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Life With Clients

I Still Love Veterinary Medicine and Here’s Why

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The charts keep piling up, the ever ringing phone is a reminder of more patients to help than available hands. Technicians bump shoulders as they quickly pass by in the hallway, rushing to the lab. The vibe inside the clinic spins along with the centrifuge, tossing those out who don’t sync in balance with the others. Exam rooms and surgery suites are dressed up each day to treat uniquely different patients, but all with the same underlying constants.

Beep, beep, beep the sound of the ECG leads gripped tightly to the patient’s skin. You can hear the humming begin, as the pump kicks on and the blood pressure cuff tightens securely around a furry leg. A trying alarm sounds, as you try adjusting the spo2 clamp for the third time, although the consistency of inaccuracy brings smirks and a laugh amongst tired staff.    This is a typical day in the back of the clinic, yet we still love veterinary medicine and here’s why.

We work in a field of measurable results and emotional connection. 

A patient comes in with a limp, we X-ray and diagnose. A patient comes in with a cough, we listen and prescribe. We work in a climate that requires puzzle-solving, as we link symptoms to lab work results and microscopic findings to samples. This, while constantly challenging ourselves to do more and be more. The eight-year-old Schnauzer who tries to bite you during every nail trim is the same one you comfort during his painful pancreatitis diagnosis. Our patient connection drives us into an unexitable roundabout of URIs And UTIs. Each patient matters the same as the last one, and as much as the next one.   

Veterinary medicine combines the two worlds of science and emotion. 

Science is dependable, consistent and measurable. Emotion is undependable, inconsistent and not measurable. This sounds like a bunch of fecal sample, right? Well, stay with me here. This could be the very reason why we stay in this stressful environment. 

Medical science is at the very core of what we do day in and day out. We can always depend on the fact that our patients will get sick. We can always depend on the fact that certain diseases present with a set of common symptoms. What we can’t count on is how the crying widow tugs at our heartstrings, as she says she can’t lose the Dachshund or deciding to sit an extra minute by the whimpering English Setter who just woke up from a spay. We can master our skills as veterinarians and technicians, but the emotion is what makes us human. 

Emotion in the clinic can lead to late hours in aged, dusty textbooks and varied VIN searches. We are driven to find the results for our patients because of our compassion and sometimes a little bit of our ego. It is always science that saves us though. Those who have forged down this road before us with groundbreaking treatments and who have created life-saving medications are our guiding lights. Our job is to bring all the pieces of the puzzle together and make them fit the mold of each patient. It is a pleasure and a privilege when all cogs click together and a treatment plan is formed.

We still love veterinary medicine because it allows us to be superheroes for our clients and satisfies our individual desire to conquer. 

We still love veterinary medicine because every day we walk through those doors, we can change someone’s life. 

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

ABOUT THE AUTHOR

Tasha Larsen is the technician manager at a small animal clinic in Utah. She joined the veterinary world after selling her Crossfit gym to pursue her passion in veterinary medicine. It was the best decision she ever made and she wouldn’t want to be anywhere else.

It’s Not All About Me

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Veterinary medicine can be hard. Sometimes we get cases that really challenge us. It may be the clinical signs don’t add up, the client declined diagnostics that would give us a definitive diagnosis, or the pet isn’t responding to treatment the way we expect. When I have a tough medical case, I use all my resources to try to help my patient, including discussing the case with colleagues, posting the case on the Veterinary Information Network for experts to weigh in, and recommending referral to a specialist. I feel it is important to explore these avenues and talk through cases making sure I haven’t missed something, learn from other people’s experience, or just to hear that’s exactly how they would have treated the patient.

Even though I seek the advice of other veterinarians, it has always bothered me when a client asks to have their records sent to another general practitioner for a second opinion. Doubts immediately creep into my head – What did I do wrong? Do they not trust me? They wouldn’t go to a specialist so why do they think the doctor down the road knows more than me? Don’t they see how much time and effort I have put into this case? 

It happened to me again last week. I have a case that has really challenged me. I cannot figure out what is wrong with the dog and why he refuses to eat. We have tried everything and he just isn’t responding. I consulted VIN and the consultant advised more tests, which were declined. I advised referral to a specialist, which was declined. The client and I had been communicating about her pet via email a few times a week. I hadn’t heard from her in a few days so I assumed he was doing better. But on my day off, I received a text message from one of my techs “You probably want to stop checking in on Bogsley, they had their records sent to another clinic.”  

The doubts started to creep into my head when I read this, but I decided to bury them. I had been working very closely with Bogsley’s family for a month and I knew they were frustrated that he wasn’t responding to treatment. I decided to reach out to them and I called for an update. I left a message that I hadn’t heard from them in a few days and I wanted to check in and see if Bogsley was doing better. I purposely didn’t say anything about them seeking a second opinion. When I didn’t hear back from them for a few hours, the doubts came back again. Of course, they don’t want to update me. They don’t trust me anymore to take care of their dog.  

