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Life With Clients

What a Tough Week Taught Me About Life With Pets

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Today was mentally taxing. It was the kind of day where you realize that you’ve been working for eleven hours and you’ve only had a granola bar. When your head finally hits a pillow, you’re so tired the room is spinning but you can’t shut your brain off. My alarm will buzz in five hours, but I’m hoping that pounding out some musings will settle my mind a bit.

We diagnosed some awesome patients with awful disease processes this week and it sucked. A patient I’ve been seeing since my first week at my current clinic crashed after perfect routine bloodwork three weeks ago. Another started having violent cluster seizures after a lifetime of good control. Another with well-controlled kidney disease developed acute-on-chronic kidney failure. Another with aggressive bone disease sustained a pathologic fracture. And still another developed respiratory distress secondary to severe tracheal collapse. We ended up euthanizing some of them.

Whenever humane end of life comes up, I think about my experience with one of my dogs. I didn’t realize how much I’d still miss her months later and I hate it when my clients begin that journey with their own pets, but every time I discuss euthanasia I silently thank her for the perspective she gave me. She allows me to identify with clients who are struggling with The Decision; I can tell them how my husband and I made The Decision and chose the timing. I think some people prefer to let their pets go while they still have some happiness left, and others prefer to wait until they’ve exhausted every last bit of happiness together. I was surprised to find out that we are the first type—the opposite of what I thought we’d be.

As usual, my dogs greeted me with wagging tails when I walked through the door this evening. They each received two pats on the neck and then I tried to ignore them while they followed me around. My husband caught on and asked me why I was avoiding them. After thinking for a moment, I realized that I was trying to distance myself physically and emotionally. Days like this cause me to imagine that I’m in my clients’ shoes and my own pets are suffering from the heartbreaking things I’ve seen. I guess my subconscious thought that if I start building a wall between us, it won’t hurt so much when we have to make The Decision again.

I told my husband this and he stared at me before he responded. “Do you want them to just be passengers in our lives? What’s the point of that?” Well, shoot. He’s right. They deserve walks, car rides, spontaneous treats, new squeaky toys to rip open, and the kind of scratches that make them lean into your hand. We should be making the kind of memories that tear your heart open when they’re gone but later make you laugh and help you patch it together again.

The author’s dog, Emma

A veterinary oncologist I greatly admire says that pets don’t live as long as us because it’s easier for us to understand life without them, than for them to understand life without us. We build bonds with them knowing that our hearts will eventually be broken. I think about this every time we take in a new pet, but I choose to welcome them with shiny tags and open arms anyways. Days like this remind me that we need to live life enjoying what’s in front of us like our pets do, not thinking about what’s to come.

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.

Are You Breaking the 6 Commandments of Professional Courtesy?

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In veterinary school, our ER clinicians had one rule that still sticks with me today: “Never talk badly about the referring DVM to a client.” One important reason for this rule is that the client’s report of what the other vet said may not be exactly accurate.

Whether the client was distracted by emotional distress or just plainly misunderstood, it’s not uncommon for the original veterinarian’s intent to become misinterpreted in that game of telephone. “The other vet said to give omega 7 skinny acid, purple-monkey-dishwasher.” Hmm, that doesn’t sound quite right. (And congratulations to anyone who caught that reference to an early TV episode of a certain yellow cartoon family.)

Now let’s address the more uncomfortable situation when you know exactly what was done and disagree with a colleague’s treatment plan. We often encounter this in multi-doctor hospitals or between competing practices. It’s common, especially in this current era, to be critical of colleagues if they are doing something differently than you.

Even though our profession has standards of practice, few veterinarians have exactly the same preferences. What do you say when your preference is different than the previous vet? And while you’re contemplating that question, also put yourself in the other vet’s shoes. How would you want a vet who disagrees with you to speak with your client?

[tweetthis]Are You Breaking the 6 Commandments of Professional Courtesy?[/tweetthis]

Here are my 6 “Courtesy Commandments” for respectfully disagreeing with a veterinary colleague. (And yes, I realize if I say “commandment”, there should probably be 10 of them. Please have the courtesy to let that detail slide.)

    • Never bad-mouth another veterinarian in front of a client.

      Just don’t do it. This is my most important “Courtesy Commandment.” I understand it can be tempting, but tearing down a colleague is not the best way to build yourself up. Okay, maybe in the short term some clients will respond to this and only want to schedule appointments with you, but you will lose respect from your colleagues.

