations like that unless I really care about the person, which if I’m forgiving them, I probably don’t care about them that much. If I’m happy to go to that much effort to forgive them. So it was just more how it’s not about condoning behavior, it’s about not holding onto it and letting it eat you alive. We all do it and it’s just awful, that we’ll sit and Harbor this rage and anger and meanness for so long. And the other person isn’t even thinking about you.

Dr. Andy Roark:

That’s the worst part.

Dr. Cherie Buisson:

That was so hard. That’s the worst part. They’re just sitting there eating apple pie with their family and you’re like, and I have this rage deep in my heart and my children’s children’s children will hate you. And it’s like, they’re like “Cherie who?” I’m like, okay, we just got to let that go.

Dr. Andy Roark:

There are a couple of things here I want to unpack. We’ll jump back to the beginning. It’s amazing. That’s the secret to writing success that people don’t know, is you write the book that you need. That’s 100% my career, is me just wrestling with something that’s bothering me or something that I’m seeing. And I go, how do I feel about this and what do I do about it? And I’m with you. I found again and again in my career that the things that I just wrestle with and I have to sit with, and I’ll research and I’ll read and I’ll go, and I will do the legwork because I enjoy it.

Dr. Andy Roark:

Because I have to know, I can’t just not do anything, I have to do something. And so I will go and figure out what I think is a good thing to do. And then I write about it and people are like, “That’s great. I needed that.” I’m like, “Oh, thank God. It’s not just me.” But I’m always wondering, when is the time I’m going to write an article that I need and everyone else is like, “What is this?”

Dr. Cherie Buisson:

I’m going to go with never because I’m always like, oh, Andy has been, he’s got cameras in my house or something because he just knows what I’m going through right now. And yeah, it’s so helpful to know we’re not alone. And especially in this perfectionist environment, people lose a patient and they act like no one’s ever lost a patient in the history of veterinary medicine. And I’m like, if you haven’t you may not have been doing this long enough. Because it happens to everybody, but you just feel so isolated and alone and what do we do? We tell the young veterinarian or the young technician, “Hey, this happened to me and here’s what I did. And here’s how it helps.” So I think just letting everybody know. And I think right now, I mean, globally as much as we’re divided, we’re all together in that everyone is in rage.

Dr. Andy Roark:

[crosstalk 00:07:43] rage.

Dr. Cherie Buisson:

There’s just so much. We are so bound by our complete rage. Like the flaming sort of justice is just in everyone’s and the whole world is lit up with it. So yeah, in fact, the article came out and I didn’t know you guys were publishing it. And I was like, oh yeah, that’s probably what I need to read again, because I’m not feeling. Well, I’m failing in this.

Dr. Andy Roark:

Do you do the thing where you read your own stuff years later and you’re like, “Man, that’s good.” [inaudible 00:08:15]. I had really had it figured out in 2016. I’ll totally do that.

Dr. Cherie Buisson:

[crosstalk 00:08:20] say, oh, do you ever read it and go, “Oh, that really needs work.” And I’m like, no, I usually am like, “Wow, I can’t believe I wrote that. That was all right.”

Dr. Andy Roark:

I’ve had some stuff that hasn’t aged as well as I wished it had, but for the most part, and when I say age as well, I tend to make jokes about things that are topical. I was like, wow, I was you really into I don’t know, into Seinfeld at the time. And Seinfeld. Like oh, the Star Wars, The Phantom Menace was all in this article. I really wish I could strip that back out now.

Dr. Cherie Buisson:

Yeah, you’re you’re just like oh, yeah. It’s like, I’m 46 now, and I’m starting to almost put references in, that I know no one’s going to get, just so I can hurt a little more. I don’t know what that’s about, but the other night on Ted Lasso, one of the British people said cheers to him and he went, “Night court.” And I cracked up and I know like half the world was like, what heck was that?

Dr. Andy Roark:

My wife makes Zoolander jokes to her college students and they do not get it. Zoolander came out when they were born. So yeah, it’s funny I do wonder sometimes like, if I am destined to figure things out and write them down and then forget them only to rediscover the article years later and go, ah, I wish I remember that. I had it figured out back then. I love your point about the little girl on the monkey bars. And you talk about that in the article, that feeling of dangling in place, it really resonates. And I think it’s a beautiful image of just, I think that’s one of the things that’s bothered me a lot recently, is I’ll be frustrated or I’ll be angry. And I don’t feel like I’m moving forward through it. I feel like I’m just hanging out here. And part of it is, say, COVID frustrations and things like that. And I go, we have a vaccine. I don’t know what’s going to change in the future that is going to be radically different.

