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Life With Clients

The Things We Say at the End

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As a small animal house-call vet, about 20 percent of my practice is hospice or euthanasia care. I’ve seen quite a variety of reactions of people to their pet’s passing and I’m always struck when people apologize for their emotions, or things they say to their pet at the end. As a lifetime pet owner and a vet for twenty years, I understand grief very well, and no one owes me any apology for expressing feelings for their loss.

When our animal friends come to the end of their lives, we almost always have something to say to them. We remember their first day with us, the day we found them, cold and shivering and hungry, the day we picked them out from the shelter, the barn, the breeder or the person who couldn’t keep them, For some, they remember the day they were born in their home. We remind them of the day we knew they would stay with us their whole lives and we whisper, “I knew then I had to keep you.”

We retell to them the memories, all the joy they gave us. We remind them of the trips to the lake, the ocean, the woods, the hours of happy mornings we spent snuggling in bed, happy evenings spent sharing bites of pizza or apples and snuggling on the couch. We remind them of naps in the sunshine, splashing in the water, runs in the field, the games they invented that we played along with, a lifetime of silly rituals no one else would understand.

We tell them how much they meant to us, how they kept us whole. “You were there when I was sad. You were there after the accident, when my body was broken. You were there when I was so sick from chemotherapy. You were there when I got divorced. You were there when my wife died. When my brother died. When my child died. You were there when I wanted to die.”

Sometimes, there are no words. There is only sobbing, or screaming, or stony tearless silence. It can take weeks or months, years, a lifetime to say the words we just can’t find at that moment. Sometimes we can write them down later, or say them when we’re alone. Sometimes we can never say them out loud.

Most of our animal friends live a short life compared to ours. We know that in our heads, however our hearts will always struggle with that truth.  But with each ending, whether the words come easily or not, veterinarians, veterinary nurses, and veterinary staff understand that some things need to be said. You don’t ever have to be ashamed or afraid of being judged, because we understand how deep, how precious, how profound your love is for the animals you share your lives with.

Today when one of my clients had to say goodbye, all he said through his tears when he held his companion was “thank you.” I think, in the end, that’s what we really mean to say. Thank you, for everything.

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. Amy Cottrille is currently a house call general practitioner for dogs and cats in Seattle’s suburban Eastside area. Her professional special interests include hospice care and pain management. Dr. Cottrille shares her home with her husband, three children, and a variety of spoiled pets, including regularly fostering kittens for MEOW Cat Rescue. As a Washington native, she enjoys outdoor activities of all sorts.

Our Clients DO Listen, but are Your Consults Two-Way?

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I am all too aware of the need to communicate in a way that my clients can understand as well as process the information delivered. This is vital if they are to ultimately feel comfortable making any kind of decision about their pet’s healthcare. After all, it might literally be a life or death decision that needs to be made.

It’s too easy though to get frustrated when the same questions are being asked at every repeat consultation, annoyed when your instructions are not followed and give up when your treatment plan is abandoned without your input.

So, let’s try and stop this in the first place!

A Communication Checklist

To try and maximize clarity, I work my way through my mental checklist:

● Avoided jargon √
● Explain how we have reached our current situation √
● Advised on potential complications or hiccups that might take place √
● Discuss the likely cost √
● Given a prognosis and plan for the future √ 
● Answered any questions √

You get my point. Now I’m no communication expert and I try to constantly refine my technique. There will be better lists out there. But you should have some kind of list, conscious or otherwise.

The volume of information we try to deliver in a single consultation can be huge. The information will also be unique to each and every situation. Add the fact that we may only have 5 minutes and clarity is key.

Time can be a scant resource!

Your Clients Aren’t Trying to Forget!

Our clients do listen. They try their best to take in every word you say and remember all the key points. They do ask questions, raise concerns and ultimately decisions are made. At the same time though, a large part of their brain will be focused on the emotion of the situation. Will their pet be OK? How will they be able to medicate them? Can they really afford the plan proposed?

Decision made, it’s time to head home.