      British Shorthair Cat In The Box

      Especially if you do this to the other vets in your own practice, it will create a toxic working environment. Don’t be that vet that all the other vets hate. Also, remember that game of telephone? The same philosophy applies here when a client reports back about what you said. Having a client tell another vet that you said they do things incorrectly is a bad idea. Bad idea. You’re just asking for your words to be misconstrued, which could come back to haunt you. Don’t fall into that trap.

    • Acknowledge what the other vet did correctly and what you learned from what the other vet has already done.

      If the patient did not respond well to the previous veterinarian’s treatment, explain what you can infer from that and why you would like to take a different approach. This is extremely important if the client is complaining about vets who also work in your practice. Those vets may not get a chance to defend themselves, so this is your chance to take a moment to have their backs and restore the client’s confidence in them even though their initial choices may not have been successful.

      Funny standing kitten and cat

      Hopefully your co-workers will have the same professional courtesy for you, too. I would also wish that even competitors could show each other similar courtesy. Maybe that’s unrealistic, but can’t I dream about a wonderful veterinary utopia where everyone is nice to everyone?

    • Avoid using negative phrases when discussing previous treatments a patient received, and instead focus on what your plan is now.

      This doesn’t throw the other vet under the bus, but instead builds the client’s confidence in you because your goal is moving forward to make their pet better.

    • Explain to the owner why you prefer something different.

      You can still be a good advocate for your methods without putting down your colleagues. For example, try to get the owner excited about doing something different by explaining why you personally prefer that option. Attempt to put more effort into explaining the benefits of your preference than into emphasizing the negatives of the previous treatment.

      domestic cat being examined

    • Don’t be afraid to continue treatments that are working.

      If the client is very happy with a previous treatment that is working and that treatment does not put the patient’s health at risk, then consider continuing the previous treatment even if it’s not how you usually would approach that case. To clarify, I’m not encouraging you to blindly continue treatments you are uncomfortable with. Still, try to keep an open mind. Discovering that a treatment different than your preference works best for that pet is not a defeat. That’s just the nature of medicine. You may just learn a new approach that could be used for your other patients in the future.

  • If you truly believe another veterinarian made a mistake, discuss that directly with the veterinarian.

    I want to acknowledge there is a huge difference between disagreeing over a preferred treatment and recognizing a colleague is practicing inappropriate medicine. I still believe the above suggestions are a good guideline of professional courtesy toward each other, but I concede that special situations exist. There are protocols in place for reporting malpractice, but I would recommend speaking with that veterinarian first. That is the kind of professional courtesy I would hope someone would have for me if the tables were turned.

Veterinary medicine is a small profession. We need to have each other’s backs. Veterinarians will never agree on everything, but that’s okay. Disagreement is healthy and promotes progress in our profession and our individual hospitals. My utopian dreamland where all vets just get along will never exist. However, I think discussion of disagreements must be conducted in a respectful manner, especially in front of clients. Hopefully these “Courtesy Commandments” encourage that. We have enough drama to deal with. We don’t need to add any purple-monkey-dishwashers.

[tweetthis]Veterinary medicine is a small profession. We need to have each other’s backs.[/tweetthis]

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.

The Real Reason Your Wait at the Vet’s Office is So Long

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I recently read a Huff Post article entitled “The Real Reason Your Wait at the Doctor’s Office is So Long.” Veterinary Medicine and Human medicine vary in a lot of very meaningful ways, but we are also often the same. And in this we share a common weakness—we sometimes run behind schedule. In fact, I’d wager to say we frequently run behind schedule.

Mid section of veterinarian and assistant examining dog

So, when I saw this article, I expected to read a well-reasoned explanation of why this is the case by someone in the know. Instead, the article read more like one woman’s angry Yelp review. Many of the comments in the article espoused similar experiences with complaints that doctors don’t value their time, overbook to cram as many appointments in as possible just to make a few bucks, and are generally greedy, no-good, shysters with big egos.

As you can imagine, myself and many other health professionals took offense to this so I am here to tell you the REAL “real reason” your wait at the doctor’s office (be that physician, dentist, veterinarian, chiropractor, etc) is so long—we care!