Dr. Andy Roark:

I think in the past, I was like, oh, we’re going to get a vaccine, and this will be a thing in the past. And now I’m like, I don’t think that’s true anymore. I think we’re just living here. And so that stasis is really heavy. And so I thought that that metaphor was really good, is to move forward, you have to let go. And so let’s talk a bit about actual forgiveness. I completely agree, the pushback that I get when I talk about forgiveness and the pushback that I feel myself is, I shouldn’t have to forgive someone one who is not sorry for what they did.

Dr. Cherie Buisson:

Oh my God. Yes. Why? Why should I do that? Because suffering is all about you. I think that’s why we have so much trouble because vet professionals tend to be about everything else and everyone else. And we rarely turn that spotlight on ourselves. And it’s like, yeah, this isn’t about me. Or this totally is about me. Forgiveness is all about whether I forgive or not has nothing to do with the other person. And that’s what’s so hard for people to get is that, the other person doesn’t ever have to know. In fact, in a lot of cases I mean, when you think about people who’ve lost a parent that they had a difficult relationship with, if you forgive them and they’re deceased, they really don’t. I mean, maybe they know in some ways, but they’re not here to be forgiven and asking for forgiveness it’s just one of those things I don’t have control over anybody, but me and that’s been a lesson.

Dr. Cherie Buisson:

If I could learn that lesson 100% of the time, I’d be the happiest person on the planet. But I forget it all the time. It’s like I have control over me. What can I do to make myself more comfortable and make this situation better and holding onto anger is never it. That is a great recipe for getting reflux in your esophagus. It’s going to give you heartburn. Don’t eat that. Don’t eat that anger, get rid of it. Let it go.

Dr. Andy Roark:

It’s super hard though. Yeah. It’s super hard. It’s like, I’m going to continue to drink this poison myself and hope that the other person suffers for it. It doesn’t work that way. But it’s so easy, especially if you have an interaction with a client, you have a dentistry and it doesn’t go the right way that you want, or the bill comes out higher than you thought it would be. And say that there was a quoting error made to the client and they say the most awful things to you. And then every time you do a dentistry after that for the rest of your career, you get angry.

Dr. Cherie Buisson:

Oh my God. That’s so true.

Dr. Andy Roark:

It is so true. I mean, so many of us live like that and I go, this is not helpful. This is no good. The text [crosstalk 00:13:09].

Dr. Cherie Buisson:

You’re cleaning teeth and you’re going Mrs. Fredrick said.

Dr. Andy Roark:

Yeah, you’re redoing it. And that’s why you are the one who needs to step back, sir.

Dr. Cherie Buisson:

You’re doing the conversation in your head where you’re just like, you’re having that, what did I wish I had said? And I think that gets a lot of us too, is that we don’t necessarily think on our feet, so somebody will tear us down and we get the greatest comebacks, like in the shower later that night. And it’s like, “That’s what I should have said.” So then I have that conversation where that’s what I said, like a thousand times, and it just eats you up. It’s just awful.

Dr. Andy Roark:

Do you have tricks for actually doing it, for actually letting go?

Dr. Cherie Buisson: Repetition, just like everything else that you become good at and people are like you just say, “I forgive you.” It doesn’t work that way. When I had people that have hurt me, I mean, I got divorced and it was a messy, ugly divorce. And it was eight years before I really felt like, you know what? That relationship was good for me, even though it turned out badly. That was what I needed to take the next step. And to actually, it tasted like vinegar, but you’re like, thank you for leaving me so that I could grow more of a

backbone. That was a hard, hard place to get to and saying it out loud, which is weird. So don’t do it in public.

Dr. Cherie Buisson:

But if you drive by the exit on the highway where that person lives just go in peace, you’re forgiven, I’m letting this go. And the more you say it, your mind hears it and believes it. I’m big on that all the time. You need to say things out loud so that your ears hear it and your brain hears it. And eventually, if you tell yourself enough, you’ll believe it. And you slip up. I mean, there are times where I’m still mad at someone that I thought I had forgiven. I have to go back and I’m like, okay, what are we going to do now? We’re going to forgive them again.

