In this episode of the Cone of Shame Veterinary Podcast, Dr. Andy Roark is joined by Dr. Emily Tincher, Chief Veterinary Officer at Nationwide Pet Insurance, to explore the concept of the “pet family perspective” in veterinary care. They discuss the importance of understanding the unique dynamics and needs of both pets and their families to provide more personalized and effective care. Dr. Tincher shares insights from her work on contextualized care, emphasizing the need to consider factors such as the pet’s behavior, family resources, and overall lifestyle. Through engaging stories and practical tips, this episode highlights how veterinarians can better support pet families and improve the accessibility and quality of care. Tune in to learn how to ask the right questions, build stronger relationships with pet families, and navigate the challenges of modern veterinary practice.
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ABOUT OUR GUEST
Dr. Emily Tincher is a collaborative leader who uses data-informed approaches to create sustainable systems that meet the needs of pet families, veterinary healthcare teams, and businesses. Continuing her family’s legacy in animal care, she graduated from Auburn University’s College of Veterinary Medicine as a second-generation veterinarian.
As Chief Veterinary Officer, Dr. Tincher manages strategy and operations for pet health programs, develops partnerships within the animal health industry, and directs engagement with veterinary students and teams. She has practiced in small animal emergency and general practice.
Dr. Tincher is President of the Board of Directors for the Veterinary Leadership Institute and is a member of the Board of Directors of the Veterinary Innovation Council. She co-authored a chapter in Veterinary Clinics of North America: Small Animal Practice, “Cost of Care, Access to Care, and Payment Options in Veterinary Practice,” and has become a sought-after speaker, most recently on cost of care and spectrum of care topics, presenting at major veterinary conferences across North America.
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. I got a good one here today talking about the pet family perspective on accessibility of care. What does that mean? It means looking at our patients specifically for the pet that’s in the room and for the family that’s in the room. There are a lot of ways that we can provide care if we have more context than we often get.
And so what does that mean? I have my friend Dr. Emily Tincher in to talk about it with me and what this looks like. She’s doing some great work and she’s gonna have some publications coming out on this topic fairly soon. I think it’s really interesting. I’ve really enjoyed talking to her.
Guys, I truly believe that one of the keys to being a fantastic veterinarian, veterinary practitioner, healer of people and pets, is your ability to ask the right question to get the information that unlocks this case, and not only tells you diagnostically what’s going on, but gives you some insight into what’s gonna be possible as far as how we’re gonna treat this pet and actually get the care that the pet needs delivered to it in a way that’s gonna work for the family.
It’s gonna work for the pet. It’s gonna work for the team. So anyway, that’s really what we get into. This is a great episode. Thanks so much to Nationwide Pet Insurance for making this episode possible. Let’s get into it.
Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast, Dr. Emily Tincher. How are you, my friend?
Dr. Emily Tincher: I’m doing great. Thanks so much for having me back. How are you doing?
Dr. Andy Roark: I am doing great. I always love having you on the podcast. You have been a friend of mine since vet school. I just love so many things about you. You are a driving force at the Veterinary Leadership Experience, VLE, which is an organization that I just, I think so highly of, and I just, I love what you do for our profession and the people in it.
You are the Chief Veterinary Officer at Nationwide Pet Insurance, and as a result of that, I have gotten to see you blossom in the last couple years in your professional or your personal, I’ve gotten to see you blossom the last couple of years in your public speaking. I see you speaking a lot at conferences.
I’ve gotten to see a lot of your presentations. You are writing a ton. You are just putting out a lot of really good stuff and it’s just been absolutely wonderful to watch. And to that end, I’ve heard you talk recently, just in our conversations, you’ve been leaning a lot more into what you call a pet family perspective on care and you’re talking more about inclusion of the family in keeping care affordable or keeping care accessible, and it’s, I think that’s, it’s seems really it’s been a big deal for you recently.
I know you guys are working on some publications and stuff are there. It’s not really out yet, but I was, I just wanted to get you on and start to talk to you about why you’re so excited about what you call a pet family perspective. And so in your mind, Emily, when we talk about getting care for pets what does that mean?
How are you sort of re-imagining what we’ve been doing in the past?
Dr. Emily Tincher: Thanks for that awesome intro and coming in and I just wanna throw out as we start to talk about this concept of a spectrum of care or contextualized care that we have been working a lot in this space at Nationwide for the last several years. And it’s a topic that I’ve been really interested in even before we had a published term for how do we meet pet families, where they are with regard to their goals, their values, their resources, the level of care they’re looking for.