[tweetthis]I am here to tell you the REAL “real reason” your wait at the doctor’s office is so long[/tweetthis]

We care about you and your pet and your health, and yes, even your time. We care, and we are people pleasers who try to make everyone happy. We do our best to schedule responsibly (although sometimes there are managers and administrators who have more of a say in this than we do) but as Robert Burns said, “even the best laid plans of mice and men, often go awry.” Nowhere is this more true than in medicine.

Things are always going awry. Sometimes it’s a true medical emergency—the dog that ran into the street and got hit by a car, the cat that can’t breathe because it’s having an asthma attack, the person who goes to their doctor for heartburn but is really having a heart attack. In these cases we have to stop everything we’re doing to care for this emergency and that takes a lot of time.

White Labradors

Sometimes the problem is our own inability to say no. We save that appointment slot for an emergency and then someone calls up because their dog has a painful ear infection. Sure, it’s not really an “emergency” but we can’t stand the thought of that dog suffering in pain until tomorrow, so we fill the slot.

Then the next thing you know, someone calls up because their cat has vomited 6 times in the last hour and really needs to be seen. Sure, we could say we’re booked and send them to the emergency clinic, but then the client will wind up spending twice as much and they have two kids in college and can’t really afford it. So we fit them in, even though there are no open spots and taking x-rays is going to put us even more behind.

nice cat

We also get behind when simple appointments turn out to be not so simple. A client schedules a wellness appointment for vaccines and then “mentions” their cat is urinating out of the litter box, and can you check this lump and his breath really smells, and oh yeah, don’t forget to cut his nails. Or the patient I saw the other day for what the client thought was an eye infection but really turned out to be lymphoma. I’m not going to rush an appointment like that just because I’m afraid of getting behind.

Yes, I feel bad that I’m making the next client wait, but I know that if something terrible ever happens to their pet, they would want me to give them as much time and attention as they need, even if there are ten people in the waiting room who are just going to have to wait a little bit longer.

And sometimes it’s not terrible news I’m delivering, but just someone who has a lot of questions. Sometimes I have to have a lengthy conversation on weight management or dental health, or the importance of heartworm prevention, that runs long.

Veterinary Assistants And Dog

I could easily skip over these issues especially when I’m running behind. It’s not a problem yet after all. But instead, I take the time to make sure my clients are fully educated about their pet’s health so that down the line I can hopefully avoid discussing diabetes management or the heartworm treatment protocol.

All of these things aren’t a once-in-a-while occurrence. They happen on an almost daily basis in medicine.

The truth is, maybe I could be on schedule more often. I really do value your time, but I value your pet’s health more and if being better at time management means I’m going to be worse as a doctor, then I’m not interested.

[tweetthis]I really do value your time, but I value your pet’s health more[/tweetthis]

Reprinted with permission from laurensmithdvm.com.

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.

 

The (Dorky) Free Gift Everyone Will Actually LOVE

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OK, let me just say upfront that I am fully aware of how nerdy this gift is. However, I’m still going to tell you about it because it makes people feel great, it doesn’t cost a thing, and it might even help your clinic. So what the heck is this magical stocking stuffer? I’ll explain:

Last year, a young couple who had just moved to my area and were looking for a veterinarian brought their two Westies in to see me. They were about my own age, energetic and upbeat — I liked them immediately. Both dentists, they had bought a little dental practice in town from someone who was retiring; and their enthusiasm for their new business and the changes they were going to make was fun and contagious. Every time they came by with their dogs, it brightened my day. So I was genuinely happy when it came time for me to get my teeth cleaned. I headed over to their new office and had a wonderful experience.

Family pets receiving gifts for Christmas - dog a kitten with sm

Then I did something I almost never do: I wrote an online review. (I told you this was going to get nerdy.) Why? Because here these people were, working with all the determination, uncertainty, and hope that many of us have about our own businesses, and I had the ability to do one simple thing to help them with one of the biggest challenges they faced — reaching out to potential new patients. It only took me a moment, but I imagined it might make their day.

Think about it: How much do you love it when people say nice things about you in front of other people? That’s what it feels like to see a new 5-star review appear for your business. It costs the person writing the review absolutely nothing except a few minutes of thought, but the resulting joy and pride are huge. Writing a nice review for someone has all the hallmarks of what I’d consider a perfect gift, too. It’s unique and personal; it shows that you are thinking of the recipient; and you make it with your own hands.

[tweetthis]This gift makes people feel great, it doesn’t cost a thing, and it might even help your clinic.[/tweetthis]

And you know what? Sometimes this gift has a very nice way of coming back to you.