Dr. Cherie Buisson:

And it’s a work in progress. I mean, it’s like someone saying you got married and now you’ve got, marriage is done. No, it’s work every day. And you just have to keep at it, and you have to forgive yourself for not being good at it. I mean, that’s the other thing is that we’re all like I can’t let this go. Why can’t I let this go? It’s okay, well, forgive yourself too. It’s okay. You’re human. But we’re not good at being human in veterinary medicine.

Dr. Andy Roark:

No, we’re supposed to be better than human. We’re supposed to have it already. So there’s a lot there. I picked up a book a while back and it’s called something like What to Say When You Talk to Yourself, and it’s very much about the-

Dr. Cherie Buisson:

I need this book.

Dr. Andy Roark:

Yeah. It’s What to Say When You Talk to Yourself. And so as someone who has a continuously running inner monologue, I thought it was interesting. And I picked it up and basically sort of said that thing that we’re sort of saying, is your mind acts on the thoughts that you have. And if you think this person wronged me, this person was awful. I was mistreated. You’re going to feel those emotions and you are going to convince yourself, even whether or not it was true.

Dr. Andy Roark:

If you tell your mind again and again, I was mistreated, I was treated unfairly, your brain will come to believe that that’s what happened. And it will act that way. And you’ll get those cortisol level increases and you’ll get that rage and you’ll get the anger and the guilt and everything that comes with it. Sort of skimming through it, I thought the book was pretty good, but it was real big on self-talk. It was like, saying things out loud is good. And so you should say it to yourself when you’re not around. And then it went farther and it was sort of like, you should listen to audio cassettes of positive self-talk and I was like, I’m out.

Dr. Cherie Buisson:

That’s too much. That’s too much for me.

Dr. Andy Roark:

My wife, if she came into the bathroom in the morning and I was listening to you are a good person and you have a lot of friends. I would have one less friend and it would be my wife.

Dr. Cherie Buisson:

Yes. Absolutely. Let me tell you, because you just reminded me about the talk, when I was a kid I hated green peas and of course my parents-

Dr. Andy Roark:

Green peas?

Dr. Cherie Buisson:

Green peas, hated them, hate with a passion. No, not green peas. Green peas, the vegetable.

Dr. Andy Roark:

[crosstalk 00:17:11].

Dr. Cherie Buisson:

No, no, no. Vegetables. We’re on vegetables. Hated green peas. And my dad said, “You don’t hate green peas. You’ve just convinced yourself that you do.” He said, “What’s your favorite thing to eat?” I said, “Sweet potatoes.” And he said, “Every time you take a mouth full of green peas, you need to say this taste likes sweet potatoes.” I mean, I was like 10, and I’m like, this is BS. I’m not doing this. But we did. And I started gagging on green peas because they were so disgusting. And eventually, it worked. Eventually, and I love green peas now, and green peas but I love green peas and I will eat them. And all we did was I told myself out loud, these taste like sweet potatoes.

Dr. Cherie Buisson:

It is, it’s like it’s mind over matter in a lot of these cases and you’ve just got to keep repeating it till you believe it. Just like if you tell somebody that they suck enough, they’re going to believe that they do. You are no exception. You live in your head all the time. So if you’re constantly telling yourself you suck or you’re angry or whatever it is you’re telling yourself, you’re going to believe it. Because you’re in there all the time.

Dr. Andy Roark:

Most of us have an inner critic I think that is absolutely ruthless. I would fire my inner critic. If anyone said something to me that I say to myself, I would throw down. No one talks to me like that, but me. You know what I mean? I would quit my job if I had a boss who talked to me the way that my brain talks to me sometimes. And that’s again, it’s the types of things that we have to be better to ourselves. What we say to ourselves matters as much as what other people say to us. I think that’s important.

Dr. Andy Roark: The vocalization just saying, I forgive you. Just saying, I’ve moved past this to yourself. I mean, it actually is beneficial. Again, I’m not advocating for the self-help audio, self-talk things necessarily. But having that clear when you start to feel that anger about the client and you say, “I’ve moved past this.” Or I said

my piece and I am done with this. And you can say it out loud or you say it in your mind, but that type of repetition to yourself, it is how we actually do move past these things. We convince our mind that we’re over and then we are actually over it. But it takes time.