It is at this point that more questions will be realized. Explanations given will become confused. That’s exactly what happens when we go to the doctor so why should a vet visit be any different for our clients? We remember a bit, forget a bit and misremember a bit. What now?

Communication is Two-Way

As a vet I’d like to think that any concerns or questions will be discussed at the next appointment, but does the client know this appointment should be made. We may be more than happy to field phone calls to address issues with the plan, but does your client think it would be impossible to reach you on the phone?

Gone are the days of dictating to our clients and expecting them to do as they’re told. A one size-fits-all approach is not something we can (or should) offer for the vast majority of situations. Any decision making is a collaborative effort. I believe we should help guide our client’s decision-making, using our knowledge and experience, to help guide them towards the best path for their situation. For this to work though we need their buy-in.

We need to take the lead but our clients are co-pilots rather than passengers.

Make Asking Questions Safe

This process and relationship rely on our clients asking us questions and engaging us in the discussion. For this to happen they have to know that we actually WANT them to ask us questions. We also need to have nurtured the relationship so that our clients will feel safe to ask anything without judgment. Starting your answer with “As I told you in our last conversation…” probably sounds judgmental.

We need to let our clients know that as vets, we can only know we haven’t done the job needed to communicate the situation, options or concerns if we are told. Equally, if the plan is not working we need to know. It is our job to make sure our clients know they can (and should) tell us without hurting our feelings.

Don’t Ignore the Elephant in the Room

If your client doesn’t feel empowered through open communication channels, where do you think they’re going to turn? Dr. Google of course!

Let’s be honest, they’ll be jumping online however they feel (sorry if this is news to you).

Effective communication also means directing your client’s personal research. Be proactive. Be the preferred source of information, but at the same time curate what they will find elsewhere. Give out information sheets for further reading, suggest websites you like and be open to questions as well as robust discussions as a result.

It is only by working together that we can do the very best for our pets. And that is what we should all be striving for.

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.

Dr. Alex AveryABOUT THE AUTHOR
Dr. Alex Avery is a companion animal veterinarian from the UK, now working in general practice in beautiful NZ. His realization and frustration about the wealth of misinformation being delivered online led to the creation of ourpetshealth.com. He is passionate about providing pet owners with information that they can trust, and strongly believes that the delivery of good information will result in a closer vet-client relationship as well as better patient care.

We Are All on the Same Team

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We all live in fear of the “Bad Review.” We don’t want to be accused of caring only about money, and we don’t want to be told we killed someone’s pet because we made a mistake. But the thing that hurts the most is to hear someone say we let them down because we just didn’t care enough. 

There are vets who care more about money than others. There are vets who make worse mistakes than others, and vets who blame others for their mistakes. We aren’t immune to bad decisions, bad planning, bad management, or bad marketing. But the one thing I don’t believe you can say about us is that we don’t care enough. It’s a sad generalization. I’m speaking about vets here because that’s what I am and therefore what I know from personal experience. But this can be said about just about everyone in your average veterinary hospital. We are flawed, sometimes emotional, sometimes abrupt – but we care. And we do it deeply.

The reason 1 in 6 veterinarians will consider suicide during their career is not that they don’t care enough. It’s almost certainly in part because we care too much, and because some of us literally would rather die than see ourselves painted as heartless or to be shamed publicly for things we could not control, or for things we didn’t even do.

The reason Fear Free and low stress handling, better pain management, and areas like acupuncture and physical therapy are gaining popularity is that they not only increase patient and client satisfaction, they make us happier at work too. We don’t like torturing animals. We care too much to be able to do that and be truly happy.

We didn’t become lawyers or stock traders or engineers because we aren’t smart or ambitious enough. We had to be plenty smart and ambitious to get into vet school, never mind get out with a degree and survive the first terrifying years of practice. We chose this career because we couldn’t imagine doing something that didn’t involve caring for animals and nurturing their relationship with people. We could make more money doing something else, possibly with fewer hours and less stress and less debt. But most of us stick around – because we care. Our hearts are full of sweet gray muzzles and kitten fluff and our pants are covered with dog hair and smushed treats at the end of the day, and we can’t imagine it any other way.