After I wrote a review for my dentists, I went on about my day with that warm feeling you get from doing something unsolicited and kind for someone else. I didn’t contact them or point the review out. I figured they would find it sometime in the future and have an especially good day.

About two months later, I got an alert from Google. There was a new 5-star rating for our veterinary practice. It positively glowed, and it mentioned me by name. I still go back and look at it every now and then when I need a little boost. You can guess who it was from, can’t you? My dentist friends. I wasn’t expecting it, and it made my day.

work with cats

So this holiday season, think about whether any of your clients own a small business. They probably feel the same way about their bakeries, shops, garages, or dental practices that you do about your clinic. Why not pop in to visit and then leave a nice review? They may return the favor one day, or they may not — what matters most is that you’ll be spreading immeasurable good cheer.

[tweetthis]How much do you love it when people say nice things about you in front of other people?[/tweetthis]

Today I Lied

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Today, I lied to a client. And I don’t feel bad about it, to tell the truth.

That’s not what I’m like, either the lying or the lack of regret. Like most veterinarians, I believe that telling the truth is an essential part of who I am, and what I do. Being honest is essential to building trust with our clients because their pets, our patients, cannot speak for themselves. We are advocates for these animals, and to accomplish this we must give their owners truthful health assessments and honest options based on our knowledge and experience so they can make informed decisions.

But it’s not just my profession that drives my veracity. My husband says I am the most honest person he has ever met; honest to a fault, sometimes. For me, lying triggers anxiety and sleepless nights.

Usually, sugarcoating the truth is the closest I can get to lying. But that wasn’t the case today.

Miss Midnight, a sweet cat as black as her name suggested and about as old as most cats hope to be – 16 – came in with her owner, Mrs. Johnson. (And, yes, both names have been altered.) Miss Midnight hadn’t eaten much in more than a week, and Mrs. Johnson wasn’t sure the last time she’d seen the kitten drink any water.

The ancient black kitty was skin and bones. Her eyes were sunken in, and she was too weak to stand up. I kept my professional demeanor in place as I observed that she was cold, her gums were pale. Blood tests showed only one abnormality, a marked nonregenerative anemia, which means the bone marrow wasn’t producing the red blood cells needed. Had I seen her earlier, she might have had a chance, and the thought made me sad, and angry. As we often say in veterinary medicine, old age isn’t a disease. The fact is that many things can be treated, and don’t need to be ignored because of an animal’s age.

As I have done so many times, I shared my professional opinion, and then discussed all the options. Mrs. Johnson couldn’t afford to hospitalize Miss Midnight, but she wasn’t ready to say goodbye. We agreed to try 24 hours of supportive care at home to see if Miss Midnight’s condition would improve.

Mrs. Johnson then told me she is a nurse in a home for senior citizens and would have to call in sick to take care of the cat. I was taken aback. A nurse? Working with elderly patients? How could she let this situation go on as long as it had? She surely knew better!

But I kept listening. She told me about Miss Midnight, how her son brought him home when he was a teenager and left her there when he went off to college. Miss Midnight had become her cat at that point, and was very much a part of her family. I could see the love she had for this suffering old kitty, and I could see the guilt on her face as we discussed how sick her cat was now.

cat3

That’s when it happened.

Mrs. Johnson asked, “Did I wait too long to bring her in?”

I watched the tears flowing down her face. “No you didn’t wait too long,” I lied. “She is just old.”

And I left it at that.

Why? I’ve thought about that a great deal, especially since I know many may disagree with what I did. The lying, and with my refusing to tell Mrs. Johnson that she was cruel and irresponsible to let her cat get this sick and thin without getting help for her.

health care, pain, stress, age and people concept - senior woman

I could have been honest and said, “yes, you did wait too long.” I could have then told her that I didn’t think it was right to let an animal get this thin and this sick without getting help for her. But it wouldn’t have changed a thing now, nor was it the best for either of them at this point.

Miss Midnight most likely only has a few days left, and she and her family deserve to cherish the time together. I know that Mrs. Johnson loves her cat, she really does, and I do not believe she should have her final memories of her special kitty tarnished with guilt.

Instead, she will remember how she spent this time hand-feeding Miss Midnight, snuggling with her to try warm her, and doing all she can before she says goodbye to her.

It was the best, most truly humane thing I could offer them, and that’s why I lied.

It’s also why I have no regret.

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.