Dr. Andy Roark:

Hey, guys. I just want to jump in real quick with a couple quick announcements this week over on the Uncharted Veterinary Podcast, we are talking about what it means to be a rad relief vet, how to set yourself up as a rad relief vet and how to set relief vets up to be rad at your practice. So it’s all about relief vets on the Uncharted Veterinary Podcast. Get it wherever you got this podcast, it’ll be there. Uncharted Veterinary Podcast.

Dr. Andy Roark:

Gang, on the uncharted side of the house, we have got some great workshops coming up. My friend Dr. Mary Ann Vande Linde is doing Team Power: Adding Value to Your Visits on September 22nd. This is all about communicating value to pet owners. It is a two-hour workshop. It is from 7:00 to 9:00 PM Eastern Time that night. It is very much about building your exam room plan so that at see value in what we do. And I know with a lot of us wearing masks, with a lot of us still doing some curbside sort of limited contact and just seeing patients in different ways. I think a lot of us are asking, do our clients see the value in what we do?

Dr. Andy Roark:

There’s never been a better time for this workshop. It is free to uncharted members. It is $99 to the public. On October the 9th, Dr. Tracy Sands is doing Empowering Your Team to Get Positive and Stay that Way. This is a team culture positivity workshop, it is all about getting your practice to be a nicer, happier place to work. It is a two-hour workshop as well, 3:00 to 5:00 PM Eastern Time on October the 9th, it is free to uncharted members and $99 to the public. I’ll put links to both of those things. The last thing I’m going to say is the Uncharted Culture Conference, October 21st through the 23rd is a virtual conference. We have been doing buy two get one free, because we really think that you should bring your whole leadership team, your medical director, and your practice manager could come together.

Dr. Andy Roark:

Your practice owner and manager can come together with the head technician. And it’s really about getting people together to have this experience and see culture training and do culture training and do workshops, and have these shared experiences to take back into your practice so that you’re not trying to take this into your practice by yourself. It’s buy two get one free, but that deal is ending and it’s ending this week. So you need to immediately bust it over to Uncharted, get registered for the Uncharted Culture Conference and get your extra, buy two get one free deal hooked up. Guys, that’s enough about that. Anyway, links in the show notes for all of these things. All right, let’s get back into this episode.

Dr. Cherie Buisson:

I have a hack for you out the listening to the self-help tapes. Listen to your own podcasts.

Dr. Andy Roark:

Listen to my own podcast.

Dr. Cherie Buisson:

I will occasionally, especially if I’m having a rough day and I know I’ve done a podcast on that particular subject, I’ll go back and listen to it with somebody interviewing me and that’s I think a legitimate way that you can talk to yourself without being too weird. But I will, I’ll be like, I had that forgiveness podcast with Andy. I’m going to go listen to myself talk about what I should do. And maybe I’ll actually listen to myself, if I say it enough. But I swear our inner critic, is it literally the flaming raging sort of justice that is our inner critic? Because I feel like that’s all it is. It’s not even really a person. It’s just the sword.

Dr. Andy Roark:

So yeah. So I came up with the flaming raging sort of justice a while back in that I feel like so often what we do in vet medicine is unfair. It’s just unfair. Life is unfair. But I feel like in vet medicine, we get a big dose of unfair, and we see a big dose of unfair. It’s not fair that this aggressive dog who was abused is now going to be put down because people can’t handle him and he is not safe to be around other people. That’s wildly unfair, and it really sucks and it really makes me mad. And so that sort of feeling of unfairness. I think a lot of us have a feeling of justice. It sort of goes back to the idea why I think it’s so hard for a lot of us to say, I forgive you.

Dr. Andy Roark:

And especially when the person doesn’t ask for it and they don’t seem to care. The idea of me forgiving them for this thing that they did and got away with, with no negative repercussions, and they don’t even remember, that feels so wrong. And that feeling, I kind of summed up as like, I want the sword of justice. I want to smite that person. I want to strike them down. I want to tell the pet owner, do not show up 25 minutes late for your appointment and pitch a fit to be seen because you are ruining my day and you’re going to make everyone else wait and pets are going to be waiting all day because of you and it’s your fault and you’re going to be rescheduled. And if you don’t, I’ll smite you with this raging sword.