And today I think we’re gonna get into a little bit where do more of the pet specific fe pieces come from that too. But there we’re just part of the puzzle we are, there’s an amazing coalition of individuals and organizations that have really helped to say, okay, we we’ve striven for a long time as a profession in vet Med to personalize and contextualize the care that we offer to the people in front of us, while also acknowledging that
at times we, we’ve really been taught in a little bit more of a provider centric method, and I think having that context helps to juxtapose what it is we’re moving towards a little bit more as a profession right now. And that, language comes from human healthcare, that provider centered care. The old way of thinking is me physician or me veterinarian,
I know all the medical stuff. I know all the right information and so what I recommend is going to be the best thing. And we in Vet Med where are paralleling what’s happening in human healthcare of a trend of patient centered care. And for us that’s pet family centered care of, how do we say we know a lot.
As the medical professional, we it’s our job to bring the medical component, the evidence-based medicine component, make sure we communicate those options, but we don’t know everything. We don’t know some of the components that are happening at home, whether it’s finances, which are a huge barrier we know for pet families to access the care that they’re looking for, whether it’s transportation or the million different things that are flying in everybody’s life from career to family.
Or whether some of the pet specific factors I have in my lap. For those who are seeing on v video, you’ll get to see here exploding Poptart, my cat. And he’s perfect. He’s like, as all orange male
Dr. Andy Roark: Yeah, he’s a, he’s
Dr. Emily Tincher: perfect.
Dr. Andy Roark: a big tabby.
Dr. Emily Tincher: He’s the perfect boy. He just turned five recently and the only time he’s not perfect is when he goes to the vet.
He really does not love it. He doesn’t love restraint and neither do either of his brothers that are owned by my siblings. Knowing that about him changes the way that I think about care, whether that’s, what we might do if he ever needed hospitalization because he is a different, we don’t board him after some experiences where he became a different creature.
We find pet sitters who come to the house or friends who can help us out. And that bond that I have with him working every day, him sitting in my lap or playing on his cat bridge over there is a really tight one, but it also means I might not say yes to some really advanced care at times if that meant he was gonna have a really miserable experience if there were alternatives.
So that’s some of the idea that we wanna explore. And I do wanna back up to, you mentioned pet specifically. As a term, we tend to use lots of different terms, whether it’s pet owner, pet parent, or pet family. And we came to Pet Family at Nationwide through some of the work that Dr.
Michael Blackwell was doing and is doing with the program for Pet Health Equity and Align Care. That really reflects the fact that the family, I. And me and my husband Kyle and exploding Pop-Tart. We together are a bonded family unit and we’re gonna, we’re gonna make decisions that way because we’re, it’s not the pet and exclusion or the animal, and an exclusion of us.
The difference between that might be how do we make decisions from a herd health perspective in like a shelter, unowned pet situation. Versus once the pet family is together, how do we then need to adjust our expectations and communications to incorporate the fact that the family has to be there to make decisions and advocate on behalf of pets like Poptart.
And they’re also gonna be there to either follow through or not on the recommendations that we have for them.
Dr. Andy Roark: Yeah. So I have questions. Um, So, okay, if I had my magic wand. And I could just make things happen. It totally makes sense to approach each of the patients from this sort of family inclusion perspective and to treat the family as a unit. And everyone gets a say in the pet’s care
And, in reality, I have the husband has brought the pet in and he doesn’t know why he is there. And, mom is, doing something else and she’s not available. And I also have fears that I’m going to, to wade into this and en quote, unquote engage the family.
And I’m getting calls from, daughter at college in Illinois who’s like, tell me everything that happened. And so there’s a lot of moving parts to this strategy is what I’m hearing.
Dr. Emily Tincher: Totally, absolutely.
Dr. Andy Roark: Okay. Talk, talk to me about what this looks like in practice.
Dr. Emily Tincher: Okay. Why don’t we start with a story and then, and the story may not completely come to all of those, but let’s not miss that. But let’s make sure that we come back to that efficiency component about how do we make sure that we’re talking to,
the best right person, or if this is a family that wants to have everyone involved, that at least we’re doing that with one people here at a speaker phone right next to them so that we are not have, and or we’re setting the expectation that we’re not gonna have the same conversation 12 times whenever possible
’cause that’s just not practical for the world that we live in. So. I think it’s, helpful, I learned by stories. And so why don’t we put this in a clinical context and I still pick up relief shifts. And so a pet that I saw recently, let’s call him Ralph. I did change his name, but he looked like a Ralph to me, was a 2-year-old male neutered 111 pound hound mix.