A few hours later, I received an email from the clients.  They updated me on Bogsley’s condition and that he wasn’t doing well. “I know that we should take Bogsley to a specialist like you recommended, but we just can’t afford to take the time off of work or the money a specialist would cost. We don’t mean to offend you, but we are taking him to another clinic tomorrow for a second opinion.” 

As I read that, I realized that it wasn’t all about me. In fact, the decision to seek a second opinion had nothing to do with me. The clients needed to do all they could within their means to find out what was wrong with Bogsley. They may be desperate to help him and knew what I was doing wasn’t working. Or maybe she needed to hear from another person that Bogsley wasn’t going to get better and it was time to say goodbye. 

I realized that I needed to let my insecurities go and wish Bogsley the best. I responded “I am not offended at all. I know you want to do what is best for Bogsley and I really hope that another vet can see something that I am missing.” My email was met with the reply “Thank you, Dr. Shepherd. That means a lot!”

After all these years in practice, I am continuing to learn, especially from the most challenging cases. Bogsley’s case taught me to let my insecurities go. The clients have their own reasons when they seek a second opinion and I shouldn’t be upset or offended when they ask for their records. I offered my best care and sometimes another set of eyes is what my patient needs.

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

No, We Don’t Offer a Money-Back Guarantee

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“I wasn’t satisfied with my visit, I want a refund.”

“The bloodwork was normal, so I can get my money back, right?”

“The treatment didn’t help. I want my money back.”

For anyone in the veterinary field, we hear this a lot. It seems like owners believe that if they complain enough they will get money back. I can understand why. With the current trends, many companies offer money-back guarantees on their products. Didn’t like the food? Here is a coupon for a free meal. Product was defective? Here is your money back and a discount on your next purchase. We are used to getting it our way but owners sometimes forget that medicine is not an exact science and there isn’t going to be a money-back guarantee.  

Examinations and laboratory work take time and money to complete. When the results are not favorable people tend to demand their money back. They forgot that they aren’t paying for a good outcome but they are paying for an expert to help them get to the bottom of their pet’s issue. This can be as easy as one appointment or as difficult as a long-term ailment. Sometimes it’s a bit of a trial and error concept when treating certain diseases. It doesn’t mean that if one treatment doesn’t work you get a refund though. Yet unfortunately, a lot of people will demand money back or a discount because they are frustrated.

A few examples of this are exploratory surgeries. Veterinarians are often faced with the decision to urge an owner into exploring an abdomen or waiting to see how they do on fluids. An exploratory surgery can give us a quick answer but it can also be an expensive answer if there is a negative explore. I have had owners ask if we will give them money back if the explore turns out to be negative when in fact it was a diagnostic test giving us a lot of information. The same goes for cases of parvovirus.  We can put an animal on every treatment imaginable but in the end, if the dog’s own immune system doesn’t respond we are going to recommend euthanasia or the patient may also pass away on its own. In those cases, I have had people complain they spent 2000 dollars for nothing. We understand the situation is frustrating but medicine is not black and white. 

Sometimes client frustration leads to blackmail. Yes, daily veterinarians deal with clients blackmailing them into discounts, payment plans, and writing off a balance because they threaten us with bad reviews. Many of those bad reviews aren’t valid – see my prior article on how to decode them. But unfortunately, people are so used to complaining to get their way that they use it to blackmail veterinarians into cutting corners or the bill. This doesn’t help the pet and leads to more frustration and anger.

There is a reason we don’t offer money-back guarantees. We aren’t god. Some animals don’t play by the book. Some animals respond adversely to medications. Some animals don’t show symptoms until its too late. Sometimes we can do everything correctly and the outcome is poor. Medicine is not an exact science. As clients, we hope that you understand this and realize we are doing our best to help you. We aren’t a restaurant where you can complain about the cut of meat or lack of salt in the sauce. 

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

We Can Control Our Actions, but We Can’t Control Outcomes

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I recently went into the emergency clinic where I do relief work to help with a surgery.  When I got there, it was — well a typical weekend afternoon at the emergency clinic. The cages were full of sick patients, the rooms were full of worried clients. The doctor who was scheduled to be on was doing a thoracocentesis — while Dad watched on. Oh yeah, did I mention this was an open hospital where clients come right into the treatment area and are present for as much of their pet’s treatment as they want to be?  That part is less typical.

