Originally Published: HealthyPet Magazine, Spring 2012
Click above or here for a direct link.
Originally Published: HealthyPet Magazine, Spring 2012
Click above or here for a direct link.
Give Us an Earful: How Do YOU Treat Aural Hematomas?
Originally Published: Clinician’s Brief, March 8, 2012
Click here or above to read the complete How Do YOU Treat Aural Hematomas? article.
Give Us An Earful: How Do YOU Treat Aural Hematomas?
“What are you going to do this time?” my technician whispered as we looked into the waiting room. The 4 y.o. MN Bernese Mountain Dog looked back happily, then violently shook his head. The hair on the outside of his right ear was starting to re-grow, as was the fluid-filled pouch on the underside. His owner spotted me peeking around the doorframe as I tried to assess the situation, as well as the attitude of the client who was making his fifth visit in the last 8 weeks. He gave me a pained grin that said, “I like you a lot, but you really need to fix this.”
To be honest, I was (and still am) quite fond of this particular dog. However, frustration over this unresolved aural hematoma was threatening to seep into my bedside manner. During this case, I read widely on treatment options, and discussed everything from medical management to ear amputation with the owner. I tried multiple courses of steroids, ran blood work, evaluated clotting times, drained, opened, sedated, anesthetized, quilted, and asked for advice from almost every veterinarian I knew (and some that I didn’t).
Ultimately, it was a combination of steroids, quilting, and drains (and possibly prayer) that seemed to do the trick. I used an 6-week tapering course of prednisone with 1cm full-thickness sutures and a ¼-inch fenestrated latex drain, which I removed after 3 weeks. Having gone through this emotionally scarring ordeal, three things now happen whenever I see an aural hematoma. First, I develop a mild eye twitch that my technicians are starting to pick up on. Second, I preemptively warn the owner how frustrating treatment of this condition can be. And finally, I kick myself for not writing down all the great advice I was given on effective treatment of this condition the first time.
So today, for the sake of all the veterinarians that are battling (and will battle) this potentially humbling condition, I ask for your help. Please share your best advice for treating aural hematomas in the comment section below. Your words of wisdom may save a young (or not so young) veterinarian a lot of frustration!
The Best “You” Ever: A 1-Year Personal Strategic Plan
Originally Published: Exceptional Veterinary Team, August 2, 2011
It’s dangerous to make assumptions about people. However, I am willing to make 2 assumptions about you:
#1) Because you are a veterinary professional, I am fairly certain that you pursue a greater goal than immediate financial gain and that you are compassionate, hardworking, and dedicated. These attributes are practically requirements for our profession, and you wouldn’t be here if you didn’t have them.
#2) You are interested in improving your skills and knowledge base, and you know that you can be a better professional than you are today. If you didn’t have this introspective character or believe that you can improve yourself and those around you, then you never would have started reading an article on myEVT.com in the first place.
Our profession is an amazing place. The people that it attracts have deep inner strength and conviction. Those that choose to continue to grow professionally and develop personally within our profession have practically limitless potential. I have been blessed to see what technicians, receptionists, practice managers, and doctors are capable of when they rise above the struggles that we face daily in practice, and focus themselves and their personal energies on their own growth and development. These metamorphoses are staggering in their impact and their reward, and they are well within your reach.
The single greatest tool for both personal and professional growth that I have ever found, the one that I have continuously modified and shared since it began opening doors for me, is the personal strategic planning session. I learned this technique years ago from a program put together by Josh Kaufman at the Personal MBA (www.personalmba.com). The original program is difficult to find today, but I have included a link to it at the end of this article for those interested in the original source material.
The personal strategic plan is a mind-mapping creative exercise that will help you focus your energies on what is most important for you to advance your career and build true happiness in your life. It takes some time to work through, but it can be done in multiple phases, and the end result (a clear vision of what you need to be doing to reach your ultimate goals) is definitely worth the effort. Also, once you know what is really important for you to meet your goals, a lot of other things that are causing you stress now will become much less pressing. Let’s get started!