Dr. Andy Roark:

It feels so natural in your hand to be like, I’m going to smite her good. But the thing with the flaming raging sword of justice is it’s always a bad idea. It’s double-bladed and there’s always collateral damage, but man, putting that thing down of going, this is wrong. This is unjust. This is unfair. I think that that’s a real skill that a lot of us have to pick and it’s a very humbling skill. So yeah, it is a very humbling skill. I think there’s a lot of Buddhism in it of saying, I’m going to let this go. I’m going to find peace with this. I’m going to put this down.

Dr. Cherie Buisson:

And trading it for empathy. So you put that down to trade it for empathy. That is a skill. Because it takes a lot. I hold a lot of resentment because I have trouble telling people how I feel when I’m not hot about it. If I’m furious, oh, I can just lay into somebody. But if I have to say, when you did this, it made me feel this is way too vulnerable for me. I need the sword, but it’s the same with pet owners and being a hospice veterinarian. I’ve had to learn that people are going to say crappy things when they’re grieving. And I just put on my empathy hat and it’s like as long as I’m not in danger and no one’s screaming at me or hurting me, I’m going to let this go because this person is not at their best. And I have been at that point and I get it.

Dr. Cherie Buisson:

We do, we trade it and I will say, I have like 99.9% awesome clients. And I know a lot of those people are some veterinarian’s nightmare client, but we hit them with empathy from the minute they contact us and everything is empathy and understanding and calmness and coolness. And I think that’s why we have such great clients. It’s not the clients necessarily. It’s how we approach it. And the sort of justice it’s buried, and we don’t get to use it. I’ll rise to the defense of my team if somebody is giving them a hard time. But even then I throttle it down and it’s like, how can I approach this? So it’s a win for everybody. And the only way to do that is with empathy and that’s hard. It’s so hard.

Dr. Andy Roark:

It’s super hard. One of the things I say to myself that has been helpful over the years is everyone’s fighting a battle we don’t know anything about. I keep telling myself that. And so I use that example, about the flaming raging sort of justice. I had a client a couple of days ago come in. And she was 20 minutes late for her appointment and she called ahead and she said, I’m going to be 20 minutes late. And the front desk was like, do you still want to see her? And I didn’t really, but you know what I mean? I could 100% see how this could blow up my day. And so everyone whose’ worked appointments knows if this… I wanted to ask her if you promised this cat is 100% healthy and fine, and there’s no concerns, then you can come in, otherwise, the answer is no.

Dr. Andy Roark:

And I should have just said that, but I didn’t. But I folded, and I was just like, “Just tell her to come in. We’ll make it work.” And so she comes in and she’s like, “I’m so sorry. My chemotherapy is making me feel terrible. I couldn’t get my cat into the carrier.” And I was like, “I’m so glad you came in.” I’m so glad you came in. And it was fine. And it went great. I felt really good about accommodating this person. And she was wonderful and she was lovely. I’ve been thinking about it ever since, because I don’t think that I was wrong when they said, “Hey, do you want to see this person who’s 20 minutes late,” to feel like, no, we’ve done this. And it tends to go badly. And there’s a lot of ways this [inaudible 00:28:20] wrong. And we have a policy that says that we don’t do this.

Dr. Andy Roark:

So I still feel, probably shouldn’t do it. At the same time when she comes in and you go, oh, you’re not just a pompous jerk who stopped for lunch at the coffee shop and had a good conversation and didn’t come over, you’ve got real issues and you’re doing your best, and I got to help you. So I don’t know. I’ve just been kind of rolling that around, back and forth. I don’t that it means anything, I don’t know that there’s any sort of policy changes I would make to this, but I do think it was a really good reminder that sometimes it’s good just to assume the best about people, even just for our own sake.

Dr. Cherie Buisson:

Yes, absolutely. One of the exercises that you can do for that is if you have somebody that blows up your day if you do rounds with everybody, or you’re just talking with a team, ask them to tell a story, what is the story that this client could tell you that would make what happened okay. Did they lose their wife last week? Are they recovering from COVID and they have brain fog and they’re scared won’t be able to resume their very important job. What is it that would make you okay with this? Because we tell ourselves, he’s a pompous ass. He did this, he did that. But why can’t we tell the other story, maybe this is what’s happening. Oh my gosh, wouldn’t that be horrible? And again, you’re hearing that, it doesn’t have to be real. You’re just hearing it, and you’re like, well maybe I should be a little more understanding.