And he was presenting for vomiting and diarrhea. And so before engaging at all with the pet family, this is a sick visit, right? I happened to be in an urgent care setting. And so what are some of our options? What’s com? What’s running through your head as a veterinarian of what we might do next?
Dr. Andy Roark: He says, you said he is a young dog, right?
Dr. Emily Tincher: Two years old, yeah.
Dr. Andy Roark: Two years old. Yeah. So vomiting and diarrhea, dietary indiscretion. He’s a hound mix. He found something in the woods, who knows what he ran away in ate.
Dr. Emily Tincher: Yeah. And so we’re, thinking about risk factors. I love that. But we’re thinking in our head, he’s not 12, he’s two. What are some of the things that are at our high end list? I will say having, just in the month of March every year at Nationwide, we release our top 10 most common claims for dogs and cats.
Gastroenteritis. So this simple vomiting and diarrhea, not like the foreign body or going beyond simple vomiting and diarrhea was number two on the list of most common for dogs. And number one on the list of most common for cats.
Dr. Andy Roark: Yep.
Dr. Emily Tincher: It’s happening all day, every day. Y’all are seeing it. So Ralph, you know, we can gauge a little bit more of we’re gonna do a physical exam and, and see that he’s
QAR walking around the room, normal vital signs, tense abdomen, but otherwise, pretty unremarkable physical exam. And so at this point, I’m thinking in my mind, we can, two main routes are we can treat supportively for suspected dietary indiscretion, or we can do some diagnostics of
Dr. Andy Roark: Sure. We can do a fecal exam, stuff like that.
Dr. Emily Tincher: He’s on a, monthly preventative, but that doesn’t mean he might not still have parasites. Totally. We can go some diagnostics. We can go the supportive route. And so we start to think about that and, so a technician comes back out of the room. Remember, I’m a relief vet and so I don’t have that instant rapport that I used to have with my technicians.
I’ve been in this practice and we’ve been working together for about two hours. And she comes out and tells me about this physical exam and the vitals. And I haven’t met Ralph yet, but I do hear he’s 111 pounds. And she kind of looks at me and pauses for a second and I’m like, something’s coming.
Dr. Andy Roark: I love that spider sense tangles. Oh, buddy, there’s something here.
Dr. Emily Tincher: She’s sizing me up of what do I say here? And she says, I think if we want to restrain Ralph that’s gonna require some pharmaceutical intervention. He has a look. And so, and we, we get a little bit more history and it turns out that Ralph is on Prozac all the time and he is on Trazodone to come to the vet.
He’s very stressed and so I wanna get into it. Turns out he’s actually had, he’s had a little bit more vomiting. That makes me comfortable saying like, let’s just totally treat supportively. Over the last two to three days. And so I’m thinking in my head, gosh, he, he does sometimes chew on toys. Do we think the fact that he’s pretty BAR do we think we might want to consider some x-rays?
And so I start to talk to the pet family about this. We’re doing the exam in the room of help me understand. You haven’t, she hasn’t said anything to me yet about, I just saw from his records that he has, he takes Prozac every day. Like, help me understand. Ralph’s disposition. I know he takes medications and he seems a little nervous in here with us, and she was like, oh, yes.
He is typically under anesthesia for any like procedures because he really is he, and I’m like, he licked my face a minute ago.
Dr. Andy Roark: Yeah, I was gonna say thanks for keying me in on that 15 minutes into the appointment.
Dr. Emily Tincher: to know. I mean, we’re, we’re still like a minute in, right? Like we’re, we’re early in, but I was like, I’m gonna stand up instead of kneeling down and, petting Ralph.
He is definitely giving you the eye. At this point we’re reading body language. My technician, like she read the body language to say he has the look that I I’m concerned about how we engage with this pet. And so ultimately learning that. We had the conversation about, he’s here and getting him here is a challenge.
But if we want to take X-rays, if we are worried enough that, like we’re gonna escalate to that, he. And the pet phone. It’s great that in this case, the pet owner already completely understands and agrees he’s gonna have to be heavily sedated to do that because he’s also 111 pounds. And we have three small women working together today to take x-rays of him.