And so, in the nature of this particular hospital, a client had chosen to stay with her hospitalized dog — for the entire weekend. Hunter had gotten into a bottle of ibuprofen and was clinically fine, but needed decontamination and IV fluids. The client and pet had been set up in the back of the prep room (away from the scrub sink) with an IV pole, and a cot.

And so, as I scrubbed in for my exploratory laparotomy, I chatted with the client. She told me about how she got him and how attached he was to her husband. She told me about how she wouldn’t leave him alone in the hospital.

“You’ve got a really good Mom, Hunter,” I told him.

“No, he doesn’t, he has a terrible Mom. It’s all my fault that this happened.  I left the ibuprofen out.”

I tried to reassure her in the approximately 60 seconds of scrubbing I had left. “You can’t blame yourself.  These things happen to everyone.” I told her about the time I forgot to check the bouquet of flowers I’d received for lilies and my cat wound up in the same position.

We’re only human. We do our best every day, but we can only do so much. There is always going to be a time when we turn our back on that bottle of Advil or miss the lilies right in front of our faces. And sometimes we’ll do everything right and things will still go wrong.

Checkers, that patient with the foreign body, didn’t make it. I knew it was bad the moment I’d cut through the peritoneum. The intestine was tightly bunched and extremely angry looking. There wasn’t a rupture yet, but sharp, chewed up bits of plastic were pressing dangerously into the bowel wall in multiple locations. Three hours, a gastrotomy, two enterotomies, and a resection and anastomosis later, the foreign material was all gone, the abdomen was flushed and closed, the patient was in recovery with a plan for continued treatment, and my colleague and I had done all we could do but cross our fingers and wait and see.

Here’s a little lesson I learned recently. We can control our actions, but we can’t control outcomes. All we can do is the best we can do. After that, we need to let it go and learn to be at peace with whatever may happen.

It’s easier said than done. Hunter’s Mom is going to be a lot more careful with medication from now on, but she may never truly forgive herself for his winding up in the hospital in the first place. And a part of me will always carry Checkers with me — wondering if I could have changed her outcome.

But I am not a God and neither are you (or maybe you are, in which case, it’s pretty awesome that you’re taking the time out to read my insignificant words of wisdom.) The universe is infinitely more powerful than any one individual. What kind of hubris leads us to believe we can control it?

So what’s the point of even trying? Why go to work every day if nothing we do matters? Except that it does matter. We may not be able to control outcomes, but we can influence them. And if that small nudge from me can push the universe in the right direction, then I have to keep trying.

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


Coping With An Unknown Diagnosis

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As an ER veterinarian, I have become quite skilled at quickly assessing an animal and coming up with a plan to begin patient stabilization. Unfortunately, this does not mean that I always know exactly what the underlying cause of each patient’s illness is. If a situation arises when a diagnosis has not been reached, it may be upsetting for the pet owner, but also affects me, the veterinarian.

Imagine the following scenario: Concerned owners bring a sick cat to the emergency room because she has been acting abnormally lately. Examination reveals a high fever and some lethargy but little else. We proceed with a blood panel, urine sample and X-rays and still, there is no concrete diagnosis. The owners have now spent hundreds of dollars and, while we have ruled out many possible causes for the cat’s fever, it feels to them like we have done nothing productive. How would you feel in this situation? If you answered annoyed, aggravated, frustrated, worried or any other synonym for just plain unhappy — I am with you! Welcome to the realities of medicine.

Human or animal, medicine is imperfect. Yes, there are plenty of times when an examination and history on a patient, combined with the basic diagnostics that are available to us in an ER setting, may lead to a final diagnosis. But there are also numerous times, possibly even more times, when a clear diagnosis cannot be reached. This may be because the test required to interpret the cause of illness for the pet has not yet been tried. For example, we have not performed an ultrasound or perhaps advanced imaging like an MRI. Or it may be because the animal may have something that can be very hard to diagnose with certainties such as a viral response or behavioral-based anomaly. Whatever the case may be, a lack of diagnosis leads to feelings of frustration.  

In these moments when we have exhausted our readily available modes of diagnosis and have still not solved the mystery of the cause of the clinical signs, a feeling of frustration is fully justified. And believe me when I say that those feelings are felt by me as well. As a veterinarian, I feel it is my duty to give each and every animal my all and do everything that I can to put together the pieces of the puzzle that is each animal’s illness.  Unfortunately I, like many in my field, also struggle with attempts to hold back feelings of inadequacy in those moments. Maybe I am missing something? Maybe there is a hint on physical examination or history that I neglected? Maybe if I had another tool at my disposal I could solve this? Maybe someone “smarter” could figure this out? Well, maybe! But maybe not! As a veterinarian, and as a person, I try to do my very best. And in those situations, despite not having all the answers, I always come up with a plan to help the animal by stabilizing, increasing comfort, and then determining how best to move forward towards obtaining a concrete diagnosis.  