1) Get your supplies
This exercise doesn’t require much except:
• a quiet, distraction-free place to sit
• 5 pieces of notebook paper
2) Compartmentalize
We all have unique, and equally important, goals in different aspects of our lives. For example, your P90X fitness goal and your goal to repair your first cruciate tear are not completely related, but they may be equally important to making you the person that you want to be. In order to consider both fitness goals and professional goals as they impact your life as a whole, we first need to separate them. Here’s how we do it.
On four sheets of paper, in the center of the top line, write one of the following words: Professional, Exercise, Financial, or Personal. Each sheet of paper will become your medium for brainstorming, exploring, and prioritizing goals from different aspects of your life.
Professional – This page will include the things that you want to accomplish in your professional life. These goals may involve work/life balance, co-worker communication/relationship goals, veterinary degrees or certifications, management and/or medical skill acquisition, and long-term career aspirations.
Exercise – Exercise is important for both mental and physical health. You don’t have to set out to become a triathlete or mountain climber in the next year. My exercise routines are usually 15 minutes of posing in front of the bathroom mirror…30 minutes of cardio…and 15 more minutes of lying on the floor, clutching my side and trying to breathe (*gasp*). You don’t have to become an extreme athlete. All you have to do is make reasonable goals that will keep you active, energetic, and de-stressed. This is an important part of your life and you know it.
Financial – What are your financial goals as far as savings, income, debt, home ownership, etc.? Do you need to purchase a new car, start funding your retirement, get life insurance, or stop eating off of the dollar value menu when you go out?
Personal – Goals for things like your marriage, spirituality, personal development, parenting, and philosophic outlook on life will be focused on here. This is, in my humble opinion, the most important of the five pages, and should not be ignored.
3) Brainstorm
Find a quiet place to write and start with whichever page you are most excited about. Get as many of your goals, both short and long term, down on paper as possible. You don’t have to be committed to anything you are writing down here, but do your best to make the goals you write down specific. For example, rather than writing “I want to learn ultrasonography,” you might write, “I want to be able to perform and charge clients for a thorough abdominal ultrasound examination that covers all major organ systems (including the adrenal glands).”
Write until the ideas stop flowing freely, and then move on to the next page. If you don’t know how to make an idea specific as it pours out of your mind and onto your page, or if you feel like you are blanking on an important goal, don’t worry. We will clean up and expand upon your most important goals later on.
4) Ask “Why?” again and again
Once you have your list of goals, take a few moments to burrow down into WHY you care about these things. For each goal, ask yourself “Why? Why is this important to me?” Once you have an answer, ask the question again. Feel free to change your goals or add new goals to your list based on your responses. This is also the time to re-write any goals that are not as specific as they should be.
Here is an example of how one of my own goals changed with this exercise –
Original goal: To run a marathon by the end of the year.
Why do I want to run a marathon? I need to run on a regular basis and training for a marathon will make me do it.
Why do I need to run regularly? I need to be active for my mental and physical health, I need to exercise my dog, and my wife would train with me so I could spend quality time with her.
New Goal: Scrap the marathon. Jog for at least 30 minutes five days per week with my dog and my wife.
I don’t give you this example to talk you out of running a marathon. If you want to tackle that goal, then you should set your sights on it and do it. For me, however, the marathon is not what I really wanted to do, and I doubt that my schedule at the time would have allowed it. Also, after the marathon was finished, would I stop? By asking myself WHY I chose this goal, I was able to come up with a more feasible, valuable, and achievable goal that I could begin accomplishing immediately.