But caring so strongly about anything comes with a price. For too long now, vets have been expected to sacrifice nearly all aspects of their personal lives for the sake of the job, and we have succumbed because we had limited options and the weight of previous generations’ martyrdom on our shoulders. We all go into vet med knowing a certain amount of unpredictability is part of the deal. We might have to cancel plans because of an end-of-shift emergency. We might have days where we are swamped with calls that can’t wait. And we have charts (so many charts)  that have to get done before we forget what we saw and said, every single day. But here’s the thing: I believe the canceled plans, super late nights spent charting, and end-of-shift emergencies should be the exception, not the rule. I believe it’s OK for us to have goals outside of work that are just as important to us as being good vets. I believe it’s OK for us to have an identity that does not revolve only around whether we saw every possible patient or called every possible person back that day. And most of all, overwhelmingly, I believe this culture needs to start inside the hospital, with every member of the team.

Think about it: Those bad reviews where clients accuse us of being uncaring – the people who make a scene in the waiting room because they had to wait too long (what do they think we’re doing? We are seeing other pets! Because we care!). Those viral Facebook roasts – I mean posts – where someone blames their vet for a side effect, an “unnecessary” test or vaccine, an inability to see them at the last minute when emergency care was available elsewhere, or worst of all, a pet’s death, be it by perceived neglect or by mistake. We are walking in a social media minefield at all times. We are waiting to be the target. We can’t talk to every client about this directly, and we can’t change the minds of the angry mob once they’re shouting. But how can we expect clients to see things differently if our own team members judge us for wanting balance?

Patient care should not suffer just because a doctor wants to go home. But if there is an alternative – a drop-off appointment the next day, the ER that night, phone triage with a technician, a pain medication to send home before closing. It’s not unreasonable to expect that a client will accept one of these options and that most of the time, the doctor can go home to her family, her plans, or her microwave dinner and time on the couch with her dog. It doesn’t matter what the reason is. She’s allowed to go home without being painted by her team as indifferent. She probably poured her heart into every appointment she saw that day, every call she returned, every decision she made for her patients and her team, and she deserves to be done when she’s done.

The expression “you can’t pour from an empty cup,” is trite, but true. There are some rock star vets out there, I’m sure, who can work late every night, come in early every day, take late emergencies every Saturday, and make calls on their days off and still see every patient with a smile, treat all team members with respect, and practice excellent medicine. But for the mortals among us, we need time to recharge, get regular exercise, go grocery shopping, call our parents if we’re lucky enough to be able to, and set goals for ourselves that don’t involve work. Do team members really want to work with a burned-out, grouchy, sleep-deprived doctor with a week of canceled plans behind her? Do they really think that what defines a good vet is how many patients or calls she can make in a day without turning into a jerk?

For me, being a good vet means being a happy person, because that allows me to sit right down on the floor and chat with a client until a timid dog climbs into my lap. It means I may be running late, but because I had a good day off the day before or am looking forward to a fun weekend ahead, I don’t let the stress of being late show during my appointments and clients leave smiling even if they had to wait. It means I am able to make good decisions for both my patients and our team. It means fiercely guarding what I love about my job, so I don’t let what I don’t love about it turn into all I can see.

We are all on the same team. Front office, tech staff, kennel assistants, managers, vets – we must be advocates for one another and for our profession. We need to present a unified front to our clients. If we want to see a future in veterinary medicine that involves less burnout and lower rates of depression and suicide, we must start in our own hospitals with our own culture. Support one another. Assume the best of one another. We all tell ourselves stories every day about the people we meet and the things they do and say. Tell yourself stories that paint other team members in a positive light. There is always a choice to be made; make the kind choice. Good patient care and work-life balance for vet teams are not mutually exclusive, but lip service does nothing to show this to clients. The energy you create by lifting each other up, the assumption of best intentions whenever and wherever you can, and the message that happier vet teams provide better care – those are what clients need to see. Those are what we will get us to a better future. Those are what will save us from the dark.

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.

Haters Gonna Hate: Are We Just Gonna Stand by and Take It?