Dr. Cherie Buisson:

And I am never one to abuse, is a hard line in the sand for me. If you have to come in and take out your pain and rage on other people, I’m sorry, but you’re going to have to learn a lesson from that. And that lesson is, we don’t put up with that crap here. It’s very sad to me that a lot of vet clinics don’t feel that way, but if somebody is having a fit, but you’re like, this isn’t the whole story. Something else is going on. I’ll pull them in and be like, “Hey, this isn’t like you, what’s going on? Tell me what’s on so we can help.”

Dr. Cherie Buisson:

And then they’re like, “I’m the worst person ever.” We’re like, “Yeah, we know, but we’re going to help you anyway.” Now that you’ve down a peg, okay, now that we’ve calmed everybody down, or just come in and be like, Anne is crying. What happened in here? Usually, you come in and we have a great visit. What’s going on? And the minute you turn from defensive to tell me what’s happening, it just makes all the difference in the world. I say that super easily, because I’m sitting in my office and it’s 8:30 and it’s quiet and nothing bad is happening. But it’s something that I’ve had to work on really, really hard because of how personally I take things, and every tip and trick I can get for how to throttle back that instant rise to anger that happens because I have anxiety and I get that fight or flight thing going on if I can just take a breath and go, how do I make this a win for everybody? It totally changes the game 100%.

Dr. Andy Roark:

Yeah. That pause between receiving the information, getting the emotional impact and then responding man, it’s all make or break right there. If I take that as a slight, as something negative, if it feeds into some of the frustrations I’m feeling about the world, it’s really hard to turn it into a positive or get my head into a good space. It’s heavy lifting. I think that’s where I am these days. I generally am a very positive person. I think that I’ve been worn down over the last couple of years to where, and it just becomes sort of aware of it recently of like how often my very first thought is a negative thought when I run into a point of frustration. When I hear from the front, oh, this person’s going to be, they called, they’re just going to be a couple minutes late. I go, “Oh, sure they’re going to be a couple minutes late.” [inaudible 00:32:15].

Dr. Cherie Buisson:

Of course, they are.

Dr. Andy Roark:

Of course, they are.

Dr. Cherie Buisson:

Mrs. Smith called and she needs this. Of course, she does. That was always my response in private practice, which is why I’m not there anymore, but I totally get it.

Dr. Andy Roark: It’s such an easy response. And usually, it will make the text laugh. If I say it in front of them, they’ll be like, oh, you know? I’m not going to say it in front of them, but you’ll get pats on the back. You’ll get people who’ll go, yeah. I know, I know. But ultimately, it’s a destructive response. It’s not healthy, it’s not a good response. And it just puts me in a bad headspace to do my job, which I’m ultimately going to do anyway. And so it’s just been an interesting exercise recently, as I try to commit to getting back on the positive track or on a more positive track, just taking that pause and checking myself and going, okay, what am I thinking here?

Dr. Andy Roark:

Are my thoughts in a good place? Am I being fair to this person? Am I being empathetic to this person? The default is just no, be a jerk. Just tell him to shut up. But because it’s super easy, it takes some effort to empathize. You know what I mean? To catch and be like, I’m going to be generous to this person. I’m going to show some love and kindness to this person. It’s a muscle that we build, but man, if you get out of the habit of using it, it takes some activation energy to get it back.

Dr. Cherie Buisson:

It does. And it’s like low-stress handling for people. And it’s the same thing. We can wrestle the cat to the table and we can get done what we need to get done. But if we just take that beat and calm down and think what would make this cat more comfortable so that I can work on it easier, it helps so much. And the other cool thing about the moment of silence is that half the time, if you’re silent long enough, the client’s like, “I am so sorry.” Because people hate silence and they want to fill it in. So if somebody’s like, “I need you to explain to me right now why you did this,” and I don’t answer they’re like, or maybe we could just talk about it.