5) Choose your focus
You can do anything you want in life, but you can’t do everything. This is the part of the exercise where we select the most important goals, the goals that speak to who you are in your core, and we table the rest. This is a hard step to do, because no one wants to set aside great goals, but this step is also liberating. This is you deciding that you don’t have to pursue a million different things at once, but that you will pursue what matters most and let the rest go. The goals that you scratch off your list certainly aren’t gone forever. You can always add them to a “someday/maybe” list for future consideration.
Select one of your topic pages and pretend that you can only accomplish ½ of your listed goals. Use this criterion to cut your list in half. Now, repeat. Ouch. I know it hurts. Trim each list down to the single most important/meaningful goal for you on each page. That’s right. Only one goal is allowed. Make sure it is specific, that it can be acted upon, and that your progress can be measured. If it does not meet these criteria, then re-write the goal until it does. Also, if you are feeling overwhelmed, defeated, or lost instead of liberated and excited, then you should further re-think your goal selections.
One example of a complete professional goal would be: “To do more dental CE, cleanings, and oral surgeries than any other doctor in my practice.”
6) Time for action (steps)!!
On your fifth and final sheet of paper, write all four (now very specific) goals. Beneath each one write what you will do in the next week to begin pursuing that goal. Below that, what you will do in the next 3 months, and finally, what you will do in the coming year. Your action steps should be clear and easily measurable (meaning that you either did them or did not do them).
Action step examples might be:
Goal: To do more dental CE, cleanings, and oral surgeries than any other doctor in my practice
1 week action: To tell my practice manager and practice owner that I have a strong interest in dentistry and that I would like to assist in any advanced dentistry cases that come in. I will also call the local dental specialty center to ask if I might come and shadow occasionally on my day off.
3 month action: Visit the dental specialty practice at least 4 times and take at least 6 hours of dental CE either online or at our local VMA conference. Tell the other doctors in our practice that I have a strong interest in dentistry and would be happy to see any dental cases that they would like to send to me.
12 month action: Visit at least 2 different dental specialty practices a total of at least 8 times. I will take at least 12 hours of dental CE and market my interest in dentistry to clients by word of mouth, the hospital Facebook page, our client e-newsletter, and our website. I will also put on at least one community event to speak to our clients about the importance of dental health and disease prevention.
7) Relax and enjoy your new focus
You now have 4 very strong, very important goals. If you accomplish these 4 goals by completing the action steps that you have created, then you will have one amazing year. When you start to feel overwhelmed, when you are being pulled in too many directions, or when you feel like you don’t know where you are going in your life or career, just go back to your action step page. Keep this page where you can find it easily, and where you will see it frequently. Also, make sure to put your 3 month and 12 month deadlines on the calendar so that you will see them coming and stay on track with your master plan!
A 1-year personal strategic plan may take some time to create, and narrowing down your goals to 4 might seem like limiting your productivity. However, by pursuing this course, you will find that you can rise above the clutter in your life and make huge strides toward the goals that are most important to you. You will see that making great progress on a few key goals will be significantly more rewarding and beneficial than making a little progress on a large number of less important ones.
Don’t wait! Set your goals, make your plan, and have the most productive 12 months of your life!
Personal Strategic Master Plan from the Personal MBA:
content.personalmba.com/files/pmba-guide-masterplanning.pdf
Clients Are Not Your Friends
Originally Published: DVM NewsMagazine, August 1, 2011
Friends and family bring a lot of great things into our personal lives, but they also bring stress. For example, my wife is days away from giving birth to our second child. While she has been amazing through the past nine months, the reality is that spending time with a pregnant woman can be a bit like spending time in a field full of landmines. I recently explained this to the manager at the grocery store when I found the entire ice cream section off-limits after a freezer malfunction. He was about 18 and had no idea why I was so upset. He’ll learn someday.
I care deeply about the anxieties and problems of my family and friends. The exhaustion and discomfort my wife experiences daily are things that I internalize and carry around with me. Her happiness and her perception of me affect how I see myself as a person and a spouse. When my friends struggle or ask for advice, I take their concerns on my shoulders and roll them around in my mind as I cook dinner, brush my teeth and read princess stories to my daughter. I take these stresses on because I love these people and because they are important in my life. But when a client causes that stress, that’s another story.