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Surfing the web today I came across an online review directed at a veterinary hospital and a specific veterinarian in a small community. Reading it made me angry, but then I realized that I don’t have to remain silent. This review was not about me or about my practice, but it quite easily could have been. In fact, it has been about me in the past and like many veterinarians, I too have been victim to negative reviews, online slander and even bullying in my small community.

For 27 years, as a vet, I chose to “take the high road” and remained silent. Refusing to respond to the negative and slanderous online trolls, I tried to grow a thick skin and focus on staying positive. Only those closest to me know how much it hurt and how I struggled to not let those comments eat away at my confidence.

I still recall the experience as a new practice owner, of a truly hateful and slanderous campaign aimed at harming our small business and turning our new community against us. I was invited by a friend to join an evening painting group. I love to draw and paint, but starting a family and buying a small business had left me little free time to pursue my hobbies. I decided it was time to do something for myself and agreed to join my friend.

I introduced myself to the group as just “Elaine” and being new to the community, most of the members did not know I was “Dr. Elaine”, a veterinarian. As people worked on their art, and chatted with each other, I felt my stomach tighten as the talk turned to pets and then a discussion of local veterinarians. Opinions about local veterinarians were bantered about and then my stomach knotted as things suddenly took a nasty turn. I listened in shock, as people discussed the smear campaign of posters that were being placed around the community “exposing” the terrible new veterinarians that had recently started a practice. This was the first I had heard about this slanderous campaign and I was afraid and hurt.

With a tremor in my voice, I stood up and re-introduced myself as “Dr. Elaine Klemmensen.” I heard a collective gasp go through the room and sat back down to a room of stunned silence. I continued to paint while trying to figure out how I could get the heck out of there! Thankfully I was saved by my pager buzzing. One of the few times in my career I was happy to get called in for an after-hours emergency.

Everyone is entitled to their opinion and what I am talking about here is not respectful dialogue and open communication aimed at resolving a conflict or misunderstanding. I am talking about mean and spiteful slander aimed at harming an individual and or their business. There is a difference, and for years I ignored those trolls and refused to respond for two reasons: First, it seemed unprofessional and petty to respond. Second, I did not want to get drawn into the negative drama and chose instead, to protect myself and stay positive. I opted to focus my energies on the people and things I cared about in life and let the haters hate. It is far too easy in veterinary medicine to dwell on the negative outcomes, the negative clients and the negative reviews. It’s difficult to not let that one mean, unhappy client or coworker, ruin your day while forgetting about the 20 amazing people that put a smile on your face.

So, to all of you out there who have posted unfair, biased and downright mean reviews about your vet, rants aimed to hurt or damage their reputation with no desire to understand or resolve your issue, wake up take responsibility for your choices. When you adopted that pet, you took on the financial responsibility for that animal. It isn’t your vets responsibility to subsidize the cost of medical care for you. It isn’t your veterinarian or their team’s fault when it is injured or ill. As hard as we try, as skilled as we may be, we cannot save every patient. We cannot foresee every complication and while we are doing our best, at the end of the day we are only human. Stop making your vet feel guilty if they want to earn a fair salary for the 60+ hours a week they work and for heaven’s sake stop telling them they’re “only in it for the money”. Frankly this phrase is getting pretty old for all of us so show a little creativity and come up with something new already. Oh, and one more thing, if you are going to slander us or our team online at least have the courage to sign your real name. If you have a problem with our care or our service just talk to us – face to face, like a grownup.

When my son was in grade 5, he was the target of some school yard bullying. We talked about it and encouraged him to not react, to pretend it didn’t bother him, essentially to turn the other cheek. True to his nature, he listened, digested this information and then decided to handle it his way. This involved tossing the said bully across the room and ending up in the principal’s office. We were called in to the school to discuss our son’s anger management issues and true to our non-confrontational nature, we listened and did not say what was on our minds, something I have always regretted. Where were the other kids parents? Is it okay to constantly taunt someone with mental abuse until they snap? Thankfully his teacher gave our son the support we did not, when several weeks later, he asked him how things were going. Our lad replied that things were much better for him after he threw the kid across the room. The teacher just looked at him meaningfully and said “Sometimes you just gotta do, what you gotta do”.