Dr. Cherie Buisson:

Because I had a boss that all he would do is tip his glasses down and look at me over the tops of them. And I was like, “Shit, what did I say?” I better rethink that. And so that moment of silence gives you a second to think about a response, but also them a second to hear themselves and go, that might not have been my best move. That’s a dual thing there, but yeah, I try to a look at it like I do the low-stress handling because I’ve gotten so into that with my patients because I’m in their house, giving them a shot, their parents are crying and it’s all my fault. I’ve had to really get around like what is this pet feeling and how can I make it better?

Dr. Cherie Buisson:

And so I’ve tried to bleed that into how I handle humans. Because humans are not my favorite species. And it really, all that same principle of go slow, be quiet, be calm, find out what they need and give it to them, really makes a difference. And some people are just hopeless and that’s okay. But yeah, and I also find when I am not taking care of myself, my ability to be empathetic is crap. When I burned myself out last year, because I was just, I’m going to work. And then when I catch COVID I’ll take a break and then everything will be fine.

Dr. Andy Roark:

It’s a terrible plan.

Dr. Cherie Buisson:

I know. And I never caught COVID so I just worked the whole year without stopping, and then into-

Dr. Andy Roark:

It’s a horrible backfire.

Dr. Cherie Buisson:

I know, and then in January, I was like, God, if I don’t take a break, I’m going to die. And then we planned a vacation, but it wasn’t until May. So by May of this year, I had nothing left and people would want something and I would just grind my teeth. Thank God I had a mask on, but grind my teeth at every little request and I was like, this is not how I handle people. And I went on vacation and I came back and magically, it was better. And then a month later it got bad again. And I was like time for another break. And I took some more time off and I was like, I didn’t take any time off last year, this year I’m taking breaks whenever I need to, because I’m not recovered yet from all the abuse I gave myself in 2020.

Dr. Andy Roark:

No, I’m right there with you. It’s a whole lot easier to be forgiving, to be kind, to be patient to ourselves and to our coworkers and to our clients when you’re well maintained. And so things for me recently, I get good sleep. I have been really good about going to bed and getting a good night’s sleep. I’ve been eating better. And then by that, I mean, I’m more intentional about kind of what I’m eating and what I take to the clinic so I have some calories and things like that throughout the day. I just, I don’t want to get hangry and I’m trying not to get tired. That may sound ridiculous, but I tell you, man, that’s an investment that pays dividends.

Dr. Cherie Buisson:

Yeah. And the exercise, I have to be able to exercise, but my husband and I in this last year we usually get up really early because we’re in Florida and it’s hot. We get up and we’re exercising before it gets too hot. And I’ve needed more sleep, I just have, and it was like, you know what, if we don’t get to bed by 9:00 or 9:15 when the alarm goes off at 5:30, I’m not getting up. And I’ll get up when I’m ready and then we’ll go out. And if we have to, like you always say, choose how you suffer. I’m going to suffer in the heat as opposed to suffering because I have lack of sleep. He’s been right there with me because it’s been exhausting.

Dr. Cherie Buisson:

And how we haven’t figured out how to forgive ourselves for not being perfect in this life last year. Like this has just been a dumpster fire and everybody’s like, I don’t understand why I’m struggling. What? I do. Let me give you the list of why we’re struggling. Like it’s everything, everything is a wreck. And so we’re trying to be forgiving. We totally blew our diets out of the water last year and it was ugly. And I was like, you know what? I just don’t care. I’m going to eat what I want to eat. And we were exercising like crazy. So that was good. And now we’re kind of toning it down, getting that high cholesterol diagnosis from your doctor will do that to a girl.

Dr. Cherie Buisson:

So I was like, “Oh, God, really?” High cholesterol. Okay, fine. Will do better. But yeah, I’ve been much more forgiving of myself and also much more like treating myself like I would a kid who’s having a temper tantrum. It’s like, why don’t you just go lay down for a minute, sweetie, like go push your feet up and take a deep breath. And we’ll try again in 10 minutes. I put myself in timeout, put me in the crate. I don’t care. I need a timeout in the crate with a con and some peanut butter and I need to breathe until I can handle this like a grownup.

Dr. Cherie Buisson:

I look at vet med and how hard it’s been for everybody and how unforgiving we have been with ourselves and each other. And I hope we can start making that better, and stop hurting ourselves and each other the way that we have been. Because it just, it’s heartbreaking how bad things have been.