A client with two faces
Recently, a client started visiting the clinic on a regular basis. She had brought home a new puppy, and I helped her work through her puppy wellness visits, a few behavioral bumps, a spay and some inappropriate urination problems. She has a great dog, treats the clinic’s staff well and follows recommendations religiously. She lives near one of our technicians and always talks to her and high-fives her children when they’re out in the neighborhood. I like this lady and I’m happy when she walks in the door.
This client was in the clinic recently, and we were addressing her pup’s new affinity for urinating on expensive furniture. We laughed, she let her dog lick her mouth to the point that I got a little queasy and we generally had a good time. She elected to start a common antibiotic while awaiting diagnostic results.
Things changed a bit the next day. My receptionist came to me five minutes before closing. She said the client was on the phone, she wasn’t happy and she wanted to come in. I asked the receptionist to tell her that I’d wait for her if she came right away. I was wrapping up the last of my paperwork when I heard her walk in and say: “Yeah, the pills Roark gave me yesterday f***ed up my dog!”
“Surely she’s joking,” I thought. “She can’t be swearing at the front desk about anything an antibiotic did to her dog.” I expected her to high-five me for waiting for her rather than blow up in the waiting room.
The exam went fine, other than the fact that she refused to look at me and swore that nothing could’ve caused her dog’s behavioral change besides the single dose of antibiotic from the previous night. I did everything I could to pacify and educate this concerned and angry client before she walked out of the clinic without paying for the exam or any of the supportive care we provided. Three days later she called to mention that the dog was doing much better and that she remembered the patient might have fallen out of a van and landed on her neck shortly after receiving the antibiotic.
The aftermath
As I stood in the waiting room and watched the client drive away, I asked myself how deeply this person’s anger would affect me. It’s possible for me to let something like this wreck an entire weekend—especially when I’m so adept at devising creative ways to blame myself for medical phenomena over which I have no control. As I pondered my role in this patient’s condition, two hard-learned lessons floated back to me:
1. You’re never as good—or bad—as clients think you are. I once talked to a college professor about the reviews he got from students. He said that the key to taking feedback is to remember that no matter what you do, 10 percent of people will think you walk on water and 10 percent will think you’re the worst person they’ve ever met. Neither group is right, so remove both from consideration and use the rest of the feedback to improve what you’re doing. He was right. Don’t let the clients who love you or those who despise you control your self-image or self-confidence.
2. Clients are clients, not friends or family.As a general rule, I like my clients. There are some clients I adore. I go the extra mile for them, check on them from time to time and visit their homes if they want me to perform euthanasia in that setting. But they’re not my friends or my family.
Lesson learned
The difference between clients and friends is that friends don’t pay me for my time during the majority of our interactions. I say the majority because I do have friends who bring their pets to me. Secondly, clients have a nasty habit of substituting entitlement for friendship and becoming very upset when they feel let down. And finally, while I accept the stress of family and friends, I choose not to take the emotions and frustrations of clients home with me.
Obviously, I hold onto the positive energies that clients bring for as long as I can, and some experiences I simply can’t hang up with my white coat before clocking out. For the most part, I give my clients my best when I’m at work, I make sure they know who to go to if problems arise before I return to the clinic, and then I go home, making sure to pick up ice cream on the way.
Why Change Is Like Sledding With Children
Originally Published: DVM NewsMagazine, June 1, 2011
In my heart, I am an 8-year-old boy trapped in the body of a 34-year-old man. In reality, I am a middle-aged man blessed with a wonderful, beautiful, princess-obsessed daughter whom I really don’t understand. As a result, I spend my time looking for things that both little girls and 8-year-old boys enjoy. When I find those things, I jump all over them. These adventures are my fondest pastimes.