Maybe it is time to stand up and do what we gotta do.

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
A small animal practice owner for 20 years, Elaine recently sold her practice and hit the road to volunteer in far flung places around the globe. When not spaying dogs in the bush in Africa, she works as a locum in Canada and loves writing about her adventures at www.vetswithoutboundaries.com with the hopes of inspiring veterinarians to embrace change, try something new and build a life that brings them joy.

Why You Should Strike the Word “Radiograph” From Your Vocabulary

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Sometimes after a big, nasty mass removal, or other messy surgery, I look down at my blood-splatted scrubs and think to myself, I sure hope I don’t get pulled over by a cop on the way home. This is often followed up by me thinking about what would happen if I did get pulled over by a cop.

He’d probably ask me to get out of the car. He’d pop my trunk looking for the body. I’d try to explain that I’m a vet and it’s dog blood from a still alive dog who was anesthetized at the time the blood was spilt. The nice police officer might still be a little suspicious, so I’d need to prove myself.

“Hemangiopericytoma,” I’d say, or some other big, important-sounding medical term. After all, only a doctor would know that word.

Now, you’re probably wondering where I’m going with this story. Is there a point other than the fact that I’m super weird and have very strange daydreams?

There is. And that point is that words are powerful. Certain words can make us feel smart and important. They can give us identity. We spent a long time learning the language of medicine. My first year of vet school, I sometimes felt more like I was learning a foreign language than learning medicine. And what’s the point of memorizing all those fancy words if we never get to use them?

I found the lure of “jargon” to be especially alluring when I was a new grad. I was young and inexperienced, and I needed people to trust me and believe I knew what I was doing. So, I threw out the big words with abandon. Look how smart I am, I can tell you your dog has gastroenteritis. You cat has an eosinophilic granuloma.

But the truth is, these words may make you feel smarter, but to clients, they often just make you sound like a smart ass. When you tell a client that you’re taking their pet for a radiograph, most of them will give you a blank stare. And they may even feel stupid for not know what that means. Then, they’ll start tuning out of the rest of what you have to say.

I know, I know, our professors drilled it into our heads: X-rays are the electromagnetic currents that are used to generate the image, radiographs are the images themselves. But we’re not in school anymore (unless you still are, in which case, save this lesson for a rainy day).

I got into an argument online about this one day. I (ever so politely, I swear) explained that very few clients know what the heck a radiograph is.

“You’re right,” the person said, “next time I’ll make sure to explain the difference between an x-ray and a radiograph to them.”

I must have pulled a periocular muscle I rolled my eyes so hard (my intended audience here is vet professionals so the word “periocular” is fair game). Clearly, I wasn’t communicating well if that was her take away from what I’d said.

Honestly, do you think your clients care about the difference between an x-ray and a radiograph? Is that really what you want to spend your time explaining to them, when you could be explaining what that distended, gas-filled loop of bowel means? Your client doesn’t want to know if you can recite Dorland’s Medical Dictionary, they want to know that you can fix their pet. And if you can’t fix their pet, they want to know what you can do to relieve their pet’s suffering.

It’s tempting to use medical jargon when explaining a medical problem. It’s quick, descriptive, precise—pyogranulomatous inflammation with bacterial sepsis is a beautiful phrase — if you know what it means. But it won’t help you connect to your client. It won’t tell them what’s wrong with their pet. It’s not likely to inspire compliance when you suggest an expensive culture, then tell them to come back for a recheck. You need to speak to your clients in terms they can understand.

The truth is, you can be the smartest person in any room, but if you can’t effectively communicate your knowledge to someone else, you’ll never be a great clinician. As practicing doctors (or techs) we need clients. We need them to agree to the diagnostics we recommend, we need them to administer the medications we prescribe, we need them to bring their pets back to us. And to make any of that happen, we need our clients to understand us. So, stop with the medical-ese and speak a language your client can understand.