And so ultimately, while we might have in other cases and finances were not a concern for Ralph. We chose not to take X-rays, but to treat him very aggressively as a supportive outpatient just in hopes that this was dietary and discretion and with a plan that if he needed to come back and he wasn’t doing well we would be sedating from the beginning with him.
And so I bring up that story. For a couple reasons. One, I think a lot of the time when we talk about contextualizing care, personalizing care to the family in front of us, we are often talking about finances. And I’m not saying we shouldn’t. We should. Absolutely. That is still the top barrier to accessing care.
I work for a financial institution where we think about that a lot. There are also a lot of other reasons why pet families choose not to pursue more advanced levels of care. And sometimes it’s related to the family, but in many cases it can be related to the pet. And so how do we start thinking about that a little bit sooner?
And I, back to your point earlier, can be really inefficient if we don’t think about how to like increasingly put that into our clinic workflow so that it’s not so that it’s just part of how we have a intake form, take our history and then work through our options and communicate.
Dr. Andy Roark: Yeah, this is really interesting. I, I need to think about this a little bit because that stuff happens all the time, right? it’s just always where they say, well, this is how he is. So I, I was in the clinic earlier today and I was working with this lady and she’s got a cat and the cat’s here for diarrhea and, and some vomiting and, but it’s the cat’s bright and act.
And playful. And she said, I just live around the corner. It’s not a big deal for me to come back. And it’s those are the types of little things where you say, oh, she was very open to the idea of we might, start down this path, and then she can go away for a little bit.
And if it’s not better tomorrow it’s, and she’s retired. She’s like, I will, this is, I think she was excited to come and see us. I think she would like to come back.
Dr. Emily Tincher: social experience as
Dr. Andy Roark: Yeah. Yeah. For versus other people who are like, they’re there, they’ve got a kid in a stroller and two other kids that are climbing the shelves, you know, and they’re like, look, I had to cancel three things and we have to leave in six minutes to get to soccer practice.
It’s a whole different beast but there’s always that stuff. But Emily, like that stuff has always come out organically for me. I, now that you’re saying this, I’m thinking, I don’t know that I have questions to bring these things about. I like to think that we kinda do a good history and try to build a relationship and, and hear these things, I’m sure that there’s a lot of context like this that I’m not drawing out in an efficient way. What is your take on that? are there things that we can do to open up some doors and give us more of this context in a way that makes sense as far as like having limited time in the appointment?
Dr. Emily Tincher: I love that thought process ’cause I agree in many cases it does come up somewhat organically and it might be helpful if we switch up to a, maybe a slightly different story in which it, maybe it doesn’t to highlight where some of those pieces are. And then I do have some, we’ll maybe talk through three different ways that are really practical tips for.
How do you say, okay, I’m intuitively doing a lot of this, but how many of these conversations am I missing and how many opportunities do we have to make them a little bit more institutionalized and therefore efficient? And those are slightly different things, but related. And so another story is when I worked full-time clinically, I was an emergency veterinarian at a very large specialty, ER hospital.
And, one of the things that we had, which is fantastic to learn from and, collaborate with was seven oncologists and, this is kind of an extreme example, but if we think about other things where you have to come in frequently, chemotherapy and radiation therapy are extreme examples where you have the pets coming in, in many cases on a weekly basis.
And for radiation, that’s usually with anesthesia. Lots of things to consider there for chemotherapy and just in many cases, that’s either they’re going to their general practitioner or they’re seeing the oncologist routinely, if it’s not weekly, routinely, often with a catheter or a needle poke and a pet that really helped me think about
engaging surrounding the way that these pet factors evolve over time. I’m a golden retriever girl lover and so a golden retriever really sticks out in my name. We’ll call her sunshine. Sunshine had a typical golden retriever problem of lymphoma and, what was really interesting to me seeing Sunshine on ER is that previously Sunshine had loved going to the vet and that was part of why they decided to do a chop therapy.
Like to do this yeah, we’re gonna go into the vet a lot ’cause Sunshine loves to go to the vet. She loves to be fussed over and see all of her friends, and that worked really well until. She relapsed and they were thinking about doing a rescue protocol, so reengaging with the oncology service and what seemed like had changed to the pet family was not appreciable to me.
Sunshine was a delightful patient still, so you could tell she didn’t feel good, but she was very sweet. Still. What had changed the pet family is she didn’t wanna get in the car. And she wasn’t interested in today she didn’t feel good, but they felt like her perception of coming into the vet was different than it had been before they started the original protocol.
And so as much as we feel like these things ought to be like, I can stick this in the file and I, I’ll know every time Sunshine comes to see me that like she’s a good fit for a high touch perspective, she has a really good story for me to see. Sometimes that changes over time and her. At from a pet factor, the pet family, ultimately they decided not to move forward with anything other pal, other to palliative care and some prednisone and paid meds so they could do more of that at home.
And they decided that going back and forth was no longer something that their pet enjoyed. And that really influenced, again, not finances here, it’s how do they have the best quality of life for what their pet’s telling them and what we have to hear that. We have to hear that things are changing and, ask the questions to say, is there anything that.
So that’s going on that might influence the way that we decide to move forward and have either a high touch or a a low touch treatment plan knowing again, that’s an extreme and we don’t always have that difference in come, come in weekly versus completely palliative at home care.
Dr. Andy Roark: That totally tracks. We said early on you were sort of talking and I was sort asking questions around efficiency and including the family in a way that makes sense. And you said that you had, some perspectives on that and sort of approaches that you had found valuable. Unpack some of that for me.
Dr. Emily Tincher: Yeah, I think so. There are approaches, and one of the things that you just mentioned was an approach, so why don’t we start there? And there’s, that’s, there’s a handling component to that, right? We know things like Fear Free are a great way for anxious pets to hopefully have a little bit better experience.
Poptart has a tough time at the vet. He does better with tubes upon tubes of chiru and being snack motivated. So there, pieces of things that we can do in a clinic setting. Sometimes we can recommend things like tele triage or telehealth so that we may not have to see the pet in person every single time, if that’s a challenge.
That’s the specific way that we’re gonna handle the care. But then how do we even know, how do we find out that those are challenges? So many practices, especially general practice, have a pre triage form at this. At this point, I know not everyone always fills them out. I am guilty of, I am, I’m that person who doesn’t fill them out as a pet family seeking care.
But when you do, asking one or two questions and putting a few things in there. Very specifically either if you can, in that pre triage form or asking in your initial history with your technician or your assistant of how does your pet typically handle new environments or being separated from you?
Are there any particular triggers that cause your pet stress during visits? I know some pets, it’s restraint for Pop-Tart. That’s absolutely what it is. I trim his nails by myself at home, but that’s not gonna happen in a different environment for him. And then a, another component as you’re, is we’re thinking along is, you know, if multiple visits are
recommended or going to a different location is recommended is, are there any barriers that might pop up for you and your family that’s, that takes how long did that take us to ask that question
Dr. Andy Roark: Yeah. Yeah. 60 seconds. Yeah. At most. Yeah.
Dr. Emily Tincher: And hear back and that’s including, asking and hearing the answer back and then us maybe totally change the way that we think about what the next step we’re incredibly innovative and creative.
I think as problem solvers in VetMed, we do so much of this. To your point, intuitively. But also, how many times are we missing the opportunity to engage with pet families that might be having a tough time. And we just don’t even know about it because we didn’t ask.
Dr. Andy Roark: When you are ready to start publishing these things, where should I keep an eye out? If people are interested in the topic, and, and again, we’ve got a lot of spectrum of Care fans and they’re saying, this is an interesting evolution.
I wanna continue to learn about this. Like, where should we be paying attention?
Dr. Emily Tincher: We have an article coming out. follow me on LinkedIn. I guess we have an article that’s coming out to kind of talk a little bit more about this topic. We’re also engaging directly with some of our pet families, so our members, the people that own pet insurance policies and trying to understand from them, what are some of the things that you all have going on that are helping you navigate along your pet family’s decision making?
And how can we better help and be that partner along with your healthcare team? Hand in hand as we go forward for your pet’s health.
Dr. Andy Roark: Well I’ll put a link in for your LinkedIn page and yeah, if anything else comes out I will shout out here on the podcast. I’d love to have you back in the future. Thanks for being here.
Dr. Emily Tincher: Yeah. Thanks so much for having me and for having Pop-Tart.
Dr. Andy Roark: Absolutely. I I, it’s hard to get an appearance like that. We were quite fortunate.
Dr. Emily Tincher: Hmm.
Dr. Andy Roark: And that’s what I got guys. Thanks for being here. Thanks to Dr. Emily Tincher as always for being on the podcast. Thanks to Nationwide Pet Insurance for making it possible for us to put together episodes like this, so they’ve, they’re always wonderful to work with and appreciate their support of the podcast.
Guys, take care of yourselves, everybody. We’ll talk to you later. Bye.
