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Inter-Cat Aggression (HDYTT)

by

Dr. Lisa Radosta, veterinary behavior specialist, joins the podcast to scatter a PILE of knowledge pearls upon us! This is a wonderful discussion of inter-cat aggression and what vet professionals and clients can do to maximize their chances of success.

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

LINKS

Dr. Radosta Links: https://linktr.ee/drradostadogresources

Florida Veterinary Behavior Service: https://flvetbehavior.com/

Dr. Lisa Radosta Homepage: https://drlisaradosta.com/

Solensia (Zoetis)

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Lisa Radosta graduated from the University of Florida College of Veterinary Medicine in 2000. She completed a residency in Behavioral Medicine at the University of Pennsylvania. During her residency, she was awarded the American College of Veterinary Behaviorists Resident research award two years in a row. 

Dr. Radosta is the owner of Florida Veterinary Behavior Service, a specialty behavior practice in southeast Florida and co-owns Dog Nerds, an online educational resource for owners whose pets have behavior disorders.

She is a sought after speaker nationally and internationally. She is a coauthor of several books including: Behavior Problems of the Dog and Cat, 4th edition and From Fearful to Fear Free. She is a contributing author for Blackwell’s Five Minute Veterinary Consult, Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Canine and Feline Behavior, Decoding your Cat, Canine and Feline Behavior for Veterinary Technicians and Nurses and Feline and Small Animal Pediatrics. Her new textbook, Handbook of Behavior Problems of the Dog and Cat, 4th Edition is due out May, 2023.

She has published research articles in the Journal of Applied Animal Behavior Science, Journal of Veterinary Behavior and The Veterinary Journal and written review articles for Advances in Small Animal Medicine and Surgery, Compendium, NAVC, Veterinary Team Brief, Clinician’s Brief and AAHA Newstat. She has served on the Fear Free Executive Council and the AAHA Behavior Management Task Force.

She has been interviewed for many publications including Cat Fancy, Dog Fancy, Palm Beach Post, NAVC Clinician’s Brief, Sun Sentinel, WebMD, AAHA trends, Real Simple, Good News for Pets, Catster, DVM 360 and AAHA News Stat. She has appeared on Lifetime television, Laurie Live, local news in southeast Florida, Mitch Wilder’s Amazing Pet Discoveries, Nat Geo Wild, Animal Planet, Steve Dale’s Pet Talk and Dogs, CNBC and Cats and Scapegoats.  

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here today with a one and only Dr. Lisa Radosta. We are having a conversation about multi-cat aggression, or inner-cat aggression, I should say, but yeah, we start breaking it down. I asked her to set up a little case with three cats, and then just kind of open it to her, and, again, I love having Dr. Radosta on the program. She is so fun, and she tells great stories, and she’s just a wealth of information, and, man, she’s linking to all kinds of resources in this podcast. I’ll put them all in the show notes. Definitely hit the notes, take a look at all the stuff that’s there, but, man, this is a great episode. Let’s get into it.

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

Dr. Andy Roark:
Welcome to the podcast, Dr. Lisa Radosta. Thanks for being here.

Dr. Lisa Radosta:
Thank you for having me.

Dr. Andy Roark:
I always enjoy having you here. You have been a regular in the podcast. You are, for people who don’t know you, you are a boarded veterinary behaviorist. You are the owner of Florida Veterinary Behavior Service. You are an author of so many things From Fearful to Fear Free was just one of your books. You’ve written for the clinical handbooks. You have so much that you put out, and you’re such a source of wisdom. I so enjoy our conversations. So I wanted to come to you with a case, and I’ll sort of lay it out, but I want to get a general refresher on this topic, because I’ve seen it recently, and I want to make sure that my game is on point here.
So I’ve got a client, and she has three cats, and they are getting in fights, and so one of the cats is newish, but she has these three cats, and I just wanted to go ahead and start to get your take on apartment living, three cats, newish cat is not getting along; it’s not all-out war, and it’s just kind of one of those things where they’re having fights, but why I say the cat’s newish is because it wasn’t like, “Here’s the new cat, and it’s World War III.” It has been, at first, it was okay, and then it was not, and then it kind of was okay for a while, and just every now and then, they’re getting into it, and so can we talk a little bit about inner-cat aggression? Is that okay?

Dr. Lisa Radosta:
Yeah, let’s do it.

Dr. Andy Roark:
All right, three cats. Is that normal? Does that change how we approach this, as opposed to two cats? Let’s just start there.

Dr. Lisa Radosta:
Look, it makes it more complicated, but it doesn’t change our approach. So, number one, well, here’s generally going to happen, at least in my experience, is they’re going to bring you one cat, and they’re going to say Fluffy-

Dr. Andy Roark:
The culprit, the villain.

Dr. Lisa Radosta:
The villain. It’s always, “Fluffy X, Y, Z.” So you have to try, and I remember sitting with this elderly man. Sometimes you sit with these older people, and they are just a hoot. He was just a hoot, and every time he roadblocked me, he would do it with a big smile on his face. So then, with a big smile on my face, I would explain to him why he’s wrong. It was just a fun appointment. It was an inter-cat aggression appointment, but anyway, so they have these ideas. So the first thing I say is, “Okay, well, here’s the thing. It takes two to tango, and, most likely, at least in my experience, if you have arguments, both cats are involved. If there’s three cats arguing, three cats are involved.”
So here’s what they’ll say, “Well, when I put Cat 1 up, nobody argues, and everybody gets along. It must be Cat one,” and I say, “Well, Cat 1 changes the dynamic enough, but Cat 1 may not be the person, the cat, who’s causing the problem,” all right? So that’s the first thing, is we say, “Okay, just so you know, Ms. Jones, I’m going to need to see all the cats,” and the first step in every behavior appointment, I do not care what the presenting complaint is, I do care, but not for this talk, is to work the cat out. Cats don’t tell us when they’re sick, so you’re going to have to get a needle out, you’re going to have to draw some blood, you may have to take some x-rays, send them to… What is it? The Zoetis Solensia website, where they show the cats jumping. Love this website. I don’t know if I’m allowed to say products, but I do love that site, because the clients then can see, and one client videoed her cat doing every single activity, sent them to me so I could see it.
It was kind of fun, but anyway, the point is, I look for pain, I look for systemic disease, because maybe these cats were getting along in the beginning; somebody’s sick, someone’s irritable, someone’s acting differently. So everybody’s going to need a workup, okay? A lot of clients will push back and say, “I’m sure, I’m sure, I’m sure,” and I just tell them about my experience. “I’ve been sure, and then I treated a case through about eight months, and I couldn’t resolve the case, and you know why? Because as a doctor, I didn’t push hard enough for that lady to bring in her other cat, because the other cat needed a workup, too. So I’m going to you the best I can give you, and that’s everybody coming in, everybody getting a workup.”
So that’s the first step. Clients will bring you, because they bring their phone, videos and pictures. This is what I love. Do you ever watch the home improvement shows? And you know when they pull back the big barrier, and they see the house, and the person goes, “Oh, God!” Right? This is it. So then, they pull out their phone, she pulls out her phone, and I say, “Okay, show me the pictures.” This just happened to me, because she was sure she brought me the aggressor. I’m like, “Okay,” and so then the first picture is both cats sitting in a meatloaf position, so everybody’s defensive, both of them in a bright room, widely dilated pupils, and I went, “Oh, my God,” and she goes, “What?” And I go, “They’re both scared!” And she goes, “No!” I’m like, “Yes!” And she goes, “I can’t believe it!” I’m like, “Yes!” So then she [inaudible 00:06:11]

Dr. Andy Roark:
You were practicing a soap opera. I would just come and watch you work.

Dr. Lisa Radosta:
It is. So then she flips to the next one. I’m like, “Oh, that tail,” and this is a video, “That tail’s thumping. That cat’s agitated.” She goes, “It is?” I’m like, “Yes, it is.” So once you see the pictures, if you know anything about body language, and you might have a technician, a nurse, a doctor’s assistant, who knows a lot about body language, right? Once you start showing the client, “There’s the proof. That’s the radiograph, okay? That’s the MRI,” you’re showing the proof on her phone that everybody’s involved. Now, she’s coming in, right? So that’s step one.

Dr. Andy Roark:
Yep. Do you have resources you really love for body language for pet owners who want to learn more about it?

Dr. Lisa Radosta:
So if you go to my profile on Instagram or Facebook, you go to the profile, there’s Linktrees. There’s a Linktree for cat resources, a Linktree for dog resources, a Linktree for vets. So then you will see I update that all the time. I grab stuff from all over the place and stick it onto that Linktree. So there’s everything, from body language, to carrier training, everything. Yeah. Yeah.

Dr. Andy Roark:
Love it.

Dr. Lisa Radosta:
So yeah, the thing is, we want to educate people. We want to be preventative. I know we’re talking about treating, but what people need to know is about 50% of cats show some sort of conflict when they fight. So that’s the number one statistic we want to put into our veterinary brains. Cat is coming into you, first appointment, you’ve never seen this cat, just adopted into a family of a current client who has cats. You want her to know 50% of cats have an argument, and I want to tell you what an argument looks like: ears back, tail thumping, hissing. Because what they’ll say is they weren’t swatting, they weren’t biting, they weren’t chasing. That’s good, but that’s end of that spectrum. At the beginning of the conflict is ears back, tail thumping, hissing.
So when you see that, think of that as conflict. That means you don’t want to go farther with the introduction. What they need to know is 35% of those cats are still fighting at least once a week a year later. So we have to, as vets, go, “Here’s the thing: if you saw any of those signs, we got to go super, super slow. Maybe you need a cat trainer, right? Maybe you need to follow this handout that I’ve written for you, or that I have. Our new textbook has a handout in it for introduction. Actually, I think it’s on my website. So follow that exactly, because if you start the cats off right, the likelihood they’re going to be here in a year for fighting is a lot lower.

Dr. Andy Roark:
Yeah. No, that makes sense.
Hey guys, I just want to jump in real quick and let you know I have a secret. I have something that is coming for you that is really wonderful. As you know, I love to have fun, I love to facilitate teams learning together, and laughing together, and getting to know each other, I like to make things that are kind of zany and off the wall that will bring joy into practice, and, guys, my team has been working so hard on something very special for you. It’s not a webinar, it’s not a conference, it’s not an event, it’s not a summit, it’s not a training program; it is something entirely different, and so I just want to give you a quick heads up that there’s something exciting coming down the pipes. If you want to get the inside scoop, you can hunt around the DrAndyRoark.com website, or some of my emails, and see if you can find the question marks.
Look for some question marks, and that will link you up to some information, and some clues, and you can start to make your way towards figuring out and finding out what I got for you, but anyway, it’s going to be something really fun, and really exciting, and I can’t wait to share more with you soon. Now, let’s get back into this episode.
Okay. I love the idea of getting in the phones, I love the videos, I love working with the cats, things like that. How do you start to… You and I talked in the past about it, and you had made a distinction between the two different drivers of cat aggression. Do you want to start there as far as how you weighed into these?

Dr. Lisa Radosta:
Yeah, so you’ve got the cat who a new cat’s introduced into the home, and there’s conflict, and that conflict could be over anything. It could be one cat is fearful, it could be one cat is not well, one or more, it could be that the resources in the house aren’t plentiful enough, et cetera, et cetera, and the way we educate those clients looks really different than the way we educate the second group of clients. Those are clients whose cats, these are often littermates, not always, but often, that get along really well. I mean, they sleep in a pile of cats, which is one of the ways we figure out if cats are actually BFFs, and then they’re in a situation where one cat gets really scared, and redirects aggressively toward the other, and the relationship is forever changed. When I see that second group of cats, at least, in my practice, way better prognosis, because a couple of reasons. They had a good relationship prior. They had something to go back to, right? And also because usually clients get them to us pretty quickly because they’re shocked at what’s happening. It feels urgent because of the change in the behavior.

Dr. Andy Roark:
Yeah. No, that makes sense. Okay, so we talked about, I love the idea of setting the expectation, “This is going to take time, this is going to be a process.” Is there anything else you do to sort of set up expectations like that at the beginning?

Dr. Lisa Radosta:
Yeah. So one of the first things we do is educate. Here’s how cats live. If you ever had a barn, or barn cat, which I did, you pour out the food, and the cats come together, right? But then the cats scatter, and you notice the ones that are hanging out together look the same, bunch of ginger cats, bunch of tuxedo cats. Why is that? Because cats live in matrilineal colonies. So I tell the client, “Look, the moms, and the sisters, and the aunts, and the grandmas, they all live together, and they take care of each other’s babies, but God help you if you’re another cat, and you’re not related, and you try to come into that group, because they’re going to be aggressive toward you. So let’s normalize that what your cats are doing normal, right? Let’s also normalize that they’re not sisters, they’re not family, they’re roommates, but you did not ask them if they wanted a roommate. You just got another cat, right?” So let’s first empathize for the kitties. That’s the first thing.
The second thing, it depends on the situation. If the situation’s really bad, so if I say seek and destroy, cat sees other cat, goes after it, then I’m going to explain to them that this is going to be a challenge. “These are ways we can treat this. We can separate. We could separate forever. You could live with your cats separated. That is the cheapest thing to do. That is what your cats want, and you will divide your time, and your cats’ time will be divided. Number two, we can medicate and manage them. They can be together when you’re there to interrupt them. All across the board, of course, we’re going to do environmental enrichment, that’s a given, and then the third option is to do behavior modification with a cat trainer.
That’s going to be done virtually almost 100% of the time. That is going to be six months of your time. We’re going to meet every two weeks, and I just want you to know that, a lot of times, after six to eight months, the cats relapse and have a fight. So I want you to think about this as marriage counseling. I don’t know if you’ve ever been to any sort of relationship counseling. It’s just how I talk to people, and you don’t have to tell me that you have, but what I can tell you is that that’s not a fix. Sometimes those people are triggered again, and they fight again, right? So your cats are going to be in that situation, too. So whatever you do is up to you. I’m here to be a part of the solution. Here’s the options.”

Dr. Andy Roark:
Yeah, that makes sense. I always ask about environmental enrichment, because I think it’s so useful, and it’s so often overlooked by pet owners, and it does so much for the quality of life of cats. What are your go-tos for feline environmental enrichment? What do you love?

Dr. Lisa Radosta:
There’s a book called The Indoor Cat, which is a great, great book that is all about enrichment. That’s all that the authors write about in that book. So I tell clients to get that. Of course, I send them to our resources, but here’s the troubleshooting point, because I think the veterinarians and the veterinary nurses and technicians listening to this podcast have a lot of knowledge. Where’s the troubleshooting? When you say, “I want you to enrich the environment,” first of all, I was shocked when I got a follower on Instagram who DM’d me to say, “What is enrichment?” I had done like five posts on enrichment. “What is it?” So watch your lingo. People don’t know what that means. Okay, does your cat have stuff to do?
And then here’s the next thing they say, “Yes, my cat’s got a toy box full of toys. My cat doesn’t need anything,” and I say, “Okay. You’ve got to break through that challenge. That challenge is coming. So either you break through it by getting ahead of it,” which is what I try to do to say, “One thing we need to do is enrich your cat’s environment. Enrichment is giving your cat stuff to do and engaging all five senses, and I know, because you’re here, that you’re an amazing pet parent, and I know, because your butt is in that seat, that you got a full toy box full of cat toys, and I also know that my husband is going to walk into my closet tomorrow and say I have enough black high heel shoes, and he will be wrong, right? Because he will think I’m plenty and rich, but shoe-wise, I’m not, and your cat isn’t either.” So that is the way I talk to them, and they’ve got a smile on their faces. Now, they’re like, “Oh, that’s funny.”
So then we talk about the five senses, and we talk about rotation. Your cat is so smart, and he’s got the same toys in front of him every day. That is no fun, right? So we’re going to rotate; three toys in the drawer, bring out three new toys every day. Plus, there’s the toys that he has in his box. I tell them my three-step process for finding what your cat loves. Number one, you go on to whatever your search engine is, you Google, let’s say, “Cat toys,” and you just spend an hour shopping. You spend your budget for that month, and then you get those in the mail, and then you log, with your pen and paper, on your phone, what your cat played with, and you write down the exact characteristics in detail. Month two, spend your budget on only toys that have those exact characteristics. Repeat. By month three, you will have what your cat likes, and go forward from there, rotating and keeping it new and fresh for him.

Dr. Andy Roark:
Yeah. Oh, I love it. That’s amazing. Are there any common pitfalls that you see? Are there any mistakes that I should look out for, anywhere that I mess this up, or make my life harder?

Dr. Lisa Radosta:
Yeah, I mean, the clients, every part of our job, they push the limits too soon. I didn’t give all the cephalexin. I don’t even think we used cephalexin. You could tell me, because I don’t do skin anymore, but I didn’t give all the antibiotic. “My dog looked pretty good,” right?

Dr. Andy Roark:
It’s good enough we stop, yeah.

Dr. Lisa Radosta:
It’s good enough we stopped. So what we’re going to see is the cats are going to fine behind the closed. So the client’s going to call you, or email, or text you, and say, “I opened the door. I just wanted to see,” but the problem is, and this is what I have to explain to them, “The problem is that one negative, it takes me 1,000 positives to outweigh that one negative. So you can’t break the rules, and we did it this time, we’re going to let it go, but you can’t break them in the future. “

Dr. Andy Roark:
Yeah, that makes total sense. Oh, man. Dr. Lisa Radosta, you are amazing. Thank you so much for being here and talking through this with me. I always enjoy our time together. I have got a ton of links I’m going to be putting down in the show notes so that people can go and find. Let’s go ahead. I’m going to put you a link to your website. Are there any other resources? Talk a little bit about your social medias. Clearly, you’re active on Instagram. Where can people find you?

Dr. Lisa Radosta:
Yeah, @DrLisaRadosta is where you’ll find me, and we post on everything behavior in little digestible bites; dogs, cats. We’re living and breathing it, and I love it.

Dr. Andy Roark:
Sounds great. I will add those links as well. Guys, thanks for being here. Take care of yourselves, everybody.
And that is it, guys. That’s what we got for you. I hope you enjoyed it. I hope you got something out of the episode. Thanks so much to Dr. Lisa Radosta for being here. Thanks to you for being here and listening. Yeah, if you like the podcast, do me a favor, leave me an honest review wherever you get your podcasts. It means the world to me. Anyway, that’s all I got. Gang, take care of yourselves. Be well. I’ll talk to you soon.

Translating Human Medical Experiences to Vet Med

by

Kelsey Beth Carpenter RVT, or Vet Tech Kelsey as she’s known to her adoring fans, is a registered veterinary technician, singer/songwriter, and all-around creative genius. Her humorous takes on veterinary medicine can be found across the internet, and today she joins the podcast to discuss what she has learned about veterinary medicine from her own journey as apatient facing a chronic medical issue.

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

LINKS

Back to School Webinar Series: https://drandyroark.com/webinars/

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Kelsey Beth Carpenter is a Registered Veterinary Technician, social media manager, singer/songwriter, speaker/performer, and content creator. Kelsey has enjoyed working in emergency hospitals across California for over a decade. At her most recent clinic, she fell in love with the open hospital concept, and is passionate about teaching others how to implement this structure in their own practices. Kelsey also works as the Social Media Manager for DrAndyRoark.com, a Content Specialist for the Uncharted Veterinary Conferences and Community, and the manager of her own growing brand, Vet Tech Kelsey. With a background in the arts, Kelsey is passionate about the power of creativity, the importance of humor, and the magic that happens when art and science overlap. In her free time (what’s that?), she can be found hiking, writing goofy songs about Veterinary Medicine, and dressing up her Chihuahua even though she swore she would never be “that person”.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome, everybody, to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I’m here with someone who is near and dear to me in my heart, the one and only vet tech Kelsey, that is Kelsey Beth Carpenter, RVT. Kelsey is an RVT. She is a media personality. She has been doing social media for me for years, and she’s part of the uncharted team, and she is genuinely a wonderful, funny, very, very insightful person. And it’s a bit of a personal episode today. Kelsey has been having some medical challenges over the last couple of years, and she has spent a lot of time on the human side of healthcare as a patient. And we were talking, and we sort of laid this out in the episode as we get started, but what are the things that are in human medicine that are good that we might like to see more of in vet medicine? And what are the things that we have learned in human medicine that we do not want to see in vet medicine? Or what insights can we gain from being a patient of human healthcare that will help us do a better job of taking care of pets and pet owners?
And that’s what we talk about this episode. It’s really kind of a sprawling episode, but it’s all on that theme and topic. It’s really interesting. Kelsey is just such a wonderful person, and she’s just really insightful, and she’s obviously thought a lot about this. And so anyway, this is a really neat way to think about practice and how practice works and just to kind of check and say where am I stacking up here? Am I doing the things that turn people off? Or am I doing the things that are going to make our visits positive experiences? So anyway, guys, check it out. 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. Kelsey Beth Carpenter, how are you?

Kelsey Beth Carpenter:
I’m pretty darn good. How are you doing Dr. Andy Roark?

Dr. Andy Roark:
People are having a deja vu. They’re like I’ve heard that voice before. Yeah, she sang the theme song that you just listened to right before you got to this point in the podcast. But yes, Kelsey Carpenter, you are an RVT. You are a media personality. You are best known-

Kelsey Beth Carpenter:
Am I?

Dr. Andy Roark:
For singing a song called My Dog Ate Weed, I think. You are the social media manager for Dr. Andy Roark.

Kelsey Beth Carpenter:
Who’s that?

Dr. Andy Roark:
I don’t know. If people don’t know, it’s kind of on you. You’re a part of this too. So if they have no idea who I am, I’m not the only one responsible for that. You are here with me.

Kelsey Beth Carpenter:
Most of the time. If it’s a good thing, you were responsible. If it’s a bad thing, it’s typically me.

Dr. Andy Roark:
Totally. That’s part of a social media manager’s job, is like I need someone to throw under the bus when I drink too much and decide-

Kelsey Beth Carpenter:
Of course.

Dr. Andy Roark:
To go on social media and say inappropriate things.

Kelsey Beth Carpenter:
Which happens frequently.

Dr. Andy Roark:
All the time. It’s all the time.

Kelsey Beth Carpenter:
I think I was just really a strategic hire. It was sort of like who’s going to make me look really good on this team? And it’s like Kelsey, because when Andy can’t find something, he can’t find a document in the Google Drive, it’s okay because Kelsey can’t find the Google Drive. So it’s just sort of I’m just a strategic hire. I think every company should have one.

Dr. Andy Roark:
Right. Your job title is foil. That’s not true. You were a very strategic hire, because you are magnificent and lovely and wonderful and creative and super funny and super fun. And since I started doing social media 15 years ago, you have always got the positivity and the energy that I think is so important to kind of put out into the world and kind of what we always wanted to do. And you just radiate that as well. And I feel blessed every day that you show up to work. So that’s one of the many joys of my life. So thank you for being that person.

Kelsey Beth Carpenter:
Thank you, Andy. I feel the same way. And now also I have it on audio recording. I could play-

Dr. Andy Roark:
Listen back to it.

Kelsey Beth Carpenter:
Back to myself. Also, next time you fire me on a team meeting, I can go ahead and play that for everyone. Remember you did like me at one point.

Dr. Andy Roark:
Yeah, that happens a lot as well. That often happens. Yeah. So we were talking, and we were sort of talking with the rest of the team recently and you brought up an idea for a podcast, and then you were immediately voluntold to do the podcast, and here you are. So let’s go ahead. How do you want to open this up? Yeah, how do you want to open this up?

Kelsey Beth Carpenter:
Well, I was listening to one of your episodes recently, and now I’m blanking on which one it was, and you guys were talking about how to make clients feel heard in an exam room. And as I was listening to it, I was thinking back on all of the doctor’s appointments I’ve been through, because I’ve gone through a major medical experience over the past few years and all of the things that have made me feel heard and all of the things that I would… Ultimately I’ve seen so many doctors lately, and every time I go to a doctor’s visit, I think here’s what I would do differently if I get back into the clinic one day. Here’s what I would change about how I talk to clients or how I put someone in a room or how I discharge people, just because of what I’ve now experienced being a patient myself so many times.

Dr. Andy Roark:
Well, I thought that was great because my wife has gone through a major medical event in the last year, and I had the similar experiences of things that I’ve watched, how they’d impact her. And then I’ve been along in a lot of these appointments and things as well. And I thought this would be really fun just to go through and break down what we’ve seen in human medicine that is good that we would like to point over and then things in human medicine that are not good that we definitely don’t want to point over. And so I think that’s fun. The intention is not to throw shade on human medicine-

Kelsey Beth Carpenter:
Of course.

Dr. Andy Roark:
But I do think we’re crushing them. I think there’s so many good things about vet medicine-

Kelsey Beth Carpenter:
Not to throw shade.

Dr. Andy Roark:
That is not good-

Kelsey Beth Carpenter:
We are superior.

Dr. Andy Roark:
Not to throw shade. Yeah, I don’t want them to feel bad about that, but let’s just call a spade a spade. It’s a lot of really good things in vet medicine that got lost in human medicine, and I think that that’s worth calling out. So yeah, let’s go. How do you want to start?

Kelsey Beth Carpenter:
Well, I’ll just say this though. So we’re not trying to, yeah, throw shade on human medicine. Also not trying to say our veterinary professionals, our fellow veterinary professionals aren’t already doing many of these things, because some of them are so basic, but I think for me it’s like I had been working in veterinary medicine for 10 years, and I kind of stopped thinking about some of the things I do. A perfect example is callbacks. It’s so routine. I sit there and I do 15 callbacks in the morning, and I don’t even think twice about it. And then when I became a patient myself, realizing what that actually does for people. So there were just multiple things. I guess we could kind of just start at the top of an exam maybe.

Dr. Andy Roark:
Yeah, sure. I mean, I’m totally up with that. So we’ve been in a number of different exams over the last years and stuff, and a lot of things that we take for granted, that medicine really matter, just a warm welcome, just confirming that someone is in the right place, that this is the plan, just sit here, we will take care of you. I think that that’s so important. I think the other part that I would say here is the idea that someone actually caress that you understand what’s going on is important. I remember talking to a nurse as I was leaving an appointment one time, and I was like, “I just want you to know this is a whirlwind, and I do not feel like our questions got answered. And now we’re kind of getting dumped out the door, and the doctor’s in the next appointment.” And she was like, “Okay, well, I’ll pass that on.” And I doubt that they did, but it’s just such a simple thing to be like, “Hey, we’re going to make sure you understand what we did here.” And I had not felt that way in a long, long time.

Kelsey Beth Carpenter:
Yeah, absolutely. And it’s really hard… When you get to a point where you’ve been doing this long enough, you forget what people don’t know. Like something as simple as, “I’m going to take your dog back for x-rays,” what can the client expect? What are they supposed to do while doing that? Just the simplest things. But you started to mention just saying something as simple as making sure you’re in the right place, honestly, it’s the first simplest thing. You actually have a point about this, and it was in one of your lectures that I watched once about building trust and how every little thing you do in the exam is building up that trust level. And that first thing is just using names, introducing yourself so they know who you are and saying the patient’s name or the client’s… For me, I’m the patient… or saying the pet’s name. It just already builds that little tiny bit of trust and starts you off on the right place.
I can’t tell you how many times a doctor has walked into a room and be like, “All right, so we’re looking at this today.” And I’m like how do you know who I am? There could be another Kelsey here. How many times have I had three Fluffies sitting in the waiting room, and I could pull the wrong one? So it’s something so simple like that I never thought twice about until I had to be a patient myself.

Dr. Andy Roark:
Yeah. No, I completely agree with that. And I get it. People are busy. And you go in for a medical procedure, and they’re like, “You need to be here at this time,” because the doctor is doing their procedures, and they’re just stacked back to back to back.

Kelsey Beth Carpenter:
Of course.

Dr. Andy Roark:
And it kind of feels like a cattle train where you’re just getting pushed, a shoot where you’re here and then you’re here and you better not be late because they’re going to be upset. And I think that you can be efficient and you can move things through, but I think that we should actively work against making people feel like they’re widgets being pushed through the widget press. You know what I mean? And I’ve had that. I think there’s definitely a balance of efficiency and getting things done and then also just taking a moment to confirm to the person, “I recognize that you’re a human being, and I’m also a human being. And this is my name, and if you need anything you can call me.” I think that that’s really good.

Kelsey Beth Carpenter:
I think that’s a huge one for me, so one of the biggest ones that I just didn’t really think much about when I was a tech before, is just the acknowledgement. We talk about making people feel heard. To me, that’s not a complicated concept at all. To me, it is as simple as someone comes in, I put them in a room with their dog, and they say, “Bella’s here because she’s been vomiting. We tried doing a bland diet. She vomited three more times this morning.” We go straight into, “Okay, let me go ahead and start getting her vitals.” I’m not saying that’s wrong, but the simple statement of saying, “Wow, that sounds really rough for both of you.”

Dr. Andy Roark:
Yeah, “That must’ve been scary.” Yeah.

Kelsey Beth Carpenter:
Huge, I mean, because you think about the fact this client has been up all night, they’re cleaning up puke out of their lovely carpets, they’ve been through it, they’re exhausted, they’re stressed. It happened to me in an exam once, I… In my total time just going through my recent development of fibromyalgia and everything, I actually had to tally up how many doctors I’ve seen in total. And the last time I tallied it, which was about six months ago, I was up to about 70.

Dr. Andy Roark:
Wow.

Kelsey Beth Carpenter:
So I have a lot of experience. And I remember the first time I saw a new psychiatrist, and he was just taking a basic history on what was going on with me. And I explained to him about my chronic pain and fibromyalgia and what I’d kind of been through, and I was doing it very much in my vet tech way of, “Here’s the data that you need,” right?

Dr. Andy Roark:
Yeah.

Kelsey Beth Carpenter:
And he just literally stopped and said, “Wow, that sounds like you’ve really been through a rough time.” And I was like it’s not computing. I don’t know what to say to that. No one had ever… At that point, I was about two years into it, and I don’t think a single doctor had said to me, “That sounds really hard.” And it’s not that they’re not thinking it. You guys talked about this in another recent podcast. It’s not that we aren’t thinking it as doctors or veterinarians or technicians. It’s that we’re just in efficiency mode and we maybe don’t say it out loud. The compassion is there. It’s just sometimes making the extra effort to verbalize it, that’s huge, right?

Dr. Andy Roark:
It doesn’t take a whole lot. I completely agree. But yeah, it’s easy to get head down and just… The classic thing, and I talk about this a lot with emergency medicine, is when you’re an emergency doctor or you’re an emergency tech, you just see emergencies all day long. And this emergency is just the thing that we’re doing for 20 minutes right now before we do the next one. But to the pet owner that’s there on emergency, this is a once-in-a-lifetime experience. This is one of the worst days of their lives.

Kelsey Beth Carpenter:
Exactly.

Dr. Andy Roark:
And the dichotomy of those experiences is very real. And I just think we have to be conscious and aware of what the other person’s experiencing in order just to not have them feel like they’ve been pushed through the machine.

Kelsey Beth Carpenter:
Yeah. My favorite thing, one of the first things I would always tell newer assistants or technicians when I was training them, was my little secret for how I interact with clients is I pretend that every single client is a good friend of my mom’s-

Dr. Andy Roark:
Oh, that’s fun.

Kelsey Beth Carpenter:
Because how are you going to treat a friend of your mom’s if they come in and they’re like… Well, first of all, you’re going to go in the room and be like, “Oh my God. Hi, I’m Kelsey. I’m Cassie’s daughter.” You’re going to introduce yourself. You’re going to be like, “This must be Bella. I’ve heard about her,” you know?

Dr. Andy Roark:
Yeah.

Kelsey Beth Carpenter:
And then when they talk about Bella’s been vomiting, you’re not going to be like, “Okay, let me go ahead and get vitals.” You’re going to be like, “Oh my God, that sounds terrible. Oh, I’m so sorry you’re going through that.” How do you treat someone who’s like your second cousin or your dad’s friend from high school? How do you treat that person? That’s how I try to pretend, that’s what every client is to be, and it helps me say those things out loud, that we’re all already thinking them in our heads anyways.

Dr. Andy Roark:
Yeah, I like that a lot. I think some of the interactions we’ve had recently with nurses have made me think a lot about the technician role in communication between patients, our patients, our clients and doctors, where… We had some experiences recently where you know that I’m a big believer in empowering technicians, and I feel like in human medicine they have made big strides in empowering nurses to be communicators. And I do think that we can absolutely learn from that. I’ve seen that go really, really well, and I’ve seen it go really badly to a point it was a really frustrating experience. And the difference for me in the experiences that we sort of had is when the nurse is the point of communication and they feel like an advocate or someone who is trying to help you, that is different from the nurse as the gatekeeper who says, “I’m not going to… Nope. I’m telling you what the answer is, and I’m not going to take your question or answer. Go to the doctor.”
So for example, my wife was talking to the doctor about something, and I’m sure she wouldn’t mind me saying, but she’s very active. She works out, she exercises, and so she has a procedure. She wants to know how long is it until I can be back doing the things that I want to do? And she’s pretty aggressive in that.

Kelsey Beth Carpenter:
Yeah. No, let’s just be honest. It’s not she’s just active. She’s a badass. She’s a verifiable badass. Let’s say it as it is.

Dr. Andy Roark:
She’s over the top badass. Yeah, that’s true. But anyway, so she’s like, “Hey, look, I am taking badass time off here, and I would like to get back to my badass self.”

Kelsey Beth Carpenter:
Exactly.

Dr. Andy Roark:
“And can I do that?” And the doctor was like not a big deal, but then the nurse was like, “Oh, no, no. You don’t do anything. Don’t lift anything more than 10 pounds until your recheck in like six weeks.” And Allison was like, “That’s not going to happen.” And Allie really wants to do what she’s supposed to do. She wants to be smart. And so she got mixed messages from the doctor and from the nurse. And the nurse did not seem to take her seriously and wasn’t willing to go back to the doctor and say, “Tell me what you were thinking here.” She was like, “No, these are the rules.” And it very quickly became this adversarial feeling that I have not had in other instances. And I go, wow, this is how leveraging your support staff for communication kind of goes off the rails. And then it became I don’t want to talk to the nurse. I want to go around her because I don’t feel like they’re on the same page. And that was an interesting part to me of how you leverage and utilize your techs. You still got to communicate with them. You have to be accessible. They can help you, but it’s almost like by closing off the line of communication, you end up undermining trust.

Kelsey Beth Carpenter:
Oh, absolutely. Yeah, getting those mixed messages, it’s what starts to, like you’ve said before in these lectures, starts to drain that trust bucket that you’ve started filling up, right? Exactly. And you lose faith because then it’s that feeling of who am I supposed to trust? I don’t know now. I don’t know. That nurse could have been doing this much longer than that doctor, or vice versa. I don’t know who’s right. Yeah, that’s hard.

Dr. Andy Roark:
Talk to me a little bit about continuity of care. You said you’ve seen like 70 doctors. So I can guess what maybe that experience is like, but I could be completely wrong. So talk to me about your feeling of consistency and continuity when this has been your experience.

Kelsey Beth Carpenter:
The continuity is nice if you can do it. It can’t always happen, but I think there’s ways that lack of continuity can still be done successfully, if that makes sense. So for example, okay, I’ll give this example. My mom and I, we go to the same medical center, and it’s kind of like a tight-knit thing. And so my mother and I both have the same primary care physician, so share doctors.

Dr. Andy Roark:
Sure.

Kelsey Beth Carpenter:
We also have the same physical medicine and rehabilitation doctor as well. And so one of-

Dr. Andy Roark:
Do you carpool?

Kelsey Beth Carpenter:
I wish.

Dr. Andy Roark:
Do you drive together?

Kelsey Beth Carpenter:
We’re not that cool yet. I just realized we also do have the same physical therapist. We did once have our physical therapy appointments back to back, and that was weird. It’s all really becoming a family affair, and I don’t know whether I am enjoying that or having questions about it. Anyways, so one of the beautiful things is, for example, our primary care doctor saw my mom the other day because she finally came down with COVID, the VID, and my mom was like, “Yeah, I’m really worried. What if I gave it to Kelsey?” And immediately the doctor knew who she was talking about and was able to reference things that she would’ve only known, but she made these notes to herself. We all have places we can make notes. And it’s the continuity of having seen her numerous times and her taking the time to remember who’s connected to who or what’s going on here.
The last time I saw her, she was like, “How is it going with this supplement?” That kind of continuity is so valuable. But meanwhile, I think there’s a way that it can be done successfully where you don’t always have to be there. So one thing that I think is very important is creating a plan. And I think it’s one thing that many of us, I think, could improve on in any field. And I’m going to tie this together, I promise. We’re going to go on a journey, and then we’re going to come back.

Dr. Andy Roark:
I’m trusting you. I’m trusting you.

Kelsey Beth Carpenter:
We’re going to go on a little island, and then we’re going to float on back to the mainland. Okay, so I think one of the most important parts is to create a plan with your patient or your client and say, “Okay, this is what we’ve decided to do today. If this does not work, here are some other things that we might consider going forward.” And that doesn’t always happen. And sometimes it’s just, “All right, we’re going to prescribe you this medication,” and it leaves people, like myself, I’ve often felt sort of abandoned. It almost feels like the doctor’s saying, “All right, I’ve given you this medication, and I’m done with you.” And I kind of feel like, okay, well, if this doesn’t work, I don’t know what to expect. And many of us have brains that we like to plan ahead, okay, if this doesn’t work… How long do I wait to see if it doesn’t work?, that kind of thing. So you create this plan, and it doesn’t have to be detailed. It doesn’t have to say what dosages you’re going to give of some other antibiotic, just we are going to try this or this.
And then the beautiful thing about that is it helps your team. So now if I have to go back in through urgent care because whatever my primary care physician did didn’t work, there are now really clear notes in my primary care physician’s record about what we discussed or the next plan, or is the next thing we’re going to try. And so now this urgent care doctor’s going to say, “It looks like you guys talked about trying this as the next thing. Do you want to go in that route?” And now I feel like there is still continuity, even though I’m not seeing the first doctor that I saw. And I feel like I haven’t been abandoned. I feel safe seeing another doctor that I’ve maybe never seen before because my first doctor took the time to say, “I’m not leaving you with this. I’m going to say, ‘Here’s this, and here’s what we’re going to do if it doesn’t work,'” you know?

Dr. Andy Roark:
Yeah.

Kelsey Beth Carpenter:
So that’s important, I think.

Dr. Andy Roark:
I love that. So I can rant about medical records in vet medicine with the best of them. And so I definitely have my own position and soapbox. The very, very short version is we should think about what the purpose of a medical record is, because people write books, and I don’t think that people get trained very well in what’s required and what’s not. And the point of the medical record is to document what happened and why it happened, meaning how was the decision reached?

Kelsey Beth Carpenter:
Exactly.

Dr. Andy Roark:
Why did we not do this or why did we do this, but how was the decision reached? And the last part is what is the plan going forward? And that last part is mission critical for being able to pass cases between doctors at your practice.

Kelsey Beth Carpenter:
Exactly.

Dr. Andy Roark:
And it’s just the number of medical records I see that doctors don’t jot down even the most basic, “Hey, if this doesn’t work, we’re going to recheck blood work and consider… I don’t know… trying a different medication.” That gives the client some idea of what will happen next. If something goes bad or they just don’t get resolution, they’ve already said, “Okay, we’re going to go do this blood work.” There is a plan. They know what they’re doing. And I’ve had the exact same experience that you have had in medicine of getting a plan. And they’re like, “No, you’re just doing this now.” And I’m like, “Well, for how long?” And they’re like, “I don’t know. Forever? We’ll see.”
And so that’s not at all uncommon. And, again, my guess would be that there’s some liability fear in human medicine where they’re like, “I don’t want to take you off of medicine.”

Kelsey Beth Carpenter:
Of course.

Dr. Andy Roark:
“Just stay on it forever.” Again, I’m telling myself stories too, but I think sometimes in human medicine they’re like, “I’m going to put you in this medicine, and at some point you are going to get tired and decide it doesn’t work, and you’re just going to stop, and I’m not going to have to tell you, but then if it ever becomes an issue, you’re the one who decided to stop it, not me”. And so I don’t know about that, but I think the idea of having a plan and communicating a plan, I think it’s absolutely true. You don’t have to have a master plan either.

Kelsey Beth Carpenter:
No. Exactly.

Dr. Andy Roark:
You just don’t want to feel like you’ve been pushed off into the ocean in your little dingy, and it’s like, well, maybe we’ll bump into each other again.

Kelsey Beth Carpenter:
Exactly.

Dr. Andy Roark:
Something more than that, yeah.

Kelsey Beth Carpenter:
Well, And ultimately, like we’re saying, this doesn’t have to be some extensive conversation. It’s, “We’ve chosen to do this today. I want to hear from you in two weeks. And if it’s not working, we can consider some recheck blood work, and there’s another medication that we could try as well.” That’s as simple as it needs to be. And that one sentence saves numerous people so much time if that first medication doesn’t work. If it ends up with another doctor, it saves that doctor time. It saves the client time, or the patient time because they can know what’s going to happen. If you end up seeing the same patient again because it’s not working in two weeks, saves you time. You don’t have to go through the whole conversation of options again. You’ve already set out your plan. So even though it sounds like I’m saying do all these extra things, I think ultimately it’s actually a time-saver for everyone.

Dr. Andy Roark:
The patient portal experience in medicine, I’m a big fan. That is something I would actually like to see in vet medicine. I’m confident we could do it in a way that does not generate a ton of extra work for us, but just the ability to have your own little thing and you go and you log in, and you can pull up your blood work from the past, and you can look at radiographs or you can do whatever. Or you have the ability to send messages to the doctor, and it’s like I totally get people being like, “I don’t want clients to have immediate access to me.” Look, they’re getting access to you anyway. They’re calling. They’re being put on hold. You’re going to talk to pet owners. Go ahead and figure out how you want to do it and come up in a way that’s convenient and easy and safe and secure where you have everything documented.
And it’s just… I don’t know… the patient portal stuff, I think they’re pioneering it in human medicine. And I think that that is something that I can absolutely see us in vet medicine doing and saying for our clients, “This is kind of what your portal looks like,” and then also just the benefit of if your pet ever ends up in the emergency clinic, you can be like, here’s what we have. And I know we already have services like that. We have a number of sort of record-sharing services that work great. VitusVet is the one that was popping into my head. I know there’s others as well, but getting to the point where that’s expected, I think that’s something that’s coming.

Kelsey Beth Carpenter:
Yeah. The value of seeing things as well, at least in the practices that I’ve worked in, it’s very rare that a doctor will go over x-rays with a client without showing them the x-rays so they can point out, “This is what we’re looking at.” And there’s incredible value in that, because you see that’s my pet up there. This is what was actually done. This is what I’m paying for. This is what my doctor’s seeing, and this was what it means. That visual representation is so important. And I think sometimes that’s part of what’s missing in some of our client education. They don’t have access to their blood work. We go in and say, “The BUN and creatinine is elevated, and so we’re worried about the kidneys.” If I wasn’t in medicine, that would not process anything for me. But if it’s written out in front of me and I see the big red highlighted, oh, this is an abnormal value, now I’m going to remember that. And so I think you’re totally right. I think the portal is the best way to go. And also I think it’s an incredible opportunity for technicians. I think so many technicians are often looking for new ways to be involved in veterinary medicine that maybe isn’t blowing out their back every two seconds. And I think that’s an incredible way that we can allocate work to technicians for sure.

Dr. Andy Roark:
Yeah. I think that that’s a big part of where technicians are going in vet medicine, is in the communication, customer service sort of realm. I just think there’s so much opportunity there for sure. And again, I know everybody has different learning styles. It’s been interesting for me to recognize how much some sort of visual learning is important to me. The doctors that I’ve been most impressed with have been the ones who have visual aids.

Kelsey Beth Carpenter:
Absolutely.

Dr. Andy Roark:
Like a whiteboard, and they’re like, “All right, this is what we’re doing, and this is what it looks like.” And they’re just simple diagrams, but I was like, oh, I feel so much more informed of just understanding what’s going to happen and why it’s going to happen. But it has made me think a lot about my time in the exam room and how I want to use those tools and how much of a difference it can make for people.

Kelsey Beth Carpenter:
Yeah, it’s why I’ve always been so passionate about working in an open hospital, is that when people get to see what is being done, they retain so much more information. I always say clients can come back after being in the open hospital and be like, “My pet received subcutaneous fluids yesterday and an injection of Cerenia,” but it’s because they watched it happen. If you came and told me that’s what you did to my pet, there is no way my brain would remember that if I wasn’t in medicine. But seeing it is really different for sure.

Dr. Andy Roark:
Define open hospital for people who aren’t familiar with the term.

Kelsey Beth Carpenter:
It basically functions as if you were going to a pediatrician where you get to stay with your pet, as… I was going to say as humans stay with their children in that same way. I don’t know why that sounded funny to me in the way I said that. As humans stay with their skin babies, the clients get to stay with their fur babies.

Dr. Andy Roark:
Yeah, I think we should call pets babies and humans skin babies.

Kelsey Beth Carpenter:
Skin babies.

Dr. Andy Roark:
I think we should not call pets fur babies. Just call them babies-

Kelsey Beth Carpenter:
Just babies.

Dr. Andy Roark:
And then make humans call them skin babies.

Kelsey Beth Carpenter:
Congratulations on your new skin baby. We’re going to start something new here.

Dr. Andy Roark:
Oh, it’s going to totally catch on. Oh, yeah.

Kelsey Beth Carpenter:
This is going to catch on like wildfire.

Dr. Andy Roark:
I feel it already. Mothers are going to just go right to this as a concept. All right.

Kelsey Beth Carpenter:
There’s something that you said earlier that I wanted to touch on too that has been something that I think is maybe the biggest thing I’ve learned from being a patient. And we were talking about choices and how you come to a certain decision and then what you’ll try next and those kind of things. And one thing I found being a patient myself and going through a really difficult time and I didn’t have a clear diagnosis, and it was a rough case, I am essentially the 20-year-old geriatric, cancer and kidney disease and liver failure cat who’s mostly bones that comes in that you dread getting because they have a lot of questions. That’s me. I’m that patient. Okay?

Dr. Andy Roark:
Okay.

Kelsey Beth Carpenter:
So one thing that I learned is that I experienced an incredible burden of responsibility to care for myself. There was an incredible burden of I am the only one who can make these decisions, and hopefully they are the right ones, but my life hangs in the balance based on these decisions that only I can make. And I realize that I have that same feeling when it comes to my dog Birdie, that I have an incredible burden of responsibility, that I am the one making decisions for her life. And it’s almost even harder. At least if I’m making a decision for myself as a patient, I’m the only one who gets hurt if I make the wrong decision. If I’m making the decisions for Birdie and I make the wrong decision, let’s say I don’t take her to urgent care and I see if she gets better on her own, she’s the one who gets hurt because of that. And that is an incredible burden. That’s really heavy on your shoulders.
And so one thing that a doctor said to me recently, which made a huge difference, was I was seeing a new doctor, and we went over all of the things that I’ve tried so far for my chronic pain. And a lot of them were things that she normally has to tell people about. And she’s like, “Wow, you’ve really done your research. You are doing everything you need to be doing right now. You are doing everything right. Keep up what you’re doing.” And I, after that appointment, sat there and cried because I was so just like I needed that validation to say I am making some really good decisions. I’m doing the right thing. And it took a huge weight off of my shoulders. And I think that’s the biggest thing that I would change, is when I go to put an urgent care patient in a room, because yeah, Bella’s been vomiting for a couple days, being able to say to a client, “Gosh, you made the right call, bringing her into urgent care today. I’m definitely glad you brought her here,” or if the client decides, “I don’t think I’m ready to hospitalize her. I’m going to monitor at home,” saying, “I think that’s a reasonable choice. And we have a plan in place in case it doesn’t work,” that kind of validation is really huge.
And I think that’s the biggest thing I never thought about until I was a patient myself and I felt that burden on my shoulders.

Dr. Andy Roark:
Yeah, that’s a great point, is people want to know that they’re a good pet owner, and they want to know that they’re doing the right decision. And they always ask themselves if they’re overreacting. You can see it in pet owners’ eyes, should I have come? Maybe I’m-

Kelsey Beth Carpenter:
Absolutely.

Dr. Andy Roark:
Just being paranoid, and just that validation of, “No, you are doing the right thing,” yeah, that’s great. Kelsey Carpenter, where can people find you online? You are such a joy.

Kelsey Beth Carpenter:
Mostly silently, quietly, privately being a keyboard warrior behind the Dr. Andy Roark Facebook page.

Dr. Andy Roark:
Facebook page.

Kelsey Beth Carpenter:
I am under Vet Tech Kelsey on Facebook and Instagram, and that is it.

Dr. Andy Roark:
That is it. No, I saw Facebook launched their new sort of Twitter-like platform today.

Kelsey Beth Carpenter:
Oh, was it Threads?

Dr. Andy Roark:
Threads, yes.

Kelsey Beth Carpenter:
I’m hearing all about that, and I’m a little… I know I’m 34 when I start going, “These darn new social media platforms-

Dr. Andy Roark:
I know.

Kelsey Beth Carpenter:
“We don’t need them. I refuse to sign up for Threads.”

Dr. Andy Roark:
That’s great that you’re a social media manager for an old fart who’s like, “I don’t want to do that thing.”

Kelsey Beth Carpenter:
And I don’t want to do it either.

Dr. Andy Roark:
And you’re like, “Good, because I don’t want to do it either.” [inaudible 00:33:35].

Kelsey Beth Carpenter:
My favorite part is like Andy Roark doesn’t want to dance on TikTok, and I’m like neither do I with my Bachelor of Arts in dance.

Dr. Andy Roark:
That’s so great.

Kelsey Beth Carpenter:
I won’t touch it.

Dr. Andy Roark:
Oh, I love it. All right. Kelsey, thanks for being here. Guys, I hope you guys enjoyed the episode. I think there’s so much to think about here. I always enjoy sitting back and going what does this mean for vet medicine? So anyway, guys, take care of yourselves. Be well, everybody.
And that’s it, guys. That’s what I got for you. Thanks for being here. Thanks to Kelsey Beth Carpenter. Check her out on the social medias, if that’s where you hang out. She really is amazing and wonderful. Be well, everybody. I’ll talk to you soon. Bye.
Hey guys. I just want to jump in real quick and let you know that my Back to School webinar Series is winding to a close. I’ve had a bunch of webinars on recently. They’re done by me. They’re done by guests of mine. I’ve got one more live one coming up. It is on Tuesday, September the 19th. That is at noon Eastern time, 9:00 AM Pacific. It is a one-hour presentation. It has one-hour of RACE. It is a presentation by me. I will be getting the team on board with the spectrum of care approach. If you listen to the podcast very much, you know that I’m big on spectrum of care. I think it’s important to balance the quality of care that we put with affordability and accessibility to pet owners. This is about talking to the team about those concepts and getting everybody in the same place so we feel good about providing quality care and striving to meet pet owners where they are. So anyway, like I said, that’ll be one hour RACE. It’s me doing the presentation, getting the team on board with the spectrum of care approach. It is Tuesday, September the 19th at noon Eastern time. It is sponsored by Nationwide.
Also, I have got a webinar on demand for you. It is from Ceva Animal Health. It is called Updates in Canine Pancreatitis, Treatment Innovation with Fuzapladib Sodium for Injection. If you haven’t seen this presentation before, it is a great presentation. It’s super, super action-oriented on dealing with pancreatitis, and it talks all about the new drug on the market, Panoquell-CA1. So anyway, that is on demand. You can watch that webinar right now. I’ll put links to all this in the show notes. Okay, let’s get back into this episode, but I hope to see you on the webinar on September the 19th. All right, bye.

Leveraging AI to Improve Clinical Care in Veterinary Medicine

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Dr. Jen Chatfield (aka Dr. Jen the vet) joins Dr. Andy Roark to discuss how clinicians are already using AI and machine learning in practice, and how these tools can be leveraged to improve clinical outcomes.

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

LINKS

Chats with the Chatfields: https://chatfieldshow.com/

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Jen Chatfield (aka Dr. Jen the vet) is a national thought-leader in infectious disease and conservation medicine. She’s been a practice owner, a relief vet, worked in public health, serves as a member of the National Veterinary Response Team, and is a Medical Reserve Corps member. She serves on the advisory board for DVM360, PetVet Magazine, and VPNextGen and as an Associate Editor of the Journal of Zoo and Wildlife Medicine. Dr. Jen is one of the most popular speakers at the largest veterinary conferences and has been quoted in national magazines including Better Homes & Gardens. She was selected as a Future Leader by the AVMA and has been awarded 2 Gold Stars for contributions to veterinary medicine by the Florida Veterinary Medical Association. She loves French bulldogs, Himalayan cats, the dirtiest of vodka martinis and basking on Caribbean beaches.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I’m your host, Dr. Andy Roark. Guys, I am here with Dr. Jen Chatfield. She goes by Dr. Jen the Vet. She is a lecturer, she is a podcaster, she is a YouTuber. She has a show called Chats with the Chatfields. You can find it at chatfieldshow.com. Things like that. She is doing a webinar for VetFolio that I saw and thought was really interesting about leveraging AI to improve clinical outcomes. So I wanted to bring her in and talk about that.
We have an interesting conversation. It kind of goes all over the place. She defines AI very broadly, and so you’ll hear us talk about that. Mostly, we end up getting into talking about things like radiographic interpretation using AI. Things like that, that are right around the corner. Things that she’s already using in practice. I just think that’s really interesting.
So if you’re interested in artificial intelligence, how rubber is going to meet the road, and what we’re going to be seeing in practice as far as getting better patient outcomes, this is a really good episode. But anyway, it’s a fun conversation. I hope you guys will enjoy it. Let’s get into this episode.

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

Dr. Andy Roark:
Welcome to the podcast, Dr. Jen Chatfield. How are you?

Dr. Jen Chatfield:
I’m fantastic, Andy. How are you?

Dr. Andy Roark:
I’m great. I’m so glad to have you here. I’ve already been enjoying talking with you, because you do a lot of the weird things that I do. You have a YouTube show called Chats with the Chatfields. I became aware of you not from Chats with the Chatfields, but because I saw a presentation you were doing through VetFolio. You were talking about using artificial intelligence to improve clinical outcomes.

Dr. Jen Chatfield:
Yes.

Dr. Andy Roark:
I looked at it and I looked at the walkthrough, the agenda, the points that you were making. I was really impressed with how practical and pragmatic your approach was when you were talking about something that tends to be a lot of hand waving right now.
A lot of people are really excited about it, but you actually had insight as far as use cases and ways that people could immediately pick this up and actually make their days better. That’s what I wanted to bring you on today and talk about. Can you open up for me? Just at a high level, how do you look at artificial intelligence as a veterinarian? What is your larger picture or philosophy? Is it a tool? Is it a partner? What is it? Where are we going?

Dr. Jen Chatfield:
Well, I hate to disappoint listeners. Because that was a super high-level philosophical question right there.

Dr. Andy Roark:
That’s kind of how I go.

Dr. Jen Chatfield:
I was very deep and intense, and I’m not necessarily that person, to be honest with you. If there is any tool, piece of equipment, piece of information or philosophy that can help me raise the standard of care that I’m able to provide … I’m for that. I guess I approach it like that. “How can I be a better vet?”

Dr. Andy Roark:
No. I like it. Well, that’s it. I kind of did you wrong when I was like, “I’m interested in pragmatism. Let’s talk philosophy.” You were like, “I didn’t come here for that, Andy.”

Dr. Jen Chatfield:
I’m totally happy to wax philosophical as often as the next person, but I really appreciate data. And if I’m going to change something I’m doing, which is one reason that I feel so lucky that I accidentally became a veterinarian … Because if I’m going to change something I’m doing, then I want to either know that I’m changing it because I want to or because I have data that supports that change.
For me, that is where a little bit of my fascination personally with artificial intelligence, with the robots and the machines comes from is … I don’t know. Is it better? Is it worse? Is it the same? And then, from that point, if we answer that and we say, “It’s better.” Well, then there’s more questions. Well, what does better mean? How do you define better? For me, overall, that’s clinical outcome. Hands down.

Dr. Andy Roark:
Got you.

Dr. Jen Chatfield:
Clinical outcome. What we learned is the only reason to do a diagnostic test is if the outcome is going to change.

Dr. Andy Roark:
If you’re going to use the outcome. Right.

Dr. Jen Chatfield:
I should phrase that better.

Dr. Andy Roark:
No. No. I see what you’re saying. Exactly.

Dr. Jen Chatfield:
Not as a medical lookie-loo.

Dr. Andy Roark:
It’s always that question of, “What are we going to do with this information?”

Dr. Jen Chatfield:
Yes.

Dr. Andy Roark:
If the answer is, “Nothing,” then do we really need to run that test? Yes. I’m 100% onboard with that. Got you.

Dr. Jen Chatfield:
For me, that’s the same thing with, “Is whatever I’m doing, whether it be related to AI or not, going to change what I’m doing with this patient?”

Dr. Andy Roark:
Well, start to lay it down for me. What does that actually look like in practice? Again, there’s a lot of people who get really excited about AI. I’m not running into a whole lot of people who are like, “This is what I do in practice.” Talk to me about that.

Dr. Jen Chatfield:
There’s a lot of, like you say, hand waving. People losing their ever-loving minds talking about AI, “Are the machines going to take over?” And this and that. While I do not currently live in fear of the machine I’m talking into right now, I do live in fear of taking the human component out of any job that’s focused on care, because you just can’t convince me they can do it better.

Dr. Andy Roark:
Right.

Dr. Jen Chatfield:
I’m fascinated by that interface and how we use it. So in regular practice, in a very sneaky way, it’s already there. I go into an exam room, a dog is sick, vomiting and diarrhea. Dr. Jen the Vet loves to see vomiting and diarrhea. I say, “You know what, little fluffy white dog with strawberry jam stool? I’m concerned that we have …” It’s not called HGE anymore. What do they call it? Like ADS or AHD? It’s got a new thing.

Dr. Andy Roark:
I still call it HGE. I’m old school like that.

Dr. Jen Chatfield:
Thank you. Appreciate you. Appreciate you. So I say, “I want to roll that out. Let’s do some blood work.” So I get some blood work. I’m going to run a CBC and I’m going to run a chemistry. I put my CBC in the machine. I don’t do a manual CBC. I don’t do a manual differential. Do you?

Dr. Andy Roark:
No. I mean … No. No.

Dr. Jen Chatfield:
Hey. Neither does our doctor. We put it in the machine and the machine kicks that out. That’s AI. That is AI, because it’s scanning, looking for cells approximately this size, whatever other characteristics, and then it’s calling that a neutrophil and kicking out a differential. Or it’s calling that a red blood cell and kicking out PCV plus or minus reticulocytes.
That’s AI. You’re already using it, friends. You’re already using AI. And then, obviously, we have a chemistry going on. Another way I think it sneaks in is when we run urinalysis. All of these tests that we use benchtop in clinic screening tests that we use, that all rely on what I perceive as color. Urine dipstick, I’m looking at you. All these color changes.
As a friend who’s a hairstylist told me, “Everyone sees color differently.” We’re looking at this dipstick with a bajillion colors, and I don’t know about you, but I’m like, “I’m holding it right here.” I’m turning the canister as the seconds tick by, and I’m like, “Nope. Not that color. Maybe this color?” Hey, guess what? That is open for error with interpretation of the color changes. What do we do now?

Dr. Andy Roark:
Our dipstick reader.

Dr. Jen Chatfield:
We have a system. And that removes that subjective interpretation error. That’s AI.

Dr. Andy Roark:
Okay.

Dr. Jen Chatfield:
Another piece. This is my favorite piece, because I am the fluids doctor. I am not the blood work doctor. I am not the x-ray doctor. No one has ever accused me of being a surgeon. I love that we now have sophisticated AI available on the market that will support interpretation of diagnostic images. X-rays. Love it. Love it.
That’s probably the scariest one for people, because we’re accustomed to blood work. Just trust in that machine. But it’s reading a picture. “It’s reading a picture, Dr. Jen. What the heck?”

Dr. Andy Roark:
I think that stuff is super exciting. I think that stuff is really cool. I think it’s going to open up doors for us to do ultrasounds and things like that in the clinic. There will be a referral part of it, where you say, “Well, let’s get a second pair of eyes on this.”
It’s not something I would race to right away. I think there’s going to be a long learning curve, but I fully believe that we’re going to be feeding our radiographs and then our ultrasounds and things like that into AI and just getting our results right back.

Dr. Jen Chatfield:
Dr. Andy, I’m already feeding my radiographs to AI. Every radiograph.

Dr. Andy Roark:
Interesting.

Dr. Jen Chatfield:
Every radiograph. Now, the better question is ask me, “Why? How come?”

Dr. Andy Roark:
Okay. Tell me.

Dr. Jen Chatfield:
Because the first question I had naturally a skeptic. I’m Texan. I’m naturally a skeptic. The first thing, I was like, “I wonder how often it’s wrong?”

Dr. Andy Roark:
Of course.

Dr. Jen Chatfield:
I wonder how often I’m wrong? And so, I wanted data. Because if I’m going to start adding this component in, what does the data say? Oh my gosh. The data is amazing. It’s incredible. First of all, you have to accept that … Again, I’m not banging on radiologists at all. I would love to have a radiologist in my pocket. I would love it.
Again, I was not the x-ray doctor. I don’t like it. I like x-rays for counting puppies and kitties. So it turns out that is partly because I’m human. The diagnostic error rate for radiographic interpretation ranges anywhere from 30% to 65% or 70%.

Dr. Andy Roark:
Okay.

Dr. Jen Chatfield:
Let me give you a specific data. So it’s very different in human land, because radiologists read only one body cavity. That’s all they do. Or one body part. In vet med, we’ve got to read it all. We take catograms for heaven’s sakes. Or at least, I do. You can put your nose up in the air if you don’t, but I do.
So if I’m looking at this x-ray … There was a study that was published fairly recently. They had four veterinarians. They had two that were reported radiologists and they had two that were surgeons. I think that’s fair. Surgeons … They look at tons of x-rays.

Dr. Andy Roark:
Sure.

Dr. Jen Chatfield:
They analyzed how often they were accurate when they were looking at images to determine intervertebral disc disease. Whether it was extrusion, protrusion, viscosity, whatever. IVDD. That’s what they were looking at. They were accurate 30% of the time. Now, when they told them clinical context, then they bumped up their accuracy to … I think it was almost 60%. That’s fair.

Dr. Andy Roark:
I think it’s fair.

Dr. Jen Chatfield:
Okay. 30% with four people who were boarded specialists who spend a lot of time in the dark room.

Dr. Andy Roark:
That’s brutal.

Dr. Jen Chatfield:
Or used to be in the dark room, I guess. I’m dating myself by saying that, but I’m like, “Well, what chance does Dr. Jen the Vet have?” It’s tricky. And then, if you look at the perceptual bias and the cognitive bias that’s available for our human minds. They looked at human radiologists. Mammograms is where this was all pioneered, because it’s one of the most difficult tissues to image well and to a diagnostic standard.
They looked at this. They discovered that a conversation happening across the room while a human radiologist was looking at images, they’re not in the conversation. Consciously, they’re not listening. It can impact their diagnostic interpretation.

Dr. Andy Roark:
I believe that. That totally makes sense. Our minds are constantly picking up the things around us. Even if we don’t want to be influenced by them, we are. I could 100% see someone having a conversation about a different case and influencing what you see as you look at this radiograph.

Dr. Jen Chatfield:
Yep. I could nerd out with more. There’s more data, but it just scares you. It just tells you this is a crapshoot. So if you go to cut section imaging, this is one of my favorite things. I have a friend that’s a human surgeon. She’s like, “I need an MRI for a surgical plan. I need an MRI.”
I’m like, “Sure. No problem.” That’s basically a crapshoot with interpretation. When you look at the error rates on interpretation of cut section imaging like CT and MRI … On the human side, for radiologists, if it’s 3% to 5% on plain films, it goes up to 30% or 40% on cut section imaging. Again, when we get down to the practicality of it, you could flip a coin and you’re 50/50.
Anyway, I’m very excited for AI. Now, I don’t always agree with it. Because again, it’s the same thing as … And this is why you can’t replace the veterinarian friends. How often do you look at a patient and you get the blood work back and you say, “Yeah. No.”

Dr. Andy Roark:
Well, it’s another maxim from vet school was, “First, look at the patient.” It was the whole hammer on you that the most valuable diagnostic tool you have is your physical examination. Putting your hands on the pet is the most valuable thing that you can have. I think that there’s a lot of wisdom there.

Dr. Jen Chatfield:
Frequently, the technicians that work with me, they know I say this. I’ll be like, “Nope. Nope. I don’t want this blood work. Give me a different one.” Even though it’s for that same patient. I’m like, “No, no, no. This is not it.”
Because the white count will be 8,000 or 9,000 and I’m looking at a dog that, clearly, I was expecting septic. It was going to be either through the roof or it was going to be in the basement, but it wasn’t going to be right in the middle. And so, I proceed with what I think.
It’s the same thing when I get this newfangled thing, this radiographic interpretation from the robots, from the machine. I look at it and say, “I don’t think that’s true. No. No. I see this here.” That’s okay. And I tell clients that, because that’s the hardest thing too. How do you talk about that with the client? I’m disagreeing with artificial intelligence? Yep. Yep. I am.

Dr. Andy Roark:
Hey, guys. I just want to jump in here real quick with a nice little bit of CE love for you. That’s right. On September the 5th at 4:00 PM Eastern time, 1:00 PM Pacific, I’ve got a webinar that I am putting on. I am hosting it for my good friend, Dr. Andrea Eriksson.
She is a board certified veterinary cardiologist, and she’s doing a webinar called CARDALIS: When to Utilize RAAS Suppression and Why. Guys, this is all about the new drug CARDALIS, which is out. If it’s not in your practice yet, it will be. This is talking about what CARDALIS does, which patients should be considered for it, and why suppression of the RAAS system should be utilized in what cases.
Anyway, that’s it. It does have an hour of RACE CE attached to it. It is going to be free for you guys. I’ll put a link in the show notes, but come get some cardiology CE with me and my friend, Dr. Andrea Eriksson. Guys, let’s get back into this episode.
Do you think that the rate of improvement is going to be pretty high? Do you think that you’re going to continue to see … The number of times when we don’t match up. Is that going to go down and down? Or is this going to be a constant thing, do you think?

Dr. Jen Chatfield:
I don’t know. I don’t know. I only know my own experience thus far, which is, it’s not that often that I will disagree with the artificial intelligence interpretation of the image. What it does for me, it’s more sophisticated than that. It’s not a right or wrong. It’s the fact that the artificial intelligence looks at the entire image.
For me, when I have clinical context … Because it doesn’t care. It doesn’t care that you’re looking at a Frenchie. It doesn’t care. And that heart looks giant and you’re like, “No. I dismiss it.” One of the most common perceptual errors that we make in radiographic interpretation is wrong decision. We search and we find it … Or I’m sorry.
We search, we don’t find it. We search and we see it, but we don’t recognize it. And then, the final thing is we search, we recognize it, we actively decide it’s not abnormal. Or we make the wrong decision. 60% to 80% are perceptual errors like that. So if I’m looking at this and I look at a frenchie, I’m like, “God. That heart looks giant. It looks super globoid.” Alan Spear, if you’re listening, globoid is a real word. It looks super globoid, but it’s a Frenchie, so I’m sure it’s fine.
That’s wrong. My AI isn’t doing that. It doesn’t know it’s a Frenchie. It doesn’t care. It’s calculating vertebral heart score and going to tell me what it is. It doesn’t care. So it finds things like that, and it actually helps me. At least in my experience, it’ll help me with a more sophisticated interpretation in order to either more proactively encourage a visit today to the neurologist … Even though your dog is walking around.

Dr. Andy Roark:
We’re all so strongly affected by our own personal experiences. You have those cases and you say, “Oh my God. I did this.” Or, “One time, I missed this.” And then, you’re looking for it. If you’ve been a vet for any time, you have your own biases.
You’ve had medications that a pet had a side effect to. Now, you’re just like, “I hate that medicine.” The truth is, the data on that is great. The safety numbers are wonderful, but you had the one in a million side effect, and now you never want to do it again.

Dr. Jen Chatfield:
Please. One of my favorite pathogens is leptospirosis. I go all around the world talking about leptospirosis. The metadata says that leptospirosis as a component of your vaccination is not … It doesn’t say, “It could be.” It is not a risk factor for adverse reaction.
Millions and millions of doses and dogs. And I still run into lots of veterinarians who are like, “I’ve seen it once.” It’s hard to get over. I don’t blame them. It’s super scary.

Dr. Andy Roark:
It is. It’s the way that we’re made. When something scary happens to you, you hold onto it. It’s wired into your being that this is a thing that you’re going to remember. It’s really hard. But that is the benefit of having AI or outside data that comes in, when you can say, “I have my biases. There are not biases here.” Or they’re not the same biases as the one I have.

Dr. Jen Chatfield:
Right. Exactly. They’re different. They’re not better or worse. They’re different.

Dr. Andy Roark:
Jen, when you look into your crystal ball five years from now, how does it look different from today? Are we interacting with AI in a different way? Do you think it’s going to be about the same? What does practice look like? Five years is not a lot of time. This is right around the corner.

Dr. Jen Chatfield:
It’s not. It’s really not. My hope is that we are, because I feel like it’s rapidly becoming such a powerful tool. But the difference will be whether or not … When you grow up as a veterinarian, you grew up in vet school. Whatever you learn in vet school is the way we do it.
This is the way. That’s your Mandalorian experience, “This is the way.” I feel like if vet schools don’t begin to embrace some of these tools, then it’ll be a harder struggle for the industry. But I think that they’re so cost-effective. I do think they enhance our ability to provide care at a level that now our clients are expecting. I think if we’re going to see more and more AI, I don’t think in a rapid acceleration.
I don’t even think it’s going to even enter the realm of replacing a veterinarian. I can order a hamburger from a kiosk in a screen … My expectation of that hamburger is a little different, but I cannot hold my pet up to a camera and truly get that diagnosis in a sophisticated way. And I don’t think we’re going to be able to do that.

Dr. Andy Roark:
I love it. All right. Dr. Jen Chatfield. Dr. Jen the Vet, where can people find you online? Where can they learn more about you?

Dr. Jen Chatfield:
Well, thanks so much for asking, and again, thank you for having me on your show. It’s my first time on your show. It’s been wonderful. If you can’t find me on the internet, you’re just not trying. You can find me at chatfieldshow.com. You can find me at drjenthevet.com. You can find me on the YouTube. Almost anywhere. And if you want to find me IRL, I’m usually speaking at whatever conference you’re going to.

Dr. Andy Roark:
Awesome. Thanks for being here. Guys, thanks for tuning in today. Take care everybody. And that’s it. That’s what I’ve got for you guys. Thanks so much for being here. Thanks to Jen for coming in.
Guys, if you enjoyed the episode, let me know. Leave me an honest review wherever you get podcasts. That’s the nicest thing you can do for me. It’s how people find the show. That’s it. To anyone, just be well. Take care of yourself. I’ll talk to you later on. Bye.

Talking About Behavioral Euthanasia (HDYTT)

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Dr. Lisa Radosta, Veterinary Behavior Specialist, is on the podcast to discuss the behavioral euthanasia, the guilt and shame that pet owners experience as they consider it, and how best to support and talk to your veterinary team.

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

LINKS

Florida Veterinary Behavior Service: https://flvetbehavior.com/

Dr. Lisa Radosta Homepage: https://drlisaradosta.com/

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Lisa Radosta graduated from the University of Florida College of Veterinary Medicine in 2000. She completed a residency in Behavioral Medicine at the University of Pennsylvania. During her residency, she was awarded the American College of Veterinary Behaviorists Resident research award two years in a row. 

Dr. Radosta is the owner of Florida Veterinary Behavior Service, a specialty behavior practice in southeast Florida and co-owns Dog Nerds, an online educational resource for owners whose pets have behavior disorders.

She is a sought after speaker nationally and internationally. She is a coauthor of several books including: Behavior Problems of the Dog and Cat, 4th edition and From Fearful to Fear Free. She is a contributing author for Blackwell’s Five Minute Veterinary Consult, Blackwell’s Five-Minute Veterinary Consult Clinical Companion: Canine and Feline Behavior, Decoding your Cat, Canine and Feline Behavior for Veterinary Technicians and Nurses and Feline and Small Animal Pediatrics. Her new textbook, Handbook of Behavior Problems of the Dog and Cat, 4th Edition is due out May, 2023.

She has published research articles in the Journal of Applied Animal Behavior Science, Journal of Veterinary Behavior and The Veterinary Journal and written review articles for Advances in Small Animal Medicine and Surgery, Compendium, NAVC, Veterinary Team Brief, Clinician’s Brief and AAHA Newstat. She has served on the Fear Free Executive Council and the AAHA Behavior Management Task Force.

She has been interviewed for many publications including Cat Fancy, Dog Fancy, Palm Beach Post, NAVC Clinician’s Brief, Sun Sentinel, WebMD, AAHA trends, Real Simple, Good News for Pets, Catster, DVM 360 and AAHA News Stat. She has appeared on Lifetime television, Laurie Live, local news in southeast Florida, Mitch Wilder’s Amazing Pet Discoveries, Nat Geo Wild, Animal Planet, Steve Dale’s Pet Talk and Dogs, CNBC and Cats and Scapegoats.

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody, to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here with a really interesting episode. It is bit of a heavy episode. But this is a lot of head candy. This is a lot to sort of chew on. It’s a lot to kind of put in your mind and roll around and process. I am here with veterinary behaviorist, Dr. Lisa Radosta. And we are talking about behavioral euthanasia. And the first thing she tells me is how she doesn’t like the term behavioral euthanasia and we should stop using it, and we just start from there.
And anyway, this is a great thought-provoking interview. I am so glad that she came on and just talked through this with me. But I love her perspective. I think she provides a lot of clarity in how to work with these cases, and also how to feel okay about these cases, and also how to help pet owners feel more okay when they’re going through a situation like this.
So anyway, really good episode. I hope you guys are going to really enjoy it. Dr. Radosta throws out a bunch of really good resources, and I link to them in the show notes so you can check those out as well. Guys, 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, Dr. Lisa Radosta. How are you?

Dr. Lisa Radosta:
I’m doing great. How are you?

Dr. Andy Roark:
I’m great. I love having you here. You are one of my favorite people to talk to. I have already been picking your brain. As soon as you arrived I was like, “I have questions for you.” And I should have just hit record because you’re amazing. But, for people who don’t know, you are a fellow Florida Gator. You are a boarded veterinary behaviorist. You are the owner of Florida Veterinary Behavior Service. You have been a guest on the podcast a number of times in the past, and you are a generally wonderful person to talk to. And so I have a question for you. It’s not a fun question, but I think it’s really important. It’s something that I’ve been rolling around with a little bit recently. I’ve seen some of these cases.
I wanted to talk to you today a bit about behavioral euthanasia. The idea that we have behavioral problems that have come to a point where the owners say, “I cannot rehome this pet,” or, “I don’t feel comfortable rehoming this pet, and I think this pet should be put to sleep because it’s dangerous.” Something like that or… Yeah, let’s just go with that.
I think a lot of vet professionals really struggle with this idea. That I have heard of clinics that just say, “We don’t do behavioral euthanasia here.” And I don’t want to cast judgment, I want to understand. And so as I started to parse my own thoughts and sort of say, “Are there lines in the sand for me?” I think everybody’s got their own. But are there rules or a general perspective or even a philosophy to look at these cases? I wanted to talk to you about it and sort of get your insight as a behaviorist. Let’s just start really high up. Lisa, how do you think about these cases?

Dr. Lisa Radosta:
Yeah. So if I may turn things around and disrupt just a little bit.

Dr. Andy Roark:
Sure.

Dr. Lisa Radosta:
I want to lose behavioral euthanasia, and I want to just say euthanasia. Because the last time I checked we didn’t say kidney failure euthanasia, brain tumor euthanasia. No, we just say that patient was euthanized, right? So euthanasia is euthanasia. It’s a choice to end suffering. And I think by taking the tag of behavioral off, we can start to open our minds to the suffering of animals with behavioral problems, and we can begin to put it into the same bucket as all the other ways that animals suffer.

Dr. Andy Roark:
I like that a lot. You’re already framing this up really nicely. Let’s go ahead and start to unpack. When you start to look at cases that come to you and people say, “I have a Belgian Malinois and it scares me.” Or, “It scares my spouse. And we’ve had some incidents. It bit one of the neighbors.” How do you start to look at those? Because, obviously, as a behaviorist, you have tools in your tool belt where you can work with this pet. And oftentimes, I think that we immediately want to fix the problem. How do you start with that? So when you’re looking at the beginning of these cases and you know that euthanasia might be required if we can’t make headway here, how do you start to set those cases up? How do you set expectations, things like that?

Dr. Lisa Radosta:
Yeah. The first thing is I recognize that behavior is different, whether it’s at specialty practice, where I am, or in primary care. So when a pet parent comes to you and her older cat is urinating everywhere, she doesn’t come to you with all of the advice from all of her neighbors to euthanize her pet. The advice, “Then go to your vet.” “Well, my cat had hypothyroid.” “My cat had kidney…” “My cat.” Right? But when the dog bites someone, the advice starts coming in, “You need to euthanize.” “I would never live with that dog.” “That dog’s going to bite your kid.” So all that advice feels really different. It’s terminal advice.
And so she comes, he or she, they come to our office with a lot of emotions. And the first thing I do is let them talk. Then I express empathy and I normalize what they’re feeling. You know what? Because they say things like, “And I’m scared.” And I say things like, “And if you weren’t scared, I think you were really weird. You should be scared. Your dog’s 90 pounds.” And I saw this case about a month ago, and he had bitten through both ladies’ hands.

Dr. Andy Roark:
Oh gosh.

Dr. Lisa Radosta:
Bit both her hands. She’s a graphic designer, can’t use her hands. And I said, “You should be scared.” At that point, you can see stress starts to dissipate. They’re like, “You get it.” I’m like, “Of course I get it. Of course, yes, you’re normal. You’re afraid of your dog.” And then I also normalize, “But you still love him.” They’re like, “We do.” Normalize what they feel, because that doesn’t feel right. Why would someone that loves me hurt me? Right? Okay, but that’s not what they think when their dog has lymphoma. Right? They don’t take it personal. Okay So first we normalize, we express empathy.
Number two, now we get into the ethics of who are we as veterinary healthcare team professionals. So ever since I euthanized my first own pet, my first pet as an adult that I had to decide to euthanize, I knew in my heart that no one could make that decision for me. So I was in vet school, in my junior year of vet school. So from that, I’ve created this 23 years of veterinary practice. I refuse to tell someone when it’s time because I feel for me. No judgment of any other vet. For me, it feels disrespectful because that’s not my family member, yet I am making a final decision. So I don’t generally… Nothing’s a hundred percent. I don’t generally bring this up. Clients start to bring it up. They start to say, “My friend said that I should euthanize him. I’m going to be sued,” or, “I should put him to sleep,” or across the rainbow bridge, we’re going to call it.
Then that gives me a chance to say, “Okay, let’s talk about options. What do we have on the table?” So for this case that I saw, single lady, two dogs, one was aggressive, one is just a regular Joe. Aggressive dog is biting her, is biting visitors. You can’t make this up, is biting the other dog. It gets worse. She lives in a one bedroom apartment by herself. No significant other that even comes to stay with her. So I say, “Okay.” She’s opened up the door, “I don’t know what to do, she’s crying. I don’t know what to do, I’m sad. I’m bored, I need her.” I say, “Okay, well, let’s just talk. What can we do right now?”
So here’s what I know. So I’ve already done a physical. I already know this dog is also sick. That’s another checkbox, right? And I say, “Okay, well, here’s the thing. What I need you to do to be safe is you’re going to live for about the next four to six weeks in protected contact, like at the zoo. He’s going to be behind a baby gate, separated from your other dog and you.” She was able to leash and muzzle pretty reliably. He muzzled up and they will leash him. “You’re going to muzzle him, you’re going to leash him.” She doesn’t have a yard. “You’re going to walk him in the back, he’s going to go to the bathroom, he’s going to come inside. I’m going to prescribe medications that are going to relieve his stress and make this easier on you. I’m going to give you ways that you can get him in and out safely. We’re going to wait for our meds to work. We’re going to set you up in the trainer. And then we’re going to slowly add back in the skills he needs to live with you safely.”
He may never be able to meet visitors. I’m not even going there yet. That’s an option. Re-homing is not an option. This dog doesn’t have a breeder. There’s no place for this dog to go. I make it real clear, this dog can’t go to a shelter. Sanctuaries are unicorns and there’s a lot of ethical concerns around certain sanctuaries depending. Right? So I explain that to them. And then we talk about humane euthanasia. And I say, “Your dog’s suffering. There’s no doubt your dog’s suffering. Let’s just forget it’s a dog and look at what your dog does. And now it’s your best girlfriend. If I’m out with my best girlfriend and we’re drinking martinis as we do, and she tells me that she hits her partner, she hits her mom. Anytime a visitor comes in her house, she tries to stab him with a knife. She cries all the time because she’s upset. She’s suffering. She’s suffering.” So we talk about the suffering that occurs when you have emotional disease, and we try to kind of broach it in that way.

Dr. Andy Roark:
Yeah, I really love that.

Stephanie Goss:
Are you ready for some free CE? Well, get ready to check CE off your back-to-school to-do list. Dr. Andy Roark has invited some of his colleagues, who he considers the best and the brightest in their, to join him for a very special back-to-school webinar series. They’re going to talk about some important advancements in veterinary care. Thanks to our friends at Siva, Nationwide Pet Insurance and Hills Pet Nutrition, you can level up your skills this fall with some free CE. To save your spot and join us live for the webinars, which start August 8th and run through September, head over to the website at drandyroark.com/backtoschool to find out the times and dates and get all of the information and get yourself registered, so that you can join Dr. Roark and his friends for this exciting CE series. We can’t wait to see you there.

Dr. Andy Roark:
I was was going to ask you about managing guilt on the part of the pet owner, and I think you really kind of already answered that question in a lot of ways. Because it’s such an emotional decision for them. But I really love this idea of you can take the guilt away if you can get them to buy into the idea that their pet is suffering. I really like that.

Dr. Lisa Radosta:
Yeah. I tell people it’s normal. Feel guilty, it’s normal. But guilt doesn’t move us forward, it’s the opposite. The more we sit in guilt, the more we are stagnant. And I also tell them, and I did tell this to that particular client, I said, “Oncologists get all the credit.” I’m like, “You’ve given this dog two years he would never have with anyone else.” If an oncologist gets two years out of a job’s lymphoma, they get a big Christmas basket full of cookies and candy, right? Come on, this dog has a disorder he had from puppyhood. You gave him two years with a chronic disorder. Wow. Where’s the wow in that?
And I’m not saying all dogs should be euthanized, my God. Or all cats with behavior problems. That’s not what I’m saying. I’m saying that if we had this dog with a chronic kidney disease and the pet parent couldn’t, physically could not, forget money, could not do the treatment, who’s going to stand in judgment of her? Who’s going to do that? And if you are, then you better be prepared to adopt that dog into your home and do the treatment. So who’s willing to do the treatment on this 90 pound dog? I’m not taking him into my home, that’s for sure. You see what I’m saying?

Dr. Andy Roark:
Yeah. Oh, definitely. Do you think that vet professionals struggle with these cases more or in a different way than pet owners do?

Dr. Lisa Radosta:
I think they do. And I think my heart goes out to shelter workers because they really struggle. I recently had a shelter reach out to me, and I meet with their medical director once a month to consult. And she has a real hard time, because the morale goes down when one of these long-term cases that is good with a couple of people there, but no one else can walk the dog. And she wants to clear space to bring another animal in that she can’t adopt out. And yes, I think that we think of it differently, but it’s only because we’re not really thinking about behavior disorders as systemic disease, which is what they are. Right? We’re thinking about them as somehow in a separate bucket, and it’s just not true.

Dr. Andy Roark:
Yeah. That absolutely makes sense. What mistakes do you think… what do you see most commonly GPs making? Are there pitfalls that we fall into? I know everyone’s trying to do their best, but are there places that you see practitioners who are trying to support pet owners that fumble or they make their lives harder than they have to be as they navigate this already challenging time?

Dr. Lisa Radosta:
Yeah. I think that, first of all, we need to forgive ourselves. There are some days where I have bad days. Where I have days I’m not at my best, and by the end of the day, by the millionth appointment, I’m not as patient as I should be. Right? So we have to first forgive ourselves for whatever mistakes we make. If I back up from that and I say, well, how can we be better? Don’t judge. Clients hear you. You say all these wonderful things, then the client pushes you with that question I wish they would never ask, “What would you do if this was your dog?” And then you know shouldn’t answer, but you’re tired. You’re tired, and you say, “I would not live with this dog.” That’s all they remember.
Then they come to this specialist and they say, “My vet said I should euthanize my dog.” Again, I think your vet said more than that, but okay. Number one, let’s not put ourselves into someone else’s place, except to empathize. Right? And number two, let’s not judge. Because, I’ll give you an example, we’ve all done this in [inaudible]. One of my residents saw this patient. The patient has a dog living in a household with other dog. This dog was tearing the other dogs up. And so she gave the first recommendation, you always give separate dogs for safety while we get this plan in place. The client went home, came back to the next recheck, didn’t separate the dogs, there was another fight. And this happened for about three appointments.
So it was real easy for the vet, for my resident to go, “What’s wrong with this lady? What is wrong with her? She obviously doesn’t care about the dog. Maybe I should report her to animal control. This is animal abuse.” She’s mad, right? So by the fourth appointment, the lady says, “No, my husband has terminal cancer and my husband will not separate these dogs. And I just want you to know that.” Okay, well, God, if we had maybe asked differently or had some empathy in the beginning and said, “Explain to me why you don’t feel comfortable separating, because I know that you know it’s safest. So what is happening?” And then I usually say, “You don’t have to tell me if you don’t want to. But if you do, sometimes it can be helpful.” So it’s hard when you’re tired to find that space to do that. But let’s not judge and let’s not put ourselves in a space where we’re making a decision for someone.

Dr. Andy Roark:
I just had a case last week with this cat that came in. And it’s a four-year-old cat, and it’s gained two pounds in six months. It’s a 10 pound cat now. It’s eight pound cat, and now it’s 10 and change. And I saw this chart and I’m like, “What in the world are they doing with this poor cat?” And so I go in to kind of give them a hard time about the fact that they’re letting this cat gain weight and do these things. And very quickly, it is a wonderful lady, and she was like, “Oh no, this is my dad’s cat and he loves this cat and he has dementia. And whenever the cat yells, he gives her treats, and then he forgets that he’s given her treats.” And we kind of had a good-hearted chuckle at like, “Oh, she’s got him trained.”
But again, when you understand the context of what’s going on, it doesn’t change the fact that, and I don’t want this cat to continue to gain 25% of her body weight every time I see her, but I also understand where this person’s coming from and I can be kinder, I can be better. And so anyway, I love that. Dr. Radosta, you are amazing. I so appreciate your time and you being here. You do so many things, you have written so many books, you present all over the place. Where can people find you online? Where can they learn more?

Dr. Lisa Radosta:
So they can go to drlisaradosta.com. They can go to Instagram or Facebook at Dr. Lisa Radosta. As a veterinary healthcare professional, you might like what we put on LinkedIn. And then we have our website, which is flvetbehavior.com. And the reason I bring up our website, even if you live across the world, is that we have handouts and videos that are meant for pet parents. So if you don’t know what to say, that might be on our website. You can send the pet parent there or to our YouTube channel and you’ll get what you need.

Dr. Andy Roark:
That’s so awesome. I love the stuff that you put out for pet owners as well. It’s always great to have good resources to send people to. Because you know that they’re going to search online, and so you could just to be able to point them in a good, supportive way. That’s awesome. Thank you so much for being here. Guys, thanks for tuning in. Take care of yourselves, everybody.
And that is it, guys. That’s what we got for you. I hope you enjoyed it. I hope you got something out of the episode. Thanks so much to Dr. Lisa Radosta for being here. Thanks to you for being here and listening. Yeah, if you like the podcast, do me a favor, leave me an honest review wherever get your podcast. It means the world to me. Anyway, that’s all I got. Gang, take care of yourselves. Be well. I’ll talk to you soon. Bye.

How a Spectrum of Care Approach Can Improve Team Efficiency

by

Dr. Emily Tincher returns to the podcast to discuss how to keep teams working efficiently while implementing a spectrum of care approach inside practices.

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This episode is made possible ad-free by Nationwide.

LINKS

Embracing a Spectrum of Care: https://www.petinsurance.com/veterinarians/spectrum-of-care/

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

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

Dr. Andy Roark Swag: drandyroark.com/shop

All Links: linktr.ee/DrAndyRoark

ABOUT OUR GUEST

Dr. Emily Tincher is a collaborative and data-driven leader who advocates for a pet-parent centered approach to communication and medicine through spectrum of care approaches. She is a second-generation veterinarian and a 2016 Auburn University’s College of Veterinary Medicine graduate. Emily has practiced clinically in small animal emergency and general practice.

As the Senior Director of Veterinary Relations at Nationwide Pet, she oversees operations and strategy in the veterinary space, including industry relationships and outreach to veterinary students, veterinarians, and veterinary teams. Emily serves on the AVMA Early Career Development Committee and is President of the Board of Directors for the Veterinary Leadership Institute.

Outside of veterinary medicine, Emily enjoys traveling with her husband Kyle, competing with her horse (Blue) in the sport of Eventing, and endlessly spoiling her two perfect dogs (Tuxedo and Cricket) and rotten orange tabby (Exploding Poptart).

EPISODE TRANSCRIPT

Dr. Andy Roark:
Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. Guys, I am back with my good friend Dr. Emily Tincher. We are talking about spectrum of care making teams more efficient. People talk about, Hey, I understand the need for a spectrum of care. We want to keep care accessible. We want to make sure that we provide the best options for treatment given where different patterns are and that they have different experiences and they face different challenges. I get that. But how do we keep our teams working efficiently while being flexible in this way? And guys, that’s what we get into today. It’s a great episode. I hope you’ll enjoy it. Hope you get a lot out of it. Thanks to Nationwide for making this episode possible ad free. Guys, 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, Dr. Emily Tincher. How are you?

Dr. Emily Tincher:
I’m great. Thanks so much for having me back, Andy.

Dr. Andy Roark:
Oh man, I always love our conversations. You’re so fun to talk to. For those who don’t know, you are the senior director of Pet Health at Nationwide. You and I have known each other for at least a dozen years now. You were involved in the Veterinary Business Management Association as a student, as was I. And we have been friends ever since you got into that program many years ago. And so now you are changing the world. You’re doing a lot of speaking on spectrum of care, which is something that I’m really excited about and access to care. So lot of my, if you listen to podcasts, I do talk a lot about access to care because it is something that’s important to me. So anyway, I love having you here. Thanks for coming on. How was everything going with you?

Dr. Emily Tincher:
It’s going great. I love talking about Spectrum of Care with you. I also love just listening in and learning from the podcast, especially around communications in the exam room, which I know we’re going to talk a little bit about today too. So fun.

Dr. Andy Roark:
Yeah, well you’re very kind. But yes, I do love that stuff. All right, well let’s get into a little bit because I want to jump in. So one of the things that I want to talk with you about today is general price increases in veterinary medicine. So I’ve seen, we’ve had guests on the podcast before and we’ve talked about generally we’re looking at numbers across the nation. Number of pet appointments is down a bit and prices per appointment has gone up. So we’re not seeing a decrease in revenue, we’re just seeing an increase in sort of appointment prices and stuff like that. And so I know at Nationwide you guys are getting claims, you’re seeing this. Does that kind of jive with what you are seeing as far as pricing in our profession?

Dr. Emily Tincher:
It does and we’re seeing that for a number of reasons and certainly our nationwide claims data where we process a lot of claims every year for over 1 million pets that are insured actively. But we also see that just looking across various data sources. So one of them is the consumer price index for example, which is way outside of veterinary medicine in what they monitor. But veterinary services are one of 200 categories that they look at. And we’ve seen the consumer price index for veterinary services was pretty significantly higher than the rest of the consumer price index for 2022, for example, prices went up by over 11% in that year, which is pretty significant.

Dr. Andy Roark:
What are the main drivers? What is pushing prices up? Are we doing different kinds of services? Is it just straight up increases in pricing technology? Is it labor, the main drivers of these price increases?

Dr. Emily Tincher:
A great question. I think it’s one that we again, have to look at multiple data sources to understand. And I think our partners at Source do a really awesome job trying to explain this and a lot of industry leaders that are looking at our workforce crisis for example. So how do we help to support both recruitment and also retention of our staff members? That’s a driver one of the reasons. But we also know, especially during covid, kind of the prices for pulling in the goods that we need to do our jobs every day. They changed, they went up a little bit more than we saw before the pandemic. And there are probably other things too. We have the way that we practice medicine has changed in the last 10 years, whether that’s adapting business models, whether that’s, and we can talk about things like stratification or really knowing, honing in on who your client is, which I think you’ve done a really awesome job and a lot of platforms just understanding the complexities for this, it can get hard quickly to think about.
It’s helpful for me to simplify it down to there are a lot of reasons why this is happening. Cost is increasing amongst other reasons that pet owners are feeling the change. But the result is pet owners are feeling that. And to your point about we’re not decreasing revenue, we’re actually increasing it in the vet profession, but we are decreasing in visits in the year of 2022 saw not just because of costs. I want to inappropriately correlate those, the 17% decrease in visits compared to a year over year compared to 2021, which is pretty significant as well.

Dr. Andy Roark:
Yeah, it is significant. When you think of 2021 was kind of post pandemic people coming back, you should think our visit count would be going up as opposed to down. Yeah. That bothers me when we start to look about it, when we start to look at it, I think everyone who’s been in vet medicine, whether they’re a technician or a doctor or even probably someone at the front desk has at some point felt a pinch where you feel like, I’m here because I want to help. That’s an important part to me. And when people say to me, I can’t afford this, or one of the reasons that we get asked for advice all the time I think is that people are like, I don’t want to go to the vet and have to pay this money. I think people are trying to figure out how to get around going into the vet kind of more and more.
And it bothers me because I don’t want to be the vet police who’s like, don’t not helping you need to go to the clinic. And at the same time I go and I can empathize with them and sort of say, I get it. Don’t, not easy to throw around a couple hundred bucks every time your pet throws up on the carpet. And so I get it, but we’ve all been kind of stuck there. I think that’s why a lot of us get frustrated when people say, I don’t understand why you won’t just give me advice on the phone or I don’t understand why, you know, told me to go into the clinic as opposed to just taking care of this here at our dinner party. Yeah. Anyway. Yeah, I feel like that’s a real pain point.

Dr. Emily Tincher:
It’s a pain point from multiple perspectives, again, from the pet family side of things. We know from a couple of reports that as little as 200 to $300 in an unexpected veterinary expense can be really stressful. And for a lot of families across the US, something greater than $500 can throw a pet family into debt, which is, I don’t think a lot of us would expect necessarily. But the data and the access to care coalitions report for example, says that about three quarters of middle income families still live paycheck to paycheck. And so things like the unexpected, especially for pets, it’s a little bit easier sometimes to plan for wellness. But the unexpected of, we got to figure out this vomiting dog on the carpet, we, it’s happened five times today. We’ve got to go figure this out and help the pet out. That gets really hard for people.
And so I think even bringing that into our staff and saying they also struggle with that. I know one of the questions that’s been rattling around in my head a lot since the Uncharted conference in April was our mutual friend, Dr. Adam Little, he asked a question in his session and it was his first question of talking about costs for pet owners. And he kind of flipped it on it its head and said, who do we agree with the statement across a range? And ask everybody to get up and move around and then have a conversation in the room. Do we agree or disagree with the statement that our staff should be able to afford the most expensive levels of care that we offer and at usually the most expensive correlating with the most advanced or gold standard level care? And it really started some really interesting conversations of we are us in vet med, we are the people that we serve sometimes.
And I know for me when I worked at a specialty hospital, I as a veterinarian couldn’t have afforded a lot of the estimates that I sometimes handed out. And so that brings us back a little bit to the idea of, okay, we know costs are rising, but we also know the level of care that we can offer is rising. Those things together really make these conversations around cost of care so uncomfortable. Especially if the care being offered isn’t something that the person talking about it that the technician in the exam room talking about it also couldn’t afford.

Dr. Andy Roark:
Oh yeah. Well there’s that credibility issue too. We talk about exam room communication stuff all the time and one of his credibility is to be able to say, if you don’t say it outwardly, the fact that I do this from my own pet lets me talk with an ease where I can sort of say, yeah, I walk my talk here. This is something I actually do it. It’s important psychologically, I have thought a lot about that over the years because what does it mean to say this is the standard that we believe is required to be a good pet owner? And your technicians are like, I can’t do that for all of my pets. And I know around now there are some technicians that have 37 pets and I’m like, well that’s a whole different thing. You can’t have Noah’s Ark and make me feel bad because Cause parasiticide are expensive.
Yeah. Where’s the car? Yeah, exactly right. No, it’s all shades of gray when you get into it. But I do really feel like at some fundamental level, I want the people working in the clinic to say, yeah, I do this stuff cause otherwise, you know, get this cognitive dissonance where you’re like, man, all day long. I tell people how important this is, but I don’t do it for my own pets, which either means that I’m lying to them or it means that I’m not a good pet owner or I’m not doing something that’s important. And that’s the mental trap that people get into it. It hurts people. And so that is, I’ve wrestled with that for a long time as cost of care continues to go up. And at the same time, you know, talked about the labor shortage and trying to keep people in even before the labor shortage, we have radically underpaid people in our profession for a long time. And there’s sort of this ethical wrestling for the steering wheel of what is the greater good? Is the greater good to extract revenue so that we can pay our people a higher salary? Or is it to not extract a higher pay point to is to keep care as priced as low as possible and to let our people let our eat people eat ramen noodles. And again, I think it’s easy to think that, and we’ve kind of wrestled over that. I like to believe that there are some solutions in the middle.

Dr. Emily Tincher:
I think there’s a lot to unpack in what you said there. So that idea of if our staff can’t access or the average pet owner is stressed by accessing the level of care that we’re offering, maybe an alternative. It comes back to that idea of, well, we don’t all have to want or access the same level of care. Sure. What does it look like to provide instead and recommend actively a spectrum of care to say we have a range of options across basic to advanced that we can tailor these solutions to whatever the pet family’s goals, values and resources of course, including finances. We’re talking about cost of care today. How do we tailor those conversations as efficiently as possible? And to your point about underpaying, I think especially our staff, our technical staff, how do we work so that we collaborate with them to let them work to the very best of their ability and then also compensate them appropriately for doing that.

Dr. Andy Roark:
Yeah, that’s kind of where I wanted to go with you today specifically. And so I, I’m really interested in this cause we’ve, you and I have talked a lot about running best practices for a long time and I think that we’re pretty much in alignment that vet medicine’s a team game and as a doctor and you’ve worked as emergency doctor for many years, leveraging your technicians is smart medicine, how we get things done. And so I want well leveraged texts, I want consistent communication. I want the pet owners to kind of get a plan and I don’t want them to feel like they got told one story and then fun. Andy shows up and tells them a different story, you know what I mean? And then people at the front desk tell ’em a third story. I really want us as communication to be on the same page.
And at the same time, I really like this idea of meeting people where they are and trying to talk about what the individual person’s needs are inside the context of what we do in our practice. And trying to say, okay, given what your needs are and given who our practice is and how we practice, what is the Venn diagram overlap there where we say, hi, your needs are getting met and our needs are getting met to feel good about the work that we’re doing and this works for everybody. And so how do I set myself up to take advantage of a well leveraged staff, consistent communication, things like that. And then also have this flexibility, try to meet people where they are and understand what’s happening. Can we start to talk about what that looks like in practice?

Dr. Emily Tincher:
Yeah, I think it might be helpful to break it down into two pieces a little bit. So let’s talk a little bit about leveraging the staff first, since we’re talking about kind of dollars and cents and pay paying our staff appropriately. Why don’t we start there? I think one of the things that we always really try and do here at Nationwide is not advocate for something that we don’t see an evidence base for. And so leaning on what do we know as far as research or case studies that we can lean on? And I think what’s really tricky when we start to talk about workforce is I, I’m sure we have some listeners now that are thinking it would be great to leverage technicians, but I can’t find none of them. None of them are available and I am desperate to hire or potentially even willing to pay for their training so that I can find them. So I hear you want to acknowledge that it is a challenge that we have to find license or credentialed technicians. The other challenge that we have though is retention of them in the field. And if we look at a study that Avta conducted, I think in 2016, a couple of years ago, they asked technicians, what’s the greatest reason that you leave the field of veterinary medicine? And are you familiar with that one? What kind of pops to the top of your mind of why they might leave?

Dr. Andy Roark:
Oh yeah. So there was not being able to work at the top of their skills I think was one or no developmental path. Wasn’t that one of the big ones career path, the pay was on there, of course

Dr. Emily Tincher:
Pay, yeah, of course on there. But it’s actually not number one. Number one is exactly what you said. First is utilization of their skills to the maximum amount and actually recognition, feeling like they’re seen and valued was in the top five too. So those very quickly all come together. So yes, we have a problem with we need more technicians, but we also need them to stay. And so I think part of what our conversation can be here is how do we say, okay, we understand those are some of the reasons you’re leaving. Let’s talk about how to get you to stay in a way that helps vet healthcare teams to be able to provide more care, to be able to hopefully be a little bit more efficient and have see a few more appointments, but also do so profitably. So I think that’s really interesting is there’s another JMA study from a couple of years ago that, and I think it’s a older one at 2010 or 12, we’ll find it for the show notes of if you have a credentialed technician, they can contribute, I think it’s like $93,000 a year to profitability in a general practice if they’re leveraged, well, pretty significant improvement in the value from a business owner, from business manager to have and to use those technicians as much as we possibly can.
We also, in our college program where we speak on behalf of nationwide to all of the vet schools across the us this last springs our partnership with the V B M A where we met one of our team members, Dr. Kristen Walker, built out a case study of, okay, what does it look like to not leverage technicians in a way that we probably have all seen? And so what she built out was looking at a really common problem, ear infections, and that’s always in the top five for the most frequent claims for us for dogs, top 10 for cats too, actually every year is ear infections. So we know it’s common. We know that general practices and me in emergency and urgent urgency, urgent care are seeing these. So this is a universal problem in companion animal medicine. So what are we typically doing for ear infection?

Dr. Andy Roark:
Yeah, right, so ear cytology, ear cleaning, yeah, yeah, no, nothing Crazy. Ear

Dr. Emily Tincher:
Medications, yeah, ear medications, ear cleaning, probably

Dr. Andy Roark:
Possibly a culture, but it depends on what we see and probably not,

Dr. Emily Tincher:
Probably not, but possibly we are, especially if it’s a chronic case, we might consider something like that. But minimally, most of the time, not always, but a lot of the time we’re going to do an ear cytology. Okay, great. So we’ve done an ear cytology. Who’s doing that in most cases in your experience?

Dr. Andy Roark:
Oh man, this is hard. So I’ve been spoiled. I have great technicians, so it’s always been my technicians, but I know a lot of places that it’s not true.

Dr. Emily Tincher:
I, I’ve been really spoiled too, but I’ve also been as a relief at some practices that are really short staffed and so let’s imagine we’re at one of those or somebody’s day p t o or maybe in a practice that sometimes we’re doing great and having the technicians or the assistants being the ones that are taking the cytology, preparing it and then hopefully our technicians are reading that well, if a veterinarian is the one doing that and someti, I’ve definitely done it myself. Preparing that slide, going and looking at it, reading it and then saying, okay, we have a bacterial infection in this Labrador ears. It doesn’t feel like a big impact and if you do it on occasion, it’s pitching in and helping. If you make that systemic, if you start to do that every day, every week, every month, the case study that Dr.
Walker built out for us says that you can pretty quickly lose up to about $2,400 a week in revenue by just not by veterinarians doing tasks like that, putting in catheters. Other things that are technical staff are much honestly better than doing than me for sure. All of that adds up pretty quickly and from a business profitability perspective, we can see where that’s going, but then having to pass on that cost of the veterinarian’s time to the pet owner perspective, it doesn’t just stop at us. It doesn’t just stop with technicians feeling under underutilized. We also have to pay for that veterinarian’s time somehow. And if we’re chronically, systemically using veterinarians or sometimes licensed technicians in place of assistance where cleaning kennels perhaps that has knock-on impacts to really making it more difficult for pet families as well.

Dr. Andy Roark:
Yeah, I like that a lot. Just as far as increasing efficiency and you’ve kind of look at where do you need your people to be? I have a hundred percent seen practices. I used to do relief work as well. I have a hundred percent seen practices that were short staffed and they were very nice practices, don’t get me wrong, but the vet would swap the ear and do the cytology and then the technician or assistant, it would be the assistant. The assistant would hold the pet while the vet cleaned the ear and I’m like, oh man, you guys are putting in the vets here doing this. The actual technical, a hundred percent the technical work of the case. And I go, this is got to be a smarter way to use this doctor’s time for the benefit of the practice and also for the pets.
Talk to me a little bit when we talk about efficiency and I really like where you’re sort of going as far as letting technicians work at the top of their license is a big way that we retain them. A big part of spectrum care that I think is really interesting is the communication aspect. It’s how we talk to people about what they need and where they’re going and where we sort of understand what support do, are they looking for? What support, what ways can we support them and things like that. Can you talk to me a little bit about using your paraprofessionals, your room assistants or especially your technicians in those types of conversations? What does that look like in a well leveraged practice?

Dr. Emily Tincher:
And it’s another great place that we can lean on some already published data and then talk about the future as well. So in 2022 there’s another jamma publication about the ability and kind of engagement from pet owners when discussing care plans, when there’s some involvement from the veterinarian and some involvement from the technician, that it has this additive effect of really helping pet owners to feel like they understand the value, they understand the buy-in, and to your point from earlier, they’re not hearing two different stories from across the practice. And so how do we talk to pet owners in a way that makes them feel like they know what their options are across that spectrum of care? Again, back to the basic to advance, these are some of the options, these are some of the pros and cons that are associated with that, and then how do we do that in as efficient a way as possible?
Well, one of the things that we’ve done here at Nationwide is to say that’s a pain point and how can we help understand the subconscious drivers behind what people are looking for in pet healthcare? So we conducted some research that we’ve talked a little bit about before to understand that really they’re kind of three different groups of people across demographics and what they’re looking for. And we’re really advocating with be working on a tool that’ll be released later this year, but really advocating for involving the whole team with those conversations. We can set it up sometimes, and it depends a little bit on setting. If you’re in a wellness situation and a general practice, we can really have that education in advance and our technical staff can have most of that conversation already of what is it that is helping this PA family to make their decision?
Are they a cost focused family or are they a group that’s really focused on convenience in their decision making? Those are the two of the three and helping to identify which, what kind of things does this particular pet family value? And then I can talk to ’em about the pros and cons of two or three options that we might have for wellness. Sometimes from a sickness perspective, something’s wrong. Sometimes it can be a little bit easier for the veterinarian to enter into that conversation first and say, I’m seeing we have a pet here that is vomiting on the carpet five times, and we can do things like based on the history you’re telling, based on the physical of what I’m seeing, we’re going to tailor it down to these three stepwise options or go full tilt and go get an abdominal ultrasound after we do some blood work. We can pull those together sometimes as a vet first, but then following up with the details of and the validation, helping our technical staff to feel like they have permission to not just push the most advanced level of care is helpful too. Again, coming back to the very beginning of our conversation of if what we’re asking them to always recommend may not be even accessible to our teams, really how do we feel comfortable instead off offering those options and doing it in a non-judgmental way. Our team can really, really help with that.

Dr. Andy Roark:
Yeah, that’s fantastic. No, I completely agree. It’s going to drive me absolutely nuts. The three types of people, there’s the cost conscious person, the convenience conscious person, well, what is the third one trying? Is it the care focus person? What is it? Yeah,

Dr. Emily Tincher:
Okay. I thought that it’s an optionality focused person, so they really want to know what all their options are. Choice if you like to turn it into three Cs, which is sort that little branding and marketing working there, but the evidence base, that last group, they’re a little bit more complicated. They really want to hear more about, well, your chances of success with parvo are nine out of 10 if we do this. And not everyone needs that level or wants that level of conversation, but I think employing our technicians who can have that level of conversation when they’re experienced and they’ve been with us and sometimes if they’re new grads just like vet new grads, they need to come in the room with us and he hear us have those conversations, but they can, and if Jab MA’s publication about the willingness for pet owners to buy in is if we take that as true, they need to be part of those conversations.

Dr. Andy Roark:
Yeah, no, you are such a wealth of information. I’ve got, well, I’m going to be getting links from you to the wealth of resources that you mentioned today. Is there anything else that you recommend for people? Are there any resources that we didn’t talk about that you really particularly, yeah,

Dr. Emily Tincher:
I think it’s just deciding how is it and having that conversation with your practice. If you’re not yet talking about a spectrum of care or we don’t always have to call it that, really just offering that range of options. That’s just a term so we can all talk about something that many of us have been practicing for a long time. How do we make sure that we’re all on the same page as a practice to say, yes, we agree with this, we want to meet pet families Where they are, whether we do it or not, pet families are they’re, they’re going to ask for options and so how do we just take that barrier down and proactively do that? We have our own website, spectrum of care.com that we can include in the show notes as well. That kind of helps talk about some of those concepts and how you might talk about it with your team and it will be growing with more resources coming later this

Dr. Andy Roark:
Year. That’s fantastic. Where can people find you on online, Emily?

Dr. Emily Tincher:
They can. I’m fairly active on LinkedIn, so it’s probably a reasonable place, but yeah, I love chatting with people and can find me in the uncharted community as well.

Dr. Andy Roark:
Yeah. Cool. Alright, awesome. Thanks for being here guys. Thanks for tuning in everybody, take care of yourselves. Thanks again, Emily, for being here. Thanks for having

Dr. Emily Tincher:
Me.

Dr. Andy Roark:
And that is our episode guys. I hope you enjoyed it. Hope you got something out of it. Thanks to Emily for being here and being my guest. As always, she’s amazing. Thanks to Nationwide for making the podcast possible ad free. Guys, thanks to you for your time and attention. I hope that you guys will be well. I hope you have a great day. See you later. Bye.

The Expanding Cat

by

Last week I saw a cat that had gained 2 lbs since her last visit. I stood at the computer and double checked what I was seeing. Why would this 4 year-old cat suddenly gain 25% of her body weight in 6 months?

I decided then and there that I would have an honest conversation with this pet owner. I’d tell her how worried I was for the cat and how unacceptable an increase in weight like this was. Clearly the rules were not being followed, and this cat was the one paying the price!

I marched into the room ready to talk pointedly about why fixing this problem was vitally important.

It turns out that the person in the exam room was not the cat’s owner, but his daughter. She looked at me sheepishly and said “I know she’s gained weight. My father loves her so, so much and he has dementia. Whenever the cat meows at him, he gives her a treat… and forgets that he’s just done it.”

We had a good-hearted laugh about how the cat has been so effective at getting her father trained. 

Of course we still talked about how important weight control is, but the conversation was night-and-day different from how I imagined it being. That’s often the case in medicine. We think we know people or that we can guess what’s happening behind the scenes in the lives of those who walk through our doors… but we can’t.

One of my favorite pieces of advice on working with other people is to “seek first to understand.” 

Whether it’s talking to pet owners, team members, or significant others, I don’t know that I’ve found better insight into not just being effective as a communicator, but also into genuinely enjoying being around others.

The next time we think we know what the story is, maybe we can remember the clever cat and take a moment to investigate before passing judgment.