Dr. Andy Roark:

Yeah. I think it’s time. I really do. I hope that there’s a cultural shift going on. I think I don’t know, maybe I’m hopelessly optimistic, but I do think there are. I think that kids going back to in-person schools is a big step towards normalcy for a lot of people. For whatever reason, just this fall, I think the schools were part of it, but I just feel like a lot of us have kind of said, you know what? We’re kind of going back to work. I feel more normal now than I have in a long time, even as COVID numbers stay high, but it’s just, we’re going to work and we’re doing our job and the kids are going to school and we’re making it.

Dr. Andy Roark:

I think that that normalcy has helped me get my head back straight and being like, you know what, I’m going to treat myself better. I’m going to treat other people better. I’m going to enjoy my job again. I think that’s been a good reset. Well, Cherie, thanks for being here so much. Where can people find you online? Where can they read more of your stuff?

Dr. Cherie Buisson:

They can find me at happyvet.com. And then for my more hospice stuff, that’s geared toward clients at helpinghandspethospice.com.

Dr. Andy Roark:

Awesome. Thanks a lot for being here. Guys have a wonderful week. Thanks, everybody.

Dr. Cherie Buisson:

Thank you, bye.

Dr. Andy Roark:

And that is our episode. That’s what we got for you. Guys, I hope you enjoyed it. I hope you got something out of it. If you did, you can make my day by writing an honest review, wherever you get our podcast and just saying, “Hey, I got a lot out of this episode. This was really great.” It helps me to know what you guys like. And then also it helps people find the podcast and spread the word. So anyway, because that’s always a nice thing that you guys can do to help us out. Because my team works really hard on the show. We really do. So anyway, thank you for considering. Gang, take care of yourself. Be well. Forgive yourself and forgive others. And I will talk to you next week.

Dr. Terry Marie Curtis, board certified veterinary behaviorist, joins Dr. Andy Roark to talk about dog and cat behavior problems related to the COVID pandemic, and then get into how to treat inter-dog aggression. They discuss dominance hierarchy, pharmacological therapy, and nutritional supplements.

This episode has been sponsored by Sure Petcare

LINKS

Dr. Terry Curtis Veterinary Behavior: ​​www.terrycurtisveterinarybehavior.com/

TEAM POWER: Adding Value to Your Visits: unchartedvet.com/product/adding-v…your-vet-visits/

Uncharted Culture Conference Oct 21-23: unchartedvet.com/uvc-culture/

Charming the Angry Client On-Demand Staff Training: drandyroark.com/on-demand-staff-training/

What’s on my Scrubs?! Card Game: drandyroark.com/training-tools/

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Terry Marie Curtis, DVM, MS
Diplomate ACVB
Veterinary Behaviorist

Dr. Curtis graduated with honors from the University of Florida College of Veterinary Medicine in 1997.  She worked as a feline-only practitioner in Florida until the summer of 2000 when she began her residency in Veterinary Behavior at the University of Georgia, Athens.  Concurrently, she received a Master of Science in Psychology investigating grooming behavior in the domestic cat.  Completing her residency in June 2003, she joined the team at the University of Florida College of Veterinary Medicine – where she is currently courtesy clinical assistant professor and teaches 2 behavior courses.  Dr. Curtis, a Diplomate of the American College of Veterinary Behaviorists, does house calls in Florida and South Georgia and is a regular contributor to the annual NAVC-VMX conference, the coordinator of a day-long Behavior Symposium there.  Author of a number of articles, including book chapters in Veterinary Clinics of North America, the 7th Edition of Blackwell’s Five-Minute Veterinary Consult and Decoding Your Cat, she is a member of the Editorial Review Board for Today’s Veterinary Practice magazine, former editorial member of the Journal of Feline Medicine & Surgery, and currently serves on the Advisory Board for BluCare and for Vet Candy.  She was also a panel contributor to the 2014 AAFP & ISFM Guidelines for Diagnosing and Solving House Soiling Behavior in Cats.  Dr. Curtis has worked with the Hemingway House cats in Key West – discussing the subject on ABC’s Nightline (July, 2007), and was on the NBC Today show (July, 2008) talking about fears and phobias in dogs.  Dr. Curtis was honored with the Keuka College Alumni Association Professional Achievement Award in 2018.

Editor: Dustin Bays
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