A few months ago, a mammoth snowstorm hit the East Coast, and I remembered that both little girls and inner children enjoy sledding. I set about organizing the neighborhood kids in a bid to blaze a sled path down the hill in my yard. The process turned out to be not at all what I expected, and I distinctly remember one point where I found myself separated from my sled with my face in a snow berm. At the time, I thought, “This process is exactly like trying to make changes at a veterinary hospital.” Here’s how I got there:
The benevolent idea
Most change initiatives I see start (and end) with what I like to call “The Benevolent Idea.” This is the plan that one idealist puts forward with the greatest of certainties that other team members will see the value in it, embrace it for its brilliance, and then execute this miraculous vision.
In the case of my sled experiment, the benevolent idea took the form of me in the middle of a circle of adolescent girls. (Males seem to be scarce in nearly every aspect of my life.) My arms flailed wildly as I demonstrated the velocity and excitement that a sled course would bring after the kids had packed down the snow. The crowd dispersed, with the most polite kid remarking, “Yeah … that idea might be cool.”
The personal investment
As I stood alone with my sled and my 3-year-old watching from the living-room window, I found my resolve. While I’ve allowed many initiatives to die amidst a sea of eye rolling, that would not be the case here. I decided this was too important, and that I was willing to roll up my big, puffy sleeves and make it happen. It would be hard work, but I was confident the children would see I was invested. They would understand I was serious about this initiative and would help me create something outstanding for us all. I trudged alone to the top of that hill. I took ownership of the plan and committed myself to making it a reality.
I put my sled in the spot I believed would yield maximum velocity once the snow below was packed. I sat down. The sled sank about eight inches into the powder, and snow went up my pant legs. The urge to join my daughter in the living room surged. Instead, I started the tedious, exhausting process of slowly plowing my overloaded Dora-the-Explorer sled down the hill through the powder. My arms burned, and my shoulders ached. The process seemed never-ending.
The neighborhood kids continued a dance routine that I had interrupted with my original proposal. The sounds of Justin Bieber made me wish I had never started this process. But I had come too far to stop now. My commitment to the project was strong enough that I would pursue the goal even if everyone around me chose to ignore what I was doing.
Visible results
Just as my resolve began to waver and I was about to resign myself to a life where my daughter would dance to teeny-bopper songs instead of ride a sled with her father, it happened. The snow started to give way, and the sled made progress. Each trip I made down the hill plowed the trail further forward. Top speeds were slowly increasing, and rides were getting longer.
The bubble-gum music quieted. Soon, it stopped altogether, and kids with sleds appeared ready to take part in something that was clearly working. They packed, and the course grew longer. The vision became a reality. The team was energized and enthusiastic. My daughter and I laughed and rode together. One girl shouted, “This is great! I’m so glad we made this!”
I resisted the urge to tell her to get off my sled track and said, “Yeah! We’re really making this dope!” (I thought I heard somewhere that kids were saying that again, but the look she gave me said otherwise.) Just as in the veterinary hospital, everyone wants to be part of a success. When people see results, they’re much more willing to get involved. If you let them, this is when the tide finally turns in all change initiatives.
Sustained change
As the days went by, the kids continued to spend time on the hill (even though I was too sore to lift my arms, much less carry a sled). The snow packed down tighter and froze over to create a lightning-fast sled ride that made me glad I have extra liability insurance. The vision was realized in full, and an entire neighborhood of little girls (and one dad) benefitted. When initiatives produce results and get buy-in from the team, they become part of the culture. They become “just what we do,” and that is how changes become permanent (unless a key component of your initiative melts, of course).
As I evaluate ideas for change in the clinic where I work, I think back on this experience often. Ideas for change are exciting, but executing change is not easy. “Benevolent ideas” fail. If you’re willing to put an idea forward, then you should also be willing to stand behind it and exert the energy to make it happen. You will often work alone and without recognition, but results change minds. If you can present a plan that you believe in and push it all the way to positive results, then you can bring your team on board and make a permanent organizational change. Or at least a great sled track.