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.

How Selfies Saved My Career

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In 2014, I was teetering on the edge. I was burned out and tired of being a vet and I had only been one for five years. I spent a lot of time thinking about what jobs I might do instead, but would always boomerang back to “but it cost so much, and I worked so hard.” If people told me their kids wanted to be vets, or expressed admiration for the Dr. in front of my name, or told me they envied me because I had the best job ever – I got really prickly and launched into all the difficult and depressing parts of the profession. I would effectively shut down their enthusiasm about vets and darken my own mood by reminding myself of all the reasons I was thinking about quitting but couldn’t.

Then I went to a vet conference in 2015 and attended some incredible talks on social media and marketing, joy in practice, and the human-animal bond. I came home inspired and started to take photos with some of my patients (with permission of course) and put them on Facebook. The comments poured in. “You have the best job!” “I knew it – you just play with puppies all day!” “If you need any professional kitty snugglers, I’m available!” I thought this would annoy me. People just don’t understand our struggle and they need to know about our debt load and weird hours. They need to see how hard we work all the time! They need to know about clients who show up late with no money or who blame us for mistakes we never made or the clients who write bad reviews on Google because we couldn’t fix their neglected pet for free.

Except… I didn’t get annoyed. I was shocked to realize that not only did these comments not irritate me, it dawned on me that they were right. When they said, “You’re so lucky! I don’t get to have dogs climb in my lap at work!” they were telling the truth. I DO get to have that and that DOES make me lucky. If someone said, “That smile on your face shows how much you love your job,” it pointed out something I had forgotten – I smile a LOT at work, and for the most part, it’s genuine. Although I think we all have our moments where smiling is the only thing standing between us and hysteria or incarceration, right?

I also realized that the owners of most of the pets I photographed are pretty awesome people. They love their pets fiercely like I love mine. They want only the absolute best for them, and they sometimes ask a lot of questions to make sure that is what they are being offered. Then they decide to trust me not only with their pets’ care but also with their love.

When I was a kid in the 80s, glimpses into other people’s lives meant things I saw at sleepovers and birthday parties, photos tacked into lockers, albums pushed into my hands by people’s grandmas and the impossibly harmonious fictional world of The Cosby Show. I could envy the other kids’ sneakers and hair, but I also saw them get bad grades, eat gross lunches, and get in trouble for talking in class. I could never have imagined that one day, not long in the future, I would have 24/7 access to an endless stream of photos and videos of near or complete strangers. On social media they are seemingly living their lives spontaneously and joyfully, artfully edited, curated, and filtered with free apps and showing only the very best and most appealing parts of every day. While I used to long for the trendy clothes and breezy confidence of the popular girls, now we have literally millions of popular girls to envy, without knowing when they are sad, being privy to their family dramas, or hearing them whine about having to get up and go to work every day.

Experts tell us too much time on social media can be a barrier to happiness, because we fall into the comparison trap. Certainly, this can be true, but I would argue that social media can also be a powerful weapon in your happiness arsenal. Seeing your life through the eyes of others can be incredibly uplifting. Sometimes they point out the beautiful, amazing parts of your day that you are letting yourself miss. Yes, they’re seeing only the good parts – but don’t you deserve to enjoy those, too? And maybe even give them top billing in your mind when you think about work?

Overall, is it worth it to me to deal with the mean/noncompliant/financially irresponsible/bad-review-writing clients in order to stay in a job that allows me to sit on the floor and have puppies chew on my hair? Well… yeah. I could do something else for a living and still have to deal with people who don’t see things my way, but at least now there is always an animal involved who is blameless, voiceless, and generally adorable – and who needs my help. No matter what sad case I might see on a given day, at some point I know I will walk into a room where a smiling owner waits to start her life with a bouncy puppy who absolutely cannot bear to sit still one more second without leaping into my arms. And then we’ll take a photo. Maybe on my next down day, I’ll see that photo and remember that the bad stuff doesn’t always need to take the starring role. Try it yourself and see – if you take a simple step to let the good stuff shine, it might just make you feel a little luckier.

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.