Medicine is imperfect, even under the best of circumstances. But rest assured that while I, your emergency veterinarian, may be unable to provide you with an exact diagnosis at the time of your pet’s presentation, I will do everything in my power to help your pet by controlling the pain, alleviating discomfort, treating the clinical signs and stabilizing him/her, as best I can. If the situation necessitates obtaining additional information, I will discuss additional options with you and we will collectively formulate a plan. Not every question can be answered. But, rest assured, in those moments of frustration that stem from a diagnosis that has not been achieved, we are all in this together. 

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

ABOUT THE AUTHOR

Dr. Chivvis is a 2011 Iowa state graduate and emergency veterinarian in Roanoke, Virginia. She completed undergraduate studies in Massachusetts and moved to Iowa for veterinary school and an additional 1 year Small Animal Rotating internship. Dr. Chivvis is strictly an emergency veterinarian, who treats dogs and cats, and strives to provide her patients the highest level of care as well as communicate with, and support, their human families. 

Trust Us, Please

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Everyone who works in the veterinary profession for any amount of time has heard that “vets are only in it for the money” or that we are in cahoots with pet food and pharmaceutical companies and get kickbacks for recommending their products. But those opinions are far from the truth. We know that our clients want their pets to live a happy, long, pain-free life. Well, here’s the big secret, we want that for your pets, too. That is why we do what we do.

When we recommend vaccinations, preventatives, prescription diets and tests for your pet, we do it with your pet’s best interest at heart. The recommendations we make are based on science. We spend numerous years studying veterinary medicine before entering practice, and once we enter practice, we don’t stop learning. We read journals and attend lectures so that we can stay up to date on the most current information on disease information and prevention.

It hurts when our clients trust other sources of information over our recommendations. I’m not saying that we as veterinarians are always right, but we have a lot of education behind the recommendations we make. When I spend a large part of a puppy appointment educating a client on preventive care and all of my recommendations are declined because of what the breeder said, or when I make a thorough dietary recommendation only to have it ignored because the teenager at the pet store said something else, it’s frustrating. When this happens multiple times in a day or a week, it can become demoralizing. 

With the wide use of social media, it is hard to escape this frustration outside of the office. Because we care about your pets, we often find ourselves sharing pet health information on our personal social media pages to help educate our friends and family. And then we get argumentative responses that are based on pure opinion, not science or fact, and get a harsh reminder about how little some people trust us as professionals.

One of the current hot topics on social media is the FDA’s investigation of a link between grain-free, exotic ingredient and boutique foods and dilated cardiomyopathy, a life-threatening heart disease. The FDA recently released an updated report that listed the most common brands they have seen in the reports they have received. Information from this report has been shared widely by the veterinary community and news media. 

While many of my personal friends, family and clients have simply asked for my recommendations on what to feed, I have seen posts on many other veterinarians’ clinic or personal pages that say this is a conspiracy, there’s no real science behind it, or praising the benefits of grain-free diets (without science to back them up). There have been hundreds of cases of diet-related cardiomyopathy, yet many still deny its existence. Many of these are the same people who refuse to use certain preventatives because they saw a news report that the product caused the deaths of a handful of pets, with no actual evidence other than the pet was given the preventative and died shortly after. No, we don’t know the whole story behind diet-related cardiomyopathy, but there are many more cases of this reported and much stronger associations between diet and this disease than there have been between preventatives and death. Science is complicated and there is much work to be done to truly prove causality in either of these situations.

There are ongoing investigations and studies into diet-related cardiomyopathies. We as veterinarians will keep you updated on what we know as the information becomes available. We truly want the best for your pet, but we don’t want to spend our evening at home arguing with you on Facebook.

You don’t have to trust us without question. In fact, I encourage my clients and friends to ask questions about the information I share with them in the exam room and online. Most veterinarians are happy to have a respectful conversation, but, please, don’t just ignore what we say because your breeder, or neighbor or local pet store employee told you something different. The bottom line is that we want you to trust us because we want the same thing you do — a happy, healthy pet who lives the longest possible life. The best health for your pet will only come through a partnership between you and your veterinarian. And that partnership will only work when it is based on mutual trust.

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

ABOUT THE AUTHOR

Dr. Kate Boatright, a 2013 graduate of the University of Pennsylvania, is an associate veterinarian in western Pennsylvania. She practices small animal general practice and emergency medicine with special interests in surgery, internal medicine and feline medicine. She is actively involved in her state and local veterinary medical associations and is a founding member of the VBMA Alumni. She is passionate about the veterinary profession and enjoys educating both members of the profession, students, and clients through writing and speaking.