Become a Veterinary Conference Commando
Originally Published: DVM NewsMagazine, April 1, 2011
It’s the most wonderful time of the year—not Christmas, or Thanksgiving or spring break. It’s conference season. Every year, I beg and plead with my boss to finagle as much time off for CE as possible. I harass my fellow doctors to swap days. I badger the practice manager to tweak the schedule. And I shake down the owner to trade in sick days for CE days—as the father of a 3-year-old in daycare, my immune system is practically bulletproof, or so the argument goes.
I know other people like attending conferences, but I love them. I prepare for them like astronauts prep for a moonwalk, and these gatherings have opened innumerable doors for me. In my experience, if you want to get the most out of your time at a conference, you have to know why you’re going and you need to have a plan before you arrive for how to achieve your goals. When I prep for conferences, I make goals in three areas. They are:
Networking
Shake hands and kiss babies. It may sound odd to make this your top conference goal, but conferences are the one place where you can meet people face-to-face, all day long, who can help your career. Whether you’re interested in asking a practice management guru specific questions about your practice’s finances, making a career jump to industry, joining a new initiative in organized medicine or adding a clinical giant to your Rolodex for those “freak out” moments when your colleagues just don’t have any good advice, conferences are the place to make it happen.
Learning
Build your own curriculum. It seems like most conferences today offer somewhere between 3 million and 2 zillion hours of CE over a four-day period. The big conferences have all of your absolute favorite speakers—speaking at approximately the same time. This overlap of teaching superstars leads to what I like to call the “veterinary squirrel phenomenon.” This is when veterinarians dart full speed up one hallway to stop, look around, change their minds about what session they want to attend, and then dart right back the way they came. The affected veterinarians then become traffic hazards to all other attendees around them, and they end up late to everything they attend. Don’t be a squirrel.
The other problem with taking a wait-and-see-what-grabs-me approach to CE is that you end up with such a mixed bag of new tricks, that you never use the majority of them. You can avoid this problem by deciding what skills and topics you really want to explore, and then devise your own curriculum to make major educational gains in these select areas. You can still pack in lots of variety, but when it’s over you’ll have some new areas of expertise that you can tout to your boss, colleagues and clients. Just research the conference program ahead of time and make those tough choices on whose lectures you’ll attend so that you’ll know where you’re going and can spend break periods finding your way around the massive convention center in an orderly fashion.
Socializing
This is what you did before the days of Facebook. Obviously it’s great to bump into your friends at conferences, but given how rarely you see these people and how important staying in touch can be for your development and career, you should take socializing seriously. Most conferences have alumni receptions for veterinary schools, so start there. Once your reunion is blocked in for one evening, make sure there aren’t any irresistible recreational events offered by the conference, like behind-the-scenes tours, wine tastings, amusement park discounts and so on. If there are, then put out the word to any and all of your friends that you’ll be attending and they should join you. You’ll end up doing exactly what you want to do with a lot of your old friends. It doesn’t get much better than that.
To push your socializing to the next level, leverage social media before the conference. If you’re a fairly recent graduate, there’s a good chance that most of your classmates are on Facebook, Twitter and LinkedIn. Post the fact that you’re going to the conference, and ask who else will be there. When people respond, start coordinating ways to get groups together to catch up. Social media is also a great way to promote personal gatherings. Whether it’s at an amusement park, bar, coffee shop, breakfast buffet or dinner spot, don’t be afraid to pick a time and place and call for a party. If rock stars can have huge parties at hotel bars, so can you.
If you go to a conference and pursue networking, educational and social goals, then you can expect lots of new career opportunities, a rewarding experience, and complete exhaustion at the end of the event. So make your goals, set your plans to accomplish them, and take an extra day off work after you get home. You’re going to need it to recover